Quo vadis, esthetic dentistry? Part II: Composite resin overtreatment and social media appeal.

OBJECTIVES: This article presents case reports highlighting over-treatments with resin composites, often misconceived as minimally invasive procedures. CLINICAL CONSIDERATIONS: Tooth-colored restorative materials, such as ceramics and composites, have found widespread application to correct problems related to tooth color, shape, and alignment. When composite resin is used, these procedures can be done in a very conservative, cost-effective, and timely fashion. However, it is noteworthy that contemporary dental esthetic expectations are based on standards propagated by social media and other marketing and communications platforms. The abuse of and addiction to social media impacts can lead to unrealistic esthetic expectations and standards for both patients and dentists. CONCLUSIONS: After a critical discussion on ceramic veneers published in part I of this 2-part series, this article directs attention towards what has become a trendy fashion, i.e., the use of direct composite resins as "non-prep" veneers in clinical situations that arguably required no restorative intervention at all. We further explore how social media influences the decision-making processes of both professionals and patients.

Quo vadis, esthetic dentistry? Ceramic veneers and overtreatment-A cautionary tale.

The increased emphasis on orofacial esthetics, experienced both by dental professionals and the lay public, results in an environment where overtreatment can easily occur. Patients on the one hand feel pressure from esthetic norms that are often unrealistic, while dental professionals are compelled to deliver immediate results many times without considering what is best for the ill-informed patient. This article is an illustrated cautionary tale against overtreatment disguised as esthetic dentistry. Representative clinical examples illustrate how porcelain veneers are used without following sound operatory principles, as well as how these cases have been resolved.

Composite veneers: The direct-indirect technique revisited.

OBJECTIVE: This article provides an update on the direct-indirect composite veneer technique. CLINICAL CONSIDERATIONS: Composite veneers have long been used as a conservative and esthetic treatment option for anterior teeth. While they are generally performed using a direct technique, there has been renewed interest in the direct-indirect composite veneer technique because of its advantages and broad indications for restoration of tooth color and morphology. In the direct-indirect composite veneer technique, the selected composites are initially applied on the tooth using a layering approach, without any bonding agent, sculpted to a primary anatomic form with slight excess, and light-cured. The partially polymerized veneer is then removed from the tooth, heat-tempered, and finished to final anatomy and processed extra-orally before being luted. Advantages of this technique include enhanced physical and mechanical properties afforded by the tempering process, unrivaled marginal adaptation, enhanced finishing and polishing, and the ability to try-in the veneer before luting, enabling a shade verification and modulation process that is not possible with the direct technique. The direct-indirect approach also affords enhanced gingival health and patient comfort. CONCLUSION: This article reviews the direct-indirect composite veneer technique, and outlines critical steps and tips for clinical success. CLINICAL SIGNIFICANCE: The direct-indirect technique for composite veneers combines advantages of the direct composite placement technique with those of the indirect veneer technique, including operator control, single-visit fabrication and delivery, increased material properties, and excellent esthetics.

Fracture load of two thicknesses of different zirconia types after fatiguing and thermocycling.

STATEMENT OF PROBLEM: A direct relationship has been reported between yttria concentration and translucency in zirconia restorations. However, increased yttria concentration also increases the cubic phase of the zirconia, which reduces its strength. The effect of increased yttria content on the fracture resistance of zirconia as a function of material thickness after fatigue testing requires evaluation. PURPOSE: The purpose of this in vitro study was to use the biaxial flexural test to evaluate the effect of yttria concentration on the mean fracture load (N) before and after fatiguing and thermocycling as a function of zirconia thickness. MATERIAL AND METHODS: Disk-shaped specimens of 5 mol% yttria partially stabilized zirconia (5Y-PSZ, BruxZir Anterior Solid Zirconia) and 3 mol% yttria partially stabilized zirconia (3Y-PSZ, BruxZir Shaded Zirconia) were prepared to thicknesses of 1.2 and 0.7 mm. For each thickness, the biaxial flexural test was used to measure the fracture load (N) before and after fatigue testing, with 1.2 million cycles at a 110-N load and simultaneous thermocycling at 5 °C to 55 °C (n=20). The data were analyzed by repeated-measures ANOVA (α=.05). RESULTS: Yttria concentration, thickness, and exposure to fatiguing had a statistically significant effect on the mean biaxial flexural load (yttria concentration: P<.001; thickness: P<.001; fatiguing: P=.004 for the 3Y-PSZ). One of the major findings in this study was that 30% of the 1.2-mm-thick 5Y-PSZ specimens and 80% of the 0.7-mm-thick 5Y-PSZ specimens fractured during fatiguing. All specimens of the 3Y-PSZ groups survived the fatiguing protocol. The 3Y-PSZ groups had statistically significant higher flexural loads than the 5Y-PSZ groups. The 1.2-mm thickness groups had statistically significant higher flexural loads than the 0.7-mm thickness groups. CONCLUSIONS: Yttria concentration had a significant effect on the strength of zirconia. 5Y-PSZ was considerably less resistant to fracture before and after fatigue testing than 3Y-PSZ. Decreasing the thickness of zirconia reduces its fracture resistance, regardless of the zirconia type.

The inconspicuous nature of COVID-19 and its impact to dentistry.

To state that the new coronavirus SARS-CoV-2 has broadly and deeply impacted our lives is an understatement. Since it first showed up on our radar in December 2019, the new coronavirus has wreaked havoc on virtually all businesses and industries across the globe. The impact is equally felt in developing, developed, industrialized, rural, rich, and poor countries and communities, irrespective of how well-prepared those countries and communities felt they were 9 months ago. To this day we are still learning to prepare for, respond to, and adapt to the broad and deep impact of this virus. This essay presents different perspectives on the impact of the novel coronavirus to dentistry, through the lenses of a private practice-based general dentist, a nursing home-based public health dentist, and a school of dentistry clinical director. The goal of the essay is to share our experiences and challenges, as well as highlight our capacity to respond to a crisis with resilience, determination, creativity, inventivity, and, most importantly, humility and altruism.

Effect of surface treatment and cement type on dentin bonding of processed resin composite.

PURPOSE: To examine the effect of surface treatment and cement type on dentin bonding of processed resin composite restorations. METHODS: Bovine incisors were sectioned to expose mid-dentin, and randomly assigned to four different groups: Group ULT, Lava Ultimate composite blocks were bonded to dentin with RelyX Ultimate; Group ULT-CJ was treated as in Group ULT but CoJet was used to treat the intaglio surface prior to bonding; Group UNC was bonded with RelyX Unicem 2; and Group UNC-CJ was treated as in Group UNC but CoJet was used to treat the intaglio surface. RelyX Unicem 2 was used as a self-adhesive resin cement, while RelyX Ultimate was used as an adhesive resin cement with Scotchbond Universal. All adhesives and resin composites were polymerized with a high-irradiance LED polymerizing light (Elipar DeepCure-S). After bonding, all specimens were kept in 100% humidity and 37°C for 7 days and then processed for microtensile bond strength (µTBS) testing (n=15). The failure mode was analyzed under SEM as cohesive, adhesive, or mixed. Data were analyzed for statistical significance using two-way ANOVA and Tukey's HSD post-hoc test (α=0.05). RESULTS: Mean µTBS values ranged from 8.83 MPa (±3.13 MPa) for UNC to 25.63 MPa (±5.94 MPa) for ULT-CJ. Means were statistically significantly higher for the adhesive cement when compared with the self-adhesive cement (P< 0.05), and, for the adhesive cement, CoJet resulted in statistically significantly higher means (P< 0.05). The number of pre-test failures was uniform across groups (n=2-4). Failures were predominantly adhesive and mixed. The adhesive resin cement RelyX Ultimate performed significantly better than the self-adhesive resin cement RelyX Unicem 2, and surface treatment with CoJet improved bond strengths of Lava Ultimate to dentin. CLINICAL SIGNIFICANCE: CoJet treatment and adhesive resin cements should be used when bonding laboratory/CAD-CAM processed resin composite restorations to dentin.

Esthetic and functional management of an ankylosed central incisor with a conservative restorative approach.

In this case report, we share a conservative and simple restorative management approach for a relatively complex esthetic situation on an adult patient with an ankylosed maxillary central incisor in infra-occlusion. A 37-year-old healthy female patient presented for a consultation with a chief complaint of an unappealing smile. The intraoral exam revealed tooth #8 (FDI 11) was in obvious and significant infra-occlusion due to altered eruption. Periapical radiographs of this area were non-contributory and all teeth responded within normal limits to pulp vitality tests. After review of several treatment options, the patient opted for a conservative restorative approach in which a partial ceramic veneer was planned for the ankylosed tooth, while composite resin was used on the contralateral central incisor to achieve a symmetric and pleasant result. CLINICAL SIGNIFICANCE: A relatively complex clinical problem was satisfactorily resolved with a very conservative option in which composite resin and a ceramic veneer were used to restore an asymmetric smile.

Effect of composite type and placement technique on cuspal strain.

OBJECTIVE: To compare the cuspal strain in Class II restorations made with bulk-fill and conventional composite resins. MATERIALS AND METHODS: Fifty extracted maxillary premolars were mounted into phenolic rings and divided into five groups (n = 10). Specimens received standardized MOD preparations. A two-step self-etch adhesive was applied and the preparations were restored using a custom matrix as follows: Filtek Supreme Ultra in eight 2-mm increments (FSUI); Filtek Supreme Ultra in bulk (FSUB); SonicFill in bulk (SF); SureFil SDR flow in bulk, covered with a 2-mm occlusal layer of Filtek Supreme Ultra (SDR/FSU); Tetric EvoCeram Bulk Fill in bulk (TEBF). Strain gages bonded to the buccal and lingual cusps recorded cuspal strain during restorations. End strain values were determined and data were subjected to Kruskal-Wallis testing, followed by one-way ANOVA and Tukey´s post hoc test. RESULTS: Combined strain values and standard deviations (in µÉ›) were: FSUI: 723 ± 102.8, FSUB: 929.2 ± 571.9, SF: 519.1 ± 80.2, SDR-FSU: 497.4 ± 67.6 and TEBF: 604.5 ± 127.1. A significant difference was found between group FSUI and groups SF, SDR-FSU, and TEBF. Group FSUB showed significantly higher mean strain and greater standard deviation than all other groups due to cuspal fractures, and was thus excluded from the statistical analysis. CONCLUSIONS: The tested bulk-fill composite resins exerted less strain onto tooth structure than the incrementally placed conventional composite resin, although the magnitude of generated strain was product-dependent. Bulk-filling with conventional composite resins is contraindicated. CLINICAL SIGNIFICANCE: Bulk-fill composite resins exerted less strain onto adjacent tooth structure than a traditional composite, even when that composite is was placed incrementally. Bulk-filling with traditional composite resins is unpredictable and contraindicated.

CAD/CAM post-and-core using different esthetic materials: Fracture resistance and bond strengths.

PURPOSE: To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. METHODS: 90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). RESULTS: The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±100.3 (RC), and 407.6±109.0 (FG), with RC showing significantly higher FR values (P< 0.05). For BS, there was no statistically significant difference among the materials, with and without fatigue (P> 0.05). The type of material used to obtain the CAD/CAM-customized post-and-cores had a significant effect on the FR, but not on the BS of the specimens. Fatigue did not influence the BS for the tested materials. CLINICAL SIGNIFICANCE: CAD/CAM custom-made esthetic post-and-cores showed good performance relative to fracture resistance and bond strength to root canal dentin walls. The CAD/CAM materials tested could be used as an alternative to restore wide flared root canals in esthetically compromised teeth.

Accuracy evaluation of intraoral optical impressions: A clinical study using a reference appliance.

STATEMENT OF PROBLEM: Trueness and precision are used to evaluate the accuracy of intraoral optical impressions. Although the in vivo precision of intraoral optical impressions has been reported, in vivo trueness has not been evaluated because of limitations in the available protocols. PURPOSE: The purpose of this clinical study was to compare the accuracy (trueness and precision) of optical and conventional impressions by using a novel study design. MATERIAL AND METHODS: Five study participants consented and were enrolled. For each participant, optical and conventional (vinylsiloxanether) impressions of a custom-made intraoral Co-Cr alloy reference appliance fitted to the mandibular arch were obtained by 1 operator. Three-dimensional (3D) digital models were created for stone casts obtained from the conventional impression group and for the reference appliances by using a validated high-accuracy reference scanner. For the optical impression group, 3D digital models were obtained directly from the intraoral scans. The total mean trueness of each impression system was calculated by averaging the mean absolute deviations of the impression replicates from their 3D reference model for each participant, followed by averaging the obtained values across all participants. The total mean precision for each impression system was calculated by averaging the mean absolute deviations between all the impression replicas for each participant (10 pairs), followed by averaging the obtained values across all participants. Data were analyzed using repeated measures ANOVA (α=.05), first to assess whether a systematic difference in trueness or precision of replicate impressions could be found among participants and second to assess whether the mean trueness and precision values differed between the 2 impression systems. RESULTS: Statistically significant differences were found between the 2 impression systems for both mean trueness (P=.010) and mean precision (P=.007). Conventional impressions had higher accuracy with a mean trueness of 17.0 ±6.6 µm and mean precision of 16.9 ±5.8 µm than optical impressions with a mean trueness of 46.2 ±11.4 µm and mean precision of 61.1 ±4.9 µm. CONCLUSIONS: Complete arch (first molar-to-first molar) optical impressions were less accurate than conventional impressions but may be adequate for quadrant impressions.

A Predictive Model for Root Caries Incidence.

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance]. A sensitivity analysis added treatment to the models for both the control and treatment participants (n = 301) to predict RC for the control participants. Forty-nine percent of the control participants had incident RC. The model including the number of follow-up years at risk, the number of root surfaces at risk, RC index, gender, race, age, and smoking resulted in the best prediction performance, having the highest AUC and lowest Brier score. The sensitivity analysis supported the primary analysis and gave slightly better performance summary measures. The set of risk indicators best able to predict RC incidence included an increased number of root surfaces at risk and increased RC index at baseline, followed by white race and nonsmoking, which were strong nonsignificant predictors. Gender, age, and increased number of follow-up years at risk, while included in the model, were also not statistically significant. The inclusion of health, diet, RPD use, toothbrush use, income, education, and dental insurance variables did not improve the prediction performance.

Effect of finishing technique on the occurrence and length of microcracks in resin-based materials.

PURPOSE: To evaluate the presence and length of microcracks in resin-based materials finished with different techniques, using optical coherence tomography (OCT). METHODS: Standardized Class V preparations (3x2x2mm) were made in the facial and lingual surfaces of 20 recently-extracted human third molars. 20 preparations were restored with a resin-based composite material (RBC; Filtek Supreme Ultra) and the other 20 with a resin-modified glass-ionomer material (RMGI; Ketac Nano). After final polymerization, specimens were further stratified by finishing system: aluminum oxide discs (Sof-Lex) or spiral fluted carbide bur series (H48L). By random allocation, each extracted tooth therefore received one RBC and one RMGI restoration, and equal numbers of restorations from each material were finished using each finishing system (n= 10). After 24 hours of storage in 100% humidity at room temperature, the specimens were evaluated at x20 to x600 under environmental SEM. Cross-sectional occlusal-cervical B-mode images were obtained in increments of 25 mm from the mesial margin to the distal margin of the restoration using a spectral-domain (SD) OCT system and analyzed using Image J software to identify and measure microcrack penetration into each restoration. The total length (mm) at the point of the deepest microcrack penetration in each specimen was recorded. Data were statistically analyzed using a t-test. RESULTS: No microcracks were observed in the RBC samples. However, microcrack presence was identified in all of the RMGI specimens. The t-test showed a statistically significant difference (P< 0.05) in mean microcrack length values based on the finishing technique used for the RMGI samples. [SofLex: 0.67 (± 0.28) mm; carbide: 1.26 (± 0.30)] mm. Two-way ANOVA showed significant differences in the factors "finishing technique" and "restorative material" (P< 0.001). The interaction of these two factors was also statistically significant (P< 0.001). For the tested RMGI, Tukey post-hoc test revealed that the finishing with aluminum oxide groups resulted in statistically significant lower mean microcrack length when compared to spiral fluted carbide burs (P< 0.001). CLINICAL SIGNIFICANCE: Resin-modified glass-ionomer (RMGI) is more susceptible to microcrack presence than resin-based composites. Also, aluminum oxide discs produced lower values of mean microcrack length than spiral fluted carbide burs after the finishing procedure of RMGI restorations.

Effect of Finishing and Polishing on the Surface Roughness of Four Ceramic Materials after Occlusal Adjustment.

PROBLEM: Intraoral occlusal adjustment of ceramic restorations can create a significant increase in surface roughness that can produce wear of the opposing dentition. PURPOSE: To compare the surface roughness of glazed and polished monolithic ceramics with the surface roughness produced by different intraoral polishing systems on adjusted monolithic ceramics. MATERIALS AND METHODS: Milled ceramic discs (10 mm diameter × 2 mm thickness) were manufactured and distributed according to the following groups (n = 10): BruxZir (glazed and polished), Zenostar (glazed and polished), IPS Empress CAD, and IPS e.max CAD. Surface roughness, expressed as arithmetic average height (Ra ), was measured using atomic force microscope and profilometer before and after adjustment and polishing with the following intraoral polishing systems: BruxZir and Dialite ZR (for BruxZir), Zenostar and Dialite ZR (for Zenostar), and OptraFine and Dialite LD for IPS Empress CAD and IPS e.max CAD. Mean and standard error for each material and polishing system were calculated. T-test, one-way ANOVA, and Bonferroni post hoc tests were used to analyze data. RESULTS: BruxZir zirconia presented smoother surfaces with Dialite ZR system compared to BruxZir system, Zenostar zirconia shown smoother surfaces with Zenostar system compared to Dialite ZR system and IPS Empress CAD and IPS e.max CAD presented smoother surfaces with OptraFine system in comparison to Dialite LD system. CONCLUSION: All materials presented smoother surfaces at baseline than after adjustment and polishing. CLINICAL SIGNIFICANCE: This paper reveals the results of an in vitro study that provides information to clinicians regarding which intraoral polishing system will produce a smoother surface after the adjustment and polishing of IPS Empress CAD, IPS e.max CAD, BruxZir and Zenostar ceramic materials. (J Esthet Restor Dent 28:382-396, 2016).

Effect of Finishing Techniques on the Marginal Integrity of Resin-Based Composite and Resin-Modified Glass Ionomer Restoration.

UNLABELLED: The purpose of this study was to evaluate the marginal integrity of resin-based composite (RBC and resin-modified glass ionomer cement (RMGIC) restorations as a function of finishing technique and location of the tooth. Forty extracted third molars were assigned to four groups (N = 10) according to finishing instruments (aluminum oxide discs, fluted carbides, fine diamonds, and coarse diamond). Each specimen received standardized Class V preparations on the facial and lingual surfaces with occlusal margins on enamel and gingival margins on dentin. Each preparation was randomly assigned to be restored with either RBC or RMGIC. Specimens were finished with standardized pressure at approximately 0.16 N and evaluated at a magnification of 600× using an environmental scanning electron microscope. Occlusal and gingival margins were analyzed using an imaging software, and means for all measured gaps were calculated. Data were analyzed with a factorial analysis of variance. All possible two-way interactions were included, and the level of significance was set at 0.05. There were no statistically significant differences among the four types of finishing instruments used in the study. RBC-restored specimens exhibited significantly smaller mean marginal gaps (1.70-7.56 µm) than RMGI-restored specimens (5.24-14.24 µm) in enamel and dentin margins, respectively. There was a statistically significant difference between enamel and dentin with regard to marginal gap formation. Under the conditions of this study, marginal gap formation was not affected by finishing technique. RBC margins exhibited significantly less marginal gap than RMGI margins, whereas enamel margins resulted in significantly less marginal gap than did dentin margins. CLINICAL SIGNIFICANCE: Multiple factors can affect the marginal integrity and the longevity of direct restorations. From these, the finishing and polishing techniques are critical steps that are under the clinician's control, and proper finishing and polishing techniques should be applied for avoiding introduction of stress to the margin of the restoration. It seems that instrumentation do not play a significant role, as much as the restorative material and the substrate to bond.

Degree of conversion of dual-polymerizing cements light polymerized through monolithic zirconia of different thicknesses and types.

STATEMENT OF PROBLEM: Monolithic zirconia restorations are increasingly common. Dual-polymerizing cements have been advocated for cementation. The opacious nature of zirconia restoration can attenuate light, compromising optimal resin polymerization and eventually restoration debonding. PURPOSE: The purpose of this in vitro study was to evaluate the influence of material thickness on light irradiance, radiant exposure, and the degree of monomer conversion (DC) of 2 dual-polymerizing resin cements light-polymerized through different brands of monolithic zirconia. MATERIAL AND METHODS: Dual-polymerizing resin cements (RelyX Ultimate; 3M-ESPE, and Variolink II; Ivoclar, Vivadent) were mixed according to the manufacturers' instructions with a film thickness of 40 µm, placed under a 10 × 10 mm specimen of monolithic zirconia (Prettau Anterior by Zirkonzahn, Katana by Noritake, BruxZir by Glidewell, and Zenostar by Wieland) and a zirconia core control (ICE zirkon by Zirkonzahn) at various thicknesses (0.50, 1.00, 1.50, and 2.00 mm, n = 5 of each thickness). Each specimen was irradiated for 20 seconds (RelyX Ultimate) and 40 seconds (Variolink II) with Elipar S10 (3M-ESPE, 1200 mW/cm(2)). The amount of irradiance and radiant exposure was quantified for each specimen. Fourier transform infrared spectroscopy was used to measure the DC from the bottom surface of the resin. Statistical analysis was performed with 2-way ANOVA and post hoc Tukey honest significant difference (HSD) tests (α = .05). RESULTS: Light irradiance and radiant exposure decreased as the thickness of the specimen increased (P < .05) regardless of the brand. The ranking from least to highest was BruxZir < ICE zircon = Wieland < Katana = Prettau Anterior. The zirconia brand, thickness, and cement type had a significant effect on the DC (P < .001). The DC decreased significantly as the thickness of the zirconia increased (P < .001). Katana and Prettau Anterior showed the highest DC and BruxZir showed the lowest. CONCLUSION: The thickness of zirconia affects the DC of resin-based cements. The DC of the resin cements differed significantly between cements and among zirconia brands. More polymerizing time may be needed to deliver sufficient energy through some brands of zirconia.

Modified shifted angular spectrum method for numerical propagation at reduced spatial sampling rates.

The shifted angular spectrum method allows a reduction of the number of samples required for numerical off-axis propagation of scalar wave fields. In this work, a modification of the shifted angular spectrum method is presented. It allows a further reduction of the spatial sampling rate for certain wave fields. We calculate the benefit of this method for spherical waves. Additionally, a working implementation is presented showing the example of a spherical wave propagating through a circular aperture.

Simulation framework for coherent and incoherent X-ray imaging and its application in Talbot-Lau dark-field imaging.

A simulation framework for coherent X-ray imaging, based on scalar diffraction theory, is presented. It contains a core C++ library and an additional Python interface. A workflow is presented to include contributions of inelastic scattering obtained with Monte-Carlo methods. X-ray Talbot-Lau interferometry is the primary focus of the framework. Simulations are in agreement with measurements obtained with such an interferometer. Especially, the dark-field signal of densely packed PMMA microspheres is predicted. A realistic modeling of the microsphere distribution, which is necessary for correct results, is presented. The framework can be used for both setup design and optimization but also to test and improve reconstruction methods.

Energy weighted x-ray dark-field imaging.

The dark-field image obtained in grating-based x-ray phase-contrast imaging can provide information about the objects' microstructures on a scale smaller than the pixel size even with low geometric magnification. In this publication we demonstrate that the dark-field image quality can be enhanced with an energy-resolving pixel detector. Energy-resolved x-ray dark-field images were acquired with a 16-energy-channel photon-counting pixel detector with a 1 mm thick CdTe sensor in a Talbot-Lau x-ray interferometer. A method for contrast-noise-ratio (CNR) enhancement is proposed and validated experimentally. In measurements, a CNR improvement by a factor of 1.14 was obtained. This is equivalent to a possible radiation dose reduction of 23%.

Three-year clinical evaluation of a silorane composite resin.

STATEMENT OF PROBLEM: Composite resins are still outperformed by amalgams in the clinical practice with secondary caries and fractures being their most common failures. A material that suffers less polymerization shrinkage might improve the clinical performance of composite resins. PURPOSE: To evaluate the clinical performance of a low-shrink silorane-based composite resin (Filtek LS Low Shrink Posterior Restorative, 3M ESPE, St. Paul, MN, USA) in comparison with a methacrylate-based composite resin (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Principality of Liechtenstein) over time. MATERIALS AND METHODS: Candidates in need of Class II composite resin restorations participated in this randomized controlled clinical trial. Those were 25 female and six male subjects with average age of 44.3 ± 12.7 years. Participants received 82 restorations, being 54 in premolars and 28 in molars. Procedures, which included the restoration of primary caries lesions or replacement of failing restorations, were done using modified preparations with no bevels or additional retention. Restorations were placed using Filtek LS (and dedicated self-etch adhesive) or Tetric EvoCeram (with AdheSE, Ivoclar Vivadent), following manufacturers' instructions. Incremental placement technique was applied and the restorations were immediately finished. Follow-up evaluations occurred at six, 12, 24, and 36 months and were done using the Fédération Dentaire Internationale criteria. Statistical analysis was performed using generalized estimating equations. RESULTS: The recall rate at 36 months was 89%. All interaction terms were not significant. CONCLUSIONS: Filtek LS performs as well as Tetric EvoCeram performs in the clinical setting at 36 months. CLINICAL SIGNIFICANCE: The silorane-based composite resin Filtek LS and the conventional methacrylate-based composite resin Tetric EvoCeram performed similarly well in posterior restorations over at least 36 months of clinical service.

Projection angle dependence in grating-based X-ray dark-field imaging of ordered structures.

Over the recent years X-ray differential phase-contrast imaging was developed for the hard X-ray regime as produced from laboratory X-ray sources. The technique uses a grating-based Talbot-Lau interferometer and was shown to yield image contrast gain, which makes it very interesting to the fields of medical imaging and non-destructive testing, respectively. In addition to X-ray attenuation contrast, the differential phase-contrast and dark-field images provide different structural information about a specimen. For the dark-field even at length scales much smaller than the spatial resolution of the imaging system. Physical interpretation of the dark-field information as present in radiographic and tomographic (CT) images requires a detailed look onto the geometric orientation between specimen and the setup. During phase-stepping the drop in intensity modulation, due to local scattering effects within the specimen is reproduced in the dark-field signal. This signal shows strong dependencies on micro-porosity and micro-fibers if these are numerous enough in the object. Since a grating-interferometer using a common unidirectional line grating is sensitive to X-ray scattering in one plane only, the dark-field image is influenced by the fiber orientations with respect to the grating bars, which can be exploited to obtain anisotropic structural information. With this contribution, we attempt to extend existing models for 2D projections to 3D data by analyzing dark-field contrast tomography of anisotropically structured materials such as carbon fiber reinforced carbon (CFRC).