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Biosurface and Biotribology 3 (2017) 196–210

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Attrition-corrosion of human dental enamel: A review

Yun-Qi Wu, Joseph A. Arsecularatne, Mark Hoffmann
School of Materials Science and Engineering, UNSW Sydney, Sydney 2052, Australia
Received 31 October 2017; accepted 4 December 2017

Abstract

Attrition-corrosion is a dental wear process involving enamel-on-enamel sliding contact in an acidic environment. Since it involves both
mechanical and chemical effects, attrition-corrosion is considered more representative of the dental wear processes that occur in the oral
environment. This paper reviews previous studies on the attrition-corrosion process of human enamel and the underlying wear mechanisms, and
also compares them to the associated individual wear processes, attrition and corrosion. Additionally, factors influencing the wear behavior of
attrition-corrosion, modelling of this process and finally, areas for further research are discussed.
& 2017 Southwest Jiaotong University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Human dental enamel; Tooth/dental wear; Attrition-corrosion

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
2. Human enamel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
2.1. Structure of a human tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
2.2. Composition and structure of human enamel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
2.3. Mechanical properties of enamel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
3. Dental wear processes and terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
3.1. Corrosion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
3.2. Attrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
3.3. Abrasion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
3.4. Abfraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
3.5. Tribocorrosion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
4. Attrition-corrosion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
4.1. In vitro tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
4.2. Factors influencing attrition-corrosion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
4.2.1. Mechanical factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
4.2.2. Chemical factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

n
Corresponding author.
E-mail addresses: yunqiwu@qq.com (Y.-Q. Wu), j.arsecularatne@unsw.edu.au (J.A. Arsecularatne), mark.hoffman@unsw.edu.au (M. Hoffman).
Peer review under responsibility of Southwest Jiaotong University.

https://doi.org/10.1016/j.bsbt.2017.12.001
2405-4518/& 2017 Southwest Jiaotong University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
4.2.3. Biological factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.4. Other factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3. Modeling of the attrition-corrosion process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Conclusions and future work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Introduction
The term attrition-corrosion is used to describe tooth wear
caused by direct tooth-to-tooth sliding contact in the presence
of acids. Accordingly, it is the interplay of mechanical and
chemical effects on dental tissues. In the oral environment, a
variety of factors can contribute to tooth wear with different
intensity and duration [1] It is acknowledged that each
etiological factor is unlikely to cause the ultimate dental tissue
loss individually [2]. In contrast, different factors work
simultaneously with one dominating [3]. Hence, attrition-
corrosion is considered a better representation of tooth wear
than a single factor, e.g., attrition or corrosion.
Tooth wear (or non-carious wear) is considered a natural
physiological process. However, its intensity can vary [4]. For
mild tooth wear, the resulting reduction of occlusal vertical
dimension is compensated or adapted through associated
structures [5]. However, changes in individual life styles and
a boom in the consumption of acidic beverages in recent
decades have raised concerns on tooth wear. Moreover,
symptoms linked to increased stress, including gastroesopha-
geal reflux disease [6] and bruxism [7], are also potential
hazards to teeth. Additionally, increased life spans make it
more challenging for teeth to survive without severe tooth
wear [8]. Thus it is difficult to diagnose pathological tooth
wear. A widely accepted definition of pathological tooth wear
is given by Smith and Knight [9]: “the teeth become so worn
that they do not function effectively or seriously mar appear-
ance before they are lost through other causes or the patient
dies. The distinction between acceptable and pathological
tooth wear at a given age is based on the prediction of whether
the tooth will survive the rate of wear”.
Pathological tooth wear can trigger symptoms such as tooth
hypersensitivity, pulpal complications, discoloration and loss
of functions [10]. Additionally, esthetics of patients can also be
impaired when severe loss of tooth substance changes the
patients’ physiognomy, such as position of the smile line, the
horizontal occlusal plane and the incisal edge position [11].
Therefore, prevention and clinical treatments are needed for
the pathological dental wear. Thus both dentists and research
professionals are required to devise strategies to minimize
and/or manage dental wear based on an understanding of
associated wear mechanisms.
Hitherto, studies on dental wear mainly focused on wear
process with single etiological factor. Though there is an
increasing number of studies on alternating single factor wear
processes (such as corrosion followed by attrition), these
studies are not able to account for the interplay of different
197
205
206
206
207
208
209
wear processes. In this paper, the attrition-corrosion wear of
human enamel is reviewed.
In Section 2, human dental enamel, its composition, structure
and mechanical properties are discussed. In Section 3, different
dental wear processes and their terminologies will be discussed.
In order to investigate the attrition-corrosion process, the
required experiments can be performed using in vivo, in vitro,
etc., techniques. The advantages/disadvantages of these techni-
ques, previous studies on attrition-corrosion process and the
influencing factors are reviewed in Section 4. The current
knowledge on the attrition-corrosion process and gaps in our
knowledge are discussed in Section 5 while the conclusions
drawn from the current review and suggestions for future work
are given in Section 6.
2. Human enamel
Dental enamel is one of the hardest structures in the human
body. It functions as a shield to withstand masticating forces,
as well as protecting the underlying dentin and nerves from
mechanical and chemical impacts [12]. It hence can suffer the
most damage due to tooth wear. Moreover, unlike other human
tissues, enamel does not remodel or regrow when damaged.
In most attrition-corrosion studies, molars have been used.
They are the first erupting teeth in the permanent arch [13] and
hence likely to suffer greater wear. Additionally, the extraction of
molars for dental health reasons is a relatively common surgical
intervention in clinics and hence, they are less difficult to obtain.
Moreover, the load on teeth was reported to increase toward the
posterior of the dentition [14,15]. The use of molars to study the
attrition-corrosion wear of enamel has thus clinical relevance,
especially when investigating tooth wear under high loads.
2.1. Structure of a human tooth
A human tooth mainly consists of four structures, pulp,
dentin, the dento-enamel junction (DEJ) and enamel, from
inner to outer, and the latter three structures are more important
for dental wear. Dentin, approximately 70% inorganic, 18%
organics and 12% water by weight [16], has a hierarchical
structure as oriented tubules are surrounded by dentin sheaths
and an inter-tubular collagen matrix [17]. From a tribological
viewpoint, dentin is a ductile and soft structure compared to
enamel owing to its higher organic content. Dentin, hence, acts
as a cushioning layer to maintain the mechanical integrity of
enamel and protect the inner pulp [15,17]. The DEJ is a bio-
interface between dentin and enamel and can be considered as
a fibril-reinforced bond [18]. It can efficiently transfer loads
198 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
Fig. 1. Hierarchical structure of enamel. (a) the occlusal plane, where enamel
prisms are cross-sectioned, and shows keyhole-shaped structures; (b) one
enamel prism and the arrangement of the HAP crystallites [25].
from enamel to dentin as well as arrest cracks originating in
enamel [18,19].
2.2. Composition and structure of human enamel
Enamel is a non-uniform layer and its thickness varies from
about 0.1 mm in the cervical region to about 2 mm in the
occlusal region [20]. It is a highly mineralized tissue, approxi-
mately 96% by weight of enamel is substituted calcium
hydroxyapatite [21,22]. Additionally, enamel also contains 1%
organic substances and 3% water by weight [22]. Though the
amount is small, the organic substances enable enamel to remain
functional in a complex oral environment with cyclic loads.
Similar to most biomaterials, enamel has a hierarchical
structure (Fig. 1). At the ultra-structure level, HAP crystallites
are glued by proteins into prisms/rods [2,23]. These keyhole
shaped prisms are approximately 3–6 mm in diameter [24].
Between prisms, there is a narrow area named interprisms,
where HAP crystallites orientate less regularly and more
proteins aggregate [25]. The prisms and interprisms constitute
the second hierarchical level. In this micro-structural level,
prisms are parallel to each other and approximately perpendi-
cular to the enamel surface. Notably, the surface enamel (up to
a depth of 100 μm) is aprismatic which is more mineralized
than prismatic enamel [26]. The above hierarchical structure
regulates the mechanical properties of enamel to adapt to the
complex loading conditions in the oral environment.
2.3. Mechanical properties of enamel
In the oral environment, the loads on teeth show strong
variability and stochasticity. The main functions of enamel are
to enable teeth to withstand these physiological loads during
biting and chewing, retain the initial shape and protect the
underlying dentin and soft pulp [24]. To function effectively
over an individual's lifetime, enamel is required to possess
superior mechanical properties.
The hardness (H) and elastic modulus (E) are two widely
used indicators for the mechanical properties of a material and
also important properties in determining the wear resistance of
a material. For human enamel, the hardness varies from 3 GPa
to 6 GPa, and the elastic modulus from 70 GPa to 115 GPa
[27]. The reported values vary depending on the assessment
method, measured position (for example cusp tip, cervical
region, etc.), orientation (normal or parallel to the prism axis),
the tooth type and tooth donor (age and gender). Some of the
observed trends of H and E are summarized below.
a) The H and E reach peak values near the cusp tips, and
gradually decrease towards the DEJ [27];
b) The lingual side, which experiences higher loads during
mastication, shows higher values of H and E at the
occlusal surface and lower values at the DEJ than the
buccal side. Additionally, the intercuspal regions also
show higher H and E for sustaining higher loads [27];
c) Enamel is anisotropic with high H and E in the direction
parallel compared to those perpendicular to prisms;
d) Compared to interprisms, prisms show higher H and E
values;
e) Lower H and E values were obtained from macro-scale
tests compared to those obtained from micro and nano
scale tests [28].
Clearly, enamel is an inhomogeneous material. This char-
acteristic is considered to be caused by local chemical
composition, microstructure, prism orientation and the inter-
actions of these factors [24]. This is an adaption to complex
loadings on different parts of enamel and is of great clinical
significance.
In addition to high hardness and elastic modulus, ena-
mel possesses good crack resistance properties. Its toughness
(a measurement of a material's ability to resist crack extension)
is 3 times higher than that of geologic HAP [28] and is
attributed to the organic phase in human enamel, located
between the HAP crystallites and prisms. Hence, cracks can
propagate along these three-dimensional cleavage planes
(defined by inter-prisms) so that the energy is dissipated
laterally over a larger volume. Moreover, the organic phase
also provides limited movement within prisms [29] to mini-
mize catastrophic failure of enamel. At the molecular level, the
loading energy may also be dissipated through numerous
peptide chains within proteins [28,30].
To summarize, enamel inherits high hardness and stiffness
from its main constituent, relatively hard HAP. Meanwhile,
enamel's soft and ductile organic phase reduces the risk of
catastrophic failure. Thus human enamel is able to withstand
high mastication loads with good fracture resistance and
structural reliability.
3. Dental wear processes and terminology
Currently, terms of erosion, attrition and abrasion for dental
wear are generally used by dental professionals mainly based
on clinical manifestations [31]. However, these terms cause
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
confusion as they have different meanings in tribology [2]. By
considering the underlying wear mechanisms, a tribological
terminology for dental wear processes has also been suggested
(Table 1). However, since the dental terminology is the most
widely used to date, it is used in this review paper except for
the corrosion/erosion process.
Corrosion/erosion. In the dental literature, the term erosion
is used to describe the superficial loss of dental hard tissue due
to a chemical process without the involvement of bacteria.
However, in engineering, it describes the progressive loss of a
material from a solid surface due to mechanical interaction
between that surface and a multicomponent fluid [15]. There-
fore, the term corrosion which describes the wear caused by
the chemical degradation of the surfaces in engineering will be
used in the present paper instead of the term erosion.
Attrition. The term attrition is used to describe the tooth-to-
tooth contact wear without involvement of foreign materials.
Attrition hence occurs between two teeth as well as a tooth and
enamel fragments generated due to wear/chipping. Conse-
quently, attrition wear facets are usually found on the occlusal
surfaces or incisal edges of teeth where tooth-to-tooth contact
mostly happens [32].
Abrasion. Abrasion describes wear due to friction of
exogenous material forced over the enamel surface by
masticatory, grasping functions and tooth cleaning [5]. Com-
mon exogenous materials include toothpaste/brush and food
particles.
Table 1
Comparison of dental and tribological terminologies of tooth wear [2,15].
Dental Tribological
Erosion Chemical wear/corrosion
Attrition Delamination/fatigue wear
Two-body abrasion
Abrasion Three-body abrasion
Abfraction Fatigue wear
Fig. 2. Formation of multilayer structure of enamel due to corrosion. The arrow indicates the direction of acid attack [39].
199
Abfraction. This is a recently defined wear process and is
caused by stress due to flexure of a tooth under heavy lateral
loads, leading to displacement or fracture of enamel prisms at
the cemento-enamel junction [33].
Tribocorrosion. This is a wear process in which corrosion
and abrasion/attrition act simultaneously or successively.
3.1. Corrosion
It has been reported that the percentage of subjects demon-
strating enamel corrosion can range from 3% to 100% depend-
ing on the observation/assessment methods used, the subjects
recruited, etc. [34,35,36]. A higher prevalence has been noted
with younger subjects compared to the older ones [37].
The acidic chemicals involved in the corrosion of teeth can be
intrinsic or extrinsic. The former are mainly stomach substances
brought by recurrent vomiting or regurgitation processes [17],
while the extrinsic acids include acidic work environments and
consumption of acidic food and beverages. The acidic beverages
with a low pH ranging from 2.6 to 3.6 are considered as a major
contributor to corrosion. In recent decades, the consumption of
soft drinks increased dramatically. The habit of soft drink
consumption is especially popular among the youth and is
carried over into adulthood [38].
Corrosion of human enamel has been studies extensively.
Since corrosion play a prominent role in the tribocorrosion
process, important features of corrosion are discussed below.
The corrosion of enamel is progressive and forms a three-
layer structure; a) an irreversible bulk loss layer, b) a softened
layer and c) a transition layer from the outer surface to the
inner [39]. The softened layer is a partially demineralized
structure. Under suitable conditions, demineralized enamel can
be rehardened with the tissue remained acting as a scaffold
[17]. However, if the demineralization continues, the softened
layer can be totally dissolved and irreversible bulk loss may
occur. As the acid penetrates along the organic sheaths,
dissolution is progressed into inner sound enamel and a
 200
Table 2
Comparison of attrition-corrosion wear testing configurations and parameters in different studies.

Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210

Configuration Specimen Antagonist Load Speed Duration Lubricant
(cycle/min)

Kaidonis et al. Flat surface- Buccal and lingual halves from human molars 31.4–158.8 N 80 / Hydrochloric acid (pH 1.2)
[58] on-flat surface (3.2–16.2 kg) Acetic acid (pH 3)
Water (pH 7)
Natural saliva
Eisenburger and Cusp-on-flat Buccal/lingual surfaces of Cusp cut from 5.9 N 76 2280 cycles (30 min) Citric acid lubricants (pH
Addy [56] surface human third molar human third molar (600 g) 3.2 and 5.5)
Saline and citric acid (pH 7.0)
Shabanian and Flat surface- Buccal and lingual halves from human molars 0.0, 31.4, 65.7 and 97.5 N 80 80,000 cycles (10,000 cycles for Lubricants of tap water (pH 7)
Richards [59] on-flat surface (0.0, 3.2, 6.7 and 9.95 kg) hydrochloric acid) Acetic acid (pH 3.3)
Hydrochloric acid (pH 1.2)
Zheng et al. [60] Ball-on-flat Titanium alloy ball Cusp cut from 10, 20 and 40 N 120 45 min (2000 cycles with a non-testing 0.001 M citric acid (pH 3.20)
surface human second molar interval of 3 min at every 200 cycles) artificial saliva (pH 7.00)
Wu et al. [52] Cusp-on-flat Occlusal surface of human Cusp cut from a 5N 66 2280 cycles (
30 min) Citric acid (pH 3.2 and 5.5)
surface molar human molar Acetic acid (pH 3.2 and 5.5)
Distilled water
Zhang et al. [57] Cusp-on-flat Occlusal surface of human Cusp cut from a 4N 13 200 cycles Citric acid (pH 3.1–3.3)
surface molar human molar (15 min) Acetic acid (pH 3.3–3.5)
Lactic acid (pH 3.1)
Distilled water
Wiegand et al. Cusp-on-flat Front teeth of labial Cusp cut from a 2.9 N 60 1080 cycles Citric acid at pH 2.6
[48] surface surface human molar (300 g)
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
transition layer is formed (Fig. 2). In this layer, crystals near
organic sheaths are corroded slightly but those within the
prisms are less affected [39].
The thicknesses of the above layers have been measured in
vitro/situ. The corresponding depth due to substance loss
ranged from hundreds of nanometres to tens of micrometres
in vitro [40,41], and 50 7 30 nm in situ [42]. For softened
layer, a short-term demineralization (5–10 min) produces layer
of approximately 1–2 mm [39,43]. And a longer exposure time
(30–45 min) could increase its thickness up to 15 mm [44,45].
However, by further increasing the demineralization time, the
depth of softened layer may plateau [23]. Compared to bulk
loss and softened layers, measurements of transition layer are
few. Cheng et al. [39] reported a layer thickness of approxi-
mately 1–7.4 mm for enamel exposed to citric acid at pH
3.8 for 1–12.5 mins.
3.2. Attrition
For healthy people, enamel wear attributed to attrition alone is
within the non-pathological range [46]. However, attrition is
considered to significantly contribute to dental wear for elderly
people [41] (). Moreover, grinding (bruxism) and/or clenching
of teeth not for the purposes of mastication can wear out enamel
by attrition. The reported prevalence of bruxism among adults
ranges from 10% to 90% [7,47]. For patients with severe
bruxism, the occlusal load can be 2–10 times higher than that
for ordinary people [15]. Moreover, bruxism patients also suffer
longer contact time of teeth, e.g., 30 min to 3 h in a 24 h period
compared to 10 min for non-bruxers. Hence, bruxism can cause
excessive enamel wear due to attrition.
3.3. Abrasion
Abrasion occurs due to friction between enamel and foreign
substance(s), which are mainly food bolus and toothpaste/
brush in the oral environment. During mastication, food
particles can be trapped and dragged between the opposing
teeth leading to abrasive wear which depends on the occlusal
conditions (load, occlusal surface roughness, etc.) and food
particles (size, hardness, etc.) [17]. However, highly factory-
processed contemporary food is delicate and hence the risk of
enamel wear during mastication is low in contemporary
populations.
Toothbrushing, which is a contemporary tooth cleaning
routine activity, has almost no or little effect on hard enamel,
while much softer dentin is more susceptible to toothbrushing
abrasion [17]. However, incorrect oral hygiene habits (e.g.,
over-brushing of teeth for the purpose of teeth whitening) can
result in severe wear of enamel.
3.4. Abfraction
During the abfraction process, high stresses are concentrated
in the cervical region where the enamel layer is thin. Hence
cracking and subsequent enamel loss can occur in this region
201
once the shear stresses exceed the failure stress of enamel,
forming non-carious cervical lesions (NCCLs) [15].
3.5. Tribocorrosion
In the oral environment, corrosion is often accompanied by
attrition or abrasion. It is important to distinguish simultaneous
and alternating tribocorrosion as they are different wear
processes and have distinct microscopic wear mechanisms.
To be more specific, simultaneous tribocorrosion is an inter-
play of both mechanical and chemical factors, while the
alternating one is a sequential effect of these two factors. As
a result, the severity of resulting enamel loss is also different.
For example, approximately 200% more enamel wear loss was
obtained with simultaneous, compared with alternating attri-
tion and corrosion [48]. In this paper, the terms attrition-
corrosion and abrasion-corrosion are used to indicate the
simultaneous multi-etiologic factor wear processes.
Previous studies on tribocorrosion mainly focused on
combined abrasion and corrosion, especially toothbrushing
and corrosion applied in a consecutive manner. Both in vitro
and in situ studies reported a higher wear loss for corrosion
followed by toothbrushing compared to either corrosion or
toothbrushing alone [49,50]. Abrasion by the tongue following
corrosion was also found to be more detrimental to dental
enamel than either abrasion or corrosion alone [51]. Moreover,
greater enamel loss was observed in vitro with corrosion
followed by attrition than with the individual wear processes.
The increased enamel loss seems to be associated with the
reduced resistance of enamel to mechanical assault due to
preceding softening by acids. In contrast, the studies on
simultaneous tribocorrosion are limited and the associated
wear mechanisms remain unidentified [52].
4. Attrition-corrosion
4.1. In vitro tests
In a study of dental wear, the tests can be performed either
in vitro or in vivo. An in vitro research utilizes extracted teeth
specimens. Specimen treatments are performed ex vivo and any
tooth substance losses are determined in a laboratory environ-
ment. In vitro testing provides accurate control of key variables
during wear studies. It also allows separation of specific effects
due to variables, unlike in vivo experiments.
The amount of natural dental material loss can be small,
leading to challenges in accurately measuring wear. Parameters
of an in vitro wear test can be controlled and adjusted to create
a measurable amount of wear in a short term in vitro test,
which is not practical in vivo, as accelerating wear intention-
ally may lead to lesions on volunteers’ teeth. However, there
are still some shortcomings with in vitro experiments. First of
all, the complex jaw movements and loading processes in
the mouth cannot be duplicated on standard wear machines
in vitro. Additionally, specimens used in vitro are ground
to create a flat testing surface, whereas natural teeth have
complicated 3-dimensional anatomical shapes. Hence, the
202 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210

results derived in vitro showed limited correlation to in vivo

data [53]. The extrapolation of in vitro results to the clinic
should be for obtaining trends and qualitative assessments and
indications.
An alternative method is in situ experiments. It utilizes
specimens made from extracted teeth and attaches them
directly to the dentition, dentures, or custom-made intra-oral
devices of volunteers [54]. Hence, the in situ method offers the
choice of sample treatments in or ex vivo. Following testing,
the treated specimens can be directly subjected to laboratory
analyses. To date, it appears that only the in vitro method has
been used in studies of attrition-corrosion. This can be
attributed to the associated requirement of the control of
environmental variables during testing, which is difficult with
in vivo or in situ methods.
To simulate the clinical masticatory cycle and oral environ- Fig. 3. Enamel wear rate versus load curves for different lubricants [58].
ment, there is a comprehensive list of enamel wear test devices
with different emphases [55]. The simplest test rig is a pin-on-disc
machine with a rotating disc-shaped specimen worn by a pin of
appropriate material under applied load. With the increasing
understanding of enamel wear and the continuing development of
testing devices, more sophisticated functions such as adjustable
load and introduction of lubricant have been incorporated.
The cusp-on-flat surface configuration is widely used in
attrition-corrosion wear tests in vitro [48,52,56,57] possibly
because it is available in many tribometers and also reasonably
mimics the in vivo process of an enamel cusp sliding on an
opposing cuspal surface of a tooth.
The in vitro configuration consists of an enamel cusp sliding
on a flat surface specimen with the enamel cusp cut from a
human molar [48,52,56,57]. Other configurations used Fig. 4. Wear loss by depth (total height of each bar) in different treatment
included buccal half sliding on lingual half with the specimens groups. Error bars represent standard deviation [56].
obtained from human molars [58,59], and ball-on-flat surface
where the ball was made of titanium alloy [60]. were used as lubricant with pH in the range 1.2–5.5. Although
The required flat surface enamel specimens were cut from: the types of acids used in the above studies are limited, test
(i) molar buccal/lingual surfaces [56,58,59]; (ii) occlusal surface configurations, wear partners, test parameters and lubricant pH
of molar teeth [52,57,60]; (iii) labial surface of front teeth [48]. varied from study to study.
In addition to the configuration and wear-partners, para- In attrition-corrosion wear studies of enamel, two of the
meters of an in vitro wear test are also significant in simulating main factors of interest are the wear severity and the under-
the oral environment. For attrition-corrosion, these parameters lying wear mechanism. It is controversial whether attrition-
primarily include load, sliding speed, duration and lubricant. A corrosion causes more enamel loss than that of attrition, while
summary of these parameters reported in the literature is agreement has been reached that attrition-corrosion was more
presented in Table 2. harmful to enamel than corrosion. Despite some attempts to
The mastication loads/forces observed in vivo are in the uncover the underlying wear mechanisms of attrition-corrosion
range 10–120 N [61] , which depended on the measurement they remain unclear. The important findings of recent research
technique, individual subject, position in the dentition, etc. on this process are summarized below.
[62]. In terms of the chewing rate, 90 cycles/min was reported
clinically [14] and 60–102 cycles/min is widely used in wear  A comparison of attrition-corrosion wear behaviour in
tests in vitro [63]. As shown in Table 2, the loads used for in acetic and hydrochloric acids (at pH 3 and 1.2 respectively)
vitro attrition-corrosion wear tests in the literature are in the and attrition in human saliva and water (at pH 7) revealed
low range of the reported mastication loads, while the sliding lowest enamel wear in acetic acid at pH 3 under all loads
speeds used in most studies correspond well with those used (Fig. 3) [58].
observed clinically and reported in vitro.  A comparison of attrition-corrosion wear behaviour with
The in vitro test duration varied from 200 to 80,000 cycles, citric acid lubricants (at pH 3.2 and 5.5) and attrition with
and some studies also contained non-testing intervals [48,60]. saline and citric acid (both at pH 7.0) also revealed lower
Table 2 also indicates that, in the reported investigations of enamel wear in acidic lubricants [56]. Compared to the pH
attrition-corrosion, acetic, citric, lactic and hydrochloric acids neutral lubricants, reduction of wear depth with acidic
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
Fig. 5. Wear rate versus contact load curves for (a) water, acetic acid and hydrochloric acid. Since the wear rate is much higher for hydrochloric acid, the data for
lubricants at pH 3.3 and 7.0 are replotted in (b) (original data from [59].
Fig. 6. Variation of wear volume versus contact load (original data from [60].
lubricants was approximately two thirds at pH 3.2 and three
quarters at pH 5.5 (Fig. 4).
 However, attrition-corrosion in citric acid at pH 2.6 caused
approximately 70 times greater enamel wear than attrition in
artificial saliva [48].
 A study by Shabanian and Richards [59] that used the same
tribometer and the test configuration as those by Kaidonis et
al. [58] above reported the opposite trend, i.e., a higher
wear loss due to attrition-corrosion in acetic acid (pH 3.3)
compared to attrition with water (at pH 7) under all tested
loads (Fig. 5b). Although the reasons for this conflicting
result were not investigated, these studies have used two
different wear quantification methods: weight [58] and wear
depth by optical microscope [59]. This indicates that the
measured attrition-corrosion wear loss can be profoundly
influenced by the quantification method.
 Higher enamel wear during attrition-corrosion than during
attrition was also reported by Zheng et al. [60] (Fig. 6).
Notable differences in their study are use of titanium alloy
203
Fig. 7. Enamel wear loss versus hardness reduction for different lubricants.
The experimental data points are represented by symbols. The error bars
represent the standard deviations; the curve represents the best fit to the
experimental data [52].
antagonist (human enamel antagonists were used in other
studies) and a non-testing interval of 3 min in every 200
cycles in a 2000 cycle wear test.
 It was also revealed that the measured attrition-corrosion
wear is related to the corrosive potential1 of a lubricant,
which was determined by corresponding corrosion tests [52].
Thus a lubricant with the optimized corrosive potential
caused the least wear, while wear loss increased for a
lubricant with higher or lower corrosive potential (Fig. 7).
Accordingly, wear loss of attrition-corrosion was found to be
higher with acetic acid at pH 3.2 and lower with other acidic
lubricants (Table 2) when compared to attrition (Fig. 8).
 Wear results under extreme acidic conditions (e.g., hydro-
chloric acid at pH 1.2 which simulated the regurgitated
gastric acid) are limited to lower loads due to extremely
high attrition-corrosion wear rate. While the results of
1
The corrosive potential (or corrosivity) of a lubricant indicates the
dissolution or demineralization of enamel due to the exposure to the
corresponding lubricant, and the more dissolution or demineralization of
enamel, the higher the corrosion potential of the corresponding lubricant is
and vice versa.
204 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
Fig. 8. Attrition–corrosion wear loss (by volume) with different lubricants
under 5N load. The error bars represent standard deviations [52].
Fig. 9. Schematic of shaving of the softened layer mechanism of enamel [57].
Kaidonis et al., [58] showed a marked influence by the load
(i.e., increasing wear with load) those of Shabanian and
Richards [59] did not show such influence.
It can be seen that the attrition-corrosion studies in vitro
revealed that acid at very low pH (e.g., 1.2) can cause
extremely high enamel loss. They also reveal that food acid
at low pH (e.g., citric acid at pH 2.6) can cause high attrition-
corrosion wear compared to attrition. However, food acids at
high pH, e.g., acetic/citric acid at pH 5.5 caused much lower
attrition-corrosion wear compared to attrition. It seems that a
lubricant with optimized corrosive potential caused lower
attrition-corrosion wear which, however, increased for a
lubricant with higher or lower corrosive potential.
It appears that the quantification method influenced the
measured attrition-corrosion wear loss which may be attributed
to the difficulties in obtaining the required reference surfaces
that are damaged due to the attack by the acidic lubricant [56].
Wear loss is also likely to be influenced by the antagonist
material in that a non-enamel antagonist (that was not softened
by acid) caused greater attrition-corrosion wear. Moreover, a
non-testing interval during an attrition-corrosion wear test can
Fig. 10. Subsurface profiles from flat-surface enamel specimens following
wear testing with (a) lactic acid and (b) acetic acid lubricants. Small arrows and
the circle indicate subsurface cracks [57].
also increase the wear loss due to the generation of a thicker
softened layer which is removed by the sliding antagonist once
testing is resumed.
It is also clear that only a limited number of attrition-
corrosion studies were reported and a very few of them
investigated the underlying wear mechanism(s), notably Zheng
et al. [60] used LCSM to analyze the wear surfaces while Wu
et al. [52] used FIB/SEM/TEM to analyze the wear surfaces/
subsurfaces.
4.2. Factors influencing attrition-corrosion
The different factors that can influence the attrition-corro-
sion wear behavior of dental enamel can be categorized
primarily as mechanical, chemical and biological factors, and
are discussed below along with some other observed factors.
4.2.1. Mechanical factors
Load is a crucial parameter influencing tooth wear through
both its magnitude and type [62]. The load on the teeth has a
strong stochastic nature. The chewing loads in the mouth
decrease with increasing chewing cycles [64]. Besides, they
also have a strong dependency on the location. For example,
higher loads were observed in the posterior region compared to
the anterior region, especially in the preferred chewing region
[14]. Additionally, properties of food also seem to influence
the magnitude and pattern of loads [65].
In vitro attrition-corrosion studies with contact loads in the
range 2.0–158.8 N, have revealed that enamel loss increased with
increasing load [58,59,60,66,67]. Furthermore, for a lubricant
with relatively low corrosive potential, Kaidonis et al. [58] found
that, the wear rate was low up to a certain load, and then
increased considerably (e.g., acetic acid at pH 3 (Fig. 3)). An
explanation for this change of wear loss variation with load is as
follows [67]: attrition-corrosion of enamel can be considered as a
process of softened layer generation due to demineralization by
acid and its removal by the sliding enamel cusp (Fig. 9). This
softened layer seems to play an important role in regulating the
mechanical and chemical effects. However, with increasing load,
the influence of the softened layer dwindled as the sliding cusp
penetrated deeper into it and eventually broke it. Then the wear
mechanism of attrition-corrosion is likely to be delamination,
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
which is more destructive to enamel with severe wear and a
rough surface [68,69].
In contrast, for a lubricant at very low pH (such as
hydrochloric acid at pH 1.2 (Fig. 3)), the wear volume can
increase linearly with rising load. This can be attributed to the
very high corrosive potential of the acidic lubricant at low pH
[58,67]. The softened layer produced in this environment was
likely to be thick and loads higher than those used in the above
studies were needed to initiate wear that increased at an
exponential rate. Furthermore, it was also noticed that in some
studies, the difference of enamel loss between attrition-corro-
sion and attrition decreased with rising load [52,60]. Zheng
et al. [60] considered this to be a result of increased
contribution of the external loading and the brittle nature of
enamel but decreased chemical effect on wear. Wu et al. [67],
who assumed the “shaving-off” mechanism (Fig. 9) for
attrition-corrosion argued that the chemical factors affected
wear through the formation of the softened layer due to acid
attack. Under high load, the enamel cusp penetrated deeper
into the opposing enamel surface which decreased the influ-
ence of chemical factors.
In addition to wear loss, the influence of load on the wear
scar morphology during attrition-corrosion is also of interest.
While some researchers did not observe a significant difference
on the wear scar or its subsurface for loads in the range 5–13 N
from SEM and TEM analyses [67] others observed greater
delamination with increasing load using LCSM [60]. More-
over, their SEM analyses showed clear enamel prisms on the
wear surface under higher load. The above different wear scar
morphologies could be attributed to different testing methods
used in the two studies e.g., continuous testing against an
enamel cusp for 2250 cycles by Wu et al. [67]; a non-testing
interval of 3 min in every 200 cycles in a 2000 cycle wear test
against a titanium alloy ball by Zheng et al. [60].
4.2.2. Chemical factors
Owing to the high content of minerals, human enamel can
be demineralized in an acidic environment. The chemical
factors associated with attrition-corrosion of enamel are related
to: (1) corrosive solution, e.g., acid type, pH/titratable acidity,
acid concentration and concentrations of calcium and phos-
phorus; (2) exposure parameters, e.g., temperature, and dura-
tion. Considering that the present review focuses on in vitro
experiments, the relevant factors are discussed below.
In terms of acid type, greater wear loss due to attrition-
corrosion was observed with acetic acid compared to citric acid
at pH 3.2, but the opposite trend was noted at pH 5.5 [52].
Wear scar subsurface analyses by FIB/SEM [57] follow-
ing attrition-corrosion tests with acetic, citric and lactic
acids revealed subsurface cracks (indicated by small arrows
in Fig. 10). These parallel subsurface cracks were considered
to develop along the interprisms, which was confirmed by
TEM [67]. However, a subsurface crack that can propagate
further and form a large wear particle [68] was also noted with
205
acetic acid lubricant (indicated by the circle in Fig. 10b).
Accordingly, enamel wear with acetic acid was considered to
be more severe than with other acidic lubricants [57].
It was elucidated that attrition-corrosion wear was greatly
influenced by the corrosive potential of a lubricant which was
determined not only by acid type, but also by factors such as
pH and concentration [52].
As an indicator of the activity of hydrogen ions in a solution,
pH is known to have a marked influence on the demineralization
of enamel. Hence, it also has the potential to affect attrition-
corrosion of enamel. It was reported that the enamel loss due to
attrition-corrosion was high with acids at low pH [56] (Fig. 4).
This was verified by Wu et al. [52] for acetic and citric acids at
pH 3.2 and 5.5 (Fig. 8). This increase in wear loss with
decreasing pH can be explained using shaving of the softened
layer wear mechanism which is considered to be dominant
during attrition-corrosion [52]. A lubricant at low pH produced a
thicker softened layer which, when removed by the sliding cusp
resulted in a higher wear loss.
In addition to pH, titratable acidity also indicates the amount
of hydrogen ions in a solution, specifically, those that can
interact with enamel when the pH is brought from original value
to a given one. It was also considered to be a factor that would
greatly influence the enamel wear in an acidic environment [70].
However, in most of the attrition-corrosion studies, a lubricant
used was abundant and at a stable pH with proper agitation.
Accordingly, the amount of hydrogen ions available for inter-
action is also abundant. In this case, pH is a more determinative
indicator of demineralization of enamel by the acid. In contrast,
the effect of titratable acidity is more relevant in a situation
where a small amount of beverage is left in the mouth and
mixed with saliva or for an unstirred, still solution [71].
In addition to those discussed above, there are other
chemical factors that are likely to influence attrition-corrosion
wear of dental enamel. These include acid concentration,
temperature, concentration of calcium and/or phosphate ions
in the lubricant. However, their effects on attrition-corrosion
are not yet investigated.
4.2.3. Biological factors
Saliva, acquired dental pellicle, tooth position in relation to
soft tissues, etc. are biological factors that can influence dental
wear. Among these factors, the first two can reduce the
attrition-corrosion wear of enamel mechanically and/or chemi-
cally. Human saliva with water and proteins as major
constituents [72] protects teeth from dental wear by (1) diluting
and cleaning the acids; (2) neutralizing and buffering acids;
(3) remineralizing corroded enamel; (4) acting as a lubricant
and (5) forming a protective film (pellicle) on enamel surface
[17,73,74]. During attrition-corrosion, the above processes can
occur simultaneously in the oral environment to influence the
wear process. Pellicle is an organic biofilm formed on all solid
surfaces in the mouth with proteins and carbohydrates from
saliva [72]. This bio-film can act as perm-selective membrane
206 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
to adjust the diffusion of mineral and acidic ions [75].
Moreover, pellicle is considered to act as a lubricant, protect-
ing the solid substrates from abrasive damages [76].
Although the effects of the above biological factors on
attrition-corrosion process are not yet investigated, it is
anticipated that the protective effects of saliva and pellicle
may be impaired during attrition-corrosion since the acidic
lubricants can dilute saliva, wash away the acquired pellicle
and/or weaken the adsorption of proteins in pellicle to enamel
at low pH [77]. Moreover, the mechanical sliding which occurs
during attrition-corrosion can damage the pellicle and there is
insufficient time for its re-growth during the wear process.
4.2.4. Other factors
Generally, the test duration can affect substance loss due to
the processes of physical sliding and demineralization of
enamel by acids. Measurements of attrition-corrosion wear
with citric acid lubricant at pH 3.2 for 760, 1520 and 2280
cycles (10, 20 and 30 min) revealed increasing substance loss
with increasing cycles (Fig. 11) [66].
4.3. Modeling of the attrition-corrosion process
In vitro tests have revealed that enamel suffers more
substance loss during attrition-corrosion than corrosion alone
[48,52,56]. However, compared to attrition, there was no
agreement on the severity of attrition-corrosion: while some
studies report consistently less enamel wear during attrition-
corrosion compared to attrition [56,58], others report the
opposite [48,59,60]. Moreover, Wu et al. [52] reported both
higher and lower enamel loss from attrition-corrosion depend-
ing upon the corrosive potential of the lubricant compared to
attrition. This discrepancy appears to result from the complex
interplay of mechanical and chemical effects with the test
configurations, parameters and the wear quantification techni-
que may also contribute to the above contradictory results.
Fig. 11. Attrition and attrition-corrosion wear depth versus number of cycles
(original data from [66].
Fig. 12. Morphology of the wear scar on flat enamel surface samples (SEM
images) following wear testing with lubricants of [52]: (a) acetic acid at pH
3.2; (b) distilled water.
As noted earlier, in different studies, the wear loss was
quantified using different parameters, e.g., depth, volume and
weight. Wear by volume and weight can be compared by
assuming the density of enamel as a constant. However, it is
difficult to compare the wear loss by depth to those by volume/
weight. One concern is that depth is an indirect wear measure
and is influenced by individual wear scar geometry [78] which
can vary in different wear tests. However, an in vitro study
reported good agreement between volumetric and vertical loss
by three quantification methods: a laser scanner, a contact
profilometer and an optical sensor [79]. Considering these
results were obtained under the same contact conditions (e.g.,
contact area) with dental materials (including dental compo-
sites, ceramic and amalgam), the applicability of the above
findings to other materials, in particular, dental enamel is not
known.
In addition to wear loss, the underlying wear mechanism of
attrition-corrosion is also of great importance for both clinical
practitioners and researchers. With SEM, a smoothing effect of
enamel by acidic lubricants during attrition-corrosion wear
was observed [52,56]. As shown in Fig. 12a, acidic lubricant
(pH 3.2) produced a relatively smooth wear surface with some
grooves parallel to the sliding direction indicating abrasion
[52]. In contrast, the enamel exposed to a pH neutral
environment revealed delamination morphology with a rough
surface with cracks and enamel particles (Fig. 12b). Accord-
ingly, it was argued that the acid softened the enamel surface
and reduced the coefficient of friction, and hence alleviated
fatigue wear [56].
Further attempts to explain the wear mechanism are noted in
the literature. A model presented to describe the observed
higher enamel loss during attrition-corrosion compared to
attrition shows that, during attrition, softer inter-prism regions
were worn first, while relatively hard enamel prisms sustained
most of the load [60]. This led to little plastic deformation and
low wear loss (Fig. 13a). In contrast, during attrition-corrosion,
the prisms were corroded by acidic lubricant, leaving the
protruding soft interprism regions, which were easily worn,
resulting in a higher substance loss (Fig. 13b).
Conversely, shaving of the softened layer wear mechanism
was considered dominant during attrition-corrosion [48,52,57]
where generation of a softened layer (due to demineralization
by an acidic lubricant) and its removal (by the sliding cusp)
occurring repeatedly (Fig. 9). It appears that the softened
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
Fig. 13. Schematics of suggested enamel wear processes in different environ-
ments: (a) artificial saliva and (b) citric acid; R and IR indicate rods and inter-
rods [60].
enamel layer plays a crucial role in determining the severity of
the wear process [56]. It is further deduced that in a lubricant
with optimized corrosive potential, the softened layer is able to
regulate the chemical and mechanical effects in such a manner
that minimizes the wear loss [52]. To summarize, the above
two assumed wear mechanisms are based on different attrition-
corrosion wear behaviors observed, and hence lacked consis-
tency at both micro and macro levels. Therefore, the wear
mechanism of attrition-corrosion of dental enamel remains
unclear.
Modelling of dental wear can provide predictions/estimates
of tooth tissue loss based on prevailing conditions. Consider-
ing that dental wear is progressive, a reliable predictive model
can help dental practitioners to diagnose and intervene based
on existing symptoms. However, reported attempts aimed at
modelling of dental wear are very limited. A model recently
developed for attrition-corrosion of enamel involving different
acidic lubricants [52] is discussed below.
Based on the observed abrasive wear morphology (Section 4.1),
the Archard equation [3] can be used to model the attrition-
corrosion of dental enamel. According to the Archard equation,
the wear loss by volume (V) is proportional to the normal load
(P) and sliding distance (L), and inversely proportional to the
hardness of enamel surface (outside the wear scar (H)) which is
given by the relationship:
V ¼ KPL=H ð1Þ
where K is a dimensionless wear coefficient. When the wear tests
are carried out under constant load and sliding distance for
different lubricants, Eq. (1) is simplified as:
V ¼ k=H ð2Þ
where k is a constant and k ¼ KPL. Eq. (2) indicates a linear
relationship between the wear loss and 1/H. Experimental wear
results obtained for a range of acidic lubricants have revealed
that Eq. (2) is applicable for all the lubricants used [52] (Fig. 7).
The above model is simple and explicit as the wear volume
only depends on enamel hardness. With Eq. (2), the enamel
207
loss during attrition-corrosion in an acidic environment can be
predicted with k (or K) value obtained from the experimental
results for selected acidic lubricant(s). However, the above
model provides no insight into the associated wear mechanism.
5. Discussion
Tooth wear or non-carious loss of dental hard tissues, is one
of the main causes of tooth loss in contemporary populations
[21]. With the increasing requirement to retain healthy teeth
longer and awareness of their influence on individuals’ health,
dental/enamel wear is attracting more attention from both
clinical practitioners and researchers. As the outmost layer of a
tooth, enamel sustains more wear and naturally it has devel-
oped a unique hierarchical structure and properties to resist
contact load and catastrophic failure. Together with other
structures of a tooth, enamel is able to withstand cyclic
mastication loads and maintain its integrity. However, wearing
of the enamel exposes the underlying soft dentin, which is
more susceptible to the deleterious effects of wear.
As acknowledged in the literature, wear of teeth in the
oral environment is generally due to different wear processes
and/or their interplay with one dominating [31]. Accordingly,
attrition-corrosion, with simultaneous mechanical and chemi-
cal effects on dental enamel, is considered a better representa-
tion of dental wear. In this paper, previous studies on attrition-
corrosion of enamel were reviewed.
It is clear that the consumption of acidic beverages
has increased dramatically in many countries and this
trend is expected to continue [81]. The frequent presence
of acids in the mouth increases the risk of attrition-corrosion
of dental enamel. Though the saliva has the capability of
buffering/clearing acidic solutions in the oral environment, it
takes a few minutes for the pH to increase sufficiently to
prevent the dissolution of HAP [82]. It was also suggested
that the involvement of simultaneous mechanical effects
during corrosion exacerbated the enamel loss [83] and is a
major contributor to excessive tooth wear [84]. Accordingly,
an in-depth understanding of the attrition-corrosion process
and identification of underlying wear mechanisms will greatly
assist in minimizing its adverse effects and/or treatment.
Although studies on simultaneous chemical and mechanical
effects, in particular, attrition-corrosion are limited, the avail-
able studies reveal much higher substance loss with attrition-
corrosion compared to corrosion alone. However, controversy
remains regarding whether attrition-corrosion causes greater
enamel loss than attrition. This can be attributed, in part, to the
different wear testing configurations/conditions, specimen
geometries, wear quantification methods etc. used in different
studies. For example, a ball-shaped antagonist was found to
cause less wear loss from the opposite specimen compared to a
cusp-shaped one [85]. Though an ISO (International Organiza-
tion for Standardization) standard is available for dental
materials and may be applicable to enamel, several testing
configurations and wear machines have been used.
208 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
Additionally, different studies used different ranges of contact
loads during their tests. The contact load seems to have a
significant influence on the attrition-corrosion process and the
underlying wear mechanism(s), causing large variations in the
observed wear rates [60,67].
Based on the differences in the wear scar morphology and
substance loss compared to attrition, two different macro/micro
level wear processes of attrition-corrosion of dental enamel
have been suggested [57,60,67]. At a macro level, Zheng et al.
[60] observed delamination during attrition-corrosion, while
abrasion was observed in other studies. At the micro level,
high wear rate due to attrition-corrosion was attributed to the
low resistance of soft interprisms and weakened prisms (due to
demineralization in the acidic environment) to loadings [60].
In other studies, the softened enamel layer due to deminer-
alization was considered to play a crucial role in attrition-
corrosion [52,56,57]. Shaving of this softened layer by
opposing enamel cusp was considered to be the wear mechan-
ism [52,57].
In addition to the wear behavior and wear mechanism of
attrition-corrosion, the influence of different factors on this
wear process is also reviewed. These were classified primarily
as mechanical, chemical and biological factors. Among them,
factors of normal load, acid type, pH of a lubricant and the
number of cycles (or the duration of a test) were most
significant. It is acknowledged that a high load exacerbates
enamel loss during attrition-corrosion. Yet, different trends for
wear loss (with increasing load) were observed in different
studies. The influence of acid type on the enamel wear
behavior during attrition-corrosion is significant. It is observed
that the acid type affects both the wear morphology and
enamel loss through the corrosive potential of the acid [52].
The pH of a lubricant is another important factor influencing
attrition-corrosion. It is found that a very high substance loss
occurs in an environment of low pH and this is attributed to the
lubricant's high corrosivity [52,58]. In addition to the above
factors, there are other mechanical (e.g., sliding speed and
stroke), chemical (e.g., concentrations and temperature of
lubricant) and biological factors (e.g., saliva and pellicle) that
are considered to affect the attrition-corrosion process/mechan-
ism. But their influence on this wear process is not yet
investigated.
The modeling of attrition-corrosion of dental enamel is also
important. A model presented by Wu et al. [52] was based on
the Archard equation [80]. No contact conditions, including
the nature of the macroscopic contact (e.g. Hertzian elastic),
configuration, etc., were specified in this model. With a
simplified equation, the influence of lubricant on the enamel
loss during attrition-corrosion was quantitatively predicted for
different lubricants [52].
The frequent presence of various acids in the mouths of a
large part of the population is a concern for both dental
practitioners and researchers. Yet, the progression of attri-
tion-corrosion of human enamel is not yet fully understood.
It is also unclear whether attrition-corrosion is more
destructive to enamel than attrition alone. It was also noted
that an in vivo study [86] has reported 37 times higher risk
of tooth wear2 in individuals who consumed two or more
portions of citrus fruits per day compared to those who
consumed these fruits less often. It seems further studies are
needed to uncover the underlying wear mechanism(s) of
attrition-corrosion, as well as to determine the severity of
the process. The electron microscope techniques, such as
SEM, FIB, TEM, etc. can provide insight into the wear
process at micro-/nano-level.
6. Conclusions and future work
Attrition-corrosion is a multi-effect dental wear process, and
involves the interplay of mechanical and chemical factors. The
rising consumption of acidic beverages, especially among the
youth, increases the risk of attrition-corrosion of dental enamel.
To develop clinical treatment and prevention strategies, the wear
mechanisms of attrition-corrosion and the resulting deterioration
of enamel are of great importance. It was acknowledged that the
involvement of mechanical effects during attrition-corrosion
cause more enamel loss compared to corrosion, while the
severity of attrition-corrosion compared to attrition is under
investigation. With electron microscopy observations (e.g. SEM,
FIB and TEM), assumptions for the wear mechanism of
attrition-corrosion have been made, and attempts also made to
explain wear phenomena using the assumptions. As a multi-
factor wear process, attrition-corrosion can be influenced by
mechanical factors of mastication; load and cycles were found
to cause more severe wear at higher values. The acid type
affects attrition-corrosion through the corrosive potential of a
lubricant and hence showed a complex effect. In terms of
lubricant pH, a low pH environment caused higher enamel loss.
With regard to modeling of the attrition-corrosion process, only
one attempt is reported so far.
It is clear that more in vitro studies are needed to verify the
wear mechanisms of attrition-corrosion, further investigate the
wear severity of attrition-corrosion compared to single-factor
wear, and to develop the required quantitative models. More-
over, considering that attrition-corrosion can be influenced by
different factors (mechanical, chemical and biological) and
only some of these factors (load, duration, pH and acid type of
lubricant) are investigated, further studies on the effects of the
remaining factors are required to deepen our understanding of
attrition-corrosion. In particular, the influence of biological
factors such as saliva and pellicle and their protection against
attrition-corrosion of enamel require further investigation.
These together with appropriate in vivo or in situ test data
should enable the development of more effective strategies for
the prevention and/or treatment of enamel wear due to
attrition-corrosion and for improving the oral health.
2
In this study, tooth wear was identified by: (i) absence of developmental
ridges on the enamel resulting in a smooth/glazed enamel surface; (ii)
concavities in the cervical region on the labial enamel surfaces with much
higher breadth than depth; (iii) edges of tooth restorations raised above the
level of the adjacent tooth surface; and (iv) depression of the cusps of posterior
teeth, producing 'cupping'; (v) involvement of dentin, in more severe cases.
 Y.-Q. Wu et al. / Biosurface and Biotribology 3 (2017) 196–210
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