Caries Lesion Assessment Using 3D Virtual Models by Examiners with Different Degrees of Clinical Experience.

Background and Objectives: Dental caries is a preventable, reversible disease in its early stages. This study evaluated the intra-rater agreement of International Caries Assessment and Detection System (ICDAS) scores with Medit i500® and Omnicam® scanners versus traditional clinical examinations and the inter-rater agreement using the Omnicam® among senior dentists and dental students and between these two groups. Materials and Methods: A total of 24 patients aged between 21 and 34 years, randomly selected from dental students and interns, underwent four examinations (three intraoral scans and one clinical examination), and the corresponding ICDAS scores were recorded by a randomly selected rater out of the 31 available examiners. The examination team consisted of dental students, dentists with less than 3 years, and dentists with more than 5 years of clinical experience. The following inter- and intra-rater agreement tests for the ordinal data were chosen: Fleiss' kappa coefficient, Cohen's weighted kappa, and inter-class correlations. Results: For all examination techniques, there was statistically significant agreement for the experienced raters (p < 0.05). The highest positive interclass correlation was obtained for inter-rater agreement tests of 288 observations recorded by senior dentists: ICC = 0.969 (95% CI 0.949-0.981). Conclusions: Intra-rater reliability was excellent for Omnicam compared to clinical exams conducted by senior dentists but moderate for Medit i500. Although inter-rater agreement using Omnicam was poor between students and between senior dentists and students, it was excellent among senior dentists.

Recent Trends in Hydroxyapatite Supplementation for Osteoregenerative Purposes.

Bone regeneration has gained attention in the biomedical field, which has led to the development of materials and synthesis methods meant to improve osseointegration and cellular bone activity. The properties of hydroxyapatite, a type of calcium phosphate, have been researched to determine its advantages for bone tissue engineering, particularly its biocompatibility and ability to interact with bone cells. Recently, the advantages of utilizing nanomolecules of hydroxyapatite, combined with various substances, in order to enhance and combine their characteristics, have been reported in the literature. This review will outline the cellular and molecular roles of hydroxypatite, its interactions with bone cells, and its nano-combinations with various ions and natural products and their effects on bone growth, development, and bone repair.

The use of digital dental photography in an Eastern European country.

Aims: To assess the use of digital photography in dentistry and its relation with the professional experience of the dental practitioners in Romania. Methods: An anonymous questionnaire including eight questions was distributed online to collect information on the use of dental photography. Results: 84.84% of the respondents were using a photographic equipment in their clinical practice. Regarding the type of photographic equipment used, 51.79% of the participants indicated DSLR cameras, 44.05% smartphones, 2.38% compact cameras and 1.78% other devices for taking clinical images. There was a significant association (p<0.05) between the experience of the practitioners and the use of dental photography, type of equipment and protocol used. Conclusions: Respondents with more than 10 years of experience were more likely to use digital photography in their practice than those with less experience. Most of the digital photography users with more than 10 years of experience were taking images with a DSLR Camera (65.52%) followed by 31.04% smartphone users. Conversely, 56.42% of the clinical photography users with less than 5 years of experience mainly preferred a smartphone device and 41.02% a DSLR Camera.

Evaluation of smartphone dental photography in aesthetic analysis.

Aims To investigate the influence of the system used for digital photography upon the aesthetic analysis in dental medicine.Materials and methods The aesthetic parameters were evaluated on photographs taken with different systems: two DSLR camera set-ups (DSLR + ring flash and DSLR + twin flash) and a smartphone-based system using a five-point Likert scale questionnaire.Results Generally, the DSLR camera + twin flash photographic method performed the best with an overall average score of 4.3, receiving the highest scores for eight statements included in the questionnaire, followed by the smartphone-based system with an average score of 4.04 (the highest values for three statements) and DSLR camera + ring flash with an average score of 3.92 (the highest values for four statements). The scores recorded for the images taken with the DSLR camera + twin flash, DSLR camera + ring flash and smartphone-based system were significantly different for each statement (p <0.05).Conclusions When analysing the characteristics of the dental arches and of individual teeth, images taken with the DSLR camera and twin flash photographic method received the best evaluation, while for the examination of the dentofacial relations and the gingival characteristics, the images obtained with the DSLR camera and ring flash setting, respectively, with the smartphone-based system were considered optimal.

Solid Plasmonic Substrates for Breast Cancer Detection by Means of SERS Analysis of Blood Plasma.

Surface enhanced Raman spectroscopy (SERS) represents a promising technique in providing specific molecular information that could have a major impact in biomedical applications, such as early cancer detection. SERS requires the presence of a suitable plasmonic substrate that can generate enhanced and reproducible diagnostic relevant spectra. In this paper, we propose a new approach for the synthesis of such a substrate, by using concentrated silver nanoparticles purified using the Tangential Flow Filtration method. The capacity of our substrates to generate reproducible and enhanced Raman signals, in a manner that can allow cancer detection by means of Multivariate Analysis (MVA) of Surface Enhanced Raman (SER) spectra, has been tested on blood plasma samples collected from 35 healthy donors and 29 breast cancer patients. All the spectra were analyzed by a combined Principal Component-Linear Discriminant Analysis. Our results facilitated the discrimination between healthy donors and breast cancer patients with 90% sensitivity, 89% specificity and 89% accuracy. This is a direct consequence of substrates' ability to generate diagnostic relevant spectral information by performing SERS measurements on pristine blood plasma samples. Our results suggest that this type of solid substrate could be employed for the detection of other types of cancer or other diseases by means of MVA-SERS procedure.

The accuracy of dental shade matching using cross-polarization photography.

The aim of this study was to assess the influence of a polarizing filter on the accuracy of dental shade matching using digital photography. A comparison was performed using ΔEab parameters between CIE L*a*b* values obtained from digital images taken under two different conditions (with direct light and with polarized light) and the values given by the dental spectrophotometer SpectroShade Micro, which is considered to be the standard. Color differences (ΔEab) calculated between the parameters recorded with the dental spectrophotometer and polarized photography were below or at the level of the 50:50% acceptability threshold of 2.7 in 23% of the cases. Interdevice agreement found between the dental spectrophotometer and polarized photography exceeded 0.82 for all the three parameters recorded. Digital photography with polarizing filters might be a useful tool for dental shade matching.

Effect of accelerated staining and bleaching on chairside CAD/CAM materials with high and low translucency.

The aim of the study was to assess the effect of staining and bleaching on CAD/CAM materials with high (HT) and low translucency (LT or T). Samples were stored in coffee and subsequently bleached. CIELAB parameters were recorded at baseline, after coffee immersion, after bleaching. Translucency parameter (TP), whiteness index (WID) and color changes were calculated (ΔE00). Influence of staining and bleaching was analyzed with repeated-measures ANOVA and color differences between materials were analyzed with one-way ANOVA (α=0.05). Staining and bleaching significantly affected CIELAB parameters and WID for all materials (p<0.001). TP was significantly influenced by staining and bleaching for Crios and Enamic (p<0.05). Mean color differences were significantly different between materials (p<0.001). The greatest color changes due to staining were observed for Lava Ultimate while the lowest for e.max CAD. Both coffee staining and bleaching induced greater color changes for HT materials of the same brand compared to LT.

The Effects of Low-Dose Irradiation on Human Saliva: A Surface-Enhanced Raman Spectroscopy Study.

Biological effects of low-dose ionizing radiation (IR) have been unclear until now. Saliva, because of the ease of collection, could be valuable in studying low-dose IR effects by means of surface-enhanced Raman spectroscopy (SERS). The objective of our study was to compare the salivary SER spectra recorded before and after low-dose IR exposure in the case of pediatric patients (PP). Unstimulated saliva was collected from ten PP before and after irradiation with a cone beam computed tomography (CBCT) machine used for diagnostic purposes. The SERS measurements have been recorded on dried saliva samples using a solid nanosilver plasmonic substrate synthesized using an original method developed in our laboratory. The experimental results showed that salivary SER spectra are dominated by three vibrational bands (441,735 and 2107 cm-1) that can be assigned to bending and stretching vibrations of salivary thiocyanate (SCN-). After exposure, an immediate increase of vibrational bands assigned to SCN- has been recorded in the case of all samples, probably as a result of IR interaction with oral cavity. This finding suggests that SCN- could be used as a valuable biomarker for the detection and identification of low-dose radiation effects.

A comparative study of the accuracy of five CAD-CAM systems.

BACKGROUND AND AIMS: The study aims at comparing the precision of different CAD/CAM systems: original systems built by the same manufacturer as opposed to systems whose components are built by different manufacturers. METHODS: We used the same physical cast which was scanned with five different scanners. The design of the PMMA copings was done by the same operator for the five virtual casts. Each coping was milled three times by each milling machine, thus obtaining 75 copings. The internal space was analyzed by scanning the replicas in light body silicone. RESULTS: The results analyzed the vertical marginal space (VMS) at the preparation limit, the axial internal space (AIS) and the internal occlusal space (IOS). For VMS the best results were obtained for scanner no 5 (S5) and milling machine 3 (M3). For AIS the best results were obtained with S4 and M3 combination. For IOS the best results were obtained with S45 and M3 combination. CONCLUSIONS: According to the results of the study, we are able to confirm the working hypothesis by stating the following conclusions: the quality of the prosthetic elements obtained through CAD/CAM processing differs depending on the CAD/CAM system used and is influenced by each component of every system individually, both the scanner and the milling unit; changing/switching any component of the CAD/CAM system has an impact on the quality of the resulting prosthetic work, but in an unpredictable manner.

Development of a novel biomaterial with an important osteoinductive capacity for hard tissue engineering.

In this study we designed a composite biomaterial based on a high viscosity soft propolis extract (70% propolis) and shell clam, with antiseptic and osteoinductive qualities, that can be used in dentistry, orthopedics and other areas where hard tissue regeneration is needed. We assessed it in interaction with stabilized human cells isolated from dental papilla of wisdom teeth (D1MSCs). We performed detailed characterization of the obtained material by Scanning Electronic Microscopy (SEM), X-Ray Diffraction (XRD), Energy Dispersive X-Ray Spectroscopy (EDX), Fourier Transform Infrared Spectroscopy (FTIR) techniques. SEM investigation revealed the roughness and porosity of the shell, which acted like a scaffold, as it allowed cells to penetrate the pores, proliferate on the surface, spread and grow in the depressions provided by the substrate. in vitro cell viability, proliferation and differentiation assays showed that the newly obtain biomaterial presented low toxicity on D1MSCs and determined the development of numerous osteogenic nodules that were in a higher number even than in the specific induction medium. Our results demonstrated that the shell-propolis based biomaterial promoted and sustained human stem cells attachment, proliferation and differentiation, presenting an important osteoinductive effect essential for mineralized tissue reparation process.

Translucency and masking properties of two ceramic materials for heat-press technology.

OBJECTIVES: To assess the translucency of two pressable ceramics and to analyze their masking property when placed on different tooth-shaded backgrounds. MATERIALS AND METHODS: Thirty discs (1-mm thickness) were fabricated using two pressable ceramics (shade/translucency): 1M1T/HT, 1M2T/HT, 2M2T (VITA PM9), and A1LT/HT, B1LT/HT, A2LT (e.max Press). Color measurements of discs were performed with a dental spectrophotometer on tooth-colored backgrounds (A1/A2/A3/A3.5/A4), and black and white backings. The masking property was calculated as the color difference (CIEDE2000) between parameters of discs on control (A1, A2) and test backgrounds (A3, A3.5, A4). One-way ANOVA was used for assessing differences in translucency parameter (TP) between ceramics. Two-way ANOVA was used for detecting differences among groups when measured over tooth-shaded backgrounds (α = 0.05, Bonferroni correction). RESULTS: TP ranged between 14.96 (B1LT) and 25.18 (1M1HT). A significant difference in TP was found between tested ceramics (F = 949.949, P < .001). However, TP did not vary significantly between 1M1HT and 1M2HT (P > .05), 1M1T, A1HT and B1HT (P > .05), 1M2T, 2M2T, and A2HT (P > .05). A significant interaction effect of underlying background on color of ceramic discs was found (F = 107.994, P < .001). CONCLUSION: VITA PM9 demonstrated higher translucency than e.max Press ceramics. Except A1LT, all ceramic materials evaluated showed poor masking properties on A4 background. CLINICAL SIGNIFICANCE: Highly translucent ceramics should be wisely used for restoring the appearance of dental structures since background color has a large effect upon these materials. The more recently introduced pressable ceramics showed high levels of translucency.

Shade-Matching Performance Using a New Light-Correcting Device.

PURPOSE: To evaluate the shade-matching performance of dental students when using a new light-correcting device with polarization filter. MATERIALS AND METHODS: A total of 21 observers assessed the shade of the upper frontal teeth in one patient under three lighting conditions: daylight (A), daylight and a light-correcting device (Smile Lite, Switzerland) (B), daylight and a light-correcting device with a polarization filter attached (C) by using two shade guides: VITA Classical and 3D Master. Matching scores were calculated as a sum of the color differences between the reference shades and the selected shades (ΔEab *). Data were analyzed using analysis of variance (ANOVA) test (α = 0.05). RESULTS: A significant difference was found between the shade-matching scores under the three lighting conditions (p < 0.001). However, pairwise comparisons showed that between A (ΔEab *A = 1,873.6) and C (ΔEab *C = 2,019.1), there was no significant difference (p > 0.05). The best matching scores were calculated for B (ΔEab *B = 1,652.5). Significant differences were found in respect to the observer's gender (p < 0.05) and color competency (p < 0.05), as well as with the shade guide used (p < 0.05). CONCLUSIONS: Dental students' shade-matching ability was better when the light-correcting device was used, but the addition of the filter to it did not prove beneficial. The shade guides used, the observer's gender, and color competency influenced the shade matching. CLINICAL SIGNIFICANCE: The light-correcting device influenced the shade-matching performance; however, the attached polarization filter did not improve the results of the shade matching.

Peri-implant soft tissue colour around titanium and zirconia abutments: a prospective randomized controlled clinical study.

OBJECTIVES: To objectively determine the difference in colour between the peri-implant soft tissue at titanium and zirconia abutments. MATERIALS AND METHODS: Eleven patients, each with two contralaterally inserted osteointegrated dental implants, were included in this study. The implants were restored either with titanium abutments and porcelain-fused-to-metal crowns, or with zirconia abutments and ceramic crowns. Prior and after crown cementation, multi-spectral images of the peri-implant soft tissues and the gingiva of the neighbouring teeth were taken with a colorimeter. The colour parameters L*, a*, b*, c* and the colour differences ΔE were calculated. Descriptive statistics, including non-parametric tests and correlation coefficients, were used for statistical analyses of the data. RESULTS: Compared to the gingiva of the neighbouring teeth, the peri-implant soft tissue around titanium and zirconia (test group), showed distinguishable ΔE both before and after crown cementation. Colour differences around titanium were statistically significant different (P = 0.01) only at 1 mm prior to crown cementation compared to zirconia. Compared to the gingiva of the neighbouring teeth, statistically significant (P < 0.01) differences were found for all colour parameter, either before or after crown cementation for both abutments; more significant differences were registered for titanium abutments. Tissue thickness correlated positively with c*-values for titanium at 1 mm and 2 mm from the gingival margin. CONCLUSIONS: Within their limits, the present data indicate that: (i) The peri-implant soft tissue around titanium and zirconia showed colour differences when compared to the soft tissue around natural teeth, and (ii) the peri-implant soft tissue around zirconia demonstrated a better colour match to the soft tissue at natural teeth than titanium.

Influence of light source and clinical experience on shade matching.

INTRODUCTION: Shade is one of the most important attributes when evaluating the success of a restoration. Several factors can influence the visual shade matching process, and therefore the outcome of the final restoration. OBJECTIVES: 1. to assess the importance of clinical experience on shade matching accuracy; 2. to assess the influence of two standard light sources on the ability to match shade tabs; 3. to identify the area in a VITA Classical shade guide where matching errors are most likely to appear. METHODS: 28 subjects were enrolled in the study: 14 undergraduate dental students and 14 dentists. All subjects had passed the Ishihara blindness test previously. Participants had to match 16 pairs of tabs from two shade guides, under two versions of illuminants of a viewing booth: D50 and D65, on a neutral background, 0°/45° viewing geometry. Paired and independent samples t tests were used to investigate the significant differences between the groups. RESULTS: The clinical experience had no significant influence on shade matching (p>0.05). According to participants' color discrimination competency, three groups were formed: superior competency, average competency and poor competency. The light source did not significantly influence the matching scores of subjects with superior or average color discrimination competency (p>0.05). However, in the group of subjects with poor competency the light source significantly influenced the results (p<0.05). Moreover, for the group of students the light source also influenced shade matching results (p<0.05). The most frequently mismatched tabs were C2 with D4 (11 subjects - 39.28%), B3 with B4 (11 subjects - 39.28%), B3 with A3.5 (8 subjects - 28.57%). CONCLUSIONS: The light source was proved to influence the shade matching results for subjects with a low level of clinical experience and for subjects with poor competency in color discrimination.

Patients' perspective on dental aesthetics in a South-Eastern European community.

OBJECTIVES: To assess the importance attributed to dental aesthetics by subjects from a Romanian community. In addition, the role played by dental color, the group-distributions based on the self-evaluation of dental color and the previous experience regarding whitening treatments are analysed. METHODS: A multiple-choice questionnaire was administered to 540 patients in dental offices in Cluj-Napoca, Romania; the subjects were also asked to self-evaluate their dental shade, using a set of images as a comparison. Answers to the questionnaires were statistically analysed using Microsoft Excel and SPSS 13.00 (Pearson's chi-square test, Fisher's exact test, Kendall's tau b). RESULTS: From the participants, 17.96% were motivated by aesthetic reasons to ask for treatment; most of the patients evaluated their smile as "acceptable" (38.51%) or "having some defects" (29.44%) and were self-included in groups of medium and dark shades (33.7% and 33.89%, respectively). Whilst 22.40% of the subjects considered the dental color as being the most evident defect of their dentition, 39.07% indicated a self-perception of "an abnormal dental shade". A strong correlation between darker self-assessed tooth color-groups and the self-perception of an abnormal tooth color was found (Chi square p≪0.001, Kendall's tau-c=0.44, with p≪0.001). Previous whitening treatments were reported by 8.88% of the subjects. CONCLUSIONS: Among patients who wanted to improve one of their oral functions, the majority requested changes in aesthetics. Dental shade is one of the aspects recognized as problematic by the participants, but nonetheless the percentage of patients who had previously benefited by whitening treatments was moderate.