Cardiac metastases from neuroendocrine neoplasms: complementary role of SSTR PET/CT and cardiac MRI.

BACKGROUND: Cardiac metastases from neuroendocrine neoplasms (NENs) are being detected with increasing frequency, although the optimal imaging strategy remains unclear. We performed a single-center retrospective study to explore the role of somatostatin receptor positron emission tomography/computed tomography (SSTR PET/CT) and cardiac magnetic resonance imaging (CMR) in NEN cardiac metastases, determine the degree of concordance between the findings of these imaging modalities, and examine the advantages and disadvantages of each imaging technique. A secondary aim was to determine if cardiac metastases were associated with adverse cardiac events during peptide receptor radionuclide therapy (PRRT). METHODS AND RESULTS: 19 patients with NEN cardiac metastases were identified. A retrospective review of electronic medical records was performed, and if available SSTR PET/CT and CMR were blindly re-reviewed by imaging specialists, documenting the number and location of cardiac metastases. All 19 patients had SSTR PET/CT, and 10/19 patients had CMR. SSTR PET/CT identified more metastases than CMR. When identified on CMR, metastases were more accurately localized. 12/19 patients received PRRT, with no cardiac adverse effects. CONCLUSION: SSTR PET/CT and CMR are complementary investigations in the imaging of NEN cardiac metastases. SSTR PET/CT appears more sensitive for lesion detection, and CMR offers better lesion characterization. Both investigations present useful information for the planning of treatment including PRRT, which was administered safely.

Effect of Bleaching Treatment on Fatigue Resistance and Flexural Strength of Bovine Dentin.

PURPOSE: To determine the effects of bleach on dentin fatigue resistance and flexural strength. MATERIALS AND METHODS: Eighty bovine dentin specimens (2 × 2 × 17 mm) were treated with: placebo or 10% carbamide peroxide bleach. Treatment was applied for 6 hours/day for 2 or 8 weeks. After treatment, 10 specimens per group were subjected to fatigue testing (10(6) cycles) whereas the other 10 were stored in artificial saliva as fatigue controls. The specimens undergoing fatigue were checked daily for visible signs of fracture and excluded from subsequent flexural strength tests if fractured. Fatigue control and surviving fatigued specimens were subjected to flexural strength testing. Chi-square, Kruskal-Wallis, factorial analysis of variance (p < 0.05) and Mann-Whitney (p < 0.002) tests were performed. RESULTS: There were significant differences in fatigue resistance (p = 0.003) and flexural strength rank scores (p < 0.0001) among the groups. None of the specimens in the "8-week bleach" group survived the fatigue testing. Fatigue (p = 0.005) and interaction of time and treatment (p = 0.039) were significant factors in the flexural strength results. Fatigued specimens had lower flexural strength than nonfatigued and "8-week bleach" had lower flexural strength than placebo and "2-week bleach" groups. CONCLUSIONS: Prolonged direct bleaching of bovine dentin reduces its fatigue resistance and flexural strength in vitro. Further research is needed in this area. CLINICAL SIGNIFICANCE: It remains prudent to advise patients to limit their exposure to tooth bleaching materials by avoiding direct application of bleach to exposed dentin and by minimizing the duration of bleach treatment.

The use of MDP-based materials for bonding to zirconia.

STATEMENT OF PROBLEM: A strong and stable bond between the luting resin and overlying ceramic restoration is critical to longevity, but no technique has been established for how to provide such a bond when the core material is zirconia. PURPOSE: The purpose of this study was to evaluate the effect of different materials containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) on the bond strength to yttria-tetragonal zirconia polycrystal (Y-TZP) ceramic. MATERIAL AND METHODS: Forty Y-TZP slices (Lava) were cemented to substrates (8 groups; n=5 in each) with or without the previous application of an experimental primer (0.5% MDP) or an MDP-based adhesive (Clearfil S3 Bond Plus or Scotchbond Universal) with either an MDP (Clearfil SA) or a non-MDP (RelyX Ultimate) luting resin. Specimens were cut, stored in distilled water, and microtensile tested (5 beams per specimen) at 48 hours and again at 6 months after luting procedures. The data were analyzed by 4-way ANOVA (α=.05) and the Tukey test (α=.05). The mode of failure was classified with a stereomicroscope, and the treated surfaces were analyzed with energy-dispersive x-ray spectroscopy. RESULTS: Both adhesive (P<.001) and time (P<.001) significantly affected bond strength. The interaction of any of the factors was not significant. The use of an MDP-containing adhesive and the shorter storage time were associated with higher bond strengths. At 48 hours, an overall incidence of 50.5% of Type 1 mode of failure (adhesive at ceramic/resin interface) occurred, as opposed to 68% after 6 months of water storage. Energy-dispersive x-ray spectroscopy results showed peaks of carbon and phosphorus when MDP-based materials were used. CONCLUSIONS: The application of an MDP-based adhesive may improve bond strength to zirconia. However, microtensile bond strength results for all groups did not remain stable over 6 months.

Bi-specific T-cell engagers (BiTEs) in prostate cancer and strategies to enhance development: hope for a BiTE-r future.

Metastatic castrate resistant prostate cancer (mCRPC) continues to have poor survival rates due to limited treatment options. Bi-specific T cell engagers (BiTEs) are a promising class of novel immunotherapies with demonstrated success in haematological malignancies and melanoma. BiTEs developed for tumour associated antigens in prostate cancer have entered clinical testing. These trials have been hampered by high rates of treatment related adverse events, minimal or transient anti-tumour efficacy and generation of high titres of anti-drug antibodies. This paper aims to analyse the challenges faced by the different BiTE therapy constructs and the mCRPC tumour microenvironment that result in therapeutic resistance and identify possible strategies to overcome these issues.

A survey of amalgam use to guide dental education curriculums.

OBJECTIVES: To identify behavioral, preferential, and professional factors influencing the use of amalgam in private practices; and to compare the incidence of the placement of amalgam versus composite resin restorations in the province of Ontario and its pedagogical implications on dental curricula. METHODS: Participants responded anonymously to a 23-question online survey about their current use of dental amalgam and composite resins as well as their opinions regarding both dental materials. The explanatory variables were associated bivariately with the outcome variables, and the most significant predictors were identified using the multivariate analysis. RESULTS: Higher percentages of amalgam use were reported among clinicians who trained in Canada only (P = .009), who graduated before 1980 (p = <.001) and who work outside private practice (p = <.001). Familiarity with amalgam was higher among clinicians who are female (p = <.001), older (p = <.001), trained only in Canada (p = .017), who graduated prior to 2000 (p = <.001), and who work in locations with populations over 100,000 (p = .042). Familiarity with composite resin was higher among clinicians who graduated more recently (p = .002). A higher percentage of females (p = <.001), younger clinicians (p = <.001), recent graduates (p = <.001), and clinicians who work in private practice (p = .043) suggested that over 50% of dental student training time be allocated to amalgam. CONCLUSIONS: Decreased amalgam use was reported by later dental graduates and private practitioners; this may be impacted by familiarity with dental amalgam. As amalgam remains a safe and effective dental material, its removal may not be prudent. Dental educators play a crucial role in the future of amalgam opinion and use.

Room-temperature atomic layer deposition of SiO2 on microcracked ZrO2 layers.

Yttria-stabilized zirconia (Y-SZ) has become a reliable material option to restore severely compromised teeth. Y-SZ materials are prone to low-temperature degradation (LTD), which generates a tetragonal-to-monoclinic (t-m) transformed, porous layer. We suggest that room-temperature atomic layer deposition (RT-ALD) could be used for the infiltration and deposition of nanoscale SiO2 film over this layer, creating a protective hybrid surface against further degradation by LTD. This study investigated the potential of developing a Y-SZ transformed layer under controlled conditions for the infiltration of silica using RT-ALD, aiming to develop a hybrid zirconia-silica interface, and to investigate the effect of silica deposition/infiltration via RT-ALD on the surface roughness and wettability of zirconia-based materials. Sintered specimens (14 mm × 4 mm x 2 mm) were prepared from four different Y-SZ materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid, FX white). Specimens were exposed to hydrothermal treatment (HTT) to develop similar depths of crystalline changes. RT-ALD was used to deposit a thin film of silica (SiO2). Surface roughness and wettability analyses were performed to investigate the effect of treatment (HTT and RT-ALD) and material on Y-SZ surface properties, and data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). RT-ALD and HTT-RT-ALD treated specimens of 3Y-LT and 5Y-HT materials were exposed to further hydrothermal aging (HA) and the surface was characterized by time-of-flight secondary ion mass spectrometry (ToF-SIMS). There was a significant interaction effect of material and treatment (HTT and RT-ALD) on roughness (p = 0.02), and surface wettability (p < 0.001). Silica deposition via RT-ALD resulted in a significant increase in surface roughness of all materials tested, while surface wettability was either improved or not changed based on the material type and HTT exposure. Nanofilms of SiO2 were successfully deposited on Y-SZ materials and infiltrated 3Y-LT zirconia.

Failure rate in the untreated contralateral node negative neck of small lateralized oral cavity cancers: A multi-institutional collaborative study.

OBJECTIVES: The importance of treating the bilateral neck in lateralized small oral cavity squamous cell carcinoma (OCC) is unclear. We sought to define the incidence and predictors of contralateral neck failure (CLF) in patients who underwent unilateral treatment. MATERIALS AND METHODS: We performed a multi-institutional retrospective study of patients with pathologic T1-T2 (AJCC 7th edition) OCC with clinically node negative contralateral neck who underwent unilateral treatment with primary surgical resection ± adjuvant radiotherapy between 2005 and 2015. Incidence of CLF was estimated using the cumulative incidence method. Clinicopathological factors were analyzed by univariate (UVA) and multivariate analysis (MVA) for possible association with CLF. Kaplan-Meier analysis was used to estimate overall survival (OS). RESULTS: 176 patients were evaluated with a median of 65.9 months of follow-up. Predominant pathologic T-stage was T1 (68%), 8.5% of patients were N1, 2.8% were N2b. Adjuvant radiotherapy was delivered to 17% of patients. 5-year incidence of CLF was 4.3% (95% CI 1.2-7.4%). Depth of invasion (DOI) > 10 mm and positive ipsilateral neck node were significant predictors for CLF on UVA. DOI > 10 mm remained significant on MVA (HR = 6.7, 95% CI 1.4-32.3, p = 0.02). The 2- and 5-year OS was 90.6% (95% CI 86.2-95.0%) and 80.6% (95% CI 74.5-86.8%), respectively. CONCLUSION: Observation of the clinically node negative contralateral neck in small lateralized OCC can be a suitable management approach in well selected patients, however caution should be applied when DOI upstages small but deeply invasive tumors to T3 on 8th edition AJCC staging.

Microleakage of posterior composite restorations lined with self-adhesive resin cements.

PURPOSE: This study determined the microleakage of Class II composite restorations lined with self-adhesive resin-cements as bonding agents. METHODS: Forty-five caries-free extracted molars were sterilized, mounted in acrylic bases and divided into five equal groups according to the adhesive used: RXU (RelyX-Unicem, self-adhesive resin-cement, 3M ESPE), BRZ (Breeze, self-adhesive resin-cement, Pentron Clinical Technologies), MON (Monocem, self-adhesive resin-cement, Shofu), PAN (Panavia-F-2.0, resin-cement with self-etch primer, Kuraray) and SBMP (Scotchbond Multi-Purpose, total-etch three-step adhesive, 3M ESPE). Class II MOD cavities were prepared with gingival floors located on dentin at one side and on enamel on the other. The bonding agent SBMP, used according to the manufacturer's directions, or a thin layer of resin cement, was applied on all cavity walls and cavosurface margins. Filtek Z250 (3M ESPE) was used to restore cavities in all groups. The specimens were subjected to 1,000 thermocycles between 5 degrees C and 55 degrees C. All tooth surfaces were sealed with nail-varnish to within 1 mm from the restoration margins. The specimens were immersed in 2% fuchsine red solution for 24 hours at 37 degrees C. The teeth were then sectioned mesiodistally and dye penetration was assessed according to a five-point scale. Data were statistically analyzed with the Chi-square test (p < 0.05). RESULTS: Microleakage scores revealed that, on enamel margins, the SBMP group had significantly less microleakage than the RXU and BRZ groups, which, in turn, had significantly less microleakage than the MON and PAN groups; whereas on dentin margins, the RXU and BRZ groups had significantly less microleakage than the SBMP, MON and PAN groups. CONCLUSIONS: This in-vitro study showed that, when two self-adhesive resin-cements (RXU & BRZ) were used as liners in Class II composite restorations, they resulted in low microleakage scores as compared to the two other cements at both the enamel and dentin cavosurface margins.

Comparative translucency of esthetic composite resin restorative materials.

OBJECTIVE: To evaluate the translucency of currently available composites classified by their respective manufacturers as "opaque," "dentin," "body" (or "universal") and "enamel" materials. MATERIALS AND METHODS: Four disk-shaped specimens were produced using a split-ring mould (13 mm in diameter and 2 mm in thickness) from each of 39 proprietary composite restorative materials. Enamel and dentin samples of equivalent thickness were obtained from extracted human teeth. Colour values for lightness (L*), red-green chromatic coordinate (a*) and blue-yellow chromatic coordinate (b*) were recorded against standard white and black backgrounds with a Minolta CR-300 chroma meter under the standard illuminant D65. Translucency parameter values were calculated and compared using analysis of variance and the Tukey test, with significance set at p < 0.05. RESULTS: A continuum of values for the translucency parameter was obtained, ranging from the most opaque (Filtek Supreme Plus A2D) to the most translucent (Ceram X Duo E2). In general, "opaque" and "dentin" composites yielded relatively low translucency values, "body" (or "universal") composites yielded intermediate values, and "enamel" composites yielded relatively high values. However, the boundaries between these categories were not distinct, and there was some overlap. The mean value of the translucency parameter for human enamel was within the range of values for "enamel" shade composites. The individual values for specimens of human dentin were more variable (i.e., greater standard deviation around the mean) than those for human enamel. The mean value obtained for dentin was intermediate between the ranges for composites with low and intermediate translucency. CONCLUSIONS: The various categories of composite from different manufacturers yielded a wide range of translucency, with minimal distinction between the extremes in adjacent categories. The measured translucency values provided more information than the respective category types. Knowledge of the relative translucency and opacity of different commercial materials can assist clinicians in the choice of composite for clinical use.

The effect of bleaching time on dentin fracture toughness in vitro.

STATEMENT OF PROBLEM: A recent study reported a decrease in dentin fracture toughness after the application of peroxide bleaching products to dentin in vitro. PURPOSE: The objective of the present study was to investigate this in vitro decrease in fracture toughness further by evaluating the effect of different peroxide application times on dentin fracture toughness. MATERIALS AND METHODS: Compact test fracture toughness specimens were prepared from coronal human. These were divided into five groups (N = 12) and subjected to either bleach (10% carbamide peroxide) and/or placebo gel for a total of 336 consecutive hours (0 and 336, 84 and 252, 168 and 168, 252 and 84, 336 and 0 hours of bleach and placebo application time, respectively). The gel materials were changed every 6 hours. Fracture toughness testing was done 24 hours after the end of bleaching using tensile loading at 10 mm/min. Results were analyzed by analysis of variance and linear regression (p < 0.05). RESULTS: Dentin fracture toughness after 252 and 336 hours was significantly reduced compared to the 0- and 84-hour bleach times. An association between fracture toughness and bleach time (r(2) = 0.82) with an inverse linear regression line (K(1C) = -0.0032 [hour] + 3.386) was found. CONCLUSIONS: A significant correlation was found between bleach time and dentin fracture toughness. Dentin fracture toughness was reduced over time during the 336-hour course of in vitro bleaching. CLINICAL SIGNIFICANCE: The results suggest that it would be prudent to minimize the length of time for clinical bleaching procedures when dentin is directly exposed to bleach.

The bond between resin composite restorations and dentin may degrade in the mouth over time.

SUBJECTS: The subjects were outpatients who attended the Department of Pediatric Dentistry of Hokkaido University for treatment of caries. The laboratory study of the dentin-restoration interface of the pulpal wall of Class II composite resin restorations in extracted deciduousmolars were collected from 2 different sources. The first source was restored teeth from a prospective cohort with up to 3 years of observations (n = 22), and the second source was intact teeth from a cross-sectional convenience sample that were subsequently prepared using the same restorative materials and procedure as in vivo and restored extraorally (n = 13) as control specimens. Ethical approval was obtained by the appropriate institutional review board. KEY EXPOSURE/STUDY FACTOR: The primary study factor was the length of time spent by the resin-dentin bond in the oral cavity: (1) control (24 hours in distilled water only); (2) 1 to 2 years; or (3) 2 to 3 years. MAIN OUTCOME MEASURE: The primary outcome measure was the integrity of the resin-dentin bond, measured within 2 weeks of tooth extraction represented by microtensile bond strength and by micromorphometric measurements of the fracture surfaces in a scanning electron microscope. MAIN RESULTS: There were significant differences inmicrotensile bond strengths among all 3 groups-control group, 28.3 +/- 11.3 MPa; 1 to 2 years, 15.2 +/- 4.4 MPa; 2 to 3 years, 9.1 +/- 5.1 MPa (P < .05)-to suggest that the structural integrity of resin-dentin bonds decreased over time. The investigators related the characteristics of the microstructure of the fractured specimens to the observed reductions in microtensile bond strength and attributed this association to in vivo degradation of adhesive and composite resin and of exposed collagen located in the demineralized dentin beneath the resin-impregnated hybrid layer. CONCLUSIONS: The authors concluded that degradation of resin-dentin bond structures occurs after aging in the oral cavity.

The Canadian Core Cariology Curriculum: Outcomes of a national symposium.

Despite the efforts that have been made in dental education and clinical practice to adopt the evidence-informed, risk-based, nonsurgical caries management approach, the surgical treatment approach continues to prevail. There is an urgent need to understand resistance to such a paradigm shift and establish a coordinated evidence-based Cariology teaching approach in Canadian dental schools so trainees are equipped to implement caries management in their practice. To work towards this goal, a two-day interinstitutional symposium was organized in Montreal, QC, bringing together clinical and research experts in cariology and dental education from all 10 Canadian dental schools to develop a consensus on an evidence-informed Core Cariology Curriculum, and strategies for its implementation. Through consensus, participants produced the Core Cariology Curriculum for Canadian dental schools and articulated the challenges and solutions for its implementation. Future work will include working collaboratively on the curriculum integration and evaluation.

Simulated occlusal adjustments and their effects on zirconia and antagonist artificial enamel.

PURPOSE: The aim of this study was to evaluate the effect of occlusal adjustments on the surface roughness of yttria-tetragonal zirconia polycrystal (Y-TZP) and wear of opposing artificial enamel. MATERIALS AND METHODS: Twenty-five Y-TZP slabs from each brand (Lava, 3M and Bruxzir, Glidewell Laboratories) with different surface conditions (Control polished - CPZ; Polished/ground - GRZ; Polished/ground/repolished - RPZ; Glazed - GZ; Porcelain-veneered - PVZ; n=5) were abraded (500,000 cycles, 80 N) against artificial enamel (6 mm diameter steatite). Y-TZP roughness (in µm) before and after chewing simulation (CS) and antagonist steatite volume loss (in mm3) were evaluated using a contact surface profilometer. Y-TZP roughness was analyzed by three-way analysis of variance (ANOVA) and teatite wear by two-way ANOVA and Tukey Honest Difference (HSD) (P=.05). RESULTS: There was no effect of Y-TZP brand on surface roughness (P=.216) and steatite loss (P=.064). A significant interaction effect (P<.001) between surface condition and CS on Y-TZP roughness was observed. GZ specimens showed higher roughness after CS (before CS - 3.7 ± 1.8 µm; after CS - 13.54 ± 3.11 µm), with partial removal of the glaze layer. Indenters abraded against CPZ (0.09 ± 0.03 mm3) were worn more than those abraded against PVZ (0.02 ± 0.01 mm3) and GZ (0.02 ± 0.01 mm3). Higher wear caused by direct abrasion against zirconia was confirmed by SEM. CONCLUSION: Polishing with an intraoral polishing system did not reduce the roughness of zirconia. Wear of the opposing artificial enamel was affected by the material on the surface rather than the finishing technique applied, indicating that polished zirconia is more deleterious to artificial enamel than are glazed and porcelain-veneered restorations.

Flexural strength, elastic modulus, and pH profile of self-etch resin luting cements.

PURPOSE: To determine the flexural strength, modulus of elasticity, and 24-hour pH profile of three self-etching resin luting cements and to obtain comparative data for representative conventional resin and resin-modified glass ionomer luting cements. MATERIALS AND METHODS: Three self-etching resin luting cements [RelyX Unicem (3M ESPE), Maxcem (Kerr), Embrace Wetbond (Pulpdent)] were tested and compared with two conventional resin cements [RelyX ARC (3M ESPE), Linkmax (GC)] plus two resin-modified glass ionomer luting cements [Fuji Plus (GC), RelyX Luting Plus (3M ESPE)]. Flexural strength and modulus of elasticity were determined using bar-shaped specimens (2 x 2 x 25 mm(3)) at 24 hours, using an Instron universal testing machine. Setting pH was measured using a flat-surface pH electrode at 0, 2, 5, 15, and 30 minutes and 1, 2, 4, 6, and 24 hours after mixing. Testing was performed under both dual-cured and self-cured conditions for all dual-cure cements. Data analysis included ANOVA and Tukey's test (p < 0.05). RESULTS: The self-etching cements showed similar flexural strength to the conventional resin cements, except for Embrace Wetbond self-cured, which was considerably lower. Modulus of elasticity results were both higher and lower than for conventional resin cements. All photopolymerized conventional and self-etch dual-cure cements showed markedly higher flexural strength and modulus than when solely self-cured. The resin-modified glass ionomer cements were characterized by lower flexural strength and elastic modulus. Self-etching resin cements showed lower initial pH (2.0 to 2.4) than conventional resin cements (4.8 to 5.2) and a wide range of final pH values (3.9 to 7.3) at 24 hours. One self-etching cement (Unicem) revealed a unique pH profile characterized by a more rapid rise in pH to neutrality both when dual-cured (15 minutes) and when auto-cured (1 hour). CONCLUSIONS: The self-etching resin cements evaluated in this study displayed disparate properties and cannot be considered a homogeneous group. Flexural strength properties were most uniform and were similar to those of the conventional resin cements, whereas moduli of elasticity showed greater variation. Setting pH profiles differed, depending on the brand and mode of cure, even within the same category of luting cement. All cements with dual-cure capability, both conventional and self-etch, showed significantly superior properties when photopolymerized.

Fracture strength and fatigue resistance of all-ceramic molar crowns manufactured with CAD/CAM technology.

PURPOSE: All-ceramic crowns are subject to fracture during function, especially in the posterior area. The use of yttrium-stabilized zirconium-oxide ceramic as a substructure for all-ceramic crowns to improve fracture resistance is unproven. The aim of this study was to compare fracture strength and fatigue resistance of new zirconium-oxide and feldspathic all-ceramic crowns made with computer-aided design/computer-aided manufacturing (CAD/CAM). MATERIALS AND METHODS: An ivorine molar was prepared to receive an all-ceramic crown. Using epoxy resin, 40 replication dies were made of the prepared tooth. Twenty feldspathic all-ceramic crowns (Vita Mark II) (VMII) and 20 zirconium-oxide crown copings (In-Ceram YZ) (YZ) were made using CAD/CAM technique (CEREC-3D). The YZ copings were sintered and veneered manually with a fine-particle ceramic (VM9). All crowns were cemented to their respective dies using resin cement (Panavia F 2.0). Ten crowns in each group were subjected to compressive fatigue loading in a universal testing machine (instron). The other ten crowns from each group were loaded to fracture at a crosshead speed of 1 mm/min. Data were statistically analyzed using independent t-test and Fisher's exact test at alpha= 0.05. RESULTS: There was a significant difference between the survival rates of the two materials during the fatigue test (p < 0.001). All VMII crowns survived without any crack formation, while all YZ crowns fractured (40%) or developed cracks (60%). All the YZ crown fractures occurred within the veneering layer during the fatigue test. There was no significant difference in mean fracture load between the two materials (p= 0.268). Mean fracture loads (standard deviation) in N were: 1459 (492) for YZ crowns and 1272 (109) for VMII crowns. CONCLUSIONS: The performance of VMII crowns was superior to YZ crowns in the fatigue test. The premature fractures and cracks of the YZ crowns were attributed to weakness in the YZ veneer layer or in the core/veneer bond.

Effect of Training Method on Dental Students' Light-Curing Performance.

The aims of this study were to evaluate 1) the effect of different light-curing training methods on first-year dental students' light-curing performance immediately after and one year after training and 2) the effect of dental student year (first vs. third year) and different light-curing training methods on students' light-curing efficacy. The study was organized into two parts, conducted in 2013 and 2014. In the first part, all students (N=66) in the first-year restorative course at a Canadian dental school were invited to participate in a light-curing activity immediately after training; after 12 months, those students (now in their second year) were asked to again perform the light-curing activity. In the second part, all the subsequent first-year students (N=75) and third-year students (N=95) were invited to perform the same light-curing activity after training. Each class was divided into three groups: the Control group received a lecture; the Tips group received the same lecture plus tips on "7 Steps to Ensure Better Light Curing"; and the Simulator group received the lecture, tips, and hands-on training using the patient simulator. In the first part of the study, all 66 students participated in the first year; 39 of those participated a year later. In the second part, all students in both years participated. For the first part, time had a significant effect on light-curing performance, with significantly higher results in the second year. When the first-year students' results were isolated, training method had a significant effect on mean and maximum irradiance values. The second part found a significant effect of training on mean (p=0.003) and maximum (p=0.021) irradiance. The interaction DDS*training was significant (p=0.037) when the after-training values were analyzed. These results point to the need for further research to determine the most effective light-curing training methods.

Exploring Positive Survivorship Experiences of Indigenous Australian Cancer Patients.

Amongst Indigenous Australians, "cancer" has negative connotations that detrimentally impact upon access to cancer care services. Barriers to accessing cancer services amongst Indigenous Australians are widely reported. In contrast, factors that facilitate this cohort to successfully navigate cancer care services ("enablers") are scarcely reported in the literature. Through qualitative interviews, this article examines factors that assist Indigenous Australians to have positive cancer experiences. Semi-structured interviews were conducted with twelve adult Indigenous oncology patients recruited from a tertiary hospital in Queensland, Australia during 2012-2014. Data generated from the interviews were independently reviewed by two researchers via inductive thematic analytical processes. Discussions followed by consensus on the major categories allowed conclusions to be drawn on potential enablers. Two major categories of enablers were identified by the researchers: resilience and communication. Individual's intrinsic strength, their coping strategies, and receipt of support improved participant's resilience and consequently supported a positive experience. Communication methods and an effective patient-provider relationship facilitated positive experiences for participants. Despite potential barriers to access of care for Indigenous cancer patients, participants in the study demonstrated that it was still possible to focus on the positive aspects of their cancer experiences. Many participants explained how cancer changed their outlook on life, often for the better, with many feeling empowered as they progressed through their cancer diagnosis and treatment processes.

Effect of tooth whitening strips on fatigue resistance and flexural strength of bovine dentin in vitro.

OBJECTIVE: To determine the effects of whitening strips on bovine dentin fatigue resistance and flexural strength in vitro. MATERIALS AND METHODS: A total of eighty bovine dentin specimens (2x2x17mm) were treated with either: control glycerine gel on plastic film wrap or whitening strips containing 9.5% hydrogen peroxide. Treatment was applied for 30 minutes, twice a day, for 1- or 4-weeks. After the last treatment, ten specimens per group were randomly selected to undergo fatigue testing (106 cycles, 3Hz, 20N) while the other ten were subjected to flexural strength testing after ten days of storage in artificial saliva. Kaplan-Meier method with a log rank test, Wilcoxon test and Cox regression were used to assess fatigue test results (p<0.05). One-way ANOVA and Tukey's tests were used to compare the flexural strength results (p<0.05). RESULTS: There were significant differences in survival during the fatigue test among the groups (p<0.001). Treatment (control or bleach) was a significant factor for specimen survival (p<0.001, Exp(B) = 33.45). There were significant differences in mean flexural strength (p<0.001). No significant difference was found between "1-wk control" and "4-wk control". The mean flexural strength and fatigue resistance of the "4-wk bleach" were significantly lower than all the other groups. CONCLUSIONS: The use of whitening strips reduced the fatigue resistance and flexural strength of bovine dentin in vitro. Until the effect of whitening strips on mechanical properties of human dentin is fully elucidated, it remains prudent to advise patients to avoid excessive direct use of whitening strips on dentin.

Fracture toughness of chairside CAD/CAM materials - Alternative loading approach for compact tension test.

OBJECTIVE: This in-vitro study determined plane-strain fracture toughness (KIC) of five different chairside CAD/CAM materials used for crown fabrication, following alternative innovative loading approach of compact tension test specimens. METHODS: Rectangular-shaped specimens were cut from CAD/CAM blocks (n=10): Vita Mark II (Vident) (VMII); Lava-Ultimate (3M/ESPE) (LU); Vita Enamic (Vident) (VE); IPS e.max CAD (Ivoclar Vivadent); crystallized and un-crystallized (E-max and E-max-U, respectively); and Celtra Duo (Dentsply) fired and unfired (CD and CD-U, respectively). Specimens were notched with thin diamond disk prior to testing. Instead of applying tensile loading through drilled holes, a specially-made wedge-shaped steel loading-bar was used to apply compressive load at the notch area in Instron universal testing machine. The bar engaged the top » of the notch before compressive load was applied at a cross-head speed of 0.5mm/min. Fracture load was recorded and KIC calculated. Data was statistically-analyzed with one-way ANOVA at 95% confidence level and Tukey's tests. RESULTS: Means and SDs of KIC in MPam(1/2) for VMII, LU, VE, E-max, E-max-U, CD and CD-U were: 0.73 (0.13), 0.85 (0.21), 1.02 (0.19), 1.88 (0.62), 0.81 (0.25), 2.65 (0.32) and 1.01 (0.15), respectively. ANOVA revealed significant difference among the groups (p<0.001). CD and E-max had significantly highest mean KIC values. SIGNIFICANCE: Mean KIC values of the tested materials varied considerably, however, none of them reached mean KIC of dentin (3.08MPam(1/2)) previously reported. For E-max and CD, specimens firing significantly increased mean KIC. The modified test arrangement was found to be easy to follow and simplified specimen preparation process.