Er:YAG laser-induced damage to a dental composite in simulated clinical scenarios for inadvertent irradiation: an in vitro study.

Inadvertent Er:YAG laser irradiation occurs in dentistry and may harm restorative materials in teeth. The aim of this in vitro study was to quantify Er:YAG laser-induced damage to a nanohybrid composite in simulated clinical scenarios for inadvertent direct and indirect (reflection) laser irradiation. The simulation was performed by varying the output energy (OE;direct˃indirect) reaching the specimen and the operating distance (OD;direct˂indirect). Composite specimens were irradiated by an Er:YAG laser. The ablation threshold was determined and clinically relevant parameters were applied (n = 6 for each OE/OD combination) for direct (OE: 570 mJ/OD: 10 mm, OE: 190 mJ/OD: 10 mm) and indirect irradiation (OE: 466 mJ/OD: 15 mm, OE: 57 mJ/OD: 15 mm, OE: 155 mJ/OD: 15 mm, OE: 19 mJ/OD: 15 mm). The extent of damage in the form of craters was evaluated using a laser scanning microscope (LSM) and a conventional light microscope (LM). The ablation threshold was determined to be 2.6 J/cm2. The crater diameter showed the highest value (LM: 1075 ± 18 µm/LSM: 1082 ± 17 µm) for indirect irradiation (reflectant:dental mirror) (OE: 466 mJ/OD: 15 mm). The crater depth showed the highest and comparable value for direct (OE: 570 mJ/OD: 10 mm; LSM: 89 ± 2 µm) and indirect irradiation (OE: 466 mJ/OD: 15 mm; LSM: 90 ± 4 µm). For each OD, the crater diameter, depth, and volume increased with higher laser fluence. However, the OD-and thus the laser spot diameter-also had an enlarging effect. Thus, indirect irradiation (reflectant:dental mirror) with only 47% of the laser fluence of direct irradiation led to a larger diameter and a comparable depth. The three-dimensional extent of the crater was large enough to cause roughening, which may lead to plaque accumulation and encourage caries, gingivitis, and periodontitis under clinical conditions. Clinicians should be aware that reflected irradiation can still create such craters.

Characterization of the transmission behavior of dental filling materials and cements for the diode lasers' and the Nd:YAG laser's wavelengths.

OBJECTIVES: Diode lasers and the Nd:YAG laser are used in periodontal therapy and soft tissue surgery. Dental filling materials or cements might be inadvertently damaged. The underlying mechanism of the damage is based on the dental material's specific transmission and thus absorption behavior. MATERIALS AND METHODS: Twenty-four material representatives for composites, glass ionomer cements and other material classes (e.g., compomer) were processed to 100 µm and 200 µm planar specimens and spectroscopically measured for their collimated transmission in the photo spectrometer Varian Cary 5000. The (1) mean intensity of transmitted light was determined for the laser wavelengths of interest (810 nm, 940 nm, 980 nm, 1,064 nm) and used to calculate the (2) absorption lengths. RESULTS: The (1) mean intensity of transmitted light ranged between 9.51 % (Panavia F 2.0 for 810 nm) and 96.79% (Artegral Cem for 1,064 nm) for the composite specimens (100 µm) and was-with few exceptions-near zero for the representatives of glass ionomer cement and the other material classes. The (2) absorption lengths were between 0.06 mm (Panavia F 2.0 for all wavelengths of interest) and 1.33 mm (Coltène Duo Cement Plus for 1,064 nm) for the composites and below or equal 0.15 mm (PermaCem for 1,064 nm) for the few representatives of glass ionomer cements and the other material classes with mean intensities of transmitted light, which were not near zero and thus permitted to calculate absorption lengths. CONCLUSIONS: The transmission behavior varied between the different material classes and even within, albeit less pronounced. Composites generally showed the highest intensities of transmitted light and are thus least susceptible to surface damage by laser light (810 nm, 940 nm, 980 nm, 1,064 nm). The results can be used to improve and develop laser applications involving purposeful interactions between laser light and dental materials. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Accuracy of Dental Implant Placement with Dynamic Navigation-Investigation of the Influence of Two Different Optical Reference Systems: A Randomized Clinical Trial.

This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6-3.9°) than group A, with a value of 6.3° (95% CI 4.0-8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92-2.78 mm) and 1.62 mm for workflow B (95% CI 1.2-2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.

Er:YAG laser activation of sodium hypochlorite for root canal soft tissue dissolution.

BACKGROUND AND OBJECTIVE: The aim of this in vitro study was to investigate the effect of Er:YAG laser irradiation on the ability of sodium hypochlorite (NaOCl) to dissolve soft tissue during endodontic procedures. MATERIALS AND METHODS: Two acrylic glass plates, each containing a semi-canal, were bolted together to form a complete canal. This geometry permitted one semi-canal to be filled with fine liver sausage of bovine origin dyed by methylene blue and the other with NaOCl (4.00-4.99% available chlorine; Sigma-Aldrich Corporation, St. Louis, MA), which was then activated by Er:YAG laser irradiation (KEY Laser 3; KaVo, Biberach, Germany) using a plain-ended fiber tip and a range of output energy and repetition rate. To achieve relatively low output energy from high input energy, the laser beam was attenuated by placing glass slides in the beam path. The resultant images acquired were analyzed using pixel-based analysis. Samples were statistically analyzed (two-way ANOVA, P < 0.05, univariate, bifactorial; IBM SPSS Statistics 19, SPSS Inc., Chicago, IL). RESULTS: Both output energy and repetition rate significantly influenced the tissue dissolution ability of NaOCl (P < 0.05). CONCLUSION: Within the limitations of this in vitro study, we conclude that laser activation of NaOCl at 200 mW output power leads to effective soft tissue dissolution. This finding can be of use to endodontists pursuing effective soft tissue dissolution from their irrigants.

Technical Complications of Removable Partial Dentures in the Moderately Reduced Dentition: A Systematic Review.

The aim of this study was to conduct a systematic literature review with a subsequent meta-analysis on the technical complications and failures of removable partial denture (RPD) therapy in the moderately reduced dentition. A systematic literature search of established medical databases, last updated 06/2022, was conducted. RCTs and prospective and retrospective studies were included that had information on technical complications and failures of RPDs, at least 15 participants, an observation period of at least two years and a drop-out rate of less than 25%. Publications were selected on the title, abstract and full-text level by at least three of the participating authors. The evidence of the included studies was classified using the GRADE system. The bias risk was determined using the RoB2 tool and the ROBINS-I tool. Of 19,592 initial hits, 43 publications were included. Predominantly, retention of the prosthesis, retention loss of anchor crowns (decementations), fractures/repairs of frameworks, denture teeth, veneering or acrylic bases, and a need for relining were reported depending on prosthesis type and observation time. Focusing on technical complications and failures, only very heterogeneous data were found and publications with the highest quality level according to GRADE were scarce. Whenever possible, data on technical complications and failures should be reported separately when referencing the tooth, the prosthesis and the patient for comparability. Prostheses with differing anchorage types should be analyzed in different groups, as the respective complications and failures differ. A precise description of the kinds of complications and failures, as well as of the resulting follow-up treatment measures, should be given.

Digital Evaluation of Vertical Ridge Augmentation with the Modified Shell Technique Using a Xenogeneic Bone Lamina: A Case Series.

Vertical ridge augmentation is a demanding and technique-sensitive surgical procedure. In the present case series, cone beam CT (CBCT) scans from the clinical routine of patients treated using a novel approach for vertical bone augmentation were assessed. All patients showed a single-tooth class 5 defect and were treated using a modification of the original shell technique. Cortical bone plates were replaced with a lamina composed of a partially demineralized porcine xenograft. CBCT scans of six consecutive patients were treated with the lamina and particulate bone from the mandibular ramus prior to a single tooth implant in the anterior maxilla were included. Pre- and postsurgical CBCT data sets were superimposed and analyzed digitally using surface matching and Boolean subtraction. The volume of the grafted area was calculated with and without the xenograft. The vertical gain of the ridge height measured in this case series varied from 7 to 11.3 mm. The mean vertical gain was 8.97 mm. The mean volume including the xenograft was 382.59 mm3 (SD 73.39) and 250.84 mm3 (SD 53.67) without the lamina. The modified shell technique used in this case series for the vertical augmentation of single-tooth class 5 defects provided sufficient bone for single implant restorations.

The Microbiome and Protein Carbamylation: Potential Targets for Protein-Restricted Diets Supplemented with Ketoanalogues in Predialysis Chronic Kidney Disease.

In chronic kidney disease (CKD), metabolic derangements resulting from the interplay between decreasing renal excretory capacity and impaired gut function contribute to accelerating disease progression and enhancing the risk of complications. To protect residual kidney function and improve quality of life in conservatively managed predialysis CKD patients, current guidelines recommend protein-restricted diets supplemented with essential amino acids (EAAs) and their ketoanalogues (KAs). In clinical studies, such an approach improved nitrogen balance and other secondary metabolic disturbances, translating to clinical benefits, mainly the delayed initiation of dialysis. There is also increasing evidence that a protein-restricted diet supplemented with KAs slows down disease progression. In the present review article, recent insights into the role of KA/EAA-supplemented protein-restricted diets in delaying CKD progression are summarized, and possible mechanistic underpinnings, such as protein carbamylation and gut dysbiosis, are elucidated. Emerging evidence suggests that lowering urea levels may reduce protein carbamylation, which might contribute to decreased morbidity and mortality. Protein restriction, alone or in combination with KA/EAA supplementation, modulates gut dysbiosis and decreases the generation of gut-derived uremic toxins associated, e.g., with cardiovascular disease, inflammation, protein energy wasting, and disease progression. Future studies are warranted to assess the effects on the gut microbiome, the generation of uremic toxins, as well as markers of carbamylation.

Decentralisation in Times of Crisis: Asset Or Liability? The Case of Germany and Italy During Covid-19.

How did the legal and political-administrative relationship between central and local governments of two decentralised states shape their response to COVID-19? Literature and theories on decentralisation argue that federal and decentralised states are less able to respond to crises in a coordinated manner due to their perceived greater susceptibility to political conflict. Situated within this theoretical debate and based on the analysis of legal acts, political decisions, and relevant national news media articles between March and August 2020 in Germany and Italy, this research note shows that, counterintuitively, more decentralisation does not necessarily translate into more legal and political stress during pandemic management. In responding to the COVID-19 pandemic, Germany, a highly decentralised state, experienced less legal and political tensions than the less decentralised Italy. The key to understanding this variation lies in different institutional arrangements, complemented by the specific political cultures of both states.

Comment la relation juridique et politico­administrative entre les gouvernements centraux et locaux de deux États décentralisés a­t­elle modelé leur réponse au COVID­19 ? La littérature et les théories sur la décentralisation soutiennent que les États fédéraux et décentralisés sont moins capables de répondre aux crises de manière coordonnée en raison de leur plus grande prédisposition aux conflits politiques. Cette note de recherche contribue à ce débat théorique par une analyse des actes juridiques, des décisions politiques et des articles de la presse nationale entre mars et août 2020 en Allemagne et en Italie, qui montre que, contre toute attente, plus de décentralisation n'a pas nécessairement conduit à plus des tensions juridiques et politiques lors de la gestion de la pandémie. En réponse au COVID­19, l'Allemagne, un État très décentralisé, a connu moins de tensions juridiques et politiques que l'Italie, moins décentralisée. La clé pour comprendre cette variation réside dans les différents arrangements institutionnels, complémentés par les cultures politiques spécifiques des deux États.

Quantification of MRP8 in immunohistologic sections of peri-implant soft tissue: Development of a novel automated computer analysis method and of its validation procedure.

BACKGROUND: As manual cell counting lacks objectivity in the assessment of positive marker cells in immunohistologic sections, there has been a shift to automated computer analysis solutions. However, quantifying inflammation around dental implants is still often done by manual cell counting. METHOD: With mucosal sections stained against MRP8 harvested around dental implants, we developed an automated method (AM) to identify positive marker cells. In this proof-of-concept study, we developed a procedure for its validation on an exemplary data set. Therefore, the sections were also analyzed with the manual method (MM). Intrarater and interrater reliability as well as time analyses were conducted. RESULTS: The newly developed AM was based on a color deconvolution in the open-source software ImageJ2. We embedded the determination of the most appropriate filter setting into the systematic validation procedure, implementing the intraclass correlation (ICC) and the Bland-Altman bias (BA). The newly developed validation procedure carried out on the data set of this proof-of-concept study resulted in an excellent reliability of the AM (ICC = 0.97). Both the reliability and time analyses' results were in favor of the AM. CONCLUSION: Our newly developed AM showed advantages in terms of repeatability and objectivity combined with a shorter duration. The detailed descriptions of its application and its validation procedure offers the opportunity to apply it for further immunohistologic questions. The prerequisite for the replacement of the MM is that the validation, carried out on a sufficient number of samples, leads to satisfactory results.

Gingival Displacement in the Vertical and Horizontal Dimension under the Condition of Mild Gingivitis-A Randomized Clinical Study.

This randomized clinical study aimed at quantifying the gingival displacement performance in the vertical and horizontal directions of the 3M™ Astringent Retraction Paste (3M Oral Care, Seefeld, Germany) in comparison with the double-cord technique with aluminum chloride as an astringent. Afterward, any soft-tissue changes were assessed for 12 months. After inducing mild gingivitis, 18 probands received the intervention 'cord' and 22 probands received the intervention 'paste' at the palatal half of upper premolars prior to conventional impression making. The resulting plaster casts were digitized and analyzed for the vertical and horizontal gingival displacement, applying a newly developed computer-assisted methodology. The entire palatal half of the tooth was evaluated instead of only single sites. Under the condition of mild gingivitis, the gingival displacement performance was comparable for both techniques in the horizontal direction (width) and only somewhat better for the cord technique in the vertical direction (depth). The magnitude of displacement was in a similar range in both directions, with somewhat higher values in the vertical direction. The marginal gingiva height changes were of such low extent during the follow-up period of 12 months with only minimally higher values for the paste that they cannot be considered as clinically relevant recessions.

Effects of abutment height and type of cements on bond strength of monolithic zirconia single crowns luted to one-piece zirconia implants.

PURPOSE: To test the bond strength of one-piece zirconia implants with either standard or reduced height using different luting agents and pretreatments of the ceramic crowns' inner surfaces. MATERIALS AND METHODS: Twenty monolithic CAD/CAM-fabricated zirconia single crowns were cemented onto 10 one-piece zirconia implants with either 5-mm or 4-mm abutment height (Z-Look3 Evo SLM, Z-Systems) using 13 different luting agents. After water storage, the crowns were removed using a specially developed test fixture in a universal testing machine (Z010, Zwick/Roell). The maximum force was recorded (N), and the force per area was calculated (MPa). The statistical evaluation was performed using univariate analysis of variance (SPSS version 25.0, IBM). RESULTS: A mean of 4.19 MPa (SD 2.90) at 5 mm and 3.89 MPa (SD 2.85) at 4 mm was obtained for all luting agents. The highest values were achieved for a resinmodified glass-ionomer cement, with 12.37 MPa (4 mm)/12.00 MPa (5mm). The lowest values were shown for a long-term temporary material, with 0.73 MPa (4 mm)/1.07 MPa (5 mm). Only a polycarboxylate cement (P < .001) and a glass-ionomer cement (P = .006) showed statistically significant differences, in favor of the reduced abutment height. The latter did not significantly reduce bond strength for any of the materials examined. CONCLUSION: Implants with a reduced abutment height are clinically suitable. Pretreatment of the crowns' inner surfaces with ceramic primer showed to be advantageous.

Influence of the Gingival Condition on the Performance of Different Gingival Displacement Methods-A Randomized Clinical Study.

This randomized clinical study examined the influence of the gingival condition-healthy versus mild inflammation-on sulcus representation and possible gingival recession for two gingival displacement procedures prior to conventional impression making. The interventions double cord technique or a kaolin paste containing aluminum chloride were applied to 40 probands. The opposite quadrant served as intrapersonal reference (split-mouth design). Precision impressions were then made. Extraoral digitization of the plaster models resulting from the reference impression prior to gingival displacement, the intervention impression and control impressions were the basis for the computer-aided three-dimensional analysis. After six months, a mild artificial gingivitis was induced, and the contralateral quadrant (cross-over design) was examined for the intervention. The gingivitis deteriorated the sulcus representation for the double cord technique group but did not affect the paste technique group. The gingival condition had no influence on the marginal gingiva height changes. The minor extent of those changes, which were measured up to six months after intervention at the palatal study site, were not considered to be in the clinically relevant range for gingival recession. For healthy gingiva, the cord technique showed superior sulcus representation compared to the paste technique. This advantage was lost to a great extent under the conditions of mild gingivitis.

Glutamine as indispensable nutrient in oncology: experimental and clinical evidence.

BACKGROUND: In hypermetabolic situations, glutamine is intensively used by rapidly dividing cells such as enterocytes, lymphocytes, and fibroblasts as nitrogen source and/or alternative energy fuel. It is hypothesized that in cancer patients the increased glutamine demands of the host increase the capacity of endogenous production resulting in a strong glutamine deprivation with detrimental effects on organ functions. In long-term periods of cancer cachexia, an adequate nutrition support including glutamine can essentially contribute to cover glutamine needs and, thus, to spare energy reserves of the host and to retard severe complications such as multi-organ failure. Due to the early in vitro knowledge that cancer cells preferably consume glutamine, oncologists often refuse to supply glutamine to the tumor-bearing host to avoid any potential risk. An objective evaluation whether supplemental glutamine supports tumor growth in vivo is, however, still lacking. AIM OF THE STUDY: The present review evaluates in vivo experimental and clinical data with respect to potential effects of glutamine administration in tumor-bearing hosts and draws conclusions for the use of glutamine supplements in clinical oncology. METHODS: Experimental and clinical intervention studies were identified in a systematic review of MEDLINE Database (last entry: June 2008) using key search terms and review articles. These studies were supplemented with reports identified through manual searches and other studies previously known by the authors. RESULTS: Numerous experimental studies (rat/mouse model) show that oral/enteral or intravenous glutamine supports metabolism of the tumor-bearing host and can ameliorate gastrointestinal toxicity of therapeutical measures. Within the last two decades, 36 (24 oral/enteral, 12 parenteral) clinical studies evaluating the tolerance, safety and effects of glutamine in various patient groups have been published. In the great majority of these clinical studies, glutamine supplementation in cancer patients improves host metabolism and clinical situation without increasing tumor growth. Potential mechanisms of glutamine effects include maintenance of mucosal integrity, improved immune competence, inhibition of cell proliferation, increased apoptosis rate, increased synthesis of glutathione, induction of heat shock protein synthesis, and increased synthesis of glucagons-like peptides. CONCLUSIONS: In various clinical situations, appropriate exogenous glutamine supply is safe and can beneficially contribute to diminish risks of high-dose chemotherapy and radiation. In addition, there is some evidence that adequate glutamine availability can beneficially affect outcome, especially in patients undergoing bone marrow transplantation.

Reliability of light microscopy and a computer-assisted replica measurement technique for evaluating the fit of dental copings.

The aim of this in vitro study was to assess the reliability of two measurement systems for evaluating the marginal and internal fit of dental copings. Sixteen CAD/CAM titanium copings were produced for a prepared maxillary canine. To modify the CAD surface model using different parameters (data density; enlargement in different directions), varying fit was created. Five light-body silicone replicas representing the gap between the canine and the coping were made for each coping and for each measurement method: (1) light microscopy measurements (LMMs); and (2) computer-assisted measurements (CASMs) using an optical digitizing system. Two investigators independently measured the marginal and internal fit using both methods. The inter-rater reliability [intraclass correlation coefficient (ICC)] and agreement [Bland-Altman (bias) analyses]: mean of the differences (bias) between two measurements [the closer to zero the mean (bias) is, the higher the agreement between the two measurements] were calculated for several measurement points (marginal-distal, marginal-buccal, axial-buccal, incisal). For the LMM technique, one investigator repeated the measurements to determine repeatability (intra-rater reliability and agreement). For inter-rater reliability, the ICC was 0.848-0.998 for LMMs and 0.945-0.999 for CASMs, depending on the measurement point. Bland-Altman bias was -15.7 to 3.5 µm for LMMs and -3.0 to 1.9 µm for CASMs. For LMMs, the marginal-distal and marginal-buccal measurement points showed the lowest ICC (0.848/0.978) and the highest bias (-15.7 µm/-7.6 µm). With the intra-rater reliability and agreement (repeatability) for LMMs, the ICC was 0.970-0.998 and bias was -1.3 to 2.3 µm. LMMs showed lower interrater reliability and agreement at the marginal measurement points than CASMs, which indicates a more subjective influence with LMMs at these measurement points. The values, however, were still clinically acceptable. LMMs showed very high intra-rater reliability and agreement for all measurement points, indicating high repeatability.

Accuracy of intraoral and extraoral digital data acquisition for dental restorations.

UNLABELLED: The computer-aided design (CAD) and computer-aided manufacturing (CAM) process chain for dental restorations starts with taking an impression of the clinical situation. For this purpose, either extraoral digitization of gypsum models or intraoral digitization can be used. Despite the increasing use of dental digitizing systems, there are only few studies on their accuracy. OBJECTIVE: This study compared the accuracy of various intraoral and extraoral digitizing systems for dental CAD/CAM technology. MATERIAL AND METHODS: An experimental setup for three-dimensional analysis based on 2 prepared ceramic master dies and their corresponding virtual CAD-models was used to assess the accuracy of 10 extraoral and 4 intraoral optical non-contact dental digitizing systems. Depending on the clinical procedure, 10 optical measurements of either 10 duplicate gypsum dies (extraoral digitizing) or directly of the ceramic master dies (intraoral digitizing) were made and compared with the corresponding CAD-models. RESULTS: The digitizing systems showed differences in accuracy. However, all topical systems were well within the benchmark of ±20 µm. These results apply to single tooth measurements. CONCLUSIONS: Study results are limited, since only single teeth were used for comparison. The different preparations represent various angles and steep and parallel opposing tooth surfaces (incisors). For most digitizing systems, the latter are generally the most difficult to capture. Using CAD/CAM technologies, the preparation angles should not be too steep to reduce digitizing errors. Older systems might be limited to a certain height or taper of the prepared tooth, whereas newer systems (extraoral as well as intraoral digitization) do not have these limitations.

Glutamine: an obligatory parenteral nutrition substrate in critical care therapy.

Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care.

Comparison of an analog and digital quantitative and qualitative analysis for the fit of dental copings.

BACKGROUND: Precision in fit is crucial for dental crowns and bridges. Most analyses of fit are based on analog 2D techniques. Aim of this in-vitro study was to compare an analog and a digital quantitative and qualitative analysis for the fit of CAD/CAM fabricated dental copings. METHODS: A prepared steel canine served as master die. CAD surface models, varying in data density, were purposely enlarged in height (Ez), circumference (Exy) and both of these aspects at once (Exyz). Two titanium copings for each variation were produced. The silicone-replica-technique was applied to analyze the fit by means of a 2D analog light microscope measurement (LMM) and a 3D computer-assisted measurement using an optical digitizing system (ODKM97), respectively. RESULTS: In most cases, restorations based on the low data density showed a better fit than those based on high data density. Original size low density data showed the lowest marginal and axial values in the quantitative 2D analyses (LMM and ODKM97). The 3D measurements (ODKM97) revealed best fit of the low density original size specimens, whereas the Ez specimens showed the highest values. Noticeable variations in fit were detected marginally and axially depending on the specific measurement point (mesial, distal, oral, or buccal) for both measurement systems. DISCUSSION: The analog 2D replica technique revealed a loss of information due to the necessary cutting process. By contrast, the digital computer-based method provided 3D quantitative and qualitative results without data loss over the complete surface.

Interaction of titanium, zirconia and lithium disilicate with peri-implant soft tissue: study protocol for a randomized controlled trial.

BACKGROUND: Against the background of increasing use of dental implants, and thus an increasing prevalence of implant-associated complications, a deeper understanding of the biomolecular mechanisms in the peri-implant tissue is needed. Peri-implant soft tissue is in direct contact with transmucosal dental implant abutments. The aim of this trial is to distinguish the biomolecular and histological interactions of various dental abutment materials with peri-implant soft tissue. METHODS/DESIGN: The study is designed as a prospective, randomized, investigator-initiated clinical pilot trial with blinded assessment. We will ultimately include 24 eligible patients who opt for implant treatment to replace a single missing posterior tooth. Three months after implantation (submerged procedure), the study begins with the second-stage surgery. Each of the 24 patients will be given three different transmucosal abutments (zirconia, lithium disilicate, titanium) consecutively. The sequence in which the three materials are used is randomized. Peri-implant crevicular fluid is sampled weekly around the respective abutment for biomolecular analyses. After one month of wearing time, the stamping press from the second-stage surgery is used to gain a narrow gingival ring biopsy around the abutment for immunohistochemical analyses. The next abutment is then inserted. The same procedure is used for all three abutments. After sampling is completed, the patients will receive a definitive crown. The primary outcome measure of the trial is biomolecular detection of specific markers in the peri-implant crevicular fluid: matrix metalloproteinase 8, interleukin- 1ß, polymorphonuclear elastase, and myeloid-related protein MRP8/14 (calprotectin). Secondary outcome measures include immunohistochemical analyses and clinical parameters. DISCUSSION: The study design will allow us to perform correlation analyses between the clinical indices with biomarkers' expression in the interface of the transmucosal abutments and the peri-implant soft tissue. A deeper understanding of the three abutment materials' interactions with peri-implant soft tissue will help us understand the formation mechanisms of implant-associated complications and then develop prevention strategies. TRIAL REGISTRATION: The trial is registered at the German Clinical Trial Register and the International Clinical Trials Registry Platform by the WHO under DRKS00006555 (Registered on 27 October 2014).

Performance of dental impression materials: Benchmarking of materials and techniques by three-dimensional analysis.

Among other factors, the precision of dental impressions is an important and determining factor for the fit of dental restorations. The aim of this study was to examine the three-dimensional (3D) precision of gypsum dies made using a range of impression techniques and materials. Ten impressions of a steel canine were fabricated for each of the 24 material-method-combinations and poured with type 4 die stone. The dies were optically digitized, aligned to the CAD model of the steel canine, and 3D differences were calculated. The results were statistically analyzed using one-way analysis of variance. Depending on material and impression technique, the mean values had a range between +10.9/-10.0 µm (SD 2.8/2.3) and +16.5/-23.5 µm (SD 11.8/18.8). Qualitative analysis using colorcoded graphs showed a characteristic location of deviations for different impression techniques. Three-dimensional analysis provided a comprehensive picture of the achievable precision. Processing aspects and impression technique were of significant influence.

Reliability of light microscopy and a computer-assisted replica measurement technique for evaluating the fit of dental copings

Abstract The aim of this in vitro study was to assess the reliability of two measurement systems for evaluating the marginal and internal fit of dental copings. Material and Methods: Sixteen CAD/CAM titanium copings were produced for a prepared maxillary canine. To modify the CAD surface model using different parameters (data density; enlargement in different directions), varying fit was created. Five light-body silicone replicas representing the gap between the canine and the coping were made for each coping and for each measurement method: (1) light microscopy measurements (LMMs); and (2) computer-assisted measurements (CASMs) using an optical digitizing system. Two investigators independently measured the marginal and internal fit using both methods. The inter-rater reliability [intraclass correlation coefficient (ICC)] and agreement [Bland-Altman (bias) analyses]: mean of the differences (bias) between two measurements [the closer to zero the mean (bias) is, the higher the agreement between the two measurements] were calculated for several measurement points (marginal-distal, marginal-buccal, axial-buccal, incisal). For the LMM technique, one investigator repeated the measurements to determine repeatability (intra-rater reliability and agreement). Results: For inter-rater reliability, the ICC was 0.848-0.998 for LMMs and 0.945-0.999 for CASMs, depending on the measurement point. Bland-Altman bias was −15.7 to 3.5 μm for LMMs and −3.0 to 1.9 μm for CASMs. For LMMs, the marginal-distal and marginal-buccal measurement points showed the lowest ICC (0.848/0.978) and the highest bias (-15.7 μm/-7.6 μm). With the intra-rater reliability and agreement (repeatability) for LMMs, the ICC was 0.970-0.998 and bias was −1.3 to 2.3 μm. Conclusion: LMMs showed lower interrater reliability and agreement at the marginal measurement points than CASMs, which indicates a more subjective influence with LMMs at these measurement points. The values, however, were still clinically acceptable. LMMs showed very high intra-rater reliability and agreement for all measurement points, indicating high repeatability.