Comparison of the performance of various virtual articulator mounting procedures: a self-controlled clinical study.

OBJECTIVES: This clinical study aimed to compare the performance of various virtual articulator (VA) mounting procedures in the participants' natural head position (NHP). MATERIALS AND METHODS: Fourteen participants with acceptable dentitions and jaw relationships were recruited in this study registered in the Clinical Trials Registry (#NCT05512455; August 2022). A virtual facebow was designed for virtual mounting and hinge axis measurement. Intraoral scans were obtained, and landmarks were placed on each participant's face to register the horizontal plane in NHP. Six virtual mounting procedures were performed for each participant. The average facebow group (AFG) used an indirect digital procedure by using the average facebow record. The average mounting group (AMG) aligned virtual arch models to VA's average occlusal plane. The smartphone facial scan group (SFG) and professional facial scan group (PFG) used facial scan images with Beyron points and horizontal landmarks, respectively. The cone-beam computed tomography (CBCT) scan group (CTG) used the condyle medial pole, and horizontal landmarks were applied. The kinematic facebow group (KFG) served as the control group, and a direct digital procedure was applied using a kinematic digital facebow and the 3D skull model. Deviations of the reference plane and the hinge axis between the KFG and other groups were calculated. The inter-observer variability in virtual mounting software operation was then evaluated using the interclass correlation coefficient (ICC) test. RESULTS: In virtual condylar center deviations, the CTG had the lowest condylar deviations. The AFG showed larger condylar deviations than PFG, SFG, and CTG. There was no statistically significant difference between the AFG and the AMG and between the PFG and the SFG. In reference plane deviations, the AMG showed the largest angular deviation (8.23 ± 3.29°), and the AFG was 3.89 ± 2.25°. The angular deviations of PFG, SFG, and CTG were very small (means of each group < 1.00°), and there was no significant difference among them. There was no significant difference between the researchers, and the ICC test showed moderate to excellent reliability for the virtual condylar center and good to excellent reliability for the reference plane in the operation of the virtual mounting software. CONCLUSIONS: CBCT scan provided the lowest hinge axis deviation in virtual mounting compared to average mounting, facebow record, and facial scans. The performance of the smartphone facial scanner in virtual mounting was similar to that of the professional facial scanner. Direct virtual mounting procedures using horizontal landmarks in NHP accurately recorded the horizontal plane. CLINICAL RELEVANCE: Direct digital procedures can be reliably used for virtual articulator mounting. The use of a smartphone facial scanner provides a suitable and radiation-free option for clinicians.

Comparison of occlusal contact errors of 6 chairside CAD/CAM crowns: a self-controlled clinical study.

OBJECTIVES: The purpose of this self-controlled clinical study was to evaluate the trueness of occlusal contacts of chairside CAD/CAM crowns fabricated using different ceramic materials. MATERIALS AND METHODS: Ten volunteers (8 females, 2 males, average aged 20-30) were recruited in this study registered in the Clinical Trials Registry (#NCT05346744). After tooth preparation on tooth 36 or 46, an optical scan unit (CEREC Omnicam, Sirona Dental Systems, Germany) was utilized to perform the intraoral scanning. For each volunteer, 6 crowns were fabricated via the chairside CAD/CAM process (CEREC, Sirona Dental Systems, Germany) using the following materials: InCoris TZI (ZIR), Celtra Duo (CD), e.max CAD (EMA), UP.CAD (UP), Enamic (ENA) and Hyramic (HY). The microhardness of the milled surfaces was measured through a Vickers hardness Tester (HVS-50Z, Trojan, China). Together with the amount of occlusal adjustment, the occlusal contact trueness at both milling and postprocessing stages were quantitatively analyzed by using a high-precision scanner (ATOS, GOM Technologies, USA) and a reverse engineering software (Geomagic Control, 3D Systems, Rock Hill, SC). The times of chairside occlusal adjustment were also recorded. Data were analyzed by one-way analysis of variance (ANOVA) and ANOVA with randomized block design followed by Bonferroni test (p = 0.05). RESULTS: Significant differences were found in surface microhardness of the materials tested (CD > EMA ~ UP > ENA > HY > ZIR, p < 0.05). Regarding the occlusal contact trueness at milling stage, ZIR showed the lowest (p < 0.05), while no significant difference was found among others (p > 0.05). At postprocessing stage, except for ENA, the occlusal contact trueness of ZIR was significantly lower than that of others (p < 0.05). As for occlusal adjustment amount, ZIR was lower than CD and ENA (p < 0.05). In addition, ENA, HY and ZIR required fewer times of occlusal adjustment than EMA, UP and CD. CONCLUSIONS: The type of chairside CAD/CAM ceramic materials affected the occlusal contact trueness throughout the process of manufacturing and the amount of clinical occlusal adjustment as well. Zirconia exhibited the worst occlusal contact trueness at both milling and postprocessing stages, while the amount of occlusal adjustment was the least, which recommended the least occlusal compensation. CLINICAL RELEVANCE: For better trueness, different negative occlusal offsets are suggested to be applied in the design process, so as to suit the material of the restoration.

Comparative analysis of leaching residual monomer and biological effects of four types of conventional and CAD/CAM dental polymers: an in vitro study.

OBJECTIVES: The objective of this study is to investigate leaching residual monomer and biological effects of four types of conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) dental polymers on human gingival fibroblasts (HGFs). MATERIALS AND METHODS: A total of 540 disk-shaped specimens were fabricated from four different materials (n=135 per group): compression-molding polymethylmethacrylate (PMMA) (conventional denture polymer), CAD/CAM PMMA (CAD/CAM denture polymer), bis-acrylic composite resin (conventional temporary polymer), and CAD/CAM PMMA (CAD/CAM temporary polymer). Specimens were eluted in cell culture medium for 72 h at 37°C, and the residual monomer in eluates subsequently was measured by high-performance liquid chromatography (HPLC). The biological effects of material eluates on HGFs were analyzed by CCK-8 assay, flow cytometry, real-time quantitative PCR, Western blotting, and enzyme-linked immunosorbent assay (ELISA) to identify cell death patterns and its biological mechanism. RESULTS: Methyl methacrylate (MMA) was detected only in compression-molding PMMA, and by-products were detected in bis-acrylic composite resin. The cell proliferation of CAD/CAM denture polymer or CAD/CAM temporary polymer was greater than that of compression-molding PMMA or bis-acrylic composite resin at 72 h in culture. No apoptosis and necrosis were detected in CAD/CAM dental polymers. Apoptosis was detected only in bis-acrylic composite resin and further confirmed by the upregulation of Bax and cleaved Caspase-3, as well as the downregulation of Bcl-2 gene. And no significant variation in inflammatory cytokines secretion was observed in all materials. CONCLUSIONS: CAD/CAM dental polymers (including temporary and denture polymers) have favorable biocompatibility due to lower residual monomer, which provides scientific evidence to the controversy of biocompatibility of conventional and CAD/CAM dental polymers. CLINICAL RELEVANCE: The use of CAD/CAM dental polymers is recommended in the fabrication of temporary restorations and dentures due to their favorable biocompatibility.

In vitro study of surface properties and microbial adhesion of various dental polymers fabricated by different manufacturing techniques after thermocycling.

OBJECTIVES: The study aims to investigate surface properties and microbial adhesion of various dental polymers fabricated by different manufacturing techniques before and after thermocycling. MATERIALS AND METHODS: The following six materials were used to fabricate disk-shaped specimens: conventional denture polymer (Vertex Acrylic Resin, VAR), CAD/CAM denture polymer (Organic PMMA eco Pink, OP), conventional temporary polymer (Protemp™ 4, PT), CAD/CAM temporary polymer (Die Material, DM), conventional denture framework polymer (BioHPP, PB), and CAD/CAM denture framework polymer (breCAM.BioHPP, CB). The specimens were tested before and after thermocycling (5000 and 10,000 cycles, 5 °C/55 °C). Surface roughness (SR), hydrophobicity, and surface topography were determined by profilometry, water contact angle, and scanning electron microscopy (SEM). Then specimens were incubated with Staphylococcus aureus, Streptococcus mutans, and Candida albicans for 24 h, respectively. Microbial adhesion was assessed using colony-forming unit counts, XTT assay, and SEM. RESULTS: SR and hydrophobicity of VAR group were higher than that of OP group. S. aureus and C. albicans adhesion on VAR and PT groups were higher than that on OP and DM groups, respectively. There was no difference in surface properties and microbial adhesion between PB and CB groups. After thermocycling, SR (expect OP group) of all materials increased and hydrophobicity decreased, and the amount and activity of S. aureus and C. albicans adhesion also increased. The adhesion of S. aureus and C. albicans showed a moderate positive correlation with SR, independent of hydrophobicity. CONCLUSIONS: CAD/CAM denture polymers and temporary polymers showed less S. aureus and C. albicans adhesion when compared to conventional ones, which were mainly affected by surface roughness, independent of hydrophobicity. Thermocycling could increase surface roughness, decrease hydrophobicity, and affect microbial adhesion of the materials. CLINICAL SIGNIFICANCE: CAD/CAM dental polymers may be a better choice for the manufacture of temporary restorations and dentures to reduce microbial adhesion.

Treatment of multiple ceramic alloys before recasting.

STATEMENT OF PROBLEM: Dental laboratories often reuse dental casting alloys by recasting them, but the processing methods before recasting require further research. PURPOSE: The purpose of the study was to determine the treatment methods to remove the surface contamination of the previously melted alloys before recasting. MATERIAL AND METHODS: Cobalt-chromium (Co-Cr), commercially pure titanium (CP Ti), palladium-copper-gallium (Pd-Cu-Ga), and gold-platinum (Au-Pt) ceramic alloys were investigated in the present study. Field emission scanning electron microscopy, energy-dispersive x-ray spectroscopy (EDAX), and x-ray photoelectron spectroscopy (XPS) were used to evaluate the changes in the surface structures and compositions of Co-Cr, CP Ti, Pd-Cu-Ga, and Au-Pt ceramic alloys after airborne-particle abrasion and immersion in various chemical solutions for different time periods. The data obtained by EDAX and XPS were statistically analyzed by Kruskal-Wallis and Nemenyi tests (α=.05). RESULTS: By using appropriate mechanical and chemical treatment procedures, the contamination content of previously cast ceramic alloys was found to be below the detection limits of EDAX and XPS. The statistical results showed that, compared to the control group (new alloys after polishing), the impurity element was not detected after being treated with these methods, which was not statistically different to control group. CONCLUSIONS: The surface contamination of ceramic alloys was effectively removed by using certain mechanical and/or chemical treatment methods. Within the limitations of the present study, the most appropriate ways to treat ceramic alloys before recasting were as follows: (1) for Co-Cr ceramic alloys: Al2O3 airborne-particle abrasion and immersion in aqua regia for 15 min; (2) for CP Ti ceramic alloys: Al2O3 airborne-particle abrasion and immersion in 65% HNO3 and 40% HF 1:7 (V/V) for 60 min; (3) for Pd-Cu-Ga ceramic alloys: glass bead airborne-particle abrasion and immersion in 40% HF solution for 30 min; and (4) for Au-Pt ceramic alloys: glass bead airborne-particle abrasion.

Intranasally administered thermosensitive gel for brain-targeted delivery of rhynchophylline to treat Parkinson's disease.

The aim of this study is to overcome the obstacle of the blood-brain barrier (BBB) in therapeutic drugs of Parkinson's disease (PD), like rhynchophylline (RIN) entry by intranasal administration and to solve the problem of short residence time of drugs in the nasal cavity by the dosage form design of thermosensitive gel. We first conducted a study of the screening of absorption enhancers and 3% hydroxypropyl-ß-cyclodextrin (HP-ß-CD) was effective to improve the nasal mucosal permeability of RIN. By adjusting the ratio of different components in order to make the gel with adhesion and rapid gelation which were determined to be Poloxamer 407 (P407) 20%, Poloxamer 188 (P188) 1%, polyethylene glycol 6000 (PEG-6000) 1% and HP-ß-CD 3%. In addition, the characterization showed that the thermosensitive gel was network cross-linked, rapidly gelation upon entry into the nasal cavity and was stable as semi-solid state with adhesion as well as sustained release properties. Moreover, pharmacokinetic study was performed to evaluate the bioavailability and brain targeting of RIN thermosensitive gel and which were 1.6 times and 2.1 times higher than those of oral administration. We also evaluated the anti-PD effects of RIN thermosensitive gel in-vitro as well as in-vivo. The results showed that RIN thermosensitive gel was effective in repairing the motor function impairment, dysregulated expression levels of oxidative stress factors, and positive neuronal damage within the substantia nigra and dopamine caused by PD. The constructed intranasal drug administration strategy through thermosensitive gel provided a new choice for targeted treatment of PD together with other central nervous system diseases.

Influence of fabrication method on the biological properties of modified PEEK.

To investigate the influence of fabrication method on the biological properties of modified PEEK. Two materials were tested in this study: press and CAD/CAM milled ceramic-reinforced PEEK (BioHPP, Bredent, Germany). The residual diphenyl sulfone in these two materials was detected and their biological effects on human gingival fibroblasts (HGFs) were evaluated by assaying cell viability, apoptosis, and inflammation. Diphenyl sulfone was not detected in press and milled BioHPP. The cell viability of them complied with ISO standards. The mRNA expression levels of Bax and Caspase-3 were up-regulated and that of Bcl-2 was downregulated when HGFs were cultured with the eluates of these two materials. There was no difference in cell viability, apoptosis, and inflammation between them. Hence, the fabrication method did not affect the biological properties of modified PEEK, the press and CAD/CAM milled modified PEEK all presented favorable cytocompatibility despite the expression of apoptosis-associated genes at the mRNA level.

A novel visible light-curing chitosan-based hydrogel membrane for guided tissue regeneration.

Inflammation and trauma destroy the tooth-supporting tissue, leading to the loss of oral function and the difficulty of denture restoration. Guided tissue regeneration (GTR) is a technique based on a barrier membrane designed to restrict soft tissue invasion and maintain the space for bone regeneration. This study examined a new formulation to prepare methacrylated carboxymethyl chitosan (CMCS-MA) hydrogel as a barrier membrane that could be crosslinked under visible-light irradiation. This new CMCS-MA hydrogel showed fast light-curing, good biocompatibility, and could be degraded by lysozyme. Further, the physicochemical property, cytotoxicity and antibacterial activity of the CMCS-MA hydrogels can be adjusted by varying the degree of substitution of methacrylic acid (DS) in a certain range. Thus, the biocompatible and biodegradable CMCS-MA hydrogels may have a promising application in periodontal tissue regeneration with convenience and flexibility.

The apoptotic and autophagic effects of cast Au-Pt, and differently manufactured Co-Cr and cp-Ti on three-dimensional oral mucosal model.

The application of digitally manufactured dental metals has aroused the attention on their biocompatibilities. Three-dimensional oral mucosal model (3D OMM) would provide excellent assessments to the biocompatibility. In the current study, we set to measure metal ion release levels in the extracts of cast gold-platinum alloy (Au-Pt), differently manufactured cobalt-chromium alloy (Co-Cr) and commercially pure titanium (cp-Ti). We further tested two scaffold materials of 3D OMM to determine the better one for the succedent work. Lastly, we evaluated the apoptotic and autophagic effects of cast Au-Pt, and differently manufactured Co-Cr and cp-Ti on mucosal cells based on 3D OMM. We found that, in the construction of 3D OMM, Matrigel showed better performance than bovine acellular dermal matrix. Thus, Matrigel was chosen to construct the 3D OMM in the succedent studies. The results of ion release and biological assessments showed that, firstly, cast Au-Pt and cp-Ti triggered less early apoptotic cells and ion release than cast Co-Cr, implying better chemical stability and biocompatibility of them; secondly, digitally manufactured (including CAD/CAM milling and SLM) Co-Cr showed significantly lower ion release levels and lesser early apoptotic effects on 3D OMM as compared to the cast one. Although cast cp-Ti released much more ions than CAD/CAM milling one, manufacturing methods had no impact on apoptotic effect of cp-Ti. Therefore, we believe that digital methods possess same or even better chemical stability and biocompatibility than conventional casting one. Thirdly, although increased autophagic levels are observed in all test groups, so far there is no evidence that the test metals trigger different levels of autophagy as compared to each other. In addition, correlation analysis indicates that Co, W, and Mn appear to be the potential inducements for the apoptotic and autophagic effects of Co-Cr.

The Influence of Recycling on the Properties of Interface between Ceramic and Dental Alloys.

PURPOSE: The purpose of this study was to evaluate the effect of recycling on the properties of interface between 2 dental alloys and their corresponding porcelains. MATERIALS AND METHODS: Noble alloy (Pd-Cu-Ga) and high-noble alloy (Au-Pt) were used in this study. Metal matrices (cylinders Φ4 mm × 4 mm with pedestal Φ5 mm × 1 mm) were prepared by arc melting in argon after recasting 1-3 times. Corresponding porcelain with overall dimensions of Φ4 mm × 2 mm was veneered on each metal cylinder. There were 22 specimens in each alloy group. Specifically, two specimens of each group were chosen randomly for interfacial morphology and diffusion analyses by scanning electron microscopy (SEM) equipped with energy-dispersive X-ray spectroscopy (EDS). The remaining 20 specimens were divided into 2 groups with or without thermal cycling. The bond strength was evaluated by shear test, and the data were analyzed by two-way analysis of variance (ANOVA). The failure mode of shear test specimen was observed with a stereoscopic microscopy and subjected to the exact probability test (α = 0.05). RESULTS: According to the results from SEM, no obvious difference was observed in the interfacial morphology of both Pd-Cu-Ga and Au-Pt alloys among different recasting specimens. EDS analysis revealed that no significant difference was found in the width of elemental diffusion among 2 test alloys after recycling 1-3 times. Notably, in Pd-Cu-Ga alloy groups, the peak of Ga in thrice recasting was lower than those in first and second recastings. And there was no significant difference (P > 0.05) in the metal-ceramic shear bond strength of Pd-Cu-Ga and Au-Pt alloys after recycling 1-3 times, with or without thermal cycling. The results of failure modes observed on specimens were not affected by the recycling and thermal cycling in the 2 tested alloys. CONCLUSIONS: Within the limitations of this study, the Pd-Cu-Ga and Au-Pt alloys can be recycled 2 times without significant changes on the properties of metal-ceramic interface, with or without thermal cycling.

Removal of dental alloys and titanium attenuates trace metals and biological effects on liver and kidney.

To determine whether the potential effects on liver and kidney caused by dental alloys could be reduced or terminated by the removal of nickel-chromium (Ni-Cr) alloy, cobalt-chromium (Co-Cr) alloy, and commercially pure titanium (CP-Ti), they were placed in the cheek pouches of Syrian hamsters according to ISO 10993-10. Then, the peak/plateau and end times of trace metals in the blood were determined with or without the removal of the dental alloys. Based on these time points, the trace metals and their effects on liver and kidney were examined. We found that trace metals released from these dental alloys and titanium were accumulated transiently in the blood, liver, and kidney but had no effect on the histopathology of the liver or kidney. Although the functions of the liver and kidney were compromised, the function of these tissues seemed to be clinically acceptable compared to those in control Syrian hamsters. In addition, the apoptotic effect on renal cells was terminated by removing the Ni-Cr and Co-Cr alloys, and that on hepatocytes was also eliminated by removing the Ni-Cr alloy. In contrast, the effect of the Co-Cr alloy on hepatocytes was temporary and recovered by itself. Taken together, Ni- and Co-based dental alloys and titanium have no effect on the histopathology or function of liver and kidney. Moreover, Ni-Cr and Co-Cr alloys induce transient trace metal accumulation and apoptotic effects in liver and kidney, which can be reduced or terminated by the removal of the alloys, while CP-Ti shows favorable biocompatibility.

[Optical properties of LED light curing unit before and after transmitting different colors and thickness of two kinds of glass ceramics].

PURPOSE: To study the optical properties of two common dental light curing units and the optical properties of the transmitted light after transmitting glass ceramics. METHODS: Two types of glass-ceramic disc named IPS e.max CAD and IPS Empress CAD were produced by CAD/CAM technology, and the colors of A2 and A3 were chosen for each type of glass ceramic, then divided into 4 groups. Eight discs were made 0.5 mm to 4.0 mm thick in each group, the total number was 32. Spectra irradiance meter and power meter were used to measure the central wavelengths and irradiance of 3 power modes of 2 new LED light curing units before and after transmitting glass-ceramic discs. Statistical analysis was performed using SPSS 25.0 software package. RESULTS: Under different power modes of light curing units, different types and colors of glass ceramics, the central wavelengths of transmitted light were significantly different (P<0.05). Under different power modes of light curing units, different types, colors and thicknesses of glass ceramics, the irradiance of transmitted light was significantly different (P<0.05). CONCLUSIONS: The power mode of light curing unit, the type and color of the glass ceramic have influence on the central wavelength of the transmitted light, but the thickness of the glass ceramic has no influence on the central wavelength of the transmitted light. The power mode of the light curing unit, the type, color, and thickness of the glass ceramic have influence on the irradiance of the transmitted light, in which glass ceramic thickness has the most significant effect on the attenuation of the irradiance of the transmitted light.

Cell death affected by dental alloys: Modes and mechanisms.

Previous reports have demonstrated that ions released from dental alloys might cause cytotoxicity. However, how dental alloys influence the organism has not been extensively studied. In order to make it clear, the cytotoxic effect of four dental alloys on L929 cells was evaluated by flow cytometry (FCM) and Real-time quantitative PCR assay (Real-time qPCR) to identify the cell death mode and its biological mechanism. The cells were treated with the leach liquors of cobalt-chromium (Co-Cr), commercially pure titanium (CP-Ti), palladium-based (Pd-based) and gold-platinum (Au-Pt) alloys for 48 and 72 h. FCM results indicated, apart from Au-Pt alloy, the major cell death of dental alloys was time-dependent early apoptosis rather than necrosis/late apoptosis. Caspase 3 and Caspase 9 mRNA expression were determined by Real-time qPCR, and shared the same trend in each group over time. Hence, except for Au-Pt alloy, dental alloys might cause time-dependent early apoptosis via the intrinsic pathway.

[Cytocompatibility of Co-Cr ceramic alloys after recasting].

PURPOSE: To evaluate the cytocompatibility of Co-Cr ceramic alloys after recasting. METHODS: Cobalt-chromium (Co-Cr) ceramic alloys were recasted for 1-3 times. Samples of Co-Cr ceramic alloys were immersed in DMEM culture medium. The concentration of ions of leaching liquor was determined by ICP-MS total quantization method. L-929 cells were cultured with leaching liquor, flow cytometry was used to test cell cycle progression, Annexin-V-FITC/PI apoptosis staining kit was used to quantitatively detect cell death patterns. SPSS 13.0 software package was used for statistical analysis. RESULTS: After casting for 1-3 times, no significant increase in the concentration of ions of Co-Cr ceramic alloys was noted (P>0.05) except Ga (P<0.05) . No significant differences in L-929 cell cycle were found in Co-Cr ceramic alloys between the samples cast for 1 time and for 2~3 times (P>0.05). No significant difference in the rates of apoptosis and necrosis was found (P>0.05). CONCLUSIONS: The biocompatibility of Co-Cr ceramic alloys casted for 1-3 times is not changed.