Surface Roughness and Microhardness of Two Recent CAD/CAM-Materials After Storage

Objectives: To investigate surface roughness and microhardness of two recent resin-ceramic materials for computer-aided design/computer-aided manufacturing (CAD/CAM) after polishing with three polishing systems. Surface roughness and microhardness were measured immediately after polishing and after six months storage including monthly artificial toothbrushing. Methods: Sixty specimens of Lava Ultimate (3M ESPE) and 60 specimens of VITA ENAMIC (VITA Zahnfabrik) were roughened in a standardized manner and polished with one of three polishing systems (n=20/group): Sof-Lex XT discs (SOFLEX; three-step (medium-superfine); 3M ESPE), VITA Polishing Set Clinical (VITA; two-step; VITA Zahnfabrik), or KENDA Unicus (KENDA; one-step; KENDA Dental). Surface roughness (Ra; μm) was measured with a profilometer and microhardness (Vickers; VHN) with a surface hardness indentation device. Ra and VHN were measured immediately after polishing and after six months storage (tap water, 37°C) including monthly artificial toothbrushing (500 cycles/month, toothpaste RDA ~70). Ra- and VHN-values were analysed with nonparametric ANOVA followed by Wilcoxon rank sum tests (α=0.05). Results: For Lava Ultimate, Ra (mean [standard deviation] before/after storage) remained the same when polished with SOFLEX (0.18 [0.09]/0.19 [0.10]; p=0.18), increased significantly with VITA (1.10 [0.44]/1.27 [0.39]; p=0.0001), and decreased significantly with KENDA (0.35 [0.07]/0.33 [0.08]; p=0.03). VHN (mean [standard deviation] before/after storage) decreased significantly regardless of polishing system (SOFLEX: 134.1 [5.6]/116.4 [3.6], VITA: 138.2 [10.5]/115.4 [5.9], KENDA: 135.1 [6.2]/116.7 [6.3]; all p<0.0001). For VITA ENAMIC, Ra (mean [standard deviation] before/after storage) increased significantly when polished with SOFLEX (0.37 [0.18]/0.41 [0.14]; p=0.01) and remained the same with VITA (1.32 [0.37]/1.31 [0.40]; p=0.58) and with KENDA (0.81 [0.35]/0.78 [0.32]; p=0.21). VHN (mean [standard deviation] before/after storage) remained the same regardless of polishing system (SOFLEX: 284.9 [24.6]/282.4 [31.8], VITA: 284.6 [28.5]/276.4 [25.8], KENDA: 292.6 [26.9]/282.9 [24.3]; p=0.42-1.00). Conclusion: Surface roughness and microhardness of Lava Ultimate was more affected by storage and artificial toothbrushing than was VITA ENAMIC.

Postmortem MR quantification of the heart for characterization and differentiation of ischaemic myocardial lesions.

OBJECTIVES Recently, an MRI quantification sequence has been developed which can be used to acquire T1- and T2-relaxation times as well as proton density (PD) values. Those three quantitative values can be used to describe soft tissue in an objective manner. The purpose of this study was to investigate the applicability of quantitative cardiac MRI for characterization and differentiation of ischaemic myocardial lesions of different age. MATERIALS AND METHODS Fifty post-mortem short axis cardiac 3 T MR examinations have been quantified using a quantification sequence. Myocardial lesions were identified according to histology and appearance in MRI images. Ischaemic lesions were assessed for mean T1-, T2- and proton density values. Quantitative values were plotted in a 3D-coordinate system to investigate the clustering of ischaemic myocardial lesions. RESULTS A total of 16 myocardial lesions detected in MRI images were histologically characterized as acute lesions (n = 8) with perifocal oedema (n = 8), subacute lesions (n = 6) and chronic lesions (n = 2). In a 3D plot comprising the combined quantitative values of T1, T2 and PD, the clusters of all investigated lesions could be well differentiated from each other. CONCLUSION Post-mortem quantitative cardiac MRI is feasible for characterization and discrimination of different age stages of myocardial infarction. KEY POINTS • MR quantification is feasible for characterization of different stages of myocardial infarction. • The results provide the base for computer-aided MRI cardiac infarction diagnosis. • Diagnostic criteria may also be applied for living patients.

Temperature dependence of postmortem MR quantification for soft tissue discrimination.

OBJECTIVES To investigate and correct the temperature dependence of postmortem MR quantification used for soft tissue characterization and differentiation in thoraco-abdominal organs. MATERIAL AND METHODS Thirty-five postmortem short axis cardiac 3-T MR examinations were quantified using a quantification sequence. Liver, spleen, left ventricular myocardium, pectoralis muscle and subcutaneous fat were analysed in cardiac short axis images to obtain mean T1, T2 and PD tissue values. The core body temperature was measured using a rectally inserted thermometer. The tissue-specific quantitative values were related to the body core temperature. Equations to correct for temperature differences were generated. RESULTS In a 3D plot comprising the combined data of T1, T2 and PD, different organs/tissues could be well differentiated from each other. The quantitative values were influenced by the temperature. T1 in particular exhibited strong temperature dependence. The correction of quantitative values to a temperature of 37 °C resulted in better tissue discrimination. CONCLUSION Postmortem MR quantification is feasible for soft tissue discrimination and characterization of thoraco-abdominal organs. This provides a base for computer-aided diagnosis and detection of tissue lesions. The temperature dependence of the T1 values challenges postmortem MR quantification. Equations to correct for the temperature dependence are provided. KEY POINTS • Postmortem MR quantification is feasible for soft tissue discrimination and characterization • Temperature dependence of the T1 values challenges the MR quantification approach • The results provide the basis for computer-aided postmortem MRI diagnosis • Diagnostic criteria may also be applied for living patients.

The molecular signature of the stroma response in prostate cancer-induced osteoblastic bone metastasis highlights expansion of hematopoietic and prostate epithelial stem cell niches

The reciprocal interaction between cancer cells and the tissue-specific stroma is critical for primary and metastatic tumor growth progression. Prostate cancer cells colonize preferentially bone (osteotropism), where they alter the physiological balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption, and elicit prevalently an osteoblastic response (osteoinduction). The molecular cues provided by osteoblasts for the survival and growth of bone metastatic prostate cancer cells are largely unknown. We exploited the sufficient divergence between human and mouse RNA sequences together with redefinition of highly species-specific gene arrays by computer-aided and experimental exclusion of cross-hybridizing oligonucleotide probes. This strategy allowed the dissection of the stroma (mouse) from the cancer cell (human) transcriptome in bone metastasis xenograft models of human osteoinductive prostate cancer cells (VCaP and C4-2B). As a result, we generated the osteoblastic bone metastasis-associated stroma transcriptome (OB-BMST). Subtraction of genes shared by inflammation, wound healing and desmoplastic responses, and by the tissue type-independent stroma responses to a variety of non-osteotropic and osteotropic primary cancers generated a curated gene signature ("Core" OB-BMST) putatively representing the bone marrow/bone-specific stroma response to prostate cancer-induced, osteoblastic bone metastasis. The expression pattern of three representative Core OB-BMST genes (PTN, EPHA3 and FSCN1) seems to confirm the bone specificity of this response. A robust induction of genes involved in osteogenesis and angiogenesis dominates both the OB-BMST and Core OB-BMST. This translates in an amplification of hematopoietic and, remarkably, prostate epithelial stem cell niche components that may function as a self-reinforcing bone metastatic niche providing a growth support specific for osteoinductive prostate cancer cells. The induction of this combinatorial stem cell niche is a novel mechanism that may also explain cancer cell osteotropism and local interference with hematopoiesis (myelophthisis). Accordingly, these stem cell niche components may represent innovative therapeutic targets and/or serum biomarkers in osteoblastic bone metastasis.

Fully automatic segmentation of AP pelvis X-rays via random forest regression with efficient feature selection and hierarchical sparse shape composition

In clinical practice, traditional X-ray radiography is widely used, and knowledge of landmarks and contours in anteroposterior (AP) pelvis X-rays is invaluable for computer aided diagnosis, hip surgery planning and image-guided interventions. This paper presents a fully automatic approach for landmark detection and shape segmentation of both pelvis and femur in conventional AP X-ray images. Our approach is based on the framework of landmark detection via Random Forest (RF) regression and shape regularization via hierarchical sparse shape composition. We propose a visual feature FL-HoG (Flexible- Level Histogram of Oriented Gradients) and a feature selection algorithm based on trace radio optimization to improve the robustness and the efficacy of RF-based landmark detection. The landmark detection result is then used in a hierarchical sparse shape composition framework for shape regularization. Finally, the extracted shape contour is fine-tuned by a post-processing step based on low level image features. The experimental results demonstrate that our feature selection algorithm reduces the feature dimension in a factor of 40 and improves both training and test efficiency. Further experiments conducted on 436 clinical AP pelvis X-rays show that our approach achieves an average point-to-curve error around 1.2 mm for femur and 1.9 mm for pelvis.

Influence of Abutment Design on Stiffness, Strength, and Failure of Implant-Supported Monolithic Resin Nano Ceramic (RNC) Crowns

BACKGROUND Recent technical development allows the digital manufacturing of monolithic reconstructions with high-performance materials. For implant-supported crowns, the fixation requires an abutment design onto which the reconstruction can be bonded. PURPOSE The aim of this laboratory investigation was to analyze stiffness, strength, and failure modes of implant-supported, computer-assisted design and computer-aided manufacturing (CAD/CAM)-generated resin nano ceramic (RNC) crowns bonded to three different titanium abutments. MATERIALS AND METHODS Eighteen monolithic RNC crowns were produced and loaded in a universal testing machine under quasi-static condition according to DIN ISO 14801. With regard to the type of titanium abutment, three groups were defined: (1) prefabricated cementable standard; (2) CAD/CAM-constructed individualized; and (3) novel prefabricated bonding base. Stiffness and strength were measured and analyzed statistically with Wilcoxon rank sum test. Sections of the specimens were examined microscopically. RESULTS Stiffness demonstrated high stability for all specimens loaded in the physiological loading range with means and standard deviations of 1,579 ± 120 N/mm (group A), 1,733 ± 89 N/mm (group B), and 1,704 ± 162 N/mm (group C). Mean strength of the novel prefabricated bonding base (group C) was 17% lower than of the two other groups. Plastic deformations were detectable for all implant-abutment crown connections. CONCLUSIONS Monolithic implant crowns made of RNC seem to represent a feasible and stable prosthetic construction under laboratory testing conditions with strength higher than the average occlusal force, independent of the different abutment designs used in this investigation.

In Vitro Implant Impression Accuracy Using a New Photopolymerizing SDR Splinting Material

PURPOSE The study aims to evaluate three-dimensionally (3D) the accuracy of implant impressions using a new resin splinting material, "Smart Dentin Replacement" (SDR). MATERIALS AND METHODS A titanium model of an edentulous mandible with six implant analogues was used as a master model and its dimensions measured with a coordinate measuring machine. Before the total 60 impressions were taken (open tray, screw-retained abutments, vinyl polysiloxane), they were divided in four groups: A (test): copings pick-up splinted with dental floss and fotopolymerizing SDR; B (test): see A, additionally sectioned and splinted again with SDR; C (control): copings pick-up splinted with dental floss and autopolymerizing Duralay® (Reliance Dental Mfg. Co., Alsip, IL, USA) acrylic resin; and D (control): see C, additionally sectioned and splinted again with Duralay. The impressions were measured directly with an optomechanical coordinate measuring machine and analyzed with a computer-aided design (CAD) geometric modeling software. The Wilcoxon matched-pair signed-rank test was used to compare groups. RESULTS While there was no difference (p = .430) between the mean 3D deviations of the test groups A (17.5 μm) and B (17.4 μm), they both showed statistically significant differences (p < .003) compared with both control groups (C 25.0 μm, D 19.1 μm). CONCLUSIONS Conventional impression techniques for edentulous jaws with multiple implants are highly accurate using the new fotopolymerizing splinting material SDR. Sectioning and rejoining of the SDR splinting had no impact on the impression accuracy.

CAD/CAM fabrication accuracy of long- vs. short-span implant-supported FDPs

OBJECTIVE To compare the precision of fit of long-span vs. short-span implant-supported screw-retained fixed dental prostheses (FDPs) made from computer-aided-design/computer-aided-manufactured (CAD/CAM) titanium and veneered with ceramic. The null hypothesis was that there is no difference in the vertical microgap between long-span and short-span FDPs. MATERIALS AND METHODS CAD/CAM titanium frameworks for an implant-supported maxillary FDP on implants with a flat platform were fabricated on one single master cast. Group A consisted of six 10-unit FDPs connected to six implants (FDI positions 15, 13, 11, 21, 23, 25) and group B of six 5-unit FDPs (three implants, FDI positions 21, 23, 25). The CAD/CAM system from Biodenta Swiss AG (Berneck, Switzerland) was used for digitizing (laser scanner) the master cast and anatomical CAD of each framework separately. The frameworks were milled (CAM) from a titanium grade V monobloc and veneered with porcelain. Median vertical distance between implant and FDP platforms from the non-tightened implants (one-screw test on implant 25) was calculated from mesial, buccal, and distal scanning electron microscope measurements. RESULTS All measurements showed values <40 μm. Total median vertical microgaps were 23 μm (range 2-38 μm) for group A and 7 μm (4-24 μm) for group B. The difference between the groups was statistically significant at implant 21 (P = 0.002; 97.5% CI -27.3 to -4.9) and insignificant at implant 23 (P = 0.093; -3.9 to 1.0). CONCLUSIONS CAD/CAM fabrication including laboratory scanning and porcelain firing was highly precise and reproducible for all long- and short-span FDPs. While all FDPs showed clinically acceptable values, the short-span FDPs were statistically more precise at the 5-unit span distance.

Dentinhaftkraft zweier neuer CAD/CAM-Materialien in Abhängigkeit verschiedener adhäsiver Zementsysteme

Zielsetzung: Ziel der Studie war die Bestimmung der Dentinhaftkraft von zwei so-genannten Hybridmaterialien für computer-aided design/computer-aided manufacturing (CAD/CAM) Restaurationen unter Anwendung von fünf verschiedenen Zementen vor und nach sechsmonatiger Lagerung. Materialien und Methoden: Aus extrahierten menschlichen Molaren wurden 300 Dentinprobekörper hergestellt (n=15 pro Gruppe; 10 Gruppen (2 Hybridkeramiken, 5 Zemente) je nach 24 h/nach sechsmonatiger Lagerung). Aus Hybridkeramikblöcken von Lava Ultimate (3M ESPE) und VITA ENAMIC (VITA Zahnfabrik) wurden Zylinder hergestellt, welche standardisiert aufgeraut wurden. Anschliessend wurden die Hybrid-keramikzylinder mit einem der folgenden fünf Zemente auf die Dentinprobekörper zementiert: mit den Kompositzementen RelyX Ultimate (3M ESPE), PANAVIA F2.0 (Kuraray), Variolink II (Ivoclar Vivadent), els cem (Saremco Dental AG) oder als Negativkontrollgruppe mit dem kunststoffmodifizierten Glasionomerzement Ketac Cem Plus (3M ESPE). Die Dentinhaftkraft der Hybridkeramikzylinder wurde einerseits nach 24 h und andererseits nach sechsmonatiger Lagerung via Scherkrafttest bestimmt. Nach dem Scherkrafttest wurde das Bruchmuster unter einem Lichtmikroskop bei 40-facher Vergrösserung beurteilt. Die Dentinhaftkraftwerte wurden mittels nichtparametrischer ANOVA gefolgt von exakten Wilcoxon Rangsummen-Tests statistisch analysiert (α=0,05). Die Beurteilung des Bruchmusters wurde deskriptiv ausgewertet. Resultate: Für die Hybridkeramik Lava Ultimate und nach 24 h erzielten die Kompositzemente RelyX Ultimate und Variolink II die höchsten Dentinhaftkraftwerte. Die Dentinhaftkraftwerte von RelyX Ultimate und Variolink II unterschieden sich nicht signifikant. Die Dentinhaftkraftwerte von PANAVIA F2.0 unterschieden sich ebenfalls nicht signifikant von denjenigen von RelyX Ultimate, waren jedoch signifikant tiefer als diejenigen von Variolink II. Unter allen Kompositzementen erzielte els cem die tiefsten Dentinhaftkraftwerte. Nach sechsmonatiger Lagerung waren die Dentinhaftkraftwerte für RelyX Ultimate die höchsten, gefolgt von Variolink II, von els cem und anschliessend von PANAVIA F2.0, welcher nach sechsmonatiger Lagerung die tiefsten Dentinhaftkraftwerte der Kompositzemente zeigte. Der kunststoffmodifizierte Glasionomerzement Ketac Cem Plus zeigte sowohl nach 24 h als auch nach sechsmonatiger Lagerung die tiefsten Dentinhaftkraftwerte. Für VITA ENAMIC war die Reihenfolge der Zemente nach Dentinhaftkraft nach 24 h ähnlich wie diejenige nach sechsmonatiger Lagerung: Die Dentinhaftkraft war für RelyX Ultimate und Variolink II am höchsten, gefolgt von PANAVIA F2.0, von els cem und schlussendlich von Ketac Cem Plus mit den tiefsten Dentinhaftkraftwerten. Nach 24 h und für alle fünf Zemente unterschieden sich die Dentinhaftkraftwerte zwischen Lava Ultimate und VITA ENAMIC nicht signifikant. Nach sechsmonatiger Lagerung unterschieden sich die Dentinhaftkraftwerte zwischen Lava Ultimate und VITA ENAMIC ebenfalls nicht signifikant für RelyX Ultimate und els cem im Gegensatz zu den Dentinhaftkraftwerten von PANAVIA F2.0, Variolink II und Ketac Cem Plus, welche signifikant tiefer waren für Lava Ultimate als für VITA ENAMIC. Das häufigste Bruch-muster war für Lava Ultimate nach 24 h und für VITA ENAMIC sowohl nach 24 h als auch nach sechsmonatiger Lagerung adhäsiv zwischen Dentin und Zement. Nach sechs-monatiger Lagerung war für Lava Ultimate das häufigste Bruchmuster tendenziell gemischte Brüche. Schlussfolgerung: Basierend auf den Resultaten kann gesagt werden, dass für beide Hybridkeramiken sowohl RelyX Ultimate als auch Variolink II empfohlen werden können. PANAVIA F2.0 kann für VITA ENAMIC empfohlen werden, für Lava Ultimate allerdings weniger, da die Dentinhaftkraft nach sechsmonatiger Lagerung abnahm. Von einer konventionellen (allerdings nicht indizierten und in dieser Studie experimentellen) Zemen-tierung der beiden Hybridkeramiken mit dem kunststoffmodifizierten Glasionomerzement Ketac Cem Plus muss abgeraten werden.

Einfluss von Politursystemen auf Oberflächenrauigkeit und mechanische Eigenschaften von CAD/CAM-Materialien

Zielsetzung: Das Ziel dieser Studie war, den Einfluss von drei Politursystemen auf die Oberflächenrauigkeit von verschiedenen Materialien für computer-aided design/computer-aided manufacturing (CAD/CAM) Restaurationen mittels Profilometrie sowie die mikromechanischen Eigenschaften der Materialien mittels Mikrohärtemessgerät zu analysieren. Materialien und Methoden: Von dem CAD/CAM-Kompositmaterial Paradigm MZ100 (3M ESPE), der CAD/CAM-Feldspatkeramik VITABLOCS Mark II (VITA Zahnfabrik) und den CAD/CAM-Hybridmaterialien Lava Ultimate (3M ESPE), VITA ENAMIC (VITA Zahnfabrik) und AMBARINO High-Class (Creamed) wurden je 60 Prüfkörper zugeschnitten, gekennzeichnet und standardisiert aufgerauht. Die standardisierte Aufrauhung wurde mit Baseline-Rauigkeitsmessungen überprüft (Ra und Rz; µm). Die Prüfkörper wurden mit einem von drei Politursystemen poliert (n=20 pro CAD/CAM-Material): 1) Sof-Lex Scheiben (Disc-System, 3 Politurschritte: medium, fein und superfein; 3M ESPE), 2) VITA Polishing Set Clinical (Silikonpolitursystem, 2 Politurschritte: medium und fein; VITA Zahnfabrik) oder 3) KENDA Nobilis (Silikonpolierer, 1 Politurschritt (universal); KENDA Dental). Nach Politur der Prüfkörper wurden Ra und Rz sowie die mikromechanischen Eigenschaften Oberflächenhärte (VHN; Vickers Härte) und Elastizitätsmodul (EM; GPa) gemessen. In den darauf folgenden sechs Monaten wurden die Prüfkörper in Leitungswasser gelagert und insgesamt sechs Mal einem maschinellem Zahnbürsten zugeführt. Anschliessend wurden erneut Ra und Rz sowie VHN und EM gemessen. Ra-, Rz-, VHN- und EM-Werte wurden mittels nichtparametrischer ANOVA global analysiert und die p-Werte mittels Bonferroni-Holm Korrektur für multiples Testen korrigiert. Als post-hoc Tests wurden Kruskal-Wallis-Tests sowie exakte Wilcoxon Rangsummen-Tests verwendet und die p-Werte wurden nicht korrigiert. Das Signifikanzniveau wurde auf α=0,05 festgelegt. Resultate: Für alle drei CAD/CAM-Hybridmaterialien ergaben Sof-Lex Scheiben nach der Politur die tiefste Oberflächenrauigkeit (d. h. die tiefsten Ra- und Rz-Werte), gefolgt von KENDA Nobilis und von dem VITA Polishing Set Clinical. Bei dem CAD/CAM-Kompositmaterial sowie bei der CAD/CAM-Feldspatkeramik ergaben Sof-Lex Scheiben und KENDA Nobilis ähnliche Resultate, gefolgt von dem VITA Polishing Set Clinical. Bei einigen CAD/CAM-Materialien zeigten sich – zum Teil in Abhängigkeit des Politursystems – nach maschinellem Zahnbürsten und Lagerung signifikant höhere Ra- und Rz-Werte. Die CAD/CAM-Materialien zeigten unabhängig des Politursystems und der Lagerung signifikant verschiedene VHN- und EM-Werte. Bei einigen CAD/CAM-Materialien zeigten sich – zum Teil ebenfalls in Abhängigkeit des Politursystems – nach maschinellem Zahn-bürsten und Lagerung signifikant tiefere VHN- und EM-Werte. Schlussfolgerungen: Die Wahl des Politursystems beeinflusste die Oberflächenrauigkeit der CAD/CAM-Materialien markant, wobei Sof-Lex Scheiben insgesamt die besten Politurresultate zeigten, gefolgt von dem Silikonpolierer KENDA Nobilis. Von der Verwendung des Silikonpolitursystems VITA Polishing Set Clinical muss eher abgeraten werden. Das CAD/CAM-Kompositmaterial Paradigm MZ100 und die CAD/CAM-Hybridmaterialien Lava Ultimate und AMBARINO High-Class als weichere und elastischere Materialien liessen sich insgesamt besser polieren, waren aber bezüglich mechanischer Eigenschaften anfälliger auf Lagerung als die härtere CAD/CAM-Feldspatkeramik VITABLOCS Mark II und das CAD/CAM-Hybridmaterial VITA ENAMIC.

CompAS: A new approach to commonality and variability analysis with applications in computer assisted orthopaedic surgery

In rapidly evolving domains such as Computer Assisted Orthopaedic Surgery (CAOS) emphasis is often put first on innovation and new functionality, rather than in developing the common infrastructure needed to support integration and reuse of these innovations. In fact, developing such an infrastructure is often considered to be a high-risk venture given the volatility of such a domain. We present CompAS, a method that exploits the very evolution of innovations in the domain to carry out the necessary quantitative and qualitative commonality and variability analysis, especially in the case of scarce system documentation. We show how our technique applies to the CAOS domain by using conference proceedings as a key source of information about the evolution of features in CAOS systems over a period of several years. We detect and classify evolution patterns to determine functional commonality and variability. We also identify non-functional requirements to help capture domain variability. We have validated our approach by evaluating the degree to which representative test systems can be covered by the common and variable features produced by our analysis.