Dimensional changes over time in stereolithographic models fabricated with a 3D printer.

This study aimed to ascertain the effects of the shape of stereolithographic models fabricated with a three-dimensional (3D) printer and the use of different types of liquid resin on the dimensional changes of these models over time, to obtain valuable information for determining the period for which such models can be used following fabrication. Stereolithography models with the shape of a large truncated cone or a small truncated cone were fabricated using liquid resin as surgical guides (Group G) or master casts (Group M). (four groups in total, each n = 11). The shapes of all experimental specimens were measured immediately after fabrication and 1 day, 1 week, 2 weeks, 3 weeks, 4 weeks, 2 months, 3 months, 6 months, 1 year, and 1.5 years later. The shape data collected immediately after fabrication were taken as baseline data, and the dimensional changes over time at each timepoint were calculated. No significant change from 1 day to 1 year after fabrication was observed in any of the groups, but the change after 1.5 years was significantly larger than the changes at the other timepoints (p < 0.001). Significantly larger changes were evident in Group M than in Group G at all timepoints (p < 0.001). These results suggested that, from the viewpoint of dimensional stability over time, stereolithographic models should be used within 1 year of fabrication, and that the type of liquid resin used for stereolithographic model fabrication may affect how its dimensions change over time.

Peri-implant tissue augmentation by volume-stable collagen matrix transplantation: a study of dog mandibles.

The aim of this study was to investigate histologically the amount of peri-implant tissue augmentation after volume-stable porcine collagen matrix transplantation. Six male beagle dogs were used in the experiment. P2, P4, and M1 distal roots were extracted under general anesthesia. After 6 months, implants were placed in the same sites, and volume-stable porcine collagen matrix transplantation was performed. Impressions were taken at 1 and 2 weeks and at 1, 2, and 3 months after transplantation. The dogs were euthanized at 3 months, and their mandibles were removed and scanned using micro-computed tomography. Standard Triangulated Language data were also obtained. Using preoperative models as a reference, the data for all time points were compared, and changes in the thickness of the cross-section of the implant sites were measured. The model created at 3 months was then compared with the mandible data, and the thickness of collected peri-implant soft tissue was measured under optical microscopy. Increased thickness was found at some of the sites on the buccal side. Regarding the peri-implant soft tissue, the thickness of the measured sites on the buccal side was significantly increased at 3 months in the experimental group. Histological observations of the internal structures of the tissue in the experimental group revealed irregular collagen fibers and a remnant collagen matrix. Endogenous tissue was observed within the collagen matrix, indicating good fusion with the surrounding autologous tissue. These results suggest that volume-stable porcine collagen matrix transplantation promotes peri-implant tissue augmentation on the buccal side.

Effects of porcelain veneering methods on conformity of the marginal and internal fit of three-unit zirconia framework.

The purpose of this study is to investigate the effects of porcelain veneering methods on the marginal and internal fit of a three-unit zirconia framework. A zirconia master model, in which the lower-left second premolar and the second left molar were used as the abutment, was obtained using an intraoral scanner. Based on the data, three-unit zirconia frameworks for fabricating all-ceramic bridges were designed and milled (FW group). Two types of all-ceramic bridge were fabricated by veneering porcelain onto these frameworks using the press-over technique (P group) and the layering technique (L group). The replica technique was used to measure the gap size between the abutments and the bridges. Measurements were taken in the marginal opening area (MO), chamfer area (CH), axial area (AX), and occlusal area (OC). Statistical analysis was performed using the Mann-Whitney U-test. There was no significant difference in MO and CH between the P and L groups. However, in AX, the L group had a significantly larger gap size than that of the P group (p = 0.003). In addition, compared with the FW group, the P group showed a significantly larger gap size in MO (p < 0.000), CH (p = 0.008), and OC (p < 0.000). These results indicate that the gap size increased after porcelain veneering using the press-over and layering techniques. In addition, the all-ceramic bridges fabricated using the press-over and layering techniques had approximately equal gap sizes in MO.

Marginal and internal fit of three-unit fixed dental prostheses fabricated from translucent multicolored zirconia: Framework versus complete contour design.

STATEMENT OF PROBLEM: Translucent multicolored zirconia materials enable more esthetic complete contour zirconia fixed dental prostheses (FDPs) than conventional zirconia, which exhibits low translucency and high opacity and is monochromatic. However, how the marginal and internal fit of translucent multicolored zirconia FDPs compare with those of traditional frameworks that require veneering is unclear. PURPOSE: The purpose of this in vitro study was to compare the marginal and internal fit of frameworks and complete contour 3-unit FDPs fabricated from translucent multicolored zirconia. MATERIAL AND METHODS: Frameworks with a thickness of 0.5 mm and complete contour FDPs with a thickness of 0.8 to 1.5 mm were manufactured by using a workflow similar to one from a zirconia master model (mandibular left second premolar-mandibular left second molar). Two polyvinyl siloxane replicas were made for each specimen to measure the marginal and internal fit. Measurement locations were mesial, lingual, buccal, and distal for each abutment. In these locations, the marginal opening (MO), chamfer area (CA), axial wall (AW), and occlusal area (OC) were measured. The data were analyzed with 2-way ANOVA and the Bonferroni post hoc test (α=.05). RESULTS: Frameworks showed significantly better mean ±standard deviation fit values than complete contour 3-unit FDPs at measurement areas MO (frameworks: 112 ±22 µm, complete contour FDPs: 144 ±37 µm) (P=.013), CA (frameworks: 89 ±12 µm, complete contour FDPs: 110 ±22 µm) (P=.006), and OC (frameworks: 182 ±36 µm, complete contour FDPs: 244 ±64 µm) (P=.008). At the measurement area AW (frameworks: 47 ±7 µm, complete contour FDPs: 50 ±9 µm of each location, no significant difference was observed between frameworks and complete contour FDPs (P=.361). CONCLUSIONS: Design differences in 3-unit FDPs fabricated from translucent multicolored zirconia influenced the marginal and internal fit. Frameworks had smaller marginal fit than complete contour FDPs for translucent multicolored zirconia.

Effects of heat conduction of implant surface at thermal stimulation on implant placement.

The purpose of this study is to investigate, in vitro, how two different implant placement methods (one and two-stage implant placement) affect implant surface temperature after thermal stimulation. Two titanium screw implants were used and three thermocouples were attached to the implant surface at 0.5 mm (ch1), 5.5 mm (ch2) and 9.0 mm (ch3) under each platform. Experimental devices were fabricated pouring polymerization resin under a condition that imitated the two embedded technique with the one-stage implant placement model (1-stage) and the two-stage implant placement model (2-stage). A hot water storage device was installed in each model and hot water at three temperatures (60 °C, 70 °C and 100 °C) was flowed. The temperature change over time at the implant surface by the thermocouple was recorded. From the measurement data, the maximum temperature (Max-temp) at the implant surface, the time to reach 47 °C (47 °C r-time), and the duration of 47 °C or more (47 °C c-time) were calculated, and the test was repeated 26 times using the same method. The mean of repeated measurements was determined and statistical analysis was performed. Max-temp showed significant differences between each implant placement method, each channel and each thermal stimulation (p < 0.01). In this study suggested that the implant surface could reach 47 °C with 60 °C thermal stimulation in a 1-stage. In addition, it rose over 47 °C at 70 °C. The 2-stage implant surface did not rise to 47 °C.

A Sinus Floor Reaugmentation Technique Around an Apically Exposed Implant Into the Maxillary Sinus.

Sinus floor augmentation (SFA) is the most predictable treatment option in the atrophic posterior maxilla. However, exposure of the apical implant body into the maxillary sinus cavity is an occasionally observed phenomenon after SFA. Although most penetrating dental implants remain completely asymptomatic, they may induce recurrent rhinosinusitis or implant loss. Removal of the implant should be considered if there is significant implant exposure that results in prolonged treatment and increased costs. This case report demonstrates a recovery approach using sinus floor reaugmentation without implant removal in a patient with an apically exposed implant into the maxillary sinus cavity.

Compartment model analysis of intravenous contrast-enhanced dynamic computed tomography in hepatic hemodynamics: A validation study using intra-arterial contrast-enhanced computed tomography.

AIM: To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). METHODS: We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k1a ) and portal venous inflow velocity (k1p ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k2 ) limits using the nonlinear least square method. The correlation coefficient between the normalized enhancement in IA-CT and CMA of IV-CT was statistically evaluated according to various k2 limits. RESULTS: The highest mean correlation coefficient between k1a and nCTHA (r = 0.65, P < 0.0001) was observed when k2 ≦0.035. The highest mean correlation coefficient between k1p and nCTAP (r = 0.69, P < 0.0001) was observed when k2 ≦0.045. The decrease in correlation coefficient was significant when the upper k2 limit was lower than 0.03 or higher than 0.07 compared to the best mean correlation coefficient (P < 0.05). CONCLUSION: Hepatic arterial and portal venous flows can be evaluated quantitatively to some extent with appropriate outflow velocity constant limits using the CMA of IV-CT.

Evaluation of splenic perfusion and spleen size using dynamic computed tomography: Usefulness in assessing degree of liver fibrosis.

AIM: To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography (CT) and spleen size in assessing the degree of liver fibrosis. METHODS: We retrospectively studied 133 patients who had undergone dynamic CT before hepatectomy. Fibrosis was histologically established in all. First we calculated splenic perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time; MTT), and K1 /k2 (distribution volume; Vd ), using compartment model analysis. Then we compared the stage of fibrosis with splenic perfusion and spleen size (long axis, R), using the Kruskal-Wallis test and multiple comparisons. After that, we assessed the diagnostic accuracy of the combination of splenic perfusion, spleen size, age, gender, and the presence or absence of hepatitis B and hepatitis C viral infection in detecting liver fibrosis, using stepwise regression and receiver operating characteristic analysis. RESULTS: Significant differences (P < 0.05) in MTT were observed in comparisons between fibrosis stages F0 and F4, between F1 and F4, and between F2 and F4. Significant differences (P < 0.05) in R were observed in comparisons between F0 and F4, and between F1 and F4. Considering the presence or absence of hepatitis B and C viral infection along with MTT and R, the areas under the receiver operating characteristic curves were 0.89 for ≥F1, 0.83 for ≥F2, 0.82 for ≥F3, and 0.82 for F4. CONCLUSION: Splenic MTT and spleen size are helpful in assessing liver fibrosis.

Quantitative estimation of progression of chronic liver disease using gadoxetate disodium-enhanced magnetic resonance imaging.

AIM: The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic resonance (MR) elastography can be estimated by a combination of gadoxetate disodium-enhanced MR imaging (EOB-MRI) and ordinary blood tests. METHODS: We evaluated 33 consecutive patients with suspected liver disease who underwent EOB-MRI using a Differential Subsampling with Cartesian Ordering MR sequence and MR elastography using a 1.5-T MR system in this prospective study. A stepwise multiple linear regression model analysis of LS was performed using various predictive values obtained from two-in-one-uptake, two-compartment model analysis of EOB-MRI (velocity constants of arterial inflow [K1a ], portal venous inflow [K1p ], hepatocellular uptake [Ki ]), and ordinary blood test results (blood platelet count, serum albumin level [ALB], total serum bilirubin level [T-BIL], and prothrombin time [PT%]). RESULTS: Multiple linear regression model analysis revealed that hepatic perfusion-uptake index (HPUI = -K1a + K1p + Ki ) (P < 0.0001), albumin-bilirubin linear predictor (ALBI-LP = 0.66 × log10 T-BIL - 0.085 × ALB) (P = 0.034), and blood platelet count (P = 0.046) were significant independent predictors of LS (r = 0.863). The area under receiver operator characteristics curve of multiple linear regression model in prediction of the liver stiffness corresponding to higher (LS > 5.0 kPa) and lower (LS < 4.2 kPa) risk for developing hepatocellular carcinoma were 0.956 and 0.938, respectively. CONCLUSION: LS can be estimated quantitatively with the use of HPUI obtained from compartment model analysis of EOB-MRI combined with ALBI-LP and blood platelet count.

Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography.

PURPOSE: Imaging criteria for diagnosing compressive ulnar neuropathy at the elbow (UNE) have recently been established as the maximum ulnar nerve cross-sectional area (UNCSA) upon magnetic resonance imaging (MRI) and/or ultrasonography (US). However, the levels of maximum UNCSA and diagnostic cutoff values have not yet been established. We therefore analyzed UNCSA by MRI and US in patients with UNE and in controls. METHODS: We measured UNCSA at 7 levels in 30 patients with UNE and 28 controls by MRI and at 15 levels in 12 patients with UNE and 24 controls by US. We compared UNCSA as determined by MRI or US and determined optimal diagnostic cutoff values based on receiver operating characteristic curve analysis. RESULTS: The UNCSA was significantly larger in the UNE group than in controls at 3, 2, 1, and 0 cm proximal and 1, 2, and 3 cm distal to the medial epicondyle for both modalities. The UNCSA was maximal at 1 cm proximal to the medial epicondyle for MRI (16.1 ± 3.5 mm2) as well as for US (17 ± 7 mm2). A cutoff value of 11.0 mm2 for MRI and US was found to be optimal for differentiating between patients with UNE and controls, with an area under the receiver operating characteristic curve of 0.95 for MRI and 0.96 for US. The UNCSA measured by MRI was not significantly different from that by US. Intra-rater and interrater reliabilities for UNCSA were all greater than 0.77. The UNCSA in the severe nerve dysfunction group of 18 patients was significantly larger than that in the mild nerve dysfunction group of 12 patients. CONCLUSIONS: By measuring UNCSA with MRI or US at 1 cm proximal to the ME, patients with and without UNE could be discriminated at a cutoff threshold of 11.0 mm2 with high sensitivity, specificity, and reliability. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Measurement accuracy of alveolar soft tissue contour using a laboratory laser scanner.

Steric analysis of morphological changes is important for evaluation of surgical techniques. This study was performed to assess the measurement accuracy of alveolar soft tissue contour with a laboratory laser scanner. The width of the maxillary alveolar soft tissue contour was evaluated in 20 volunteers. Measurement sites were established in the alveolar soft tissue contour of the maxillary incisor and canine areas. Each site was evaluated by direct measurement with a microcaliper for each subject (DMM) and image measurement using a laboratory laser scanner (IMS). The accuracy of measurement methods was evaluated. Additionally, two plaster models obtained from the same subjects were scanned and superimposed, and the nonoverlapping areas were measured. Each measurement method exhibited a strong correlation (r = 0.89). The interclass correlation coefficient (single measure) between examiners was also high for each measurement method (PMM 0.978; IMS 0.997). In the superimposed images of the two plaster models, the distance of the nonoverlapping region was only 0.06 ± 0.08 mm in the labial aspect and 0.07 ± 0.09 mm in the palatal aspect. The image measurement of the scanning data shows high accuracy in evaluation of the alveolar soft tissue contour. This technique is useful for evaluation of chronological changes in the alveolar contour after soft and hard tissue augmentation.

A stepwise under-prepared osteotomy technique improves primary stability in shallow-placed implants: a preliminary study for simultaneous vertical ridge augmentation.

Simultaneous vertical ridge augmentation (VRA) can reduce treatment procedures and surgery time, but the concomitant reduction in primary stability (PS) of a shallow-placed implant imparts risk to its prognosis. Although several studies have reported improvements in PS, there is little information from any simultaneous VRA model. This study aimed to evaluate whether tapered implants with stepwise under-prepared osteotomy could improve the PS of shallow-placed implants in an in vitro model of simultaneous VRA. Tapered implants (Straumann® Bone Level Tapered implant; BLT) and hybrid implants (Straumann® Bone Level implant; BL) were investigated in this study. A total of 80 osteotomies of different depths (4, 6, 8, 10 mm) were created in rigid polyurethane foam blocks, and each BLT and BL was inserted by either standard (BLT-S, BL-S) or a stepwise under-prepared (BLT-U, BL-U) osteotomy protocol. The PS was evaluated by measuring maximum insertion torque (IT), implant stability quotient (ISQ), and removal torque (RT). The significance level was set at P < 0.05. There were no significant differences in IT, ISQ or RT when comparing BLT-S and BL-S or BLT-U and BL-U at placement depths of 6 and 8 mm. When comparison was made between osteotomy protocols, IT was significantly greater in BLT-U than in BLT-S at all placement depths. A stepwise under-prepared osteotomy protocol improves initial stability of a tapered implant even in a shallow-placed implant model. BLT-U could be a useful protocol for simultaneous VRA.

Usefulness of three-dimensional magnetic resonance cholangiopancreatography with partial maximum intensity projection for diagnosing autoimmune pancreatitis.

PURPOSE: To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without partial maximum intensity projection (MIP) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with autoimmune pancreatitis (AIP). MATERIALS AND METHODS: Three-dimensional MRCP and ERCP images were retrospectively analyzed in 24 patients with AIP. We evaluated the narrowing length of the main pancreatic duct (NR-MPD), multiple skipped MPD narrowing (SK-MPD), and side branches arising from the narrowed portion of the MPD (SB-MPD) using four MRCP datasets: 5 original images (MIP5), 10 original images (MIP10), all original images (full-MIP), and a combination of these three datasets (a-MIP). The images were scored using a 3- or 5-point scale. The scores of the four MRCP datasets were statistically analyzed, and the positive rate of each finding was compared between MRCP and ERCP. RESULTS: The median scores for SB-MPD on MIP5 and a-MIP were significantly higher than those on MIP10 and full-MIP. In other words, partial MIP is superior to full-MIP for visualization of detailed structures. The positive rate for SB-MPD on full-MIP was significantly lower than that on ERCP, whereas the positive rate on MIP5, MIP10, and a-MIP was not significantly different from that on ERCP. Moreover, the positive rate for NR-MPD and SK-MPD on the MRCP images was significantly higher than that on the ERCP images. CONCLUSION: Partial MIP is useful for evaluating the MPD and is comparable with ERCP for diagnosing AIP.

Transmission of light in the visible spectrum (400-700 nm) and blue spectrum (360-540 nm) through CAD/CAM polymers.

OBJECTIVES: CAD/CAM-fabricated long-term temporary restorations from high-density polymers can be applied for a wide range of indications. Milled from monolithic, mono-colored polymer blocks, the translucency of the material plays an important role for an esthetically acceptable result. The aim of this study was to compare the transmittance through visible light and blue light of CAD CAM polymers to a glass-ceramic material of the same color. MATERIALS AND METHODS: Ambarino High-Class (AM), Telio-CAD (TC), Zenotec PMMA (ZT), Cercon base PMMA (CB), CAD Temp (CT), Artbloc Temp (AT), Polycon ae (PS), New Outline CAD (NC), QUATTRO DISK Eco PMMA (GQ), Lava Ultimate (LU), and Paradigm MZ 100 (PA) were employed in this study using the feldspathic glass-ceramic Vita Mark II (MK) as control group. Using a spectrophotometer, the overall light transmittance was measured for each material (n = 40) and was calculated as the integration (t c (λ) dλ [10-5]) of all t c values for the wavelengths of blue light (360-540 nm). Results were compared to previous data of the authors for visible light (400 to 700 nm). RESULTS: Wilcoxon test showed significant differences between the light transmittance of visible and blue light for all materials. CONCLUSION: CAD/CAM polymers showed different translucency for blue and visible light. This means clinicians may not conclude from the visible translucency of a material to its permeability for blue light. This influences considerations regarding light curing. CLINICAL RELEVANCE: CAD/CAM polymers need to be luted adhesively; therefore, clinicians should be aware about the amount of blue light passing through a restoration.

Fit of 4-unit FDPs from CoCr and zirconia after conventional and digital impressions.

OBJECTIVES: To evaluate the marginal and internal fit of CAD/CAM-generated frameworks for 4-unit, fixed dental prostheses (FDPs) from zirconia (Z) and cobalt-chromium alloy (C) made with conventional (CI) and digital impressions (DI). MATERIALS AND METHODS: A titanium model was digitized with an intraoral scanner (DI, LAVA™ C.O.S.; 3M ESPE; Seefeld, Germany; n = 12). Additionally, 12 conventional impressions were taken, and referring plaster casts were digitized by a laboratory-scanner (CI, LAVA™ Scan ST; 3M ESPE; n = 12). Frameworks were fabricated (3M ESPE) from cobalt-chromium (DI-C, n = 12; CI-C, n = 12) and zirconia (DI-Z, n = 12; CI-Z, n = 12) from the same datasets. A replica technique was applied to measure the accuracy. The Mann-Whitney U statistical test was applied to detect statistical differences between each material and methodology groups in terms of fit. RESULTS: Frameworks from DI-C (median 19.07 µm) showed significantly better marginal fit than CI-C (median 64.64 µm, p < 0.001). Frameworks from DI-Z (median 52.50 µm) showed significantly better marginal fit than CI-Z (median 72.94 µm, p = 0.001). Additionally, frameworks from DI-C showed a significantly better marginal fit than DI-Z (p < 0.001). CONCLUSIONS: CI and DI led to a clinically acceptable marginal fit of 4-unit FDPs from cobalt-chromium and zirconia. DI leads to better marginal fit of the cobalt-chromium frameworks; however, no effect on zirconia was found. CLINICAL RELEVANCE: The results indicate that DI is suitable for fabricating 4-unit, cobalt-chromium and zirconia frameworks with regard to fit requirements.

Radial volumetric imaging breath-hold examination (VIBE) with k-space weighted image contrast (KWIC) for dynamic gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI of the liver: advantages over Cartesian VIBE in the arterial phase.

OBJECTIVES: To compare radial volumetric imaging breath-hold examination with k-space weighted image contrast reconstruction (r-VIBE-KWIC) to Cartesian VIBE (c-VIBE) in arterial phase dynamic gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (DCE-MRI) of the liver. METHODS: We reviewed 53 consecutive DCE-MRI studies performed on a 3-T unit using c-VIBE and 53 consecutive cases performed using r-VIBE-KWIC with full-frame image subset (r-VIBEfull) and sub-frame image subsets (r-VIBEsub; temporal resolution, 2.5-3 s). All arterial phase images were scored by two readers on: (1) contrast-enhancement ratio (CER) in the abdominal aorta; (2) scan timing; (3) artefacts; (4) visualisation of the common, right, and left hepatic arteries. RESULTS: Mean abdominal aortic CERs for c-VIBE, r-VIBEfull, and r-VIBEsub were 3.2, 4.3 and 6.5, respectively. There were significant differences between each group (P < 0.0001). The mean score for c-VIBE was significantly lower than that for r-VIBEfull and r-VIBEsub in all factors except for visualisation of the common hepatic artery (P < 0.05). The mean score of all factors except for scan timing for r-VIBEsub was not significantly different from that for r-VIBEfull. CONCLUSIONS: Radial VIBE-KWIC provides higher image quality than c-VIBE, and r-VIBEsub features high temporal resolution without image degradation in arterial phase DCE-MRI. KEY POINTS: Radial VIBE-KWIC minimised artefact and produced high-quality and high-temporal-resolution images. Maximum abdominal aortic enhancement was observed on sub-frame images of r-VIBE-KWIC. Using r-VIBE-KWIC, optimal arterial phase images were obtained in over 90 %. Using r-VIBE-KWIC, visualisation of the hepatic arteries was improved. A two-reader study revealed r-VIBE-KWIC's advantages over Cartesian VIBE.

[Recognition of the importance of reversed CPC in CPC].

Clinicopathological conferences (CPC) are one of the most important clinical conferences, and processes of both diagnosis and treatment performed in an autopsy case are retrospectively and finely checked to offer better medical treatment in the future. In CPC, the medical history, physical findings, laboratory data, image findings, diagnosis and treatment are discussed in the order that a physician examines a patient. Differential diagnoses usually decrease and several important diagnoses remain as the CPC discussion progresses. Medical treatment is also reexamined to identify a better approach. In this CPC, several medical doctors in various special fields try to understand the detailed state of the patient from each standpoint, and such a CPC is called an Expert CPC at Shinshu University School of Medicine. This CPC is carried out followed by reversed-CPC (R-CPC) of the same case. The purpose of this CPC is to understand the importance of R-CPC and to understand the correct interpretation of routine laboratory data.

Effect of firing temperature on the interface between 3Y-TZP zirconia and porcelain.

PURPOSE: The purpose of this study is to clarify the porcelain firing temperature conditions that give strongest bonding strength of porcelain to zirconia to manufacture all-ceramic fixed dental prostheses (FDPs) with excellent long-term stability. METHODS: Opaque porcelain samples (8.0 × 3.0 × 1.2 mm) were placed in the center of zirconia plates (25.0 × 3.0 × 0.5 mm) and fired at temperatures of 950°C, 1,050°C, 1,100°C, and 1,150°C. Schwickerath crack initiation tests, elemental analyses, and morphological changes of the samples were compared. RESULTS: There was no difference in the bonding strength among all the groups of porcelain fired at different temperatures. Elemental analysis of Si and O2 at the interface between the zirconia and porcelain were observed in the 950°C, 1,050°C, and 1,100°C groups. No silicon was found in the 1,150°C group by elemental analysis, and the zirconia plate where the porcelain sample was placed had irregular shape changes. CONCLUSION: It is suggested that silicon is also involved in chemical bonds due to firing at high temperatures.

Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment.

Purpose: To assess the utility of measurement of the computed tomography (CT) attenuation value (CTav) in predicting tumor necrosis in hepatocellular carcinoma (HCC) patients who achieve a complete response (CR), defined using modified Response Evaluation Criteria in Solid Tumors (mRECIST), after lenvatinib treatment. Method: We compared CTav in arterial phase CT images with postoperative histopathology in four patients who underwent HCC resection after lenvatinib treatment, to determine CTav thresholds indicative of histological necrosis (N-CTav). Next, we confirmed the accuracy of the determined N-CTav in 15 cases with histopathologically proven necrosis in surgical specimens. Furthermore, the percentage of the tumor with N-CTav, i.e., the N-CTav occupancy rate, assessed using Image J software in 30 tumors in 12 patients with CR out of 571 HCC patients treated with lenvatinib, and its correlation with local recurrence following CR were examined. Results: Receiver operating characteristic (ROC) curve analysis revealed an optimal cut-off value of CTav of 30.2 HU, with 90.0% specificity and 65.0% sensitivity in discriminating between pathologically identified necrosis and degeneration, with a CTav of less than 30.2 HU indicating necrosis after lenvatinib treatment (N30-CTav). Furthermore, the optimal cut-off value of 30.6% for the N30-CTav occupancy rate by ROC analysis was a significant indicator of local recurrence following CR with 76.9% specificity and sensitivity (area under the ROC curve; 0.939), with the CR group with high N30-CTav occupancy (≥30.6%) after lenvatinib treatment showing significantly lower local recurrence (8.3% at 1 year) compared with the low (<30.6%) N30-CTav group (p < 0.001, 61.5% at 1 year). Conclusion: The cut-off value of 30.2 HU for CTav (N30-CTav) might be appropriate for identifying post-lenvatinib necrosis in HCC, and an N30-CTav occupancy rate of >30.6% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC.