Comparison of three implant systems under preload loss: A finite element analysis validated by digital image correlation methods.

PURPOSE: This study evaluated the effects of screw preload loss on three implant systems, both in silico and in vitro. METHODS: Three finite element analysis (FEA) models of implant restorations were created using bone-level (BL, 4.8×12 mm; BLX, 4.5×12 mm) and tissue-level (TL, 4.8×12 mm) implant systems. The screws in each group were subjected to preloads of 100 N and 200 N, with an additional 130 N load applied to the crown tops. An in vitro study of the principal strain was conducted using digital image correlation (DIC) under the same conditions as for the FEA models. The results were evaluated for von Mises stress, principal strain, and sensitivity index. RESULTS: During loading, the highest stress levels were observed in the implants and screws. In the BL group, the screws experienced the highest von Mises stress at 466.04 MPa and 795.26 MPa in the 100 N and 200 N groups, respectively. The BLX group showed the highest von Mises stress at 439.33 MPa and 780.88 MPa in the implants in the 100 N and 200 N groups. Sensitivity analysis revealed that the screws and abutments in the TL group were significantly more affected by the preload changes. CONCLUSIONS: The abutment in the TL group was particularly sensitive to preload changes compared with those in the BL and BLX groups. Variations in the preload significantly affect the stress distribution in implants and screws. Maintaining screw preload stability under loading is crucial in clinical practice to prevent mechanical failure.

Masking ability of CAD-CAM resin-matrix ceramics with different translucencies and thicknesses combined with four cement shades against varying background colors when facing veneer restorations.

BACKGROUND: To evaluate the comprehensive effect of translucency, thickness, cement shades, and background color on the masking ability of resin-matrix ceramic veneer restorations. METHODS: Resin-matrix ceramic specimens with 2 translucencies (LT, HT) and 3 thicknesses (0.5, 1.0, and 1.5 mm) were made of Upcera Hyramic (A2 shade). Cement specimens were made of Variolink N in 4 shades (yellow, white, transparent, and bleach XL). Five background specimens were made of IPS Natural Die Material in 5 shades (ND1, ND2, ND3, ND4, and ND5). Color coordinates of 120 subgroups (n = 5) of combined specimens composed of different ceramic, cement, and background specimens were obtained using a spectroradiometer. Color difference (ΔE00) compared with a 4-mm thick specimen of LT and HT ceramics was calculated and four-way ANOVA was used for statistical analysis (α = 0.05). RESULTS: Translucency, thickness, cement shade, background color, and their interaction had significant effects on ΔE00 (p < 0.001). ΔE00 values of HT groups were always higher than that of LT groups and were greater than 1.8 against all background colors. ΔE00 values of LT groups could be achieved to be less than 1.8 with appropriate thickness and cement shade. ΔE00 value decreased with increasing ceramic thickness. The effect of cement shade on ΔE00 had no obvious regularity, but ΔE00 values of bleach XL cement shade group were always lower than other cement shade groups under ND3 and ND5 background color. CONCLUSIONS: The masking ability of CAD-CAM resin-matrix ceramics can be simultaneously affected by translucency, thickness, cement shade, and background color. Resin-matrix ceramics with low translucency has a better masking ability than that with high translucency. The masking ability of CAD-CAM resin-matrix ceramics increase with increasing thickness. Cement shade has less impact on the final color of resin-matrix ceramic restorations.

Effects of stamp material and restoration depth on the accuracy of direct composite resin restorations using stamp technique.

OBJECTIVES: To evaluate the effects of different stamp materials and restoration depths on the accuracy of direct composite resin restorations using stamp technique. METHODS: Eighty standard resin teeth were divided into four groups based on different stamp materials: flowable composite resin (FR), vinyl polydimethyl siloxane (VPS) for bite registration (VB), VPS for impression (VI) and transparent VPS (TV). Each material group was further divided into two subgroups based on restoration depth (1 and 2 mm; n = 10). Standardized Class I cavities were prepared and restored with the corresponding stamps. Pre- and post-treatment scans of each tooth were fitted using Geomagic Control X software, generating deviation distribution maps of the occlusal surface. The accuracy indicators, including mean height variation (MHV), root mean square (RMS), and proportions of height variation with different ranges (PHVrange), were recorded to evaluate the accuracy of restorations. Analysis of variance (ANOVA) were used for statistical analysis (α=0.05). RESULTS: The type of stamp material significantly affected all accuracy indicators, while restoration depth did not show a significant effect on any of the indicators. MHV values ranged from 29.70 ± 5.88 µm to 63.52 ± 9.58 µm, and RMS values ranged from 62.78 ± 8.76 µm to 101.79 ± 13.17 µm, displaying a trend of FR0.2mm values (0.70 ± 0.50 % for 1 mm, 0.94 ± 0.47 % for 2 mm). In contrast, the TV groups exhibited the lowest PHV<0.05mm values (59.69 ± 10.23 % for 1 mm, 59.67 ± 5.70 % for 2 mm), while the VI groups showed the highest PHV>0.2mm values (7.34 ± 1.58 % for 1 mm, 8.20 ± 3.16 % for 2 mm). CONCLUSIONS: The accuracy of direct composite resin restorations using stamp made of flowable composite resin was higher than that of all tested VPS materials, thereby reducing the need for occlusal adjustment and improving clinical efficiency. Besides, restoration depth had no significant impact on the accuracy of stamp technique, regardless of the stamp material used. CLINICAL SIGNIFICANCE: The accuracy of direct composite resin restorations using stamp technique with different stamp materials varies. The flowable composite resin stamp exhibits higher accuracy compared with VPS stamps, reducing the need for occlusal adjustments.

Influence of short-span scans on trueness in the digital transfer of the maxillomandibular relationship.

OBJECTIVES: This study aimed to assess the influence of the location and distribution of short-span scans, serving as intermediate registration data, on the trueness of digitally transferring the maxillomandibular relationship in full-mouth rehabilitation. METHODS: Maxillary and mandibular complete-arch preparation casts mounted on an articulator were scanned, with and without interim restorations, using an intraoral scanner. Four types of short-span scans-right anterior, left anterior, right posterior, and left posterior-were captured from maxillary and mandibular casts. Each scan comprised two prepared teeth and two crowned teeth arranged alternately. These short-span scans served as intermediate data and were cross-registered with complete-arch interim restorations and preparation casts to transfer the maxillomandibular relationship. Based on the number (1 or 2), location (anterior or posterior), and distribution (unilateral or bilateral) of short-span scans, they were categorized into six groups. Trueness was assessed by evaluating the mandibular 3-dimensional (3D), spatial distance, angle, and linear distance deviations between the test and reference scans. RESULTS: Significant differences in the trueness of digital cross-mounting were observed among the six groups (P < .05). The group registering the bilateral posterior areas exhibited the smallest 3D, spatial distance, angle, and linear distance deviations, whereas the group registering one anterior area showed the largest deviations. CONCLUSION: The number, location, and distribution of the registered short-span scans significantly affected the trueness of transferring the maxillomandibular relationship. A posterior short-span scan had higher trueness than an anterior scan. The symmetrical distribution of the two registered larger short-span scans over the cross-arch enhanced the registration trueness. CLINICAL SIGNIFICANCE: Digital cross-mounting in full-mouth rehabilitation using short-span scans enhances transfer accuracy, improves patient comfort, and increases chairside efficiency.

Application of Chairside CAD/CAM and Its Influencing Factors among Chinese Dental Practitioners: a Crosssectional Study.

OBJECTIVE: To examine the increased use of chairside CAD/CAM among Chinese dental practitioners, and to explore the existing barriers influencing its further application and satisfaction levels. METHODS: A semi-structured questionnaire was developed to gather respondents' demographic information, as well as their experiences and behaviours regarding the implementation of chairside CAD/CAM. A specialised web-based survey system and WeChat were used to display and distribute the final questionnaire. Then, the data were analysed with Chi-square tests and regression analyses to determine the effects of various demographic variables on chairside CAD/ CAM applications. RESULTS: A total of 1,969 questionnaire responses were included in the analyses. Chairside CAD/ CAM systems were used by 36.9% of participants, with a higher usage rate observed among prosthodontists (60.0%) and dental practitioners holding a PhD degree (57.7%). Chairside CAD/ CAM-fabricated prostheses were most commonly used in the posterior maxilla (83.3%) and mandible (86.0%), followed by the anterior maxilla and mandible (63.8% and 48.6%, respectively). Major barriers to further application included high initial investment, frequent updates of equipment and software programs, and a lack of expertise in chairside CAD/CAM usage. CONCLUSION: Most dental practitioners did not use chairside CAD/CAM systems. The application rate was significantly influenced by sex, location, educational background, department and type of healthcare facility. Chairside CAD/CAM users showed limited satisfaction with the aesthetic performance of the fabricated prostheses. To improve the popularity of chairside CAD/CAM systems, especially among dental practitioners lacking advanced academic degrees, it is highly advisable to optimise CAD software programs and offer comprehensive training opportunities.

Evaluation of direct restorations for pit-and-fissure caries using stamp combined with single-shade composite resin technique: A 12-month follow-up in vivo study.

OBJECTIVES: To evaluate the clinical performance of direct restorations for pit-and-fissure caries in molars using stamp combined with single-shade composite resin (S/SCR) technique, and assess the effect of the number of stamp pressing on the trueness of S/SCR technique. METHODS: Twenty molars of fifteen patients with pit-and-fissure caries but with an intact or micro-cavitated occlusal morphology were restored using S/SCR technique and were randomly divided into single pressing group (n = 10) and double pressing group (n = 10). Intraoral scans were obtained before treatment (scan 1), after filling (scan 2) and after polishing (scan 3). Deviation distribution maps of pairwise fitting were created including comparison 1 (scan1/scan 2), comparison 2 (scan1/scan 3), and comparison 3 (scan2/scan 3) using Geomagic Control X software. Root mean square (RMS) values were calculated to evaluate the trueness of restorations. Clinical performances including esthetic, functional, and biological properties of all restorations were evaluated according to FDI criteria after a 12-month follow-up. Analysis of variance, independent-samples T test and Wilcoxon rank-sum test were used for statistical analysis (α=0.05). RESULTS: RMS values for comparison 1, comparison 2, and comparison 3 were 0.1243 ± 0.0151, 0.0966 ± 0.0136, and 0.0605 ± 0.0137 mm in single pressing group, while 0.0831 ± 0.0140, 0.0741 ± 0.0107, and 0.0475 ± 0.0099 mm in double pressing group, respectively. RMS value of single pressing group was higher than that of double pressing group in the same comparison (p ≤ 0.001). No statistically significant differences were observed between the two groups regarding esthetic, functional and biological properties (p > 0.05). For all properties, all restorations scored within 3, with over 80% scoring 1. CONCLUSION: S/SCR technique presents satisfying clinical performances for pit-and-fissure caries in molars after a 12-month follow-up. Besides, double pressing can improve the trueness of restorations compared to single pressing. CLINICAL SIGNIFICANCE: S/SCR technique is efficient in direct composite resin restoration for pit-and-fissure caries, with satisfying esthetic, functional and biological properties after a 12-month follow-up. Significantly, double pressing improves the trueness of S/SCR technique, reducing the need for occlusion adjustment.

Influence of prosthetic index structures and implant materials on stress distribution in implant restorations: a three-dimensional finite element analysis.

BACKGROUND: Mechanical complications affect the stability of implant restorations and are a key concern for clinicians, especially with the frequent introduction of new implant designs featuring various structures and materials. This study evaluated the effect of different prosthetic index structure types and implant materials on the stress distribution of implant restorations using both in silico and in vitro methods. METHODS: Four finite element analysis (FEA) models of implant restorations were created, incorporating two prosthetic index structures (cross-fit (CF) and torc-fit (TF)) and two implant materials (titanium and titanium-zirconium). A static load was applied to each group. An in vitro study using digital image correlation (DIC) with a research scenario identical to that of the FEA was conducted for validation. The primary strain, sensitivity index, and equivalent von Mises stress were used to evaluate the outcomes. RESULTS: Changing the implant material from titanium to titanium-zirconium did not significantly affect the stress distribution or maximum stress value of other components, except for the implant itself. In the CF group, implants with a lower elastic modulus increased the stress on the screw. The TF group showed better stress distribution on the abutment and a lower stress value on the screw. The TF group demonstrated similar sensitivity for all components. DIC analysis revealed significant differences between TF-TiZr and CF-Ti in terms of the maximum (P < 0.001) and minimum principal strains (P < 0.05) on the implants and the minimum principal strains on the investment materials in both groups (P < 0.001). CONCLUSIONS: Changes in the implant material significantly affected the maximum stress of the implant. The TF group exhibited better structural integrity and reliability.

Interaction between the albumin-bilirubin score and nutritional risk index in the prediction of post-hepatectomy liver failure.

BACKGROUND: Post-hepatectomy liver failure (PHLF) is the most common postoperative complication and the leading cause of death after hepatectomy. The albumin-bilirubin (ALBI) score and nutritional risk index (NRI) have been shown to assess end-stage liver disease and predict PHLF and patient survival. We hypothesized that the ALBI score and NRI interact in the prediction of PHLF. AIM: To analyze the interaction between the ALBI score and NRI in PHLF in patients with hepatocellular carcinoma. METHODS: This retrospective study included 186 patients who underwent hepatectomy for hepatocellular carcinoma at the Affiliated Hospital of Youjiang Medical University for Nationalities between January 2020 and July 2023. Data on patient characteristics and laboratory indices were collected from their medical records. Univariate and multivariate logistic regression were performed to determine the interaction effect between the ALBI score and NRI in PHLF. RESULTS: Of the 186 patients included in the study, PHLF occurred in 44 (23.66%). After adjusting for confounders, multivariate logistic regression identified ALBI grade 2/3 [odds ratio (OR) = 73.713, 95% confidence interval (CI): 9.175-592.199] and NRI > 97.5 (OR = 58.990, 95%CI: 7.337-474.297) as risk factors for PHLF. No multiplicative interaction was observed between the ALBI score and NRI (OR = 0.357, 95%CI: 0.022-5.889). However, the risk of PHLF in patients with ALBI grade 2/3 and NRI < 97.5 was 101 times greater than that in patients with ALBI grade 1 and NRI ≥ 97.5 (95%CI: 56.445-523.839), indicating a significant additive interaction between the ALBI score and NRI in PHLF. CONCLUSION: Both the ALBI score and NRI were risk factors for PHLF, and there was an additive interaction between the ALBI score and NRI in PHLF.

An NIR-propelled janus nanomotor with enhanced ROS-scavenging, immunomodulating and biofilm-eradicating capacity for periodontitis treatment.

Periodontitis is an inflammatory disease caused by bacterial biofilms, which leads to the destruction of periodontal tissue. Current treatments, such as mechanical cleaning and antibiotics, struggle to effectively address the persistent biofilms, inflammation, and tissue damage. A new approach involves developing a Janus nanomotor (J-CeM@Au) by coating cerium dioxide-doped mesoporous silica (CeM) with gold nanoparticles (AuNPs). This nanomotor exhibits thermophoretic motion when exposed to near-infrared (NIR) laser light due to the temperature gradient produced by the photothermal effects of asymmetrically distributed AuNPs. The NIR laser provides the energy for propulsion and activates the nanomotor's antibacterial properties, allowing it to penetrate biofilms and kill bacteria. Additionally, the nanomotor's ability to scavenge reactive oxygen species (ROS) can modulate the immune response and create a regenerative environment, promoting the healing of periodontal tissue. Overall, this multifunctional nanomotor offers a promising new approach for treating periodontitis by simultaneously addressing biofilm management and immune modulation with autonomous movement.

Erythrocyte-Mimicking Nanovesicle Targeting Porphyromonas gingivalis for Periodontitis.

Porphyromonas gingivalis has been demonstrated to have the strongest association with periodontitis. Within the host, P. gingivalis relies on acquiring iron and heme through the aggregation and lysis of erythrocytes, which are important factors in the growth and virulence of P. gingivalis. Additionally, the excess obtained heme is deposited on the surface of P. gingivalis, protecting the cells from oxidative damage. Based on these biological properties of the interaction between P. gingivalis and erythrocytes, this study developed an erythrocyte membrane nanovesicle loaded with gallium porphyrins to mimic erythrocytes. The nanovesicle can target and adhere with P. gingivalis precisely, being lysed and utilized by P. gingivalis as erythrocytes. Ingested gallium porphyrin replaces iron porphyrin in P. gingivalis, causing intracellular metabolic disruption. Deposited porphyrin generates a large amount of reactive oxygen species (ROS) under blue light, causing oxidative damage, and its lethality is enhanced by bacterial metabolic disruption, synergistically killing P. gingivalis. Our results demonstrate that this strategy can target and inhibit P. gingivalis, reduce its invasion of epithelial cells, and alleviate the progression of periodontitis.

Clinical efficacy of thalidomide for various genotypes of beta thalassemia.

OBJECTIVE: The objective of this study was to investigate the therapeutic efficacy of thalidomide across various genotype presentations of ß-thalassemia so as to facilitate the early screening of thalidomide-sensitive thalassemia cases and to understand the impact of iron overload on thalidomide. METHODS: From our initial sample of 52 patients, we observed 48 patients with ß-thalassemia for two years after administration of thalidomide. This cohort included 34 patients with transfusion-dependent thalassemia (TDT) and 14 patients with non-transfusion-dependent thalassemia (NTDT). We recorded the values of hemoglobin (Hb), fetal hemoglobin (HbF), and serum ferritin (SF) in the baseline period and at 1, 3, 6, 12, 18, and 24 months after enrollment, as well as the pre- and post-treatment blood transfusion volume in all 48 cases. According to the increase in Hb levels from baseline during the 6-month observation period, the response to thalidomide was divided into four levels: main response (MaR), minor response (MiR), slow response (SLR), and no response (NR). A decrease in serum ferritin levels compared to baseline was considered alleviation of iron overload. We calculated the overall response rate (ORR) as follows: ORR = MaR + MiR + SLR/number of observed cases. RESULTS: The ORR was 91.7% (44/48 cases), and 72.9% showed MaR (35/48 cases). Among the 34 patients with TDT, 21 patients (61.8%) were free of blood transfusion, and the remaining 13 patients still required blood transfusion, but their total blood transfusion volume reduced by 31.3% when compared to the baseline. We found a total of 33 cases with 10 combinations of advantageous genes, which included 5 cases with ßCD41-42/ßCD17 and 6 cases with ßCD41-42/ß-28. Based on the treatment outcomes among the 48 cases in the observation group, there were 33 cases in the MaR group and 15 cases in the SLR/NR group. There was a difference in HbF between the two groups at baseline (P = 0.041). There were significant differences between the two groups in Hb and HbF at the time points of 6 and 12 months, respectively (P < 0.001). Compared to the baseline measurement, there was a significant decrease in the level of SF at months 12 and 24 (P < 0.001). CONCLUSION: In this study, we identified 10 ß-thalassemia gene combinations that were sensitive to thalidomide. These gene combinations can be used for initial screening and to predict the therapeutic effect of thalidomide in clinical practice. We examined the therapeutic response to thalidomide and found that the administration of thalidomide in combination with standardized iron removal was more beneficial in reducing iron overload.

Epinephelus coioides Sec3 promotes Singapore grouper iridovirus infection by negatively regulates immune response.

Exocyst, a protein complex, plays a crucial role in various cellular functions, including cell polarization, migration, invasion, cytokinesis, and autophagy. Sec3, known as Exoc1, is a key subunit of the Exocyst complex and can be involved in cell survival and apoptosis. In this study, two subtypes of Sec3 were isolated from Epinephelus coioides, an important marine fish in China. The role of E. coioides Sec3 was explored during Singapore grouper iridovirus (SGIV) infection, an important pathogen of marine fish which could induce 90 % mortality. E. coioides Sec3 sequences showed a high similarity with that from other species, indicating the presence of a conserved Sec3 superfamily domain. E. coioides Sec3 mRNA could be detected in all examined tissues, albeit at varying expression levels. SGIV infection could upregulate E. coioides Sec3 mRNA. Upregulated Sec3 significantly promoted SGIV-induced CPE, and the expressions of viral key genes. E. coioides Sec3 could inhibit the activation of NF-κB and AP-1, as well as SGIV-induced cell apoptosis. The results illustrated that E. coioides Sec3 promotes SGIV infection by regulating the innate immune response.

Esthetic rehabilitation of labial tooth defects caused by caries of the anterior teeth using a composite resin injection technique with veneer-shaped 3D printing indices.

PATIENTS: An 18-year-old woman sought treatment for caries of the anterior teeth after completing orthodontic treatment. Direct composite resin restoration was chosen because the patient preferred a minimally invasive and cost-effective treatment whenever possible. Based on diagnostic wax-up, veneer-shaped indices for composite resin injection were designed to replicate and restore tooth defects rapidly and accurately. The overall esthetic result was excellent after a 1-year of follow-up. DISCUSSION: Direct freehand composite resin restorations are clinically challenging. The recently proposed 3D printing index for the composite resin injection technique is helpful for direct restoration but is challenging to remove. The veneer-shaped indices avoid the formation of an undercut in the direction of removing the index, making them easy to remove after finishing the restorations. CONCLUSIONS: Using veneer-shaped indices for composite resin injection enables rapid esthetic rehabilitation of labial tooth defects caused by caries. This approach reduces chairside time and operational difficulty while allowing for easy index removal after completing the restorations.

Nutrient requirements determined by grain yield and protein content to optimize N, P, and K fertilizer management in China.

Nutrient requirement for crop growth, defined as the amount of nutrient that crops take up from soil to produce a specific grain yield, is a key parameter in determining fertilizer application rate. However, existing studies primarily focus on identifying nitrogen (N), phosphorus (P), and potassium (K) requirements solely in relation to grain yield, neglecting grain protein content, a crucial index for wheat grain quality. Addressing this gap, we conducted multi-site, multi-cultivar, and multi-year field trials across three ecological regions of China from 2016 to 2020 to elucidate variations in nutrient requirements for grain yield and grain protein. The research findings revealed that wheat grain yield ranged from 4.1 to 9.3 Mg ha-1 (average 6.9 Mg ha-1) and grain protein content ranged from 98 to 157 g kg-1 (average 127 g kg-1) across the three regions. Notably, the N requirement exhibited a nonlinear correlation with the wheat grain yield but a linear increase with increasing grain protein, while the P and K requirements positively correlated with grain yield and protein content. Regression models were formulated to determine the nutrient requirements (MENR), enabling the prediction of N, P, and K requirements for leading cultivars with varying grain yields and protein contents. Implementing nutrient requirements based on MENR projections resulted in substantial reductions in fertilizer rates: 22.0 kg ha-1 N (10.7 %), 9.9 kg ha-1 P (20.2 %), and 8.1 kg ha-1 K (16.3 %). This translated to potential savings of 0.4 Mt. N, 0.23 Mt. P, and 0.17 Mt. K, consequently mitigating 5.5 Mt. CO2 greenhouse-gas emission and yielding an economic benefit of 0.8 billion US$ annually in China. These findings underscore the significance of considering grain yield and protein content in estimating nutrient requirements for fertilizer recommendations to realize high-yielding, high-protein wheat production, and minimize overfertilization and associated environmental risks.

Different surface treatments and adhesive monomers for zirconia-resin bonds: A systematic review and network meta-analysis.

This review examined the efficacy of surface treatments and adhesive monomers for enhancing zirconia-resin bond strength. A comprehensive literature search in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library yielded relevant in vitro studies. Employing pairwise and Bayesian network meta-analyses, 77 articles meeting inclusion criteria were analyzed. Gas plasma was found to be ineffective, while treatments including air abrasion, silica coating, laser, selective infiltration etching, hot etching showed varied effectiveness. Air abrasion with finer particles (25-53 µm) showed higher immediate bond strength than larger particles (110-150 µm), with no significant difference post-aging. The Rocatec silica coating system outperformed the CoJet system in both immediate and long-term bond strength. Adhesives containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) were superior to other acidic monomers. The application of 2-hydroxyethyl methacrylate and silane did not improve bonding performance. Notably, 91.2 % of bonds weakened after aging, but this effect was less pronounced with air abrasion or silica coating. The findings highlight the effectiveness of air abrasion, silica coating, selective infiltration etching, hot etching, and laser treatment in improving bond strength, with 10-MDP in bonding agents enhancing zirconia bonding efficacy.

Landform and lithospheric development contribute to the assembly of mountain floras in China.

Although it is well documented that mountains tend to exhibit high biodiversity, how geological processes affect the assemblage of montane floras is a matter of ongoing research. Here, we explore landform-specific differences among montane floras based on a dataset comprising 17,576 angiosperm species representing 140 Chinese mountain floras, which we define as the collection of all angiosperm species growing on a specific mountain. Our results show that igneous bedrock (granitic and karst-granitic landforms) is correlated with higher species richness and phylogenetic overdispersion, while the opposite is true for sedimentary bedrock (karst, Danxia, and desert landforms), which is correlated with phylogenetic clustering. Furthermore, we show that landform type was the primary determinant of the assembly of evolutionarily older species within floras, while climate was a greater determinant for younger species. Our study indicates that landform type not only affects montane species richness, but also contributes to the composition of montane floras. To explain the assembly and differentiation of mountain floras, we propose the 'floristic geo-lithology hypothesis', which highlights the role of bedrock and landform processes in montane floristic assembly and provides insights for future research on speciation, migration, and biodiversity in montane regions.

Advances in ceramics for tooth repair: From bench to chairside.

OBJECTIVES: To give a comprehensive review of advancement in dental ceramics, fabrication methods, and the challenges associated with clinical application. DATA, SOURCES AND STUDY SELECTION: Researches on chemical composition, biomechanical behaviors, optical properties, bonding strategies and fabrication methods were included. The search of articles was independently conducted by two authors in the PubMed, Scopus, Medline and Web of Science. CONCLUSIONS: Dental ceramics have shown significant advancements in terms of esthetics and function. However, improving fracture toughness without compromising optical properties remains a challenge. Repairing fractured zirconia or glass-matrix ceramic prostheses with the same material is difficult due to the sintering process. Developing innovative bonding techniques that provide strong and long-lasting bonding strength between ceramics and tooth structures poses a recurring obstacle. CLINICAL SIGNIFICANCE: Despite the emergence of dental ceramics and fabrication techniques, certain limitations such as susceptibility to brittleness and fracture still exist. Therefore, the current review provided valuable information around the advanced dental ceramics in tooth repair. The laboratory test data and the clinical outcome are also presented in details, aiming to guide clinicians in making informed decisions regarding ceramic restorations.

Does an incomplete ferrule affect the fracture of endodontically treated teeth? A systematic review of in vitro studies.

OBJECTIVE: The purpose of this systematic review was to assess the impact of the incomplete ferrule on the fracture of endodontically treated teeth (ETT). DATA: The keywords such as "incomplete ferrule," "ferrule," "ferrule effect," "residual dentin," "remaining dentin," or "remaining coronal dentin" were used for searching, and only in vitro studies investigating the incomplete ferrule effect on natural teeth were included. SOURCES: PubMed, Medline, Embase, Cochrane Library, and Science Direct databases, and manual-searching. STUDY SELECTION: The search strategy yielded 1633 hits, and a total of 19 in vitro studies closely related to the effect of incomplete ferrule on ETT were included. CONCLUSION: The presence of an incomplete ferrule may significantly increase the fracture resistance of restored ETT, compared with restored ETT without ferrule. The number of residual axial walls of the incomplete ferrule may have an impact on the fracture resistance and fracture mode. The location of residual axial walls of the incomplete ferrule may affect the fracture resistance but not the fracture mode. CLINICAL IMPLICATIONS: Limited data suggest that the presence of incomplete ferrule has a positive effect on the fracture resistance of restored ETT. An incomplete ferrule can be an alternative for restoring ETT when a complete ferrule is not present. Nevertheless, further high-quality studies are still needed to offer more robust evidence and to take potential confounding factors into account.

Application of deep learning in isolated tooth identification.

BACKGROUND: Teeth identification has a pivotal role in the dental curriculum and provides one of the important foundations of clinical practice. Accurately identifying teeth is a vital aspect of dental education and clinical practice, but can be challenging due to the anatomical similarities between categories. In this study, we aim to explore the possibility of using a deep learning model to classify isolated tooth by a set of photographs. METHODS: A collection of 5,100 photographs from 850 isolated human tooth specimens were assembled to serve as the dataset for this study. Each tooth was carefully labeled during the data collection phase through direct observation. We developed a deep learning model that incorporates the state-of-the-art feature extractor and attention mechanism to classify each tooth based on a set of 6 photographs captured from multiple angles. To increase the validity of model evaluation, a voting-based strategy was applied to refine the test set to generate a more reliable label, and the model was evaluated under different types of classification granularities. RESULTS: This deep learning model achieved top-3 accuracies of over 90% in all classification types, with an average AUC of 0.95. The Cohen's Kappa demonstrated good agreement between model prediction and the test set. CONCLUSIONS: This deep learning model can achieve performance comparable to that of human experts and has the potential to become a valuable tool for dental education and various applications in accurately identifying isolated tooth.

A digital guide device to facilitate CAD-CAM veneer cementation for mandibular incisors: A dental technique.

The novel design of a digital guide to facilitate the cementation of computer-aided design and computer-aided manufacturing (CAD-CAM) veneers for mandibular incisors by using a polymer infiltrated ceramic network (PICN) material is described. This guide provided an efficient, reliable, and accurate approach to facilitating multiple veneers with minimally invasive preparation during cementation, reducing the technique sensitivity of freehand practice and chairside time.