A systematic review of the clinical performance of CAD/CAM single-tooth restorations

PURPOSE: This systematic review sought to determine the long-term clinical survival rates of single-tooth restorations fabricated with computer-aided design/computer-assisted manufacture (CAD/CAM) technology, as well as the frequency of failures depending on the CAD/CAM system, the type of restoration, the selected material, and the luting agent. MATERIALS AND METHODS: An electronic search from 1985 to 2007 was performed using two databases: Medline/PubMed and Embase. Selected keywords and well-defined inclusion and exclusion criteria guided the search. All articles were first reviewed by title, then by abstract, and subsequently by a full text reading. Data were assessed and extracted by two independent examiners. The pooled results were statistically analyzed and the overall failure rate was calculated by assuming a Poisson-distributed number of events. In addition, reported failures were analyzed by CAD/CAM system, type of restoration, restorative material, and luting agent. RESULTS: From a total of 1,957 single-tooth restorations with a mean exposure time of 7.9 years and 170 failures, the failure rate was 1.75% per year, estimated per 100 restoration years (95% CI: 1.22% to 2.52%). The estimated total survival rate after 5 years of 91.6% (95% CI: 88.2% to 94.1%) was based on random-effects Poisson regression analysis. CONCLUSIONS: Long-term survival rates for CAD/CAM single-tooth Cerec 1, Cerec 2, and Celay restorations appear to be similar to conventional ones. No clinical studies or randomized clinical trials reporting on other CAD/CAM systems currently used in clinical practice and with follow-up reports of 3 or more years were found at the time of the search.

Analyzing online communication from a social network point of view: questions, problems, perspectives

This programmatic paper investigates the possibilities, chances, and risks of analyzing personal and professional online communication from the point of view of interactional sociolinguistics combined with modern social network analysis (SNA). Thus, it has two complementing goals: One is the exploration of adequate, innovative concepts and methods for analyzing online communication, the other is to use online communication and its ontological and functional specificities to enrich the conceptual and methodological background of SNA. The paper is organized in two parts. It begins with an introduction to recent developments in sociolinguistic social network analysis. Here, three interesting new concepts and tools are discussed: latent versus emergent networks (Watts 1991), coalitions (Fitzmaurice 2000a, Fitzmaurice 2000b), and communities of practice (Wenger 1998

Not for Designers: On the Inadequacies of EU Design Law and How to Fix It

Design rights represent an interesting example of how the EU legislature has successfully regulated an otherwise heterogeneous field of law. Yet this type of protection is not for all. The tools created by EU intervention have been drafted paying much more attention to the industry sector rather than to designers themselves. In particular, modern, digitally based, individual or small-sized, 3D printing, open designers and their needs are largely neglected by such legislation. There is obviously nothing wrong in drafting legal tools around the needs of an industrial sector with an important role in the EU economy, on the contrary, this is a legitimate and good decision of industrial policy. However, good legislation should be fair, balanced, and (technologically) neutral in order to offer suitable solutions to all the players in the market, and all the citizens in the society, without discriminating the smallest or the newest: the cost would be to stifle innovation. The use of printing machinery to manufacture physical objects created digitally thanks to computer programs such as Computer-Aided Design (CAD) software has been in place for quite a few years, and it is actually the standard in many industrial fields, from aeronautics to home furniture. The change in recent years that has the potential to be a paradigm-shifting factor is a combination between the opularization of such technologies (price, size, usability, quality) and the diffusion of a culture based on access to and reuse of knowledge. We will call this blend Open Design. It is probably still too early, however, to say whether 3D printing will be used in the future to refer to a major event in human history, or instead will be relegated to a lonely Wikipedia entry similarly to ³Betamax² (copyright scholars are familiar with it for other reasons). It is not too early, however, to develop a legal analysis that will hopefully contribute to clarifying the major issues found in current EU design law structure, why many modern open designers will probably find better protection in copyright, and whether they can successfully rely on open licenses to achieve their goals. With regard to the latter point, we will use Creative Commons (CC) licenses to test our hypothesis due to their unique characteristic to be modular, i.e. to have different license elements (clauses) that licensors can choose in order to adapt the license to their own needs.”

Rechnergestützte Analyse von mehrfach eingescherten Seiltrieben

Die Bestimmung der Anzahl der Biegewechsel von laufenden Drahtseilen ist ein wesentlicher Bestandteil bei der Betriebsdaueranalyse von Seiltrieben. Auf Seilabschnitte, die während der Betriebszeit die meisten Biegewechsel erfahren, sollte bei einer Seilprüfung besonderes Augenmerk gelegt werden. Gerade bei mehrfacher Einscherung ist jedoch nicht immer von vorn herein ersichtlich, um welche Seilabschnitte es sich dabei handelt. Auf der Basis der Geometrie des mehrfach eingescherten Seiltriebs wird ein rechnergestütztes Analyseverfahren zur Ermittlung der Anzahl der Biegewechsel entlang des Drahtseils bei einem Arbeitsspiel vorgestellt.

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.

Repeatability analysis of global and local metrics of brain structural networks

Computational network analysis provides new methods to analyze the human connectome. Brain structural networks can be characterized by global and local metrics that recently gave promising insights for diagnosis and further understanding of neurological, psychiatric and neurodegenerative disorders. In order to ensure the validity of results in clinical settings the precision and repeatability of the networks and the associated metrics must be evaluated. In the present study, nineteen healthy subjects underwent two consecutive measurements enabling us to test reproducibility of the brain network and its global and local metrics. As it is known that the network topology depends on the network density, the effects of setting a common density threshold for all networks were also assessed. Results showed good to excellent repeatability for global metrics, while for local metrics it was more variable and some metrics were found to have locally poor repeatability. Moreover, between subjects differences were slightly inflated when the density was not fixed. At the global level, these findings confirm previous results on the validity of global network metrics as clinical biomarkers. However, the new results in our work indicate that the remaining variability at the local level as well as the effect of methodological characteristics on the network topology should be considered in the analysis of brain structural networks and especially in networks comparisons.

A study of the impact of cigarette advertising on adolescent susceptibility to smoking among 5th-, 8th-, and 12th-grade students in Hempstead and Hitchcock Independent School Districts

This study assessed the impact of cigarette advertising on adolescent susceptibility to smoking in the Hempstead and Hitchcock Independent School Districts. A convenience sample of 217 youths, 10-19 years of age was recruited in the study. Students completed both a paper-and-pencil and a computer-aided questionnaire in April 1996. Adolescents were defined as susceptible to smoking if they could not definitely rule out the possibility of future smoking. For the analysis, an index was devised: a 5-point index of an individual's receptivity to cigarette advertising. The index is determined by the number of positive responses to five survey items (recognizing cigarette brand logos, recognizing cigarette advertisement's pictures, recognizing cigarette brand slogans, evaluating adolescent attitudes toward cigarette advertising, and the degree to which adolescents were exposed to cigarette advertisements). Using logistic regression, we assessed the independent importance of the index in predicting susceptibility to smoking and ever smoking after adjusting for sociodemographic variables, perceived school performance and family composition. Of students surveyed, 54.4% of students appeared to have started the smoking uptake process as measured by susceptibility to smoking. Camel was recognized by the majority of students (88%), followed by Marlboro (41.5%) and Newport (40.1%). The pattern for recognition of the cigarette advertisements was the same as the pattern of market for cigarette. Advertisement featuring the cartoon character Joe Camel was significantly more appealing to adolescents than were advertisements with human models, with animal models, and with text only (p $<$ 0.001). Text only advertisement was significantly less appealing than other types of advertisements. The cigarette advertisement with White models (Marlboro) had significantly higher appeal to White students than to African-American students (p $<$ 0.001). The cigarette advertisement featuring African-American models (Virginia Slims) was significantly more appealing to African-American students than other ethnic groups (p $<$ 0.001). Receptivity to cigarette advertising was to be an important concurrent predictor of past smoking experience and intention to smoke in the future. Adolescents who scored in the fourth quartile of the Index of Receptivity to Cigarette Advertising were 7.54 (95% confidence interval (CI) = 1.92-29.56) times as likely to be susceptible to smoking, and were 4.56 (95% CI = 1.55-13.38) times as likely to have tried smoking, as those who scored in the first quartile of the Index. The findings confirmed the hypothesis that cigarette advertising may be a strong current influence in encouraging adolescents to initiate the smoking uptake process than sociodemographic variables, perceived school performance and family composition. ^

A social network-based approach to assess de facto independence of regulatory agencies

This article uses a policy network perspective to assess the independence of regulatory agencies (RAs) in liberalized public utility sectors. We focus on the de facto independence of RAs from elected politicians, regulatees and other co-regulators. We go further than previous studies, which only undertook a general analysis of the de jure independence of RAs from political authorities. Specifically, we apply a social network analysis (SNA), which concentrates on the attributes and relational profiles of all actors involved in new regulatory arrangements. The concept of de facto independence is applied to the Swiss telecommunications sector in order to provide initial empirical insights. Results clearly show that SNA indicators are an appropriate tool to identify the de facto independence of RAs and can improve knowledge about the issues arising from the emergence of the ‘regulatory State’.

Lung cancer screening with CT: evaluation of radiologists and different computer assisted detection software (CAD) as first and second readers for lung nodule detection at different dose levels

OBJECTIVES To find the best pairing of first and second reader at highest sensitivity for detecting lung nodules with CT at various dose levels. MATERIALS AND METHODS An anthropomorphic lung phantom and artificial lung nodules were used to simulate screening CT-examination at standard dose (100 mAs, 120 kVp) and 8 different low dose levels, using 120, 100 and 80 kVp combined with 100, 50 and 25 mAs. At each dose level 40 phantoms were randomly filled with 75 solid and 25 ground glass nodules (5-12 mm). Two radiologists and 3 different computer aided detection softwares (CAD) were paired to find the highest sensitivity. RESULTS Sensitivities at standard dose were 92%, 90%, 84%, 79% and 73% for reader 1, 2, CAD1, CAD2, CAD3, respectively. Combined sensitivity for human readers 1 and 2 improved to 97%, (p1=0.063, p2=0.016). Highest sensitivities--between 97% and 99.0%--were achieved by combining any radiologist with any CAD at any dose level. Combining any two CADs, sensitivities between 85% and 88% were significantly lower than for radiologists combined with CAD (p<0.03). CONCLUSIONS Combination of a human observer with any of the tested CAD systems provide optimal sensitivity for lung nodule detection even at reduced dose at 25 mAs/80 kVp.

Optimal dose levels in screening chest CT for unimpaired detection and volumetry of lung nodules, with and without computer assisted detection at minimal patient radiation

OBJECTIVES The aim of this phantom study was to minimize the radiation dose by finding the best combination of low tube current and low voltage that would result in accurate volume measurements when compared to standard CT imaging without significantly decreasing the sensitivity of detecting lung nodules both with and without the assistance of CAD. METHODS An anthropomorphic chest phantom containing artificial solid and ground glass nodules (GGNs, 5-12 mm) was examined with a 64-row multi-detector CT scanner with three tube currents of 100, 50 and 25 mAs in combination with three tube voltages of 120, 100 and 80 kVp. This resulted in eight different protocols that were then compared to standard CT sensitivity (100 mAs/120 kVp). For each protocol, at least 127 different nodules were scanned in 21-25 phantoms. The nodules were analyzed in two separate sessions by three independent, blinded radiologists and computer-aided detection (CAD) software. RESULTS The mean sensitivity of the radiologists for identifying solid lung nodules on a standard CT was 89.7% ± 4.9%. The sensitivity was not significantly impaired when the tube and current voltage were lowered at the same time, except at the lowest exposure level of 25 mAs/80 kVp [80.6% ± 4.3% (p = 0.031)]. Compared to the standard CT, the sensitivity for detecting GGNs was significantly lower at all dose levels when the voltage was 80 kVp; this result was independent of the tube current. The CAD significantly increased the radiologists' sensitivity for detecting solid nodules at all dose levels (5-11%). No significant volume measurement errors (VMEs) were documented for the radiologists or the CAD software at any dose level. CONCLUSIONS Our results suggest a CT protocol with 25 mAs and 100 kVp is optimal for detecting solid and ground glass nodules in lung cancer screening. The use of CAD software is highly recommended at all dose levels.

Localization of Epileptogenic Zone on Pre-surgical Intracranial EEG Recordings: Toward a Validation of Quantitative Signal Analysis Approaches

In patients diagnosed with pharmaco-resistant epilepsy, cerebral areas responsible for seizure generation can be defined by performing implantation of intracranial electrodes. The identification of the epileptogenic zone (EZ) is based on visual inspection of the intracranial electroencephalogram (IEEG) performed by highly qualified neurophysiologists. New computer-based quantitative EEG analyses have been developed in collaboration with the signal analysis community to expedite EZ detection. The aim of the present report is to compare different signal analysis approaches developed in four different European laboratories working in close collaboration with four European Epilepsy Centers. Computer-based signal analysis methods were retrospectively applied to IEEG recordings performed in four patients undergoing pre-surgical exploration of pharmaco-resistant epilepsy. The four methods elaborated by the different teams to identify the EZ are based either on frequency analysis, on nonlinear signal analysis, on connectivity measures or on statistical parametric mapping of epileptogenicity indices. All methods converge on the identification of EZ in patients that present with fast activity at seizure onset. When traditional visual inspection was not successful in detecting EZ on IEEG, the different signal analysis methods produced highly discordant results. Quantitative analysis of IEEG recordings complement clinical evaluation by contributing to the study of epileptogenic networks during seizures. We demonstrate that the degree of sensitivity of different computer-based methods to detect the EZ in respect to visual EEG inspection depends on the specific seizure pattern.

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.