Influence of Surface Roughness on Mechanical Properties of Two Computer-aided Design/Computer-aided Manufacturing (CAD/CAM) Ceramic Materials

SUMMARY The aim of this study was to evaluate the influence of surface roughness on surface hardness (Vickers; VHN), elastic modulus (EM), and flexural strength (FLS) of two computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials. One hundred sixty-two samples of VITABLOCS Mark II (VMII) and 162 samples of IPS Empress CAD (IPS) were ground according to six standardized protocols producing decreasing surface roughnesses (n=27/group): grinding with 1) silicon carbide (SiC) paper #80, 2) SiC paper #120, 3) SiC paper #220, 4) SiC paper #320, 5) SiC paper #500, and 6) SiC paper #1000. Surface roughness (Ra/Rz) was measured with a surface roughness meter, VHN and EM with a hardness indentation device, and FLS with a three-point bending test. To test for a correlation between surface roughness (Ra/Rz) and VHN, EM, or FLS, Spearman rank correlation coefficients were calculated. The decrease in surface roughness led to an increase in VHN from (VMII/IPS; medians) 263.7/256.5 VHN to 646.8/601.5 VHN, an increase in EM from 45.4/41.0 GPa to 66.8/58.4 GPa, and an increase in FLS from 49.5/44.3 MPa to 73.0/97.2 MPa. For both ceramic materials, Spearman rank correlation coefficients showed a strong negative correlation between surface roughness (Ra/Rz) and VHN or EM and a moderate negative correlation between Ra/Rz and FLS. In conclusion, a decrease in surface roughness generally improved the mechanical properties of the CAD/CAM ceramic materials tested. However, FLS was less influenced by surface roughness than expected.

Clinical outcome of single porcelain-fused-to-zirconium dioxide crowns: a systematic review

STATEMENT OF PROBLEM The increasing demand by patients for esthetic and metal-free restorations has driven the development of ceramic restorations with good esthetic and mechanical stability. Recent clinical studies have investigated the use of zirconium dioxide as a core material for complete crowns and computer-aided-design/computer-aided-manufacturing fabricated restorations. PURPOSE The aim of this systematic review was to evaluate the clinical survival rates of porcelain-fused-to-zirconia (PFZ) single crowns on anterior and posterior teeth and to compare them with metal ceramic (MC) crowns. MATERIAL AND METHODS A systematic search was conducted with PubMed and manual research to identify literature written in English that refers to in vivo studies published from January 1, 1950 through July 1, 2011. Clinical trials that evaluated PFZ and MC single crowns on natural teeth were selected for further analysis. Titles and/or abstracts of articles identified through the electronic searches were reviewed and evaluated for appropriateness. In addition, a hand search of relevant dental journals was peformed, and reference lists of culled articles were screened to identify publications. RESULTS The search resulted in a total of 488 initial matches. Nineteen studies with a total of 3621 crowns met the inclusion criteria. The survival rates of PFZ crowns (total 300) ranged from 92.7% to 100% for a follow-up time of 24 to 39 months, whereas those of MC crowns (total 3321) ranged from 70% to 100% for a follow-up time of 12 to 298 months. Studies that reported long-term results were found only for the MC crown group. CONCLUSIONS The scientific clinical data available to compare PFZ and MC crowns are limited. The survival rates may well be influenced by the selection and appropriate use of the veneering ceramic, and, therefore, additional prospective long-term clinical trials are necessary to draw reliable conclusions.

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.

Dentin Bond Strength of Two Recent CAD/CAM-Materials after Storage

Purpose: To investigate the bond strength to dentin of two recent resin-ceramic materials for computer-aided design/computer-aided manufacturing (CAD/CAM) after 24 hours and after six months storage. Methods and Materials: Ninety cylinders were milled out of Lava Ultimate (3M ESPE) and 90 cylinders out of VITA ENAMIC (VITA Zahnfabrik) (dimension of cylinders: ∅=3.6 mm, h=2 mm). All Lava Ultimate cylinders were sandblasted (aluminium oxide, grain size: 27 μm) and cleaned with ethanol, whereas all VITA ENAMIC cylinders were acid-etched (5% hydrofluoric acid) and cleaned with water-spray. According to the three groups of cements used, the cylinders (n=30/resin-ceramic material) were further pretreated with 1) Scotchbond Universal for RelyX Ultimate (3M ESPE), 2) CLEARFIL Ceramic Primer for PANAVIA F2.0 (Kuraray), or 3) no further pretreatment for Ketac Cem Plus (3M ESPE). The cylinders were then bonded to ground human dentin specimens with 1) Scotchbond Universal and RelyX Ultimate (light-cured), 2) ED PRIMER II and PANAVIA F2.0 (light-cured), or 3) no adhesive system; Ketac Cem Plus (self-cured). Shear bond strength (SBS) was measured after 24 hours for 15 specimens/group and after six months (37°C, 100% humidity) for the other 15 specimens/group. SBS-values were statistically analysed with nonparametric ANOVA followed by exact Wilcoxon rank sum tests (α=0.05). Results: SBS of the two resin-ceramic materials and the three cements after 24 hours and after six months storage are shown in Figure 1. The statistical analysis showed that the duration of storage had a significant effect on SBS of Lava Ultimate for all three cements but had no significant effect on SBS of VITA ENAMIC. For Lava Ultimate SBS-values were (MPa; medians after 24 hours/six months): 13.5/22.5 (p=0.04) for RelyX Ultimate, 11.4/5.8 (p=0.0006) for PANAVIA F2.0, and 0.34/0.09 (p=0.04) for Ketac Cem Plus (Fig. 1). For VITA ENAMIC SBS-values were (MPa; medians after 24 hours/six months): 16.0/21.2 (p=0.10) for RelyX Ultimate, 11.4/14.4 (p=0.06) for PANAVIA F2.0, and 0.43/0.41 (p=0.32) for Ketac Cem Plus (Fig. 1). After 24 hours, there was no significant difference in SBS between Lava Ultimate and VITA ENAMIC for all three cements (p≥0.37). After six months, there was no significant difference in SBS between Lava Ultimate and VITA ENAMIC for RelyX Ultimate and Ketac Cem Plus (p≥0.07) whereas for PANAVIA F2.0, SBS was significantly lower for Lava Ultimate than for VITA ENAMIC (p<0.0001). Conclusion: SBS of Lava Ultimate was more affected by six months storage and by the cement used than was VITA ENAMIC.

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.

In vitro precision of fit of computer-aided design and computer-aided manufacturing titanium and zirconium dioxide bars

OBJECTIVES Optical scanners combined with computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide high accuracy in the fabrication of titanium (TIT) and zirconium dioxide (ZrO) bars. The aim of this study was to compare the precision of fit of CAD/CAM TIT bars produced with a photogrammetric and a laser scanner. METHODS Twenty rigid CAD/CAM bars were fabricated on one single edentulous master cast with 6 implants in the positions of the second premolars, canines and central incisors. A photogrammetric scanner (P) provided digitized data for TIT-P (n=5) while a laser scanner (L) was used for TIT-L (n=5). The control groups consisted of soldered gold bars (gold, n=5) and ZrO-P with similar bar design. Median vertical distance between implant and bar platforms from non-tightened implants (one-screw test) was calculated from mesial, buccal and distal scanning electron microscope measurements. RESULTS Vertical microgaps were not significantly different between TIT-P (median 16μm; 95% CI 10-27μm) and TIT-L (25μm; 13-32μm). Gold (49μm; 12-69μm) had higher values than TIT-P (p=0.001) and TIT-L (p=0.008), while ZrO-P (35μm; 17-55μm) exhibited higher values than TIT-P (p=0.023). Misfit values increased in all groups from implant position 23 (3 units) to 15 (10 units), while in gold and TIT-P values decreased from implant 11 toward the most distal implant 15. SIGNIFICANCE CAD/CAM titanium bars showed high precision of fit using photogrammetric and laser scanners. In comparison, the misfit of ZrO bars (CAM/CAM, photogrammetric scanner) and soldered gold bars was statistically higher but values were clinically acceptable.

Prion removal capacity of plasma protein manufacturing processes

BACKGROUND The variant Creutzfeldt-Jakob disease incidence peaked a decade ago and has since declined. Based on epidemiologic evidence, the causative agent, pathogenic prion, has not constituted a tangible contamination threat to large-scale manufacturing of human plasma-derived proteins. Nonetheless, manufacturers have studied the prion removal capabilities of various manufacturing steps to better understand product safety. Collectively analyzing the results could reveal experimental reproducibility and detect trends and mechanisms driving prion removal. STUDY DESIGN AND METHODS Plasma Protein Therapeutics Association member companies collected more than 200 prion removal studies on plasma protein manufacturing steps, including precipitation, adsorption, chromatography, and filtration, as well as combined steps. The studies used a range of model spiking agents and bench-scale process replicas. The results were grouped based on key manufacturing variables to identify factors impacting removal. The log reduction values of a group are presented for comparison. RESULTS Overall prion removal capacities evaluated by independent groups were in good agreement. The removal capacity evaluated using biochemical assays was consistent with prion infectivity removal measured by animal bioassays. Similar reduction values were observed for a given step using various spiking agents, except highly purified prion protein in some circumstances. Comparison between combined and single-step studies revealed complementary or overlapping removal mechanisms. Steps with high removal capacities represent the conditions where the physiochemical differences between prions and therapeutic proteins are most significant. CONCLUSION The results support the intrinsic ability of certain plasma protein manufacturing steps to remove prions in case of an unlikely contamination, providing a safeguard to products.

Heterosis for biomass-related traits in Arabidopsis investigated by quantitative trait loci analysis of the triple testcross design with recombinant inbred lines

Arabidopsis thaliana has emerged as a leading model species in plant genetics and functional genomics including research on the genetic causes of heterosis. We applied a triple testcross (TTC) design and a novel biometrical approach to identify and characterize quantitative trait loci (QTL) for heterosis of five biomass-related traits by (i) estimating the number, genomic positions, and genetic effects of heterotic QTL, (ii) characterizing their mode of gene action, and (iii) testing for presence of epistatic effects by a genomewide scan and marker x marker interactions. In total, 234 recombinant inbred lines (RILs) of Arabidopsis hybrid C24 x Col-0 were crossed to both parental lines and their F1 and analyzed with 110 single-nucleotide polymorphism (SNP) markers. QTL analyses were conducted using linear transformations Z1, Z2, and Z3 calculated from the adjusted entry means of TTC progenies. With Z1, we detected 12 QTL displaying augmented additive effects. With Z2, we mapped six QTL for augmented dominance effects. A one-dimensional genome scan with Z3 revealed two genomic regions with significantly negative dominance x additive epistatic effects. Two-way analyses of variance between marker pairs revealed nine digenic epistatic interactions: six reflecting dominance x dominance effects with variable sign and three reflecting additive x additive effects with positive sign. We conclude that heterosis for biomass-related traits in Arabidopsis has a polygenic basis with overdominance and/or epistasis being presumably the main types of gene action.

Additive effects of HLA alleles and innate immune genes determine viral outcome in HCV infection

BACKGROUND Chronic HCV infection is a leading cause of liver-related morbidity globally. The innate and adaptive immune responses are thought to be important in determining viral outcomes. Polymorphisms associated with the IFNL3 (IL28B) gene are strongly associated with spontaneous clearance and treatment outcomes. OBJECTIVE This study investigates the importance of HLA genes in the context of genetic variation associated with the innate immune genes IFNL3 and KIR2DS3. DESIGN We assess the collective influence of HLA and innate immune genes on viral outcomes in an Irish cohort of women (n=319) who had been infected from a single source as well as a more heterogeneous cohort (Swiss Cohort, n=461). In the Irish cohort, a number of HLA alleles are associated with different outcomes, and the impact of IFNL3-linked polymorphisms is profound. RESULTS Logistic regression was performed on data from the Irish cohort, and indicates that the HLA-A*03 (OR 0.36 (0.15 to 0.89), p=0.027) -B*27 (OR 0.12 (0.03 to 0.45), p=<0.001), -DRB1*01:01 (OR 0.2 (0.07 to 0.61), p=0.005), -DRB1*04:01 (OR 0.31 (0.12 to 0.85, p=0.02) and the CC IFNL3 rs12979860 genotypes (OR 0.1 (0.04 to 0.23), p<0.001) are significantly associated with viral clearance. Furthermore, DQB1*02:01 (OR 4.2 (2.04 to 8.66), p=0.008), KIR2DS3 (OR 4.36 (1.62 to 11.74), p=0.004) and the rs12979860 IFNL3 'T' allele are associated with chronic infection. This study finds no interactive effect between IFNL3 and these Class I and II alleles in relation to viral clearance. There is a clear additive effect, however. Data from the Swiss cohort also confirms independent and additive effects of HLA Class I, II and IFNL3 genes in their prediction of viral outcome. CONCLUSIONS This data supports a critical role for the adaptive immune response in the control of HCV in concert with the innate immune response.

Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna

Background: Current literature suggests a positive influence of additive classical homeopathyon global health and well-being in cancer patients. Besides encouraging case reports, thereis little if any research on long-term survival of patients who obtain homeopathic care duringcancer treatment. Design: Data from cancer patients who had undergone homeopathic treatment complementaryto conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in MalignantDiseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected,described and a retrospective subgroup-analysis with regard to survival time was performed.Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis ofdisease, quantitative and qualitative description of patient characteristics, and survival time. Results: In four years, a total of 538 patients were recorded to have visited the OutpatientUnit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7%(n = 287) who had undergone at least three homeopathic consultations within four years, 18.7%(n = 54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblas-toma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cellcarcinoma. Median overall survival was compared to expert expectations of survival outcomesby specific cancer type and was prolonged across observed cancer entities (p < 0.001). Conclusion: Extended survival time in this sample of cancer patients with fatal prognosis butadditive homeopathic treatment is interesting. However, findings are based on a small sample,and with only limited data available about patient and treatment characteristics. The relationshipbetween homeopathic treatment and survival time requires prospective investigation in largersamples possibly using matched-pair control analysis or randomized trials.

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.