[Three-dimensional finite element analysis of cement flow in abutment margin-crown platform switching].

OBJECTIVE: To analyze the cement flow in the abutment margin-crown platform switching structure by using the three-dimensional finite element analysis, in order to prove that whether the abutment margin-crown platform switching structure can reduce the inflow depth of cement in the implantation adhesive retention. METHODS: By using ANSYS 19.0 software, two models were created, including the one with regular margin and crown (Model one, the traditional group), and the other one with abutment margin-crown platform switching structure (Model two, the platform switching group). Both abutments of the two models were wrapped by gingiva, and the depth of the abutment margins was 1.5 mm submucosal. Two-way fluid structure coupling calculations were produced in two models by using ANSYS 19.0 software. In the two models, the same amount of cement were put between the inner side of the crowns and the abutments. The process of cementing the crown to the abutment was simulated when the crown was 0.6 mm above the abutment. The crown was falling at a constant speed in the whole process spending 0.1 s. Then we observed the cement flow outside the crowns at the time of 0.025 s, 0.05 s, 0.075 s, 0.1 s, and measured the depth of cement over the margins at the time of 0.1 s. RESULTS: At the time of 0 s, 0.025 s, 0.05 s, the cements in the two models were all above the abutment margins. At the time of 0.075 s, in Model one, the gingiva was squeezed by the cement and became deformed, and then a gap was formed between the gingiva and the abutment into which the cement started to flow. In Model two, because of the narrow neck of the crown, the cement flowed out from the gingival as it was pressed by the upward counterforce from the gingival and the abutment margin. At the time of 0.1 s, in Model one, the cement continued to flow deep inside with the gravity force and pressure, and the depth of the cement over the margin was 1 mm. In Model two, the cement continued to flow out from the gingival at the time of 0.075 s, and the depth of the cement over the margin was 0 mm. CONCLUSION: When the abutment was wrapped by the gingiva, the inflow depth of cement in the implantation adhesive retention can be reduced in the abutment margin-crown platform switching structure.

[Prediction, analysis and application of learning curve of tooth preparation for all ceramic crowns of maxillary central incisors].

OBJECTIVE: To predict the learning curve of tooth preparation for all ceramic crowns of maxillary central incisors on phantom head simulators for graduate students participating in standardized dental resident training based on the modified Wright learning curve model, then to analyze and applicate the learning curve. METHODS: Twelve graduate students participating in standardized dental resident training were selected to prepare the resin maxillary central incisors on phantom head simulators for all ceramic crowns 4 times. The results of preparation were evaluated by 3 prosthetic experts with at least 10 years' experience focusing on the reduction, contour, taper, shoulder, finish line, margin placement, adjacent tooth injury, and preparation time for tooth preparation. The learning rate of tooth preparation was calculated by scores of tooth preparation of 4 times. The learning curve of tooth preparation was predicted based on the modified Wright learning curve model. According to the criteria of standardized training skill examinations for dental residents in Beijing, 80 was taken as the qualified standard score. The minimum training times for tooth preparation to satisfy the qualified standard score (80) was calculated, to analyze the characteristics of learning curve and evaluate the effectiveness of tooth preparation. RESULTS: The scores of 4 tooth preparation were 64.03±7.80, 71.40±6.13, 74.33±5.96, and 75.98±4.52, respectively. The learning rate was (106±4)%, which showed the learning curve an upward trend. There were no significant differences between the qualified standard score and the predicted scores of tooth preparation from the 5th preparation to the 13th preparation (P > 0.05). The predicted score of the 14th preparation was higher than the qualified standard score (P < 0.05). CONCLUSION: The trend of the learning curve of tooth preparation for all ceramic crowns of maxillary central incisors on phantom head simulators for graduate students participating in standardized dental resident training is upward, which predicts the minimum training times higher than the qualified standard score is 14 times.

[Finite element analyses of retention of removable partial denture circumferential clasps manufactured by selective laser melting].

OBJECTIVE: To compare the retentions of different designs of cobalt-chromium (Co-Cr), pure titanium (CP Ti), and titanium alloy (Ti-6Al-4V) removable partial denture (RPD) circumferential clasps manufactured by selective laser melting (SLM) and to analyze the stress distribution of these clasps during the removal from abutment teeth. METHODS: Clasps with clasp arm size A (1.9 mm width/1.1 mm thickness at the body and 0.8-taper) or B (1.2 times A) and 0.25 mm or 0.50 mm undercut engagement were modeled on a prepared first premolar die, named as designs A1, A2, A3, and A4, respectively. The density and elastic modulus of SLM-built Co-Cr, CP Ti, and Ti-6Al-4V were measured and given to different groups of clasps. The density, elastic modulus, and Poisson ' s ratio of enamel were given to the die. The control group was the cast Co-Cr clasp with design A1, to which the density and elastic modulus of cast Co-Cr alloy were given. The Poisson's ratio of all metals was 0.33. The initial 5 N dislodging force was applied, and the maximum displacement of the clasp along the insertion path was computed. The load was reapplied with an increment of 5 N than in the last simulation until the clasp was completely dislodged. The retentive force range of different groups of clasps was obtained. The retentive forces of the SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with equivalent computed retentive force range to the control group were validated through the insertion/removal experiment. The von Mises stress distributions of these three groups of SLM-built clasps under 15 N loads were analyzed. RESULTS: SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with designs B1 or B2, and Co-Cr clasps with design A2 had higher retentive forces than those of the control group. SLM-built CP Ti and Ti-6Al-4V clasps with design A1 had lower retentive forces than those of the control group. SLM-built Co-Cr clasp with design A1 and SLM-built CP Ti and Ti-6Al-4V clasps with design A2 had equivalent retentive forces to those of the control group. The insertion/removal experiment showed that the measured retentive forces of these three groups of SLM-built clasps were (21.57±5.41) N, (19.75±4.47) N, and (19.32±2.04) N, respectively. No statistically significant measured retentive force difference was found among these three groups of SLM-built clasps (P>0.05). The maximum von Mises stress of these three groups of SLM-built clasps exceeded their responding yield strength except for the Ti-6Al-4V one. CONCLUSION: SLM-built Co-Cr circumferential clasps had higher retention than CP Ti and Ti-6Al-4V ones with the same clasp arm size and undercut engagement. The retention of SLM-built circumferential clasps could be adjusted by changing the undercut engagement and clasp arm size. If SLM-built circumferential clasps are used in clinical practice, the Ti-6Al-4V clasp with clasp arm size A and 0.50 mm undercut engagement is recommended considering the long-term use of RPD in the patient's mouth.

[Preliminary clinical application verification of complete digital workflow of design lips symmetry reference plane based on posed smile].

OBJECTIVE: To automatically construct lips symmetry reference plane (SRP) based on posed smile, and to evaluate its advantages over conventional digital aesthetic design. METHODS: Eighteen subjects' three-dimensional facial and dentition data were gathered in this study. The lips SRP of experimental groups were used with the standard weighted Procrustes analysis (WPA) algorithm and iterative closest point (ICP), respectively. A reference plane defined by experts based on regional ICP algorithm, served as the truth plane. The angle error values between the lips SRP of WPA algorithm in the experimental groups and the truth plane were evaluated in this study, and the lips SRP of ICP algorithm of the experimental groups was calculated in the same way. The lips SRP based on posed smile as a reference for aesthetic design and evaluate preliminary clinical application. RESULTS: The average angle error between the lips SRP of WPA algorithm and the truth plane was 1.78°±1.24°, which was smaller than that between the lips SRP of ICP and the truth plane 7.41°±4.31°. There were significant differences in the angle errors among the groups (P < 0.05). In the aesthetic design of anterior teeth, automatically constructing the lips SRP of WPA algorithm based on posed smile and the original symmetry plane by re-ference compared with the prosthetic design, the subjects' scores on the lips SRP of WPA algorithm based on posed smile (8.48±0.57) were higher than those on the original symmetry plane (5.20±1.31). CONCLUSION: Automatically constructing the lips SRP of WPA algorithm based on posed smile was more accurate than ICP algorithm, which was consistent with the truth plane. Moreover, it can provide an important reference for oral aesthetic diagnosis and aesthetic analysis of the restoration effect. In the aesthetic design of anterior teeth, automatically constructing the lips SRP of WPA algorithm based on posed smile can improve the patients' satisfaction in esthetic rehabilitation.

[Evaluation of fracture strength of two kinds of zirconia all-ceramic crowns with different edge compensation angles].

OBJECTIVE: To evaluate the effects of different edge compensation angles on the fracture strength of multilayer zirconia all-ceramic crowns and traditional uniform zirconia all-ceramic crowns. METHODS: The resin tooth preparation specimen of the mandibular first molar with a knife-edge was fabricated. A 3D digital model of the specimen was obtained by scanning it with a 3D dental model scanner. The 3D digital model was imported into computer aided design (CAD) software, and three 3D digital models of the full crown with the same surface shape are designed with the edge compensation angles of 30°, 45° and 60°, respectively. Then, the designed 3D digital model is imported into computer aided manufacturing (CAM) software. Three kinds of multilayer and homogeneous zirconia all-porcelain crowns with different edge compensation angles were fabricated, 10 each for a total of 60. The fracture load of each crown was measured under the electronic universal testing machine. RESULTS: Fracture load of multilayer and uniform zirconia all-ceramic crowns, (4 322.86±610.07) N and (5 914.12±596.80) N in the 30° group, (5 264.82±883.76) N and (5 220.83±563.38) N in the 45° group and (4 900.42±345.41) N and (5 050.22±560.24) N in the 60° group, respectively. The fracture load of multi-layer zirconia all-ceramic crowns in the 30° group was significantly lower than that of homogeneous zirconia all-ceramic crowns(P < 0.05); there was no statistical significance in 45° group and 60° group(P>0.05). In the multi-layer zirconia all-ceramic crowns: the fracture load of the 30° group was significantly lower than that of the 45° group (P < 0.05); there was no significant difference between the 30° group and the 60° group, the 45° group and the 60° group (P>0.05).In uniform zirconia full crown group: the 30° group was higher than the 45° group, the 30° group was higher than the 60° group (P < 0.05), and there was no significant difference between the 45° group and the 60° group (P>0.05). CONCLUSION: The fracture loads of three kinds of uniform and multilayer zirconia all ceramic crowns with different edge compensation angles can meet the clinical requirements. A smaller edge compensation angle is recommended when using traditional zirconia all-ceramic crowns, while 45° is recommended when using multi-layer zirconia all-ceramic crowns.

[Evaluation of methods for fitness of removable partial denture].

OBJECTIVE: To compare the differences and indications of three evaluation methods for fitness evaluation of removable partial denture (RPD). METHODS: A RPD was fabricated and seated on the stone cast of a partially edentulous mandible, and the spaces between RPD and stone cast were recorded with polyvinyl siloxane (PVS) impression material forming PVS replicas. Using cross sectional measurement, the average thicknesses of PVS replicas were measured under stereomicroscope with different numbers of selected measuring points in the denture base, major connector, occlusal rest of the RPD, and the average thicknesses of the PVS replicas measured with different numbers of measuring points were compared using one-way analysis of variance (ANOVA) and independent sample t test. Three kinds of method, including cross sectional measurement, three-dimensional analysis on the stone cast, and three-dimensional analysis on the polyether cast, were applied to measure the average thicknesses of the PVS replicas, and the average thicknesses of the PVS replicas measured by these three evaluation methods were compared with ANOVA. RESULTS: For cross sectional measurement, statistically significant differences were found in the average thicknesses of the PVS replicas in the denture base and the major connector among the different numbers of measuring points (P < 0.05), but no differences were found in the average thicknesses of the PVS replicas in the occlusal rest (P>0.05). There were significant differences among the average thicknesses of the PVS replicas measured by these three evaluation methods in each component of the RPD (P < 0.01). The average thickness measured by three-dimensional analysis on the stone cast and three-dimensional analysis on polyether cast were smaller than that measured by cross sectional measurement (P < 0.05). And there were no differences between the average thicknesses of PVS replicas measured by three-dimensional analysis on stone cast and three-dimensional analysis on polyether cast (P>0.05). CONCLUSION: For cross sectional measurement, the average thickness of the PVS replicas was influenced by the number of measuring points, and the measurement accuracy of cross sectional measurement was not reliable enough. Three-dimensional analysis on stone cast which is suitable for evaluation in vitro and three-dimensional analysis on polyether cast which is suitable for evaluation in vivo can evaluate the fitness of RPD more comprehensively and effectively than that of cross sectional measurement.

[Tribbles pseudokinase 3 inhibits the adipogenic differentiation of human adipose-derived mesenchymal stem cells].

OBJECTIVE: To identify the role of Tribbles pseudokinase 3 (TRIB3) during the process of adipogenic differentiation of human adipose-derived mesenchymal stem cells (hASCs), and to provide a new target and a novel idea for the application of hASCs in adipose tissue engineering and soft tissue regeneration. METHODS: TRIB3-knockdown hASCs (shTRIB3) and TRIB3-overexpression hASCs (TRIB3-over) were established using lentivirus transfection technique. The transfection effect was estimated by the visible presence of green fluorescence as the expression of green fluorescent protein (GFP) in the transfected hASCs. The lentiviral transfection efficiency was examined by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. After adipogenic induction, Oil Red staining and quantification, as well as qRT-PCR about several specific adipogenic markers were used to evaluate the adipogenic differentiation ability of hASCs. RESULTS: In TRIB3-knockdown hASCs, the TRIB3 mRNA expression level decreased by about 84.3% compared with the control group (P<0.01), and the TRIB3 protein level also showed obvious reduction. Oppositely, in TRIB3-overexpression hASCs, the TRIB3 mRNA expression level increased by approximately 160% compared with the control group (P<0.01), and the TRIB3 protein level also showed a significant increase. These results indicated a successful construction of TRIB3-knockdown hASCs and TRIB3-overexpression hASCs. The Oil Red staining results showed that the down-regulation of TRIB3 significantly promoted lipid droplets formation in hASCs, consistent with Oil Red quantification. On the other hand, the up-regulation of TRIB3 suppressed lipid droplets formation in hASCs, consistent with Oil Red quantification. After adipogenic induction, adipogenesis-related genes, including peroxisome proliferator-activated receptor γ (PPARγ), cluster of differentiation 36 (CD36) and CCAAT/enhancer binding protein α (C/EBPα), were increased significantly in TRIB3-knockdown hASCs compared with the control group (P<0.01). Oppositely, PPARγ, CD36 and lipoprotein lipase (LPL) were significantly decreased in TRIB3-overexpression hASCs compared with the control group (P<0.01). CONCLUSION: TRIB3 inhibited the adipogenic differentiation of hASCs. Knockdown of TRIB3 promoted the ability of adipogenesis of hASCs, while overexpression of TRIB3 inhibited the adipogenic differentiation of hASCs. Considering the important role of PPARγ in the adipogenis process, the molecular mechanism of the regulatory function of TRIB3 may be related with PPARγ signal pathway.

[Evaluation of clinical efficacy of a kind of digital complete denture].

OBJECTIVE: To compare the clinical efficacy of a kind of complete dentures fabricated using computer aided design/computer aided manufacturing (CAD/CAM) workflow with that of the complete denture fabricated using conventional workflow. METHODS: Twenty edentulous patients were included in this prospective, single-blind, self-controlled clinical trial. Two pairs of complete dentures were fabricated for each participant: one using the functional suitable denture (FSD) system with CAD/CAM, and the other using conventional fabrication workflow. In the final delivery appointment, the conventional dentures worn by the participant for 3 months at first. Then the participant swapped to wear digital denture for another 3 months. The patients' satisfaction and oral health related quality of life (OHRQoL) were measured using the visual analogue scale (VAS) and oral health impact profile (OHIP-20E) at baseline, 2 weeks, 1 month, 2 months, and 3 months following denture delivery. In addition, the masticatory efficiency of each pair of dentures was measured after three months adaptation period for each type of dentures. RESULTS: The VAS scores of the twenty patients in FSD denture group on general satisfaction, ease of cleaning, ability to speak, esthetics, stability and oral health status on these six domains were higher than that of conventional denture group 3 months after delivery. While the VAS cores in FSD denture group on comfort, ability to chew and ability to chew up were the same as those of conventional denture group. But there was no significant difference (P>0.05). The VAS score on each domain in FSD denture group was higher than that of conventional denture group 3 months after delivery, three domains of which reached statistical significance (P < 0.05), involving functional limitation, psychological discomfort and total. The masticatory performance of the FSD denture (1.20±0.54) was slightly higher than that for the conventional denture (1.16±0.53), but the difference did not reach statistical significance (P=0.691). CONCLUSIONS: The clinical efficacy of the FSD complete denture is comparable to that of the conventional complete denture. As for patient satisfaction and oral health related quality of life, FSD dentures received comparable scores as conventional complete dentures did.

[Comparison of the registration methods for the three-dimensional facial scans applied to the design of full-arch implant supported restoration].

OBJECTIVE: To compare the registration accuracy of three-dimensional (3D) facial scans for the design of full-arch implant supported restoration by five methods and to explore the suitable registration method. METHODS: According to the criteria, ten patients with maxillary edentulous jaw or end-stage dentition requiring implant supported restorations were enrolled in this study. A special rim with individual feature marks reflected appropriate occlusal relationship and esthetic characteristics was made for each patient. Both 3D facial scan data of natural laughter and with opener traction to expose the teeth or occlusal rim of each patient were acquired by facial scan and input to the digital analysis software Geomagic Qualify 2012. The dataset was superimposed by five different methods: seven facial anatomical landmark points alignment, facial immobile area alignment (forehead and nasal area), facial anatomical landmark points and immobile area combining alignment, facial feature points alignment, facial and intraoral feature points alignment with the same local coordinate system. The three-dimensional deviation of the same selected area was calculated, the smaller the deviation, the higher the registration accuracy. The 3D deviation was compared among the three registration methods of facial anatomical landmark points, facial immobile area alignment and the combination of the above two methods. Friedman test was performed to analyze the difference among the three methods (α=0.05). The effect of the aid of the facial and intraoral feature points were evaluated. Paired t test were performed to analyze the difference (P<0.05). RESULTS: The average three-dimensional deviation of the selected area after alignment with the facial anatomical landmarks was (1.501 2±0.406 1) mm, significantly larger than that of the facial immobile area best-fit alignment [(0.629 1±0.150 6) mm] and the combination of the two methods[(0.629 1±0.150 6) mm] (P < 0.001). The aid of the facial feature points could significantly reduce the deviation (t=1.001 3, P < 0.001). There was no significant statistical difference in the remaining groups. CONCLUSION: The forehead area of the 3D facial scan can be exposed as much as possible. The establishment of facial characteristic landmark points and the use of the invariant area alignment can improve the accuracy of registration. It should be clinically feasible to apply three-dimensional facial scan to the design of full-arch implant supported restoration with the registration of the immobile area on the face especially the forehead area.

[Visual sensitivity threshold of lateral view of nasolabial Angle changes in edentulous jaw patients].

OBJECTIVE: To study the visual sensitivity threshold of physician's naked eye to the difference of nasolabial angle in edentulous jaw patients, and to provide a reference value for the study of aesthetic evaluation of soft tissue profile for the difference of nasolabial angle that can be recognized by human eyes. METHODS: Three-dimensional facial images of three edentulous patients with different diagnostic dentures introoral were obtained. Lateral screenshots of each patient's three-dimensional facial image with the same scale were obtained by using reverse engineering software (Geomagic studio 2014).The screenshot of the patient's three-dimensional facial image with suitable lip support (The suitable lip support was confirmed by both patients and prosthodontists who had clinical experience for more than 20 years) was taken as the reference picture, and the remaining pictures were grouped with it respectively. All the pictures were observed in random order by the subjects. Fifteen dentists were asked to judge the difference of nasolabial angle between the two pictures of each group on the computer screen. The difference of nasolabial angle between the two pictures in each group was measured and calculated. The ROC curve was drawn, and the best cut-off value was calculated as the visual sensitivity threshold. RESULTS: The data of the 15 subjects were used to draw ROC curves separately. The maximum and minimum best cut-off values were 5.55 degrees and 3.12 degrees respectively. The ROC curve of the whole 15 subjects was drawn after data aggregation, and the best cut-off value was 5.36 degrees (AUC=0.84>0.5, P=0.000<0.05). When the difference of nasolabial angle was above 5.36 degrees, the subjects could recognize it effectively. CONCLUSION: There is a visual limit in the observation of the nasolabial angle with the naked eye. In this study, a visual sensitivity threshold of 5.36 degrees for the difference of the nasolabial angle was obtained. The difference of nasolabial angle below this value can be regarded as no clinical significance. This result provides a reference value for human eyes to recognize the difference of nasolabial angle in soft tissue profile aesthetic evaluation. It can be applied to the aesthetic evaluation of soft tissue profile and can be used as the error level of related research with nasolabial angle as an index for accuracy evaluation.

[Application of biocopy function of temporary crown occlusal morphology in patients with severe attrition].

OBJECTIVE: To explore the preliminary application of "biocopy function" in digital technology of temporary crown in severe tooth attrition, so as to reduce the difficulty of final restoration adjustment in severe tooth wear cases, and save clinical time. METHODS: Twelve patients aged between 40 and 65 years with severe tooth attrition were recruited in this study. The experimental group (6 cases, 3 females and 3 males) used the method of digital copy of temporary restoration shape when making the final restoration, and the control group (6 cases, 3 females and 3 males) used the traditional method to make the final restoration. The mean time of central occlusal adjustment and protrusive and lateral occlusal adjustment of each crown, the number of follow-up visits of the patients were recorded and statistically analyzed. The occlusal comfort of the first and the third months after wearing the prosthesis was evaluated by the patients, and the difference of the occlusal comfort of the final prosthesis made by the two methods was compared (the full score was 10 points). The occlusal adjustment time and occlusal comfort score were used as measurement data. Single sample t test was used. The number of follow-up visits was count data. Rank sum test was used for non-normal continuous variables. RESULTS: The mean occlusal time of each crown adjustment in the experimental group was significantly lower than that in the control group (P < 0.01), and the median number of follow-up visits in the experimental group was lower than that in the control group (P < 0.01). The average occlusal comfort score of the experimental group was higher than that of the control group at the first time (P < 0.01). After three months of crown wearing, the median occlusal comfort score of the experimental group was higher than that of the control group (P < 0.05). CONCLUSION: In the case of severe tooth attrition, it is feasible to use the "biocopy function" in the design software to design the final prosthesis, which is conducive to reduce the difficulty of adjustment and achieve predictable functional and aesthetic effects, which is of great significance to save clinical time and improve the accuracy of restoration.

[Independent innovation research of functionally suitable denture digital system].

Fabrication of conventional complete dentures involves a complex restoration method, requiring significant time and typically involving primary impressions, definitive impressions, jaw relation records, clinic try-in, and complete denture placement, which has been used for nearly a century without change. A novel digital system named Functionally Suitable Denture (FSD) was researched and developed so as to reduce clinical steps, operation difficulties and errors of complete denture restoration. It pioneered a unique diagnostic complete denture aided by computer aided design (CAD) & 3D printing, by which, the functional impression, jaw relation, and try-in (3 steps) were simplified to 1 step, thus the number of visits to the dentist was reduced by 2 times. Moreover, for the first time, it put forward a CAD software of template matching based on the expert design, which was an efficient and intelligent design scheme, and the excellent denture experts' experience and skills could be inherited and iterated. The system included the 3D scanner with appropriate accuracy and high efficiency, the CAD software, the special 3D printer and process software, and the innovative clinical operation process. The Patent Cooperation Treaty (PCT) patent international search report showed that all the 15 claims of the technology were of novelty, creativity and industrial utility. All the digital products were independently developed and made by Peking University School and Hospital of Stomatology, China. The design and manufacture process of denture prosthesis was fast, simple and accurate. At the same time, personalized functional and aesthetic matching of the patients after wearing prosthesis was realized. It effectively solved the global problems of "slow, difficult and inaccurate" of the traditional manual technology of complete denture, and brought good news to edentulous patients. Compared with the traditional complete denture treatment, FSD system has a wide range of applications for different types of edentulous patients, including those with severe resorption of the alveolar ridge or a high occlusal force. Furthermore, the low-cost of 3D printers, compared with expensive milling machines, may make the approach more accessible. This review describes that our research is related to the development of the FSD system, including multi-source data acquisition technology, three generations of complete denture design software, 3D printing systems of individual tray and complete denture pattern, the clinical and laboratory operation process of the FSD system.

[Application and exploration of Smile Lite MDP portable photography system in aesthetic photography of anterior teeth].

OBJECTIVE: To explore the possibility of the Smile Lite MDP (Smile Lite Mobile Dental Photograph) portable dental photography system applying in anterior teeth aesthetic photography, and to provide the chance to simplify aesthetic photography process and facilitate communication among patients, dentists and dental technitians. METHODS: The Smile Lite MDP photography system combined with the smartphone were used to photograph the front occlusal phase photos of anterior teeth. The photographic conditions including the color temperature parameter, the Smile Lite MDP light position and the intensity settings were explored. The best photographic conditions were chosen by blind evaluation within experienced dentists and technicians through the method of the visual analogue scale/score (VAS) evaluation, which went through statistical analysis to figure out the optimum photograghic conditions. Smile Lite MDP photography system was used to photograph the front occlusal phase photos of anterior teeth under the optimum parameter by different magnifications. The width/height ratio of the central incisor and the front width ratio of the upper anterior teeth in those photos were measured and calculated respectively. The accuracy of the anterior teeth photos taken by Smile Lite MDP photography system was analyzed based on the photographs taken by digital single lens reflex (DSLR) camera. RESULTS: The optimum color temperature parameter of Smile Lite MDP portable camera system was 5 000 K, the optimum magnification was 4 times, the best light position was the side lights of Smile Lite MDP, the optimum intensity of lights was 2 grades. Photos taken by the optimum parameters won the highest score during the VAS evaluation and the result of statistical analysis had significant difference compared with other groups (P<0.05). When comparing the photos of the upper anterior teeth taken by the Smile Lite MDP portable photography system using 4 times magnification or by DSLR using the standard parameters, there was no significant difference neither in the width/hieght ratio of the central incisor nor in the front width ratio of the upper anterior teeth (P>0.05). CONCLUSION: The Smile Lite MDP portable dental photography system applying in anterior teeth aesthetic analysis photography was capable to show the color and shape of anterior teeth in an accurate way by using the right photography parameters. Therefore, Smile Lite MDP portable dental photography system was considered to be a simple and easy photographic tool in clinical work.

Influenza a virus and Streptococcus pneumonia coinfection potentially promotes bacterial colonization and enhances B lymphocyte depression and reduction.

Influenza has frequently been epidemic in recent years. However, the mechanisms of severe pneumonia with postinfluenza Streptococcus pneumoniae (SP) secondary infection have not been fully understood. In this study, we explored the mechanisms of pneumonia in postinfluenza A virus (IAV) infection via a mouse model. Mice were intranasally inoculated with SP three days after IAV inoculation. We then collected samples at three time points to dynamically observe the pathological progression. In IAV infection alone, lymphocyte infiltration and widened alveolar intervals were observed. In the blood, levels of the CD19+, CD19+CD21+ and CD19+CD79ß+B lymphocyte subpopulations were reduced, and IFN-γ and IL-10 were elevated. Slight atrophy was seen in the spleen, which was due to splenic B lymphocyteinitiated apoptosis through the mitochondrial pathway. When SP infection occurred after IAV infection, the pulmonary inflammation was significantly aggravated; a fair number of lymphocytes and neutrophils infiltrated simultaneously with exfoliated bronchial epithelial cells, vascular endothelial cells, widened alveolar septum and hemorrhaging. Increasing edema fluid and bacteria accumulated in the alveolar cavity. Decreased CD19+, CD19+CD21+ and CD19+CD79ß+B lymphocyte subpopulations and increased interferon gamma (IFN-γ) or interleukin 10 (IL-10) were more prominent compared to those with viral infection alone. Spleen atrophy resulting from coinfection was more obvious because of massive splenic B lymphocyte apoptosis through the mitochondrial pathway compared to viral infection alone. This study shows that although inflammation caused by SP infection alone was temporary, preceding IAV infection provided favorable conditions for SP colonization and multiplication by destroying lung structure and suppressing humoral immunity. Synergistic IAV-SP coinfection is likely to facilitate more SP colonization and promote B lymphocyte-suppression and reduction. Eventually, the pneumonia worsened.

[Establishment of a 3D printing system for bone tissue engineering scaffold fabrication and the evaluation of its controllability over macro and micro structure precision].

OBJECTIVE: To establish a 3D printing system for bone tissue engineering scaffold fabrication based on the principle of fused deposition modeling, and to evaluate the controllability over macro and micro structure precision of polylactide (PLA) and polycaprolactone (PCL) scaffolds. METHODS: The system was composed of the elements mixture-I bioprinter and its supporting slicing software which generated printing control code in the G code file format. With a diameter of 0.3 mm, the nozzle of the bioprinter was controlled by a triaxial stepper motor and extruded melting material. In this study, a 10 mm×10 mm×2 mm cuboid CAD model was designed in the image ware software and saved as STL file. The file was imported into the slicing software and the internal structure was designed in a pattern of cuboid pore uniform distribution, with a layer thickness of 0.2 mm. Then the data were exported as Gcode file and ready for printing. Both polylactic acid (PLA) and polycaprolactone (PCL) filaments were used to print the cuboid parts and each material was printed 10 times repeatedly. After natural cooling, the PLA and PCL scaffolds were removed from the platform and the macro dimensions of each one were measured using a vernier caliper. Three scaffolds of each material were randomly selected and scanned by a 3D measurement laser microscope. Measurements of thediameter of struts and the size of pores both in the interlayer overlapping area and non-interlayer overlapping area were taken. RESULTS: The pores in the printed PLA and PCL scaffolds were regular and interconnected. The printed PLA scaffolds were 9.950 (0.020) mm long, 9.950 (0.003) mm wide and 1.970 (0.023) mm high, while the PCL scaffolds were 9.845 (0.025) mm long, 9.845 (0.045) mm wide and 1.950 (0.043) mm high. The struts of both the PLA and PCL parts became wider inthe interlayer overlapping area, and the former was more obvious. The difference between the designed size and the printed size was greatest in the pore size of the PLA scaffolds in interlayer overlapping area [(274.09 ± 8.35) µm)], which was 26.91 µm. However, it satisfied the requirements for research application. CONCLUSION: The self-established 3D printing system for bone tissue engineering scaffold can be used to print PLA and PCL porous scaffolds. The controllability of this system over macro and micro structure can meet the precision requirements for research application.

[Evaluation of one-piece polyetheretherketone removable partial denture fabricated by computer-aided design and computer-aided manufacturing].

OBJECTIVE: To explore a novel method for fabricating removable partial dentures (RPDs) using polyetheretherketone (PEEK) by computer-aided design and computer-aided manufacturing (CAD/CAM) technologies and to evaluate their fits for different assemblies in vitro. METHODS: A standard stone cast of mandibular partial edentulous jaw was scanned using a lab scanner. Based on the digital cast, thirteen complete RPDs were designed combing dental CAD software and reverse engineering software, and then fabricated using PEEK by milling machine. Fits of assemblies were evaluated quantitatively by measuring the spaces between RPDs and casts. The gaps between RPDs and stone casts in different assemblies were duplicated using light-body silicone impression material and then measured using three-dimensional (3D) digital analysis methods in virtue of a dedicated software. Statistically, one-way analysis of variance (ANOVA) was used to compare the difference of gaps among assemblies in different shapes such as occlusal rest, denture base, and major connector. Paired-samples t test was used to compare the gaps difference for the similar shape assemblies in different areas. RESULTS: One-piece PEEK RPDs were successfully designed and fabricated by CAD/CAM, and all the RPDs were well-seated on stone casts. The gaps between occlusal rests and casts [(84.3±23.6) µm] were significantly larger than those of denture bases [(32.5±27.8) µm] and major connectors [(49.9±47.0) µm], which meant that the fits of denture bases and major connectors were better than that of occlusal rests. However, the fits of all assemblies could be accepted clinically. For the similar shape assemblies in different areas, there were no significantly differences for gaps between distal extension denture bases [(25.1±55.3) µm] and non-extensive denture bases [(41.5±17.7) µm]. The gaps of occlusal rests adjacent and nonadjacent to the edentulous space were (86.1±29.8) µm and (80.8±42.1) µm respectively and there were no significantly difference between them either. These results implied that different locations had no apparent effect on the fits of assemblies. CONCLUSION: With the computer-aided design and computer-aided manufacturing technology, PEEK can be used to fabricate one-piece removable partial dentures. And all assemblies of the one-piece PEEK RPDs showed satisfying fits in vitro, indicating a promising clinical application in the future.

[Establishment and preliminary clinical evaluation of edentulous custom trays designed and fabricated by chair-side CAD and 3D printing systems].

OBJECTIVE: To design and fabricate edentulous custom trays by chair-side computer-aided design and 3-dimensional printing (CAD/3DP) system of independent research and development and to evaluate their clinical effects based on prosthodontists'satisfaction using the visual analogue scale (VAS). METHODS: Fifteen edentulous patients were randomly recruited by three prosthodontists who passed the unified operating process training. The custom trays for each patient were fabricated using both chair-side CAD/3DP system of independent development and manually conventional method, and the final impressions were made by silicone impression materials (light body). The prosthodontist's satisfaction was surveyed by the three prosthodontists via the questionnaire based on visual analogue scales. RESULTS: In the degree of the prosthodontist's satisfaction of final impressions, the average satisfactions of "try in" (the overall size, shape, convenience, etc.) on the 3DP custom tray made by independent development chair-side system and the manually conventional method were 9.18±0.19 and 8.23±0.22, respectively. The average satisfactions of the border line position (border extensions, frenal notch)were 8.91±0.40 and 7.96±0.23, respectively. The average satisfactions of the stability in border molding were 8.80±0.83 and 8.01±0.81, respectively. The average satisfactions of the quality of final impression (completeness, thickness of impression material, exposure of custom tray, shape of border) were 8.94±0.68 and 7.99±0.42, respectively. The average satisfactions of the difficulty of high quality impression (times of repetition, efficiency) were 9.20±0.37 and 7.88±0.22, respectively. The average satisfactions of the overall satisfaction were 9.11±0.49 and 7.95±0.15, respectively. There was significant difference in the satisfaction of "try in", border line position, stability in border molding, quality of final impression, difficulty of high quality impression, and overall satisfaction between the 3DP custom tray made by chair-side system of independent development and the manually conventional method (P<0.05). CONCLUSION: In the degree of the prosthodontist's satisfaction of final impression, the 3DP custom tray made by chair-side system of independent development is higher than that of the conventional custom tray, and it meets the clinical requirements and can be popularized in clinical application.

[Preliminary clinical application of complete digital workflow of design and manufacturing occlusal splint for sleep bruxism].

OBJECTIVE: To establish a complete workflow of digital design and manufacturing occlusal splint for sleep bruxism, which can be preliminarily applied in clinical use, thus observe the clinical efficacy. METHODS: Twenty-four patients with sleep bruxism were recruited in the study and randomly divided into two groups by using random number tables. Digital-occlusal-splint (experimental group) treatment plan and traditional-occlusal-splint (control-group) treatment plan were carried out for each group, respectively. For experimental group, digital models of patients' both dental arches and the occlusion relationship after elevation were captured using an intraoral scanner. The occlusal splint was carried out by computer aided design/computer aided manufacturing (CAD/CAM), including splint designing and milling. For control group, the traditional soft occlusal splint was fabricated by vacuum laminator. The two kinds of occlusal splints were tried in the patients from each group, and the occlusal contacts were tested respectively by T-scan analysis system, which recorded the changes of occlusal indicators in the two groups. The retention, appearance and occlusal comfort degree were evaluated by the two groups of patients. Mann-Whitney test was performed with IBM SPSS 20.0 software, and bilateral test was performed. P<0.05 was considered to be statistically significant. RESULTS: The complete workflow of digital design and manufacturing occlusal splint was successfully established. During the clinical use, there was no statistical difference in the retention evaluation of two kinds of occlusal splints between the two groups of patients (Z=-0.538, P=0.590). The appearance score (Z=2.038, P=0.042) and the occlusal comfort score (Z=-2.579, P=0.010) of the experimental group were higher than those of the control group, with statistically significant differences. The T-scan analysis results showed that only the second molar on both sides of the traditional occlusal splint had occlusal contact in intercupsal position, while the digital occlusal splint had stable and bilaterally balanced contact between the maxillary and mandibular teeth. Furthermore, the occlusal force was uniformly distributed in the experimental group. CONCLUSION: The complete workflow of digital occlusal splint improves the occlusal design, greatly simplifies and optimizes the traditional process of making occlusal splint. This new method is resource-saving and environmental-friendly, and it is able to serve patients more conveniently and efficiently.

[Protective effects of oligomeric proanthocyanidins in mice exposed to paraquat].

Objective: To investigate the protective effect of oligomeric proanthocyanidins (OPCs) in paraquat-exposed mice. Methods: An acute lung injury model was established by a single intraperitoneal injection of paraquat (PQ) in BALB/c mice. The mice were randomized into control group, paraquat-exposed group (PQ group) , oligomeric proanthocyanidins group (OPCs group) , and paraquat and oligomeric proanthocyanidins-exposed group (PQ+OPCs group) , with 10 mice in each group. Only normal saline was intraperitoneally injected into the mice in the control group. The mice in the PQ group were divided into 8 subgroups according to the dose of poison administered, i.e., 0, 25, 50, 75, 100, 150, 200, and 300 mg/kg; the mice in each subgroup were given a single intraperitoneal injection of PQ and were observed and recorded for death at 3, 6, 12, 24, 36, 48, 60, 84, and 96 hours after PQ injection. Origin 8.0 was used to calculate the median lethal dose (LD(50)) of the mice at 24, 36, 48, and 60 hours after PQ injection, and the PQ dose (100 mg/kg, ip) was chosen based on the accumulated mortality rate. An OPCs-treated experimental model was established by an intraperitoneal injection of OPCs followed by a single PQ injection (100 mg/kg, ip) 1 hour later to observe the effects of OPCs on the apparent poisoning effect and fatality rate in PQ-induced mice. Immunohistochemistry was used to determine the effect of OPCs on PQ-induced lung tissue lesions. The peripheral blood samples of the mice were collected to determine the effects of OPCs on PQ-induced inflammatory factors such as tumor necrosis factor-α (TNF-α) , interleukine-1ß (IL-1ß) , and transforming growth factor-ß1 (TGF-ß1) using enzyme-linked immunosorbent assay. Results: The mortality rate was significantly correlated with the dose and exposure time in PQ-exposed mice; the mortality rate gradually increased with increasing dose and exposure time of the poison (P<0.05) . The LD(50) values for the mice were 216.67, 124.11, and 71.24 mg/kg at 24, 48, and 72 hours after PQ exposure, respectively. PQ could induce animal death at 12 hours after injection, and the mortality rate of the animals was 40% (4/10) at 48 hours after PQ exposure. The PQ-induced mortality rate of the mice in the PQ+OPCs group was reduced, and the mortality rate of the animals was 10% (1/10) at 48 hours after PQ exposure. Compared with treatment in the control group, OPCs exposure alone had no significant effect on the expression of TNF-α and TGF-ß1 in the peripheral blood (P>0.05) , but it significantly inhibited the expression of IL-1ß (P<0.05) . After 48 hours, the expression of TNF-α, TGF-ß1, and IL-1ß in peripheral blood significantly increased by 39%, 45%, and 38%, respectively, in the PQ group (P<0.05) , but they significantly decreased by 31%, 13%, and 22%, respectively, in the OPCs+PQ group as compared with the PQ group (P<0.05) . Conclusion: OPCs pretreatment can significantly alleviate PQ-induced poisoning effect.

[Systemic lupus erythematosus with acquired hemophilia A: a case report].

Acquired hemophilia A (AHA) is anunusual disease resulting from autoantibodies (inhibitors) against coagulation factor VIII (FVIII) and clinically manifests as bleeding, which sometimes can cause potentially limb-threatening or life-threatening situations. AHA is associated with cancers, auto-immune disorders, infections, dermatologic conditions and certain medications, among which it is commonly secondary to multiple rheumatologic conditions, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), pollymyositis, autoimmune hemolytic anemia and undifferentiated connective tissue disease. In autoimmune diseases, it may be the result of autoantibody producing against FVIII, and some cases of AHA may act as the first manifestation of SLE. AHA should be suspected in patients who have spontaneously hemorrhagic events with an isolated prolonged activated partial thromboplastin time (APTT), reduced FVIII activity and a negative lupus anticoagulant (LA). When FVIII inhibitor is found, it can be diagnosed. The management of AHA focuses on the following goals: (1) controlling and preventing bleeding, (2) eradication of the inhibitor, (3) treatment of the underlying disease. Here, a case of AHA in a patient with lupus is reported. A 53-year-old man with a 4-year history of SLE developed arthralgia and ecchymotic skin lesions after arthrocentesis of knee joint. Ultrasound confirmed the presence of an intramuscular hematoma. Coagulation tests revealed that FVIII activity reduced to 1% and a prolonged APTT (92.2 s), FVIII inhibitors were found to be as high as 60.0 Bethesda Units. Initial treatments with methylprednisolone 200 mg/d were started but new hemorrhagic manifestation occurred and hisbiological indexes were not good. Then the patient was treated with intravenous pulse corticosteroids (methylprednisolone 500 mg/d), intravenous cyclophosphamide, and also plasma and prothrombin complex infusion. Subsequently, FVIII activity returned within normal ranges, FVIII inhibitors decreased and clinical improvement was significantly obtained. The patient's condition kept stable till now.Hemorrhagic events due to production of antibodies directed against coagulation factors were rarely observed in SLE and attentions should be paid to the association between SLE and AHA.Bypass treatment was considered as the immediate antihemorrhagic treatment. Corticosteroid combined with immunosuppressor was recommended as the main therapy to eradicate the inhibitors. However we still lack the therapeutic guidelines and standardized treatment in patients of AHA with SLE at present.