Acceptability Threshold Research Articles

Cost effectiveness of difelikefalin for the treatment of patients with chronic kidney disease-associated pruritus undergoing hemodialysis in Italy.

Chronic kidney disease (CKD)-associated pruritus is a condition that strongly impacts CKD patients and is associated with increased morbidity/mortality, and worse health-related quality of life (HRQoL). Difelikefalin is currently the only drug approved in Europe specifically for treating moderate to severe CKD-associated pruritus in patients undergoing hemodialysis. The KALM-1 and KALM-2 trials showed better efficacy of difelikefalin vs placebo and best supportive care. The aim of this study was to investigate the cost-effectiveness of difelikefalin according to the Italian National Health Service (NHS) perspective. A cohort model represented by four health states (No, Mild, Moderate, and Severe pruritus) was adapted to the Italian setting. The model used data from the KALM-1 and -2 trials for efficacy, integrated with other publications for HRQoL estimations. To assess the cost of disease management, a recent Italian publication on CKD-associated pruritus was used and a price of €27 per difelikefalin vial was assumed. The base case analysis over a 15-year time horizon, and an additional 10-year scenario analysis, were established. Additionally, both deterministic univariate analysis and probabilistic multivariate sensitivity analyses were developed. Discount rates of 3% were applied. An acceptability threshold of 40,000 €/quality-adjusted life-year (QALY) was considered. The results show that difelikefalin plus best supportive care is cost-effective vs best supportive care alone, with an incremental cost-effectiveness ratio, in the base case, of €35,823/QALY. Both the scenario and sensitivity analyses confirmed the strength of the results. Difelikefalin was found to be a cost-effective treatment for the Italian NHS. These results support its reimbursement and its inclusion in routine clinical practice.

Color Ranges and Distribution of Human Teeth: A Prospective Clinical Study.

This study investigated the in vivo color range of human teeth using a research-grade noncontact spectroradiometer, analyzing the effects of gender, age, ethnicity, and lifestyle factors, including diet, smoking, and oral hygiene. A total of 1004 participants were recruited at two research sites and stratified by gender, age, and ethnicity, and data on their dietary and oral habits were collected. Noninvasive color measurements of an upper central incisor were performed using a spectroradiometer and a fiber-coupled Xe-Arc light source. Color differences were computed using the CIELAB and CIEDE2000 color difference formulas, statistically analyzed, and interpreted through comparisons with 50:50% perceptibility (PT) and acceptability (AT) thresholds for dentistry. CIELAB and CIEDE2000 color coordinate values varied significantly. Female teeth appeared lighter and less yellow than men's. Age correlated with darker, more chromatic teeth, stabilizing only after Age 46. Significant ethnic differences were observed, particularly between African-American and Asian participants. Coffee consumption impacted teeth yellowness and chromaticity, while tea had no significant effect. Frequent tooth brushing led to lighter teeth, and tooth whitening considerably influenced color, emphasizing the effect of cosmetic dental treatments. Smoking showed minimal impact, with slight discoloration noted among light smokers compared to nonsmokers. Color coordinate values by gender, age, and ethnicity exhibited statistically significant differences and, in most cases, noticeable color differences. With exceptions, the dietary/oral habits of the patient had a significant impact on the color of human teeth. The findings from this study provide detailed information and understanding of the color range and distribution of human teeth, which can help enhance the esthetic outcome of dental care and, consequently, the patient's satisfaction.

Evaluation of segmentation and semi‐supervised learning for spotted spurge recognition in bermudagrass turf

AbstractDiverse datasets are crucial for training machine learning‐based weed recognition models. However, annotating (i.e., labeling) images can be laborious and time‐consuming. Choice of annotation method and training approach not only affects the overall model effectiveness but also its minimum training data requirements and development pace. Segmentation and semi‐supervised learning (SSL) may offer performance or training enhancements. This study evaluated (1) segmentation against object detection in spotted spurge [Chamaesyce maculata (L.) Small] recognition in Latitude 36 hybrid bermudagrass [Cynodon dactylon (L.) Pers. × C. transvaalensis Burtt‐Davy] maintained as a golf course fairway and (2) the potential of two‐step SSL‐based training procedure using data labeled both manually and automatically with a pre‐trained model to expedite the model development. The architecture used across this research was You Only Look Once version 8 (YOLOv8) employing nano, small, and medium variants. All models were trained with a dataset restricted to 1200 training and 300 validation images. Both annotation methods resulted in adequate spotted spurge identification, as evidenced with >0.60 (>0.50 acceptability threshold) medium average precision at intersection over union threshold of 0.50 (mAP@50). Although the difference was minimal, object detection performed superior to segmentation. The two‐step training effectively accelerated image annotation while preserving or improving (with 8:4 and 6:6 splits between manually and auto‐labeled data) object detection performance. Segmentation tolerated only 10:2 split and exhibited increased sensitivity to declining dataset quality proportionally to the increase in auto‐labeled images in the final training dataset. Findings show a two‐step SSL‐based training procedure expedites annotation, enhancing model development efficiency.

Cost-effectiveness of follow-up algorithms for chronic thromboembolic pulmonary hypertension in pulmonary embolism survivors

IntroductionAchieving an early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in pulmonary embolism (PE) survivors results in better quality of life and survival. Importantly, dedicated follow-up strategies to achieve an earlier CTEPH diagnosis involve costs that were not explicitly incorporated in the models assessing their cost-effectiveness. We performed an economic evaluation of 11 distinct PE follow-up algorithms to determine which should be preferred.Materials and methods11 different PE follow-up algorithms and 1 hypothetical scenario without a dedicated CTEPH follow-up algorithm were included in a Markov model. Diagnostic accuracy of consecutive tests was estimated from patient-level data of the InShape II study (n=424). The life-long costs per CTEPH patient were compared and related to Quality-Adjusted Life-Years (QALYs) for each scenario.ResultsCompared to not performing dedicated follow-up, the integrated follow-up algorithms are associated with an estimated increase of 0.89–1.2 QALY against an incremental cost-effectiveness ratio (ICER) of 25 700–46 300 € per QALY per CTEPH patient. When comparing different algorithms with each other, the maximum differences were 0.27 QALY and €27 600. The most cost-effective algorithm was the InShape IV algorithm, with an ICER of €26 700 per QALY compared to the next best algorithm.ConclusionSubjecting all PE survivors to any of the currently established dedicated follow-up algorithm to detect CTEPH is cost-effective and preferred above not performing a dedicated follow-up, evaluated against the Dutch acceptability threshold of €50 000 per QALY. The model can be used to identify the locally preferred algorithm from an economical point-of-view within local logistical possibilities.

Influence of preheating and water storage on the color, whiteness, and translucency of modern resin-based composites.

To evaluate the influence of preheating and water storage on color, whiteness, and translucency of one-shaded, group-shaded, and multi-shaded resin-based composites. A total of 270 samples were fabricated from one-shaded (Omnichroma), group-shaded (Optishade MD), and multi-shaded (Enamel Plus HRI) resin-based composites and divided into six groups: no heating (control) and 1-5 heatings (test) (n = 15). The CIE L*, a*, b*, C*, and h° color coordinates were registered over white, black, and gray backgrounds with a spectrophotometer before and after 24, 72, 144 h water storage. Kruskal-Wallis test was used to evaluate differences in the color coordinates, whiteness index, and translucency parameter (α = 0.05). The Mann-Whitney U test was performed with a Bonferroni correction (p < 0.001) for pairwise comparisons. CIEDE2000 color, whiteness, and translucency differences between groups and subgroups were evaluated using their respective 50%:50% perceptibility and acceptability thresholds. Preheating influenced color coordinates, whiteness index, and relative translucency parameters (p < 0.001). Although color differences were below the acceptability threshold for all materials, translucency differences were above the acceptability threshold for Omnichroma. Water storage significantly influenced the whiteness index of Optishade MD (p < 0.001). Preheating had a more considerable effect on the color, whiteness, and translucency of one-shaded resin-based composite, while water storage influenced group-shaded resin-based composite more importantly. Preheating influences the color, whiteness level, and translucency of the resin-based composites, but the variations remain generally clinically acceptable; however, practitioners should be aware that the modifications in translucency for one-shaded resin-based composites could be more important than for group-shaded and multi-shaded resin-based composites.

Effect of Listerine and Chlorhexidine mouthwashes with antidiscoloration system on the colour change of CAD/CAM conventional and novel lithium disilicate ceramics

Background It has been reported that using mouthwashes can discolour the surface of teeth. Their effect on the stainability of newly introduced lithium disilicate ceramics is, however, unknown. Objective: The purpose of this in vitro study was to investigate how mouth washes affected the color change of new and conventional lithium disilicate (LS2) ceramics that were finished using various techniques. Materials and Methods A total of 56 ceramic slices were produced from conventional LS2 (E Max CAD, Ivoclar) and a novel virgilite based LS2 (Cerec Tessera, Dentsply Sirona). According to the finishing method, the specimens were divided into glazed and polished subgroups. Each subgroup was further subdivided into two based on immersion in chlorhexidine (CHXD) or Listerine (LIST) mouth washes. A handheld spectrophotometer was used to measure the color attributes, and color differences (ΔE00) were then counted using specific equation. Data were analyzed using ANOVA and Tukey’s post-hoc tests. Results Significant differences in color change (ΔE00) values were observed between conventional and novel LS2 ceramics, as well as between different finishing methods and mouth-rinse solutions. Chlorhexidine induced higher color differences than Listerine, with average ΔE00 values of 0.959 and 0.885, respectively (p &lt; 0.001). The polished specimens generally exhibited higher ΔE00 values than the glazed specimens, with average values of 1.071 and 0.792 for conventional LS2, and 0.836 and 0.786 for novel LS2 (p &lt; 0.001). However, most color changes did not exceed the perceptibility and acceptability thresholds. Conclusion Using CHXD and LIST mouth washes affected the color change of polished or glazed conventional and novel lithium disilicate ceramics. In general, the stainability of polished specimens was higher than that of glazed ones. There was more discoloration on specimens immersed in CHXD than those immersed in LIST. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1178-1184

Exploring the optical behavior and relative translucency parameter of CAD-CAM resin-based composites, polymer-infiltrated ceramic network, and feldspar porcelain

ObjectivesTo evaluate and compare the optical properties and relative translucency parameter of CAD-CAM restorative materials. MethodsFour CAD-CAM materials were evaluated: Lava Ultimate (LU), Grandio Blocs (GB), VITA Enamic (VE), and VITA Mark II (VM). Disk-shaped samples in shade A2-HT were prepared (n = 10) and polished to 1.00 ± 0.01 mm of thickness. Scattering (S), absorption (K), albedo (a) coefficient, transmittance (T%), light reflectivity (RI), infinite optical thickness (X∞), and radiative transfer coefficients (μa, and μ′S) were calculated using Kubelka-Munk method and Thennadil's semi-empirical approach. Root Mean Square Error (RMSE) and Goodness of Fit (GFC) were used as performance optical behavior. Translucency differences were evaluated using the relative translucency parameter (RTP00) and 50:50 % translucency perceptibility and acceptability thresholds (TPT00 and TAT00). ResultsThe spectral distribution of S, K, T%, RI, and X∞ was wavelength-dependent. GFC and RMSE values indicated good spectral behavior matches and good comparative spectral values for RI in LU-GB, LU-VE, and GB-VE, and for K in VE-VM. VM displayed the highest scattering values across the wavelengths, while VE and VM showed lower absorption at shorter wavelengths. LU and GB had the highest transmittance. The X∞ values indicated that all 1.0 mm thick materials could be influenced by the background. No good spectral match and no good comparative spectral values were found between CAD-CAM materials and anterior bovine maxillary specimens. VM had the lowest RTP00 values with perceptible and unacceptable differences compared to CAD-CAM materials evaluated. SignificanceUnderstanding the optical behavior of different CAD-CAM materials was essential for guiding clinicians in material selection and optimizing their clinical performance. The findings confirm that the different compositions and microstructure impact the optical properties and translucency of CAD-CAM restorative materials.

Assessment of Surface Roughness, Color, and Bonding Efficacy: Self-Adhesive vs. Conventional Flowable Resin.

This in vitro study aimed to analyze the surface roughness (Ra) and color stability (ΔEab, ΔE00) following simulated mechanical brushing and to evaluate the microtensile (μTBS) of self-adhering resin flowable (SARF) to dentin. The selected materials were Constic, Yflow AS, and Tetric N flow (TNF/control). Thirty composite resin cylinders were fabricated for surface property evaluation. Ra and color were assessed both before and after simulated brushing. The thresholds of 50:50% perceptibility and acceptability of color differences in the evaluated resins were assessed. For μTBS analysis, fifteen molars were selected, sectioned to expose flat dentin surfaces, and restored according to the manufacturers' instructions for microtensile testing. There were statistically significant differences in Ra among the groups, with Constic exhibiting the highest Ra value (0.702 µm; p < 0.05), whereas Yflow AS presented the lowest Ra value (0.184 µm). No statistically significant difference in color was observed among the groups (p > 0.05). The 50:50% perceptibility and acceptability thresholds were set at 1.2 and 2.7 for ΔEab and 0.8 and 1.8 for ΔE 00. All the results fell within the acceptable limits. The mean μTBS values of Constic, Yflow AS, and TNF were 10.649 MPa, 8.170 MPa, and 33.669 MPa, respectively. This study revealed increased Ra and comparable color stability among all the tested composite resins after abrasion. However, the SARF exhibited lower μTBS compared to conventional using an adhesive system.

Dental Color-Matching Ability: Comparison between Visual Determination and Technology.

The choice of the correct color is of paramount importance in esthetic dentistry; however, there is still no consensus on the best technique to determine it. The aim of the present study is to compare the accuracy of a recently introduced colorimeter in shade matching with human vision. In addition, possible variables affecting color-matching by human eye have been analysed. 18 disc-shaped composite samples with identical size and shape were produced from a composite flow system (Enamel plus HriHF, Micerium): Nine were considered control samples (UD 0-UD 6), and nine were test samples with identical flow composite shade to the control ones. Parallelly, 70 individuals (dental students and dental field professionals) were individually instructed to sit in a dark room illuminated with D55 light and to perform visual shade matching between control and test discs. An error matrix containing ΔE94 between control and test discs was generated, containing four match-clusters depending on perceptibility and acceptability thresholds. The frequency and severity of errors were examined. The colorimeter achieved a 100% perfect matching, while individuals only achieved a 78%. A higher occurrence of mismatches was noted for intermediate composite shades without a statistically significant difference. No statistically significant differences were reported for age, sex, and experience. A statistically significant difference was present among the Optishade match and the visual determination. The instrumental shade-matching evaluation proved to be significantly more reliable than the human visual system. Further research is needed to determine whether the same outcomes are achieved in a clinical setting directly on patients.

Effectiveness of Three Bleaching Techniques for Endodontically Treated Teeth: A Randomized Clinical Trial.

Various techniques, products, and protocols are used for the bleaching of non-vital teeth. The walking bleach technique involves sealing the bleaching agent in the pulp chamber. In the inside/outside technique, a low-concentration bleaching agent is applied at home using a custom tray. In the in-office technique, a high-concentration bleaching agent is applied by a dental professional. Limited research has compared the effectiveness of these techniques. This clinical trial aimed to evaluate the effectiveness of the walking bleach, the inside/outside, and the in-office bleaching techniques. Fifty-four discolored teeth were selected according to eligibility criteria, randomized, and assigned to three treatment groups (n=18): walking bleach (sodium perborate - SP), inside/outside bleaching (7.5% hydrogen peroxide -HP7.5), and in-office bleaching (35% hydrogen peroxide - HP35). A cervical seal was placed in all the teeth, and nonvital bleaching was performed according to each technique. The CIELab color coordinates were measured using a clinical spectrophotometer at baseline, weekly, and at the 1-week follow-up. ΔE00 and ΔWID were calculated between the baseline and each evaluation time point. The ANOVA, Fisher exact, and Kruskal-Wallis tests were used to compare the quantitative variables, and the Fisher exact test, to determine the association among categorical variables. Bleaching effectiveness was interpreted by 50:50% perceptibility and acceptability thresholds. As the treatment progressed, all techniques presented a significant increase in L* and WID (p<0.001), and a significant decrease in a* and b* (p<0.001). HP7.5 and HP35 presented greater increases in WID mean values, in comparison with SP (p=0.006). No significant differences were observed among the techniques for ΔE00 after treatment completion (p=0.383). There were no statistical differences in bleaching effectiveness among the techniques after treatment completion (p=0.098). All techniques presented excellent effectiveness after treatment completion. However, HP7.5 and HP35 techniques provided a more rapid whitening response.

Technological usage of ripe banana pulp for the development of a salad dressing

Oxidized banana (OB) is one of the important food wastes which contains a high potential to use in different products such as salad dressing. OB is a good ingredient in salad dressing due to its presence of antioxidants, vitamins, dietary fibers, and starch. the current study aimed to replace OB with non-oxidized banana (T1: 0 % T2: 25 %, T3: 50 %, T4: 75 %, and T5: 100 % OB) in salad dressing formulation and focused on the effects of OB on color, sensory, physical, chemical, rheological properties, microbial growth, and consumer studies. E-nose and volatile compounds analysis by GC-MS was also performed. According to the results, L*, a*, and b* values decreased significantly (P < 0.5) leading to a darker color of the product and effected other color evaluations (Hue, chroma, and ∆E). Viscosity was decreased significantly by the addition of the OB in the dressing formulation while pH did not change between T5 and T1 treatments. All sensory attributes score (9-point hedonic scale) decreased and consumers were given of fact of OB salad dressing has environmental benefits. Steady shear flow measurements, frequency sweep analysis, and the thixotropic loop of the oxidized banana indicated that adding OB to salad dressing negatively affected textural properties. The most effective attributes are, texture, and color discriminating the underlying differences among all 5 treatments according to MANOVA Wilks’ P-values. McNemar’s test was applied to analyze before and after consumers had been given the information about OB environmental benefits indicating that emotional attributes were changed after knowing the fact state as well as the odds ratio predicted purchase intent which increased with an increase in overall liking, pleased, flavor, and satisfied attributes. The acceptability threshold for OB in salad dressing formulation is 50 % OB. Among the identified volatile organic compounds are acetic acid, hexanoic acid, 3-methyl-1-butanol, 2-methylpropyl acetate, ethyl hexanoate, and phenylethyl acetate. The volatile organic compounds identified are 3-methyl-butanoic acid, 2-methyl-butanoic acid, and (E)-2-Decenal. The electronic device could discriminate these aromas, and the results obtained agree with those of the tasting panel and the volatile compounds.

Perceptibility and acceptability thresholds for color differences of light and dark maxillofacial skin replications

The aim of this study was to assess the perceptibility and acceptability thresholds of maxillofacial silicones for light and dark skin colors and to evaluate the effect of gender and professional experience on these thresholds. Two different sets of specimens (as light and dark) each, consisting of 14 (25 × 25 × 6-mm3) silicone skin replications, were produced. Four specimens of each set were produced from the same silicon mixture of the relevant set and polymerized simultaneously to provide standardized fabrication conditions. These 4 light/dark specimens were assigned as “baseline color specimens (BCs)” in each set, while the other 10 specimens were produced with a color difference level that increased gradually from BC. These stepped levels were obtained by controlled increasing of the pigment concentration in the relevant baseline silicon mixture. Color difference levels of specimens were calculated by using the CIELAB and CIEDE2000 formulas. Observers comprised of 3 different professional experiences as first-year dental students, interns, and dentists (n = 30/group, gender-balanced) were included. Combinations consisting of 5 specimens with 4 BCs and 1 different color were shown to the observers to assess whether the color difference was perceptible or acceptable. Perceptibility and acceptability percentages were regressed with color difference levels to estimate the best fit curve and confidence intervals were calculated (α = 0.05). The highest estimation of the coefficient of determination (R2) was found in the cubic curve for all parameters. A significant difference was found between the light and dark colors. The perceptibility thresholds (ΔE*ab/ΔE00) were 0.8/0.59 and 2.63/1.75 for light and dark colors, respectively. The acceptability thresholds (ΔE*ab/ΔE00) were 3.35/2.25, 10.07/7.04 for light and dark colors, respectively. No significant differences were found between gender and among experience groups concerning visual thresholds. Regardless of gender and experience, observers could perceive color differences more easily in light skin colors.

Translucency and colour masking ability of hybrid CAD/CAM materials with different thicknesses: in vitro study

ObjectiveTo evaluate effect of material thickness and translucency of two different hybrid CAD/CAM materials on their masking ability.Materials and Methods40 rectangular-shaped specimens (12 × 14 mm) were obtained from Vita Enamic and Grandio blocks at 0.5 and 1 mm-thick (n = 10/group). Colour parameters of specimens were measured on PMMA tooth-coloured replica backgrounds (A2, C4) and black, white backings using dental spectrophotometer. Translucency parameter (TP) and masking ability (∆E00) values of tested materials with 0.5, and 1 mm thicknesses were calculated. Quantitative variables were compared between groups using student t-test.ResultsTP and ∆E00 significantly decreased as thickness of tested materials increased. Grandio showed significantly higher TP values. There were significantly lower ΔE00 values for Vita Enamic compared to Grandio at 1 mm thickness and inversely insignificant at 0.5 mm. The 0.5 mm-thick ∆E00 of tested materials was above clinical acceptability threshold, whereas, 1 mm-thick did not exceed showing better masking properties.ConclusionsThickness is more effective for colour masking than translucency. In thin thickness, the masking ability is less effective, irrespective of tested materials. Translucency of tested materials was affected by their composition. Both hybrid CAD/CAM materials are promising alternatives for masking dark discolouration at 1 mm-thick.

Effect of Coffee Thermocycling on Color Stability and Translucency of CAD-CAM Polychromatic High Translucent Zirconia Compared With Lithium Disilicate Glass Ceramic.

To evaluate the effect of coffee thermocycling on color stability and translucency of CAD-CAM polychromatic high translucent zirconia compared with lithium disilicate glass ceramic. Sixteen rectangular plates (14 × 16 × 1.0 mm) of two ceramic materials (IPS E.max CAD (IEC), IPS E.max ZirCAD Prime [IZP]) were prepared. Each specimen was measured for color coordinates using a spectrophotometer following 30,000 cycles of coffee thermocycling. CIELAB formula was used to determine color and translucency differences (ΔE and ΔTP). The means of ΔE and ΔTP were compared using independent samples t-test and were evaluated using their respective 50%:50% perceptibility and acceptability thresholds (PT and AT). One-way analysis of variance was performed to evaluate the translucency parameter (TP) and surface roughness (Ra) of each material. Mean ΔE values of IEC (4.69) and IZP (4.64) were higher than the AT (ΔE ≤ 2.7) with no significant difference found between the two groups (p = 0.202). Considering the TP, only IEC showed a statistically significant increase in TP value (p < 0.001). However, the mean ΔTP of IEC (3.25) remained within the range of acceptability (1.3 < ΔTP ≤ 4.4). Within the limitations of this current study, the color stability of all materials was clinically affected by coffee thermocycling. In terms of translucency, only lithium disilicate glass ceramic was influenced by coffee thermocycling. High translucent zirconia had superior translucency stability compared to lithium disilicate glass ceramic.

Influence of in-office whitening on the color matching and surface characteristics of single-shade resin composites.

The color matching of single-shade resin composites after in-office whitening was investigated. Four single-shade resin composites were used. A total of 35% hydrogen peroxide was used as the whitening agent. The resin composite was placed in a cavity of an artificially discolored bovine tooth. The color differences between the restoration and surrounding enamel before and after whitening were determined based on ΔE*ab, ΔE00, and ΔWID. The color stability, surface roughness (Sa), and surface gloss (GU) of the resin composite alone were also evaluated. Statistical analyses were performed using repeated-measures analysis of variance with the Tukey-Kramer test. Based on the 50:50% of perceptibility and acceptability thresholds of ΔE*ab and ΔE00, none of the resin composite restorations were clinically acceptable before or after whitening. Regarding ΔWID, although all resin composites showed "acceptable match" in the baseline, they showed "mismatch" after the third session of whitening. Most of the resin composites alone were stable in color against whitening. Although the single-shade resin composites failed to achieve the expected color matching on discolored teeth either before or after the whitening, the impact of the whitening on the color of the resin composite alone may be negligible.

Trueness and fit of complete-arch implant-supported frameworks in new-generation additively and subtractively manufactured polymers: An in-vitro study.

There is limited knowledge on the fabrication trueness and fit of additively or subtractively manufactured complete-arch implant-supported frameworks in recently introduced polymers. To evaluate the trueness and marginal fit of additively or subtractively manufactured polymer-based complete-arch implant-supported frameworks, comparing with those of strength gradient zirconia frameworks. A typodont model with 4 implants (left first molar (abutment 1), left canine (abutment 2), right canine (abutment 3), and right first molar (abutment 4)) was digitized (ATOS Core 80 5MP) and an implant-supported complete-arch framework was designed. This design file was used to fabricate frameworks from 5 different materials: strength gradient zirconia (SM-ZR), high impact polymer composite (SM-CR), nanographene-reinforced PMMA (SM-GR), PMMA (SM-PM), and additively manufactured temporary resin (AM) (n = 10). These frameworks were digitized and each scan file was virtually segmented into 4 regions (abutments, occlusal, overall without occlusal, and overall). The surface deviations at these regions, and linear and interimplant distance deviations were evaluated (Geomagic Control X). Marginal gaps were evaluated according to triple-scan protocol after seating frameworks on the model with the 1-screw test. Data were statistically analyzed (α = 0.05). Surface deviations of all regions differed among tested materials (p ≤ 0.001). AM frameworks mostly had surface deviations that were similar to or lower than those of other materials (p ≤ 0.031), except for the occlusal surface, where it mostly had higher deviations (p ≤ 0.013). Abutment 4 of SM-CR had higher linear deviations than abutment 2 (p = 0.025), and material type did not affect the linear deviations within abutments (p ≥ 0.171). Interimplant distance deviations differed within and among materials (p ≤ 0.017), except for those between abutments 1 and 2 among materials (p = 0.387). Marginal gaps of subtractively manufactured materials differed among abutments, while those of abutments 3 and 4 differed among materials (p ≤ 0.003). AM frameworks mostly had lower marginal gaps at abutments 3 and 4 (p ≤ 0.048). Although there was no clear trend among tested materials for measured deviations, marginal gaps of additively manufactured resin were mostly lower than those of subtractively manufactured materials and did not differ among abutment sites. Nevertheless, the differences in measured deviations among materials were small and marginal gaps were within the previously reported acceptability thresholds.

Measurement of inward leakage of full-face masks in EN and ISO standards: comparison of gas and aerosol test agents.

In Europe, respiratory protective devices must be certified before they can be marketed. Among the parameters of interest, inward leakage (IL) characterizes the tightness between the face seal and the face, to verify that the device is well-designed. European standard EN 13274-1 (2001) and International Organization for Standardization (ISO) standard ISO 16900-1 (2019) specify that IL should be measured using sodium chloride (NaCl) aerosol or sulfur hexafluoride (SF6) gas. For reusable masks made of nonporous materials, both test agents are considered equally acceptable. However, the few studies that have compared IL values measured with various aerosols and gases have come to divergent conclusions. This work then aimed to measure IL with the test agents recommended by the standards to determine whether they are really equivalent. Since krypton (Kr) is an interesting candidate for replacing SF6 in standard tests, IL was assessed with SF6 and Kr simultaneously, and with NaCl aerosol using various calculation methods. Tests were carried out on 5 models of full-face masks donned on a headform connected to a breathing machine simulating 3 sinusoidal breathing rates of various intensities. The respirator fit on the headform was evaluated using a controlled negative pressure method to determine a manikin fit factor. Four scenarios were then tested to represent very poor, bad, good, and excellent fit. Gas concentration was measured using a mass spectrometer, and IL was calculated for SF6 and Kr. A combination of 3 devices allowed the determination of the number-based concentration of particles with diameters between 20 nm and 2 µm, and IL was calculated for each of the 33 channels, as well as using a cumulative number concentration. In addition, to comply with standards, a conversion was carried out to calculate IL using a cumulative mass concentration. The results of this work evidenced that the IL values measured with NaCl were systematically lower than those determined with gases. IL was also shown to vary with particle size, with a maximum value exceeding that calculated with cumulative concentrations (in number or mass). As part of the revision of the standards, protocols for measuring inward leakage should be redefined. On the one hand, acceptability thresholds should be re-evaluated according to the nature of the test agent (gas or aerosol), as it is clear that the 2 options do not give the same results for a given configuration. On the other hand, the aerosol leakage measurement protocol needs to be reworked to enable the measurement of a well-defined, robust, and reproducible inward leakage value.

Effect of Er,Cr: YSGG laser debonding treatment on the optical properties and surface roughness of ceramic laminate veneers: An in vitro study.

The objective of this study was to evaluate the effect of (Er,Cr: YSGG) laser debonding treatment on optical properties and surface roughness of veneers made of different ceramic materials. Thirty bovine incisors were prepared to receive laminate veneers and divided into three groups (n = 10) according to ceramic material where group (E): IPS e.max CAD, group (S): Vita Suprinity, and group (C): Celtra Duo. Blocks were sectioned into 0.5mm thickness plates and cemented on the labial surface of incisors using resin cement. The Er,Cr: YSGG laser was applied to each specimen at 4.5W and 25Hz for group E and at 6W and 25Hz for groups S and C. Color change (△E00), translucency parameter (TP) and surface roughness in µm (Ra) values were measured and calculated before and after laser treatment. Data were analyzed using two-way mixed model ANOVA at a significance level of p < 0.05. The highest mean △E00 value was recorded in group E (1.35 ±0.09) followed by group S (1.08 ±0.16) and then group C (0.93 ±0.10) with a significant difference between them (p<0.001). All groups exceeded the perceptibility threshold but remained below the acceptability threshold. No statistically significant difference was found in TP except for group E (p=0.019). Ra values after laser debonding showed significantly higher values than before laser treatment in all three groups (p<0.001). Er,Cr: YSGG laser can be safely used for debonding ceramic veneers without altering the optical properties but it does increase the roughness of debonded ceramic restorations.

Color stability of precolored and extrinsically colored monolithic multilayered polychromatic zirconia: Effects of surface finishing and aging.

To explore the impact of zirconia types, coloring methods, and surface finishing on the color stability of monolithic multilayered polychromatic zirconia after artificial aging, including thermocycling and simulated toothbrushing. Eighty square-shaped zirconia samples were divided into 2 types (M3Y-TZP and M6Y-PSZ), further categorized based on coloring methods (precolored and extrinsically colored) and surface finishing techniques (mechanical polishing or glazing). The color stability was assessed using the CIEDE2000 formula. Artificial aging was simulated via thermocycling and toothbrushing. All samples were analyzed with a spectrophotometer to determine the post-aging color changes (ΔE00). The ΔE00 were interpreted and classified using the 50:50% perceptibility threshold (PT) and the 50:50% acceptability threshold (AT). Comparisons between groups for ΔE00 differences were performed using three-way ANOVA, with pairwise comparisons facilitated by Fisher's protected least significant difference test, α = 0.05. The study results indicated significant impacts of zirconia type, coloring method, and surface finishing on color stability. The M6Y groups experienced significantly greater color changes (6.61 ± 1.63) compared to the M3Y groups (3.40 ± 2.24), p < 0.0001. For both types of zirconia, extrinsically colored samples exhibited significantly higher ΔE00 when mechanically polished (p = 0.004). However, surface finishing had no significant effect on ΔE00 in precolored samples of either zirconia material (p = 1.000). The evaluation and categorization of ΔE00 variations indicated that nearly all color changes in the M6Y groups, regardless of being precolored, extrinsically colored, polished, or glazed, were deemed extremely unacceptable (Grade 1). In contrast, the M3Y groups showed more acceptable results, with the majority of color changes classified as moderately unacceptable (Grade 3). The color stability of multilayered polychromatic zirconia is influenced by the type of material, extrinsic coloring, and the chosen surface treatment post-artificial aging. The translucent 6Y-PSZ exhibited lower color stability, especially with only mechanical polishing. For the fabrication of M3Y-TZP and 6Y-PSZ monolithic multilayered polychromatic zirconia restorations, extrinsic coloring should be paired with glazing to maintain color stability. Conversely, in the absence of extrinsic coloring, both glazing and mechanical polishing are effective in preserving color stability.

Effect of different instrumental techniques and clinical experience on shade matching.

Many factors can affect the aesthetics of dental restorations, including the instrumental techniques used in shade matching, and can lead to clinical failure. The aim of this study was to investigate the effectiveness of using the cross-polarization digital photograph technique and intraoral scanners for shade matching, and also evaluate the effect of the level of clinical experience on shade matching success. Color analysis was performed on the maxillary right central incisors of 10 subject models with Vita Easyshade. Intraoral scanning was performed 10 times on each model using TRIOS 3 and color analysis was performed from the same spot. Then cross-polarized and non-polarized photographs of the models were taken with standard settings using a gray reference card. Each shade tab of the Vita System 3D-Master scale was also photographed with two different polarization techniques. Four groups (n = 12), including prosthodontics faculty staff, postgraduate students in prosthodontics, undergraduate students, and dental technicians matched the shade tabs and the model photographs obtained with both techniques on a standardized computer screen. Finally, the color differences between the shade tabs and maxillary central incisors matched by observers from four different groups were recorded using a colorimeter, Classic Color Meter, in accordance with the CIELAB system and CIEDE2000 (ΔE00) values were calculated. The data were compared with the acceptability threshold of 1.80 for ΔE00. The data obtained from the observers were analyzed with IBM SPSS Statistics 26.0 Release Notes program. Independent Samples t-test was used to compare normally distributed data according to binary groups. The level of significance was 0.05. A statistically significant difference was found in the shade matching on photographs taken with different techniques in postgraduate students (p = 0.02). Also, there was a statistically significant difference in success between the groups that made shade matching based on photographs obtained with the non-polarization technique (p = 0.00). The undergraduate students achieved statistically significantly lower results than all other groups (ΔE00 = 5.57±1.07). The kappa value between the intraoral scanner and spectrophotometer results was 0.10, and this value was not statistically significant (p = 0.32). The cross-polarization technique used especially for shade matching is not superior to the non-polarization technique. Academic and clinical experience might be correlated with shade-matching success with the non-polarization technique. The clinical acceptability threshold could not be achieved in the shade matchings made on digital photographs taken with both techniques. Shade matching performed with an intraoral scanner did not yield reliable results.