Effects of surface roughness of ceria-stabilized zirconia/alumina nanocomposite on the morphology and function of human gingival fibroblasts.

We evaluated the biological effects of implant abutments made from ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al2O3) with surface roughness variations using human gingival fibroblasts (HGF-1) in the transmucosal region. Two types of titanium (Ti) and Ce-TZP/Al2O3 disks with different surface roughness profiles were prepared (Ra0.9 and Ra0.02). Surface properties were evaluated using SEM, EDX, and wettability analysis. Biological parameters including cell adhesion, proliferation and morphology, collagen deposition, and inflammatory cytokine expression were evaluated for each disk. Surface morphology analysis of Ce-TZP/Al2O3 and Ti elucidated the uniform linear structures of Ra0.9 and the smooth and flat structures of Ra0.02. Cell morphology showed spindle-shaped and large, circular forms, respectively. Cell adhesion and proliferation and collagen deposition were significantly increased on Ce-TZP/Al2O3 Ra0.02 disk compared with the others, with no significant differences in cytokine expression among all the disks. The reduced surface roughness of Ce-TZP/Al2O3 was advantageous for promoting biological effects in the transmucosal region.

Duloxetine-induced hyponatraemia in a patient with hypocortisolaemia.

Duloxetine-induced hyponatraemia is a known adverse effect that can lead to potentially life-threatening complications. In addition, hypocortisolaemia is associated with the development of hyponatraemia. Here, we report a case of severe hyponatraemia rapidly presenting after duloxetine treatment in a patient with hypocortisolaemia. A 75-year-old man administered hydrocortisone for the treatment of hypocortisolaemia induced by a Rathke's cleft cyst was admitted for anorexia 3 days after the initiation of duloxetine therapy. Laboratory findings showed severe hyponatraemia, hypo-osmolality, concentrated urine, and increased urine sodium. Because the syndrome of inappropriate antidiuretic hormone was diagnosed, duloxetine was ceased. Following admission to the hospital, endocrinological analyses revealed mild hypocortisolaemia, possibly due to low adherence to hydrocortisone replacement therapy. By the sixth day after admission, the patient's hyponatraemia, serum osmolality, and urine osmolality had improved. This case suggests that health-care physicians should be aware of the possibility of duloxetine-related hyponatraemia, particularly in patients with hypocortisolaemia.

Canagliflozin improves obesity and insulin resistance in a diabetic patient with Cushings disease undergoing postoperative steroid therapy: A case report.

A 47-year-old woman with diabetes treated with high-dose insulin was admitted to Mie University Hospital, Tsu, Japan, for screening of secondary diabetes mellitus and obesity. Laboratory tests and imaging studies were consistent with Cushing's disease (CD). The patient underwent trans-sphenoidal pituitary surgery. The patient exhibited loss of body weight (85.9 to 80.0 kg), improved glycated hemoglobin (HbA1c) (11.2 to 7.8%) and required lower doses of insulin (112 to 46 U/day) 6 months after surgery. The patient's body weight and daily insulin dose remained stable during the following 5 months (6-11 months after surgery). At that point, the patient was administered with canagliflozin, a sodium-glucose cotransporter 2 inhibitor. The patient required lower daily insulin dose without decreasing the dose of postoperative hydrocortisone concurrent to the administration of canagliflozin (100 mg/day). The patient's body weight decreased to 69.5 kg and withdrawal of insulin therapy was possible 8 months after initiation of canagliflozin. Despite withdrawal of insulin therapy, the HbA1c levels remained at <7.0%. Although surgical treatment is the first-choice treatment for CD, obesity-related metabolic disorders including diabetes are frequent in CD patients following surgery. Canagliflozin may be an effective treatment to reduce body weight and improve insulin resistance following surgical treatment of CD.

A case of type 2 diabetes mellitus with metformin-associated lactic acidosis initially presenting the appearance of a sulfonylurea-related hypoglycemic attack.

Case: A 64-year-old Japanese woman with diabetes mellitus was admitted for hypoglycemia. Her diabetes had been under good control with glimepiride, voglibose, exenatide, and metformin for a few years. Although overt proteinuria was observed, the serum creatinine values were within normal range during the routine outpatient follow-up. Hypoglycemic attack caused by glimepiride and loss of appetite by urinary tract infection were diagnosed. Then, metformin-associated lactic acidosis with acute renal failure caused by dehydration was detected. Outcome: Her condition was improved by continuous veno-venous hemodiafiltration and hemodialysis, known to be useful to remove metformin. Conclusion: We reported a case of metformin-associated lactic acidosis with hypoglycemia during routine treatment of diabetes that was successfully rescued by early renal replacement therapy.

Surface quality of yttria-stabilized tetragonal zirconia polycrystal in CAD/CAM milling, sintering, polishing and sandblasting processes.

This paper studied the surface quality (damage, morphology, and phase transformation) of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) in CAD/CAM milling, and subsequent polishing, sintering and sandblasting processes applied in dental restorations. X-ray diffraction and scanning electron microscopy (SEM) were used to scan all processed surfaces to determine phase transformations and analyse surface damage morphology, respectively. The average surface roughness (Ra) and maximum roughness (Rz) for all processed surfaces were measured using desk-top SEM-assisted morphology analytical software. X-ray diffraction patterns prove the sintering-induced monoclinic-tetragonal phase transformation while the sandblasting-induced phase transformation was not detected. The CAD/CAM milling of pre-sintered Y-TZP produced very rough surfaces with extensive fractures and cracks. Simply polishing or sintering of milled pre-sintered surfaces did not significantly improve their surface roughness (ANOVA, p>0.05). Neither sintering-polishing of the milled surfaces could effectively improve the surface roughness (ANOVA, p>0.05). The best surface morphology was produced in the milling-polishing-sintering process, achieving Ra=0.21±0.03µm and Rz=1.73±0.04µm, which meets the threshold for bacterial retention. Sandblasting of intaglios with smaller abrasives was recommended as larger abrasive produced visible surface defects. This study provides technical insights into process selection for Y-TZP to achieve the improved restorative quality.

Bending properties of Ce-TZP/A nanocomposite clasps for removable partial dentures.

PURPOSE: Ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/A) has excellent fracture toughness and bending strength that could be useful for partial denture framework application. The aim of this study was to investigate the effects of three-dimensional (3D) geometry on the bending and fatigue properties of a model simulation of Ce-TZP/A clasps. MATERIALS AND METHODS: Half oval-shaped Ce-TZP/A rods were prepared in six 3D designs. Specimens were either of standard (width divided by thickness: 2.0/1.0 mm) or flat type (2.5/0.8 mm) cross-sectional areas with taper ratios of 1.0, 0.8, or 0.6. As a comparison, cobalt-chromium (Co-Cr) alloy rods of the same shape as the Ce-TZP/A standard shape rod were prepared. All specimens were subjected to the cantilever test and loaded until fracture. They were also cyclically loaded 106 times with various constant displacements, and the maximum displacement prior to fracture was determined for each specimen. Three-dimensional finite element analysis (3D FEA), simulating the cantilever test, was performed to determine the stress distribution during loading. RESULTS: Specimens with the standard cross-sectional shape exhibited higher rigidity and higher fracture loads than the flat specimens by the cantilever test. In addition, lower taper ratios were consistently associated with larger displacements at fracture. Fatigue tests revealed that the maximum displacement prior to fracture of Ce-TZP/A specimens was comparable to that of Co-Cr alloy specimens. The 3D FEA showed that specimens with a taper ratio of 0.6 had the least stress concentration. CONCLUSIONS: Ce-TZP/A clasp specimens with a standard cross-sectional shape and a 0.6 taper ratio exhibited the best bending properties among those tested.

Compatibility of Ce-TZP/Al2O3 nanocomposite frameworks and veneering porcelains.

The aim of this study was to examine the compatibility of Ce-TZP/Al2O3 nanocomposite (CTA) frameworks and veneering porcelains using the Schwickerath crack initiation test and clarify the effects on debonding/crack initiation strength (DIS) of both surface pretreatment (include heat treatment) of the frameworks, type of veneering porcelain varying the coefficient of thermal expansion (CTE), and surface roughness of the frameworks. The surfaces of Ce-TZP/Al2O3 plates were mechanically treated and followed by post-heat treatment. The liner and body porcelains were built up and fired according to the manufacturer's instructions. Surface analyses of the fractured plates showed compatibility with liner porcelains. Since no statistically difference in the DIS was found amongst the different surface treatments, post-heat treatments don't be mandatory. Whereas, since differences in DIS were found when different porcelains with different CTE were used, we concluded the matching of CTE of the porcelain with that of Ce-TZP/Al2O3 was important for successful all-ceramic restorations using Ce-TZP/Al2O3 frameworks.

Properties of experimental titanium cast investment mixing with water reducing agent solution.

This study aimed to develop a dental investment for titanium casting. ZrO(2) and Al(2)O(3) were selected as refractory materials to prepare three investments (Codes: A-C) according to the quantity of Zr. Al(2)O(3) cement was used as a binder at a ratio of 15%, they were mixed with special mixing liquid. B1 was used as a control mixed with water. Fundamental examinations were statistically evaluated. A casting test was performed with investment B. Fluidities, setting times, and green strengths showed no remarkable differences; however, they were significantly different from those of B1. Expansion values for A, B, C, and B1 at 850°C were 1.03%±0.08%, 1.96%±0.17%, 4.35%±0.23%, and 1.50%±0.28%, respectively. Castings were covered by only small amounts of mold materials. The hardness test showed no significant differences between castings from B and the ones from commercial investments. The experimental special mixing liquid effectively reduced the water/powder ratio and improved the strength and thermal expansion.

Effects of a convenient silica-coating treatment on shear bond strengths of porcelain veneers on zirconia-based ceramics.

Porcelain veneering of zirconia is necessary, but chipping of the veneer may cause clinical problems. We investigated the effects of silica coating to improve the bond strength between porcelain veneers and zirconia-based ceramics. The ceramics tested were zirconia/alumina nanocomposites stabilized with ceria. Three surface treatments, grinding with a carborundum point (CA), sandblasting with alumina (SB), and Silano-Pen treatment (SP), were performed. Untreated specimens (NT) were examined as a control. The surface roughnesses and contact angles after treatment were measured. Shear bond tests were conducted, and the average strengths were calculated. EPMA was used for elemental identifications and surface observations. The bond strengths with SP were 20.00±3.43MPa and were significantly larger than that (15.35±3.12 MPa) of NT (p<0.05). However, differences among treated specimens were not significant. Moreover, SP gave superior wettability, and smoothness as good as NT. These data suggest that SP affects the bond strength between zirconia and a porcelain veneer.

Altered gene and protein expression in liver of the obese spontaneously hypertensive/NDmcr-cp rat.

BACKGROUND: It is difficult to study the mechanisms of the metabolic syndrome in humans due to the heterogeneous genetic background and lifestyle. The present study investigated changes in the gene and protein profiles in an animal model of the metabolic syndrome to identify the molecular targets associated with the pathogenesis and progression of obesity related to the metabolic syndrome. METHODS: We extracted mRNAs and proteins from the liver tissues of 6- and 25-week-old spontaneously hypertensive/NIH -corpulent rat SHR/NDmcr-cp (CP), SHR/Lean (Lean) and Wistar Kyoto rats (WKY) and performed microarray analysis and two-dimensional difference in gel electrophoresis (2D-DIGE) linked to a matrix-assisted laser desorption ionization time-of-flight tandem mass spectrometry (MALDI-TOF/TOF MS). RESULTS: The microarray analysis identified 25 significantly up-regulated genes (P < 0.01; log10 > 1) and 31 significantly down-regulated genes (P < 0.01; log10 < -1) in 6- and 25-week-old CP compared with WKY and Lean. Several of these genes are known to be involved in important biological processes such as electron transporter activity, electron transport, lipid metabolism, ion transport, transferase, and ion channel activity. MALDI-TOF/TOF MS identified 31 proteins with ±1.2 fold change (P < 0.05) in 6- and 25-week-old CP, compared with age-matched WKY and Lean. The up-regulated proteins are involved in metabolic processes, biological regulation, catalytic activity, and binding, while the down-regulated proteins are involved in endoplasmic reticulum stress-related unfolded protein response. CONCLUSION: Genes with significant changes in their expression in transcriptomic analysis matched very few of the proteins identified in proteomics analysis. However, annotated functional classifications might provide an important reference resource to understand the pathogenesis of obesity associated with the metabolic syndrome.

Soda-lime glass as a binder in reusable experimental investment for dental castings.

In this study, different glasses were investigated to improve reusable investments. Borosilicate glass (BSG) powder and soda-lime glass (SLG) powder were prepared by milling broken beakers and microscope slides, respectively, and used in experimental investments (I-BSG, I-SLG) by blending glass powder (10 wt%) with cristobalite (90 wt%). Some properties and casting fits were evaluated with commercial gypsum-bonded investment as the control. Both BSG and SLG were mainly composed of Si, but SLG had a large Ca content. The glass transition temperatures were approximately 800°C (BSG) and 700°C (SLG). Experimental investments with heating showed the significantly (p<0.05) higher expansion than that of the control. The compressive strength of I-SLG was higher than that of I-BSG, and increased with temperature. The MOD inlay obtained from I-SLG had a significantly smaller gap than that from I-BSG, and was comparable to the control. These results suggest SLG could be applied clinically as a reusable dental investment.

Novel fabrication method for zirconia restorations: bonding strength of machinable ceramic to zirconia with resin cements.

A novel method was developed to fabricate all-ceramic restorations which comprised CAD/CAM-fabricated machinable ceramic bonded to CAD/CAM-fabricated zirconia framework using resin cement. The feasibility of this fabrication method was assessed in this study by investigating the bonding strength of a machinable ceramic to zirconia. A machinable ceramic was bonded to a zirconia plate using three kinds of resin cements: ResiCem (RE), Panavia (PA), and Multilink (ML). Conventional porcelain-fused-to-zirconia specimens were also prepared to serve as control. Shear bond strength test (SBT) and Schwickerath crack initiation test (SCT) were carried out. SBT revealed that PA (40.42 MPa) yielded a significantly higher bonding strength than RE (28.01 MPa) and ML (18.89 MPa). SCT revealed that the bonding strengths of test groups using resin cement were significantly higher than those of Control. Notably, the bonding strengths of RE and ML were above 25 MPa even after 10,000 times of thermal cycling -adequately meeting the ISO 9693 standard for metal-ceramic restorations. These results affirmed the feasibility of the novel fabrication method, in that a CAD/CAM-fabricated machinable ceramic is bonded to a CAD/CAM-fabricated zirconia framework using a resin cement.

Combination treatment of tribochemical treatment and phosphoric acid ester monomer of zirconia ceramics enhances the bonding durability of resin-based luting cements.

The aim of the present study was to evaluate the bonding durability of resin-based luting cement to partially stabilized tetragonal zirconia (Y-TZP) achieved by combination treatment of tribochemical (TBC) treatment and two different phosphate acid ester monomers. Two phosphate acid ester monomers (EP: Epricord opaque primer, AZ: AZ primer) were applied to each surface modification followed by application of resin-based luting cement (Rely-X ARC). Bonding specimens were placed in deionized water at 37 degrees C and stored for 24 h. The other groups were subjected to 30,000 cycles of a thermal stress for the durability test. Shear bond tests were done using a universal testing machine at 1 mm/min. Shear bond strengths of combination treatments using EP and AZ on TBC treatment after thermal stress showed no significant difference (p>0.05) compared with those of storage after 24 h. Combination treatment using phosphoric acid ester monomer could achieve a durable bond.

A review of dental CAD/CAM: current status and future perspectives from 20 years of experience.

In this article, we review the recent history of the development of dental CAD/CAM systems for the fabrication of crowns and fixed partial dentures (FPDs), based on our 20 years of experience in this field. The current status of commercial dental CAD/CAM systems developed around the world is evaluated, with particular focus on the field of ceramic crowns and FPDs. Finally, we discuss the future perspectives applicable to dental CAD/CAM. The use of dental CAD/CAM systems is promising not only in the field of crowns and FPDs but also in other fields of dentistry, even if the contribution is presently limited. CAD/CAM technology will contribute to patients' health and QOL in the aging society.

Bonding strength of resin cement to silicate glass ceramics for dental CAD/CAM systems is enhanced by combination treatment of the bonding surface.

To increase the bond strength of CAD/CAM-fabricated, leucite-reinforced glass ceramics with a resin cement, the effects of the following were investigated: surface modification by tribochemical (TBC) treatment, followed by combined application of a silane coupling agent and a functional monomer as a primer. Bond strength was evaluated by a shear bond test. It was found that a silane coupling agent was useful for all the surfaces, particularly for the TBC-treated surface. This was because of the presence of a silica layer on the modified surface. The combination of a silane coupling agent and a functional monomer on the TBC surface allowed marked improvement in bonding, whereby the bonding endured 20,000 cycles of thermal cycling. Therefore, TBC treatment in combination with a silane coupling agent and a functional monomer as a primer substantially increased the bond strength of CAD/CAM-fabricated glass ceramics with resin cement, if the treatment conditions were appropriate.

Effect of sintering on the marginal and internal fit of CAD/CAM-fabricated zirconia frameworks.

The aim of this study was to investigate the effect of post-machining sintering on marginal and internal fit of CAD/CAM-fabricated zirconia frameworks. Single crown copings (A: abutment), three-unit bridge frameworks (APA, P: pontic), four-unit bridge frameworks (APPA), and five-unit bridge frameworks (A1P1A2P2A3) were fabricated with raw-stage zirconia blanks using a commercial CAD/CAM system (KATANA, Noritake Dental Supply Co. Ltd., Aichi, Japan). Crown copings and frameworks were cemented to their respective master abutment models, and thickness of the cement layer was measured at specific measuring points. Marginal and internal fit of both APA and APPA were within clinical acceptance. However, the marginal gap and thickness of the cement layer on the axial surface of the pontic side of APA and APPA were slightly higher than those of the non-pontic side. As for the marginal gap of A1P1A2P2A3 framework, it was superior to those of APA and APPA because the center abutment supported the framework to prevent distortion.

Experimental binder-free investments reused to cast dental precious alloys.

This study aimed to develop reusable dental investments. SiO2 and MgO were selected as refractory materials to prepare three types of investment (coded as 60S-40M, 80S-20M, 100S) with 40, 20, and 0 wt% of MgO. Each type of investment was reused twice. Thermal expansion and compressive strength were examined and statistically evaluated by ANOVA. To evaluate fit of castings, full crowns were cast by using a commercial Au-Ag-Pd alloy with all investment types. Marginal fit was statistically analyzed by cement thickness. It was found that although MgO strengthened the mold, it had little influence on expansion. The strength of 60S-40M was the highest, and 100S had the greatest advantage with regard to thermal expansion. In the evaluation for clinical applicability, all investments were able to cast successfully, but their castings might be undersized. Among the experimental binder-free investments reused for dental casting in this study, 100S in particular showed to be a good candidate for repeated fabrication of precision fit castings.

Novel method for titanium crown casting using a combination of wax patterns fabricated by a CAD/CAM system and a non-expanded investment.

OBJECTIVES: For titanium casting, most commercial investments for titanium recommend casting at a low mold temperature to reduce oxidation. However, the thermal expansion values of the molds at low casting temperatures may be insufficient. The purpose of the current study was to investigate the possibility of obtaining accurate titanium crown casts using wax pattern fabricated by a CAD/CAM system with a non-expanded mold. METHODS: Three types of experimental magnesia-based investments (A, B and C) were made and their properties were evaluated for dental use. Two kinds of wax patterns for full-coverage coping crowns (S-0: cement space of 0 microm; S-20: cement space of 20 microm) were fabricated using a commercial CAD/CAM system. A traditional method (TM) using inlay wax was performed for comparison. The investment for titanium casting was decided from the fundamental data of experimental investments. Titanium crowns were replaced on the stone die and the thickness of the cement layer was evaluated. RESULTS: There were no significant differences for the setting time and setting expansion among the experimental investments, but the aluminous cement content played a role in hardening and contracting the mold. The fit of the titanium crowns differed significantly between the TM and the CAD/CAM system. The ranges of thickness obtained from the TM, S-0 and S-20 were 20.78-357.88 microm, 25.12-107.46 microm and 17.84-58.92 microm, respectively. SIGNIFICANCE: High quality titanium crown casting was obtained using a combination of wax patterns fabricated by a CAD/CAM system and a non-expanded MgO-based investment.

Fracture toughness measurement of dental ceramics using the indentation fracture method with different formulas.

This study examined fracture toughness (KIC) measurements obtained using the indentation fracture (IF) method with a view to improving their reliability. The KIC values of five dental ceramics were measured using the IF method with five different formulas, and the single-edge precracked beam (SEPB) method was used as a control. The elastic moduli of the dental ceramics were evaluated by dynamic hardness test. Load conditions of the dental ceramics that produced a median/radial crack for the IF method formulas were investigated. Based on the resultant c/a and P/c1.5 values, the indentation load (P) required for median/radial crack occurrence varied greatly from 29.4 to 196 N depending on the ceramic used. Among the five formulas, none of the KIC values obtained by the IF method with Miyoshi's formula differed significantly (p > 0.05) from the values obtained using SEPB method. These results suggested that, after an appropriate indentation load is determined, reliable KIC values for small dental ceramic specimens can be easily obtained using the IF method if Miyoshi's formula is used in combination with the dynamic hardness test.

Recycling of used commercial phosphate-bonded investments with additional mono-ammonium phosphate.

Industrial waste is on the increase, resulting in severe environmental contamination. Against this background, this study sought to investigate the possibility of recycling used phosphate-bonded investments. Commercial phosphate-bonded investment was mixed and heated according to manufacturer's instructions, then powdered with a ball mill machine to be used as recycled investment (Code: R). Mono-ammonium phosphate (NH4H2PO4) of 2, 5, 8, 11, and 14 g were added to 100 g of R because of residual MgO, and coded as Ra, Rb, Rc, Rd, and Re respectively. Investment properties were then examined. Particle size of R was 50.66 microm and close to the original investment. It was found that more NH4H2PO4 led to larger setting expansion, smaller thermal expansion, and lower fired strength. The data of Re in these three aspects were 1.42 +/- 0.09%, 0.78 +/- 0.21%, and 8.85 +/- 0.88 MPa respectively, and differences against the original investment were significant. Ra showed significantly longer setting time than other investments. Based on the results of this study, we concluded that it was possible to set used phosphate-bonded investments by adding NH4H2PO4; in particular, Rd showed suitable expansion and acceptable mechanical properties.