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Objective This integrative review aimed to report the toxic effect of submicron and nano-scale commercially pure titanium (cp Ti) debris on cells of peri-implant tissues. Materials and methods A systematic search was carried out on the PubMed electronic platform using the following key terms: Ti “OR” titanium “AND” dental implants “AND” nanoparticles “OR” nano-scale debris “OR” nanometric debris “AND” osteoblasts “OR “cytotoxicity” OR “macrophage” OR “mutagenic” OR “peri-implantitis”. The inclusion criteria involved articles published in the English language, until December 26, 2020, reporting the effect of nano-scale titanium particles as released from dental implants on the toxicity and damage of osteoblasts. Results Of 258 articles identified, 14 articles were selected for this integrative review. Submicron and nano-scale cp Ti particles altered the behavior of cells in culture medium. An inflammatory response was triggered by macrophages, fibroblasts, osteoblasts, mesenchymal cells, and odontoblasts as indicated by the detection of several inflammatory mediators such as IL-6, IL-1β, TNF-α, and PGE2. The formation of a bioactive complex composed of calcium and phosphorus on titanium nanoparticles allowed their binding to proteins leading to the cell internalization phenomenon. The nanoparticles induced mutagenic and carcinogenic effects into the cells. Conclusions The cytotoxic effect of debris released from dental implants depends on the size, concentration, and chemical composition of the particles. A high concentration of particles on nanometric scale intensifies the inflammatory responses with mutagenic potential of the surrounding cells. Clinical relevance Titanium ions and debris have been detected in peri-implant tissues with different size, concentration, and forms. The presence of metallic debris at peri-implant tissues also stimulates the migration of immune cells and inflammatory reactions. Cp Ti and TiO 2 micro- and nano-scale particles can reach the bloodstream, accumulating in lungs, liver, spleen, and bone marrow.

The aim of this work was to perform an integrative literature review on the influence of laser irradiation on zirconia implants to enhance surface topographic aspects and the biological response for osseointegration. An electronic search was carried out on the PubMed database using the following search terms: “zirconia” AND “laser” AND “surface modification” OR “surface treatment” AND “dental implants” OR “bone” OR “osteoblast” OR “osseointegration.” Of the identified articles, 12 studies were selected in this review. Results reported that the laser irradiation was capable of promoting changes on the zirconia surfaces regarding topographic aspects, roughness, and wettability. An increase in roughness was recorded at micro- and nano-scale and it resulted in an enhanced wettability and biological response. Also, adhesion, spreading, proliferation, and differentiation of osteogenic cells were also enhanced after laser irradiation mainly by using a femtosecond laser at 10nJ and 80 MHz. After 3 months of osseointegration, in vivo studies in dogs revealed a similar average percentage of bone-to-implant contact (BIC) on zirconia surfaces (around 47.9 ± 16%) when compared to standard titanium surfaces (61.73 ±16.27%), denoting that there is no significant difference between such different materials. The laser approach revealed several parameters that can be used for zirconia surface modification such as irradiation intensity, time, and frequency. Laser irradiation parameters can be optimized and well-controlled to reach desirable surface morphologic aspects and biological response concerning the osseointegration process.

Objective The main aim of this study was to conduct an integrative review on the influence of the zirconia veneer thickness on the degree of conversion of resin-matrix cements. Materials and method An electronic search was performed on PubMed using a combination of the following search items: zirconia, thickness, veneer, degree of conversion, resin cement, light curing, and polymerization. Articles published in the English language, up to July 2020, were included regarding the influence of ceramic veneer thickness on the degree of conversion of resin-matrix cements. Randomized controlled trials and prospective cohort studies were also evaluated. Results Of the 21 selected studies, 9 investigated the light-curing effect, while five other articles evaluated the ceramic translucency. Three studies evaluated the degree of conversion of the resin-matrix cement while four articles assessed the veneer thickness. Results revealed a significant decrease of light transmission through the zirconia with a thickness ranging from 0.1 up to 1.5 mm. However, the ultra-thin thickness around 0.1 and 0.3 mm allowed a full polymerization of the dual-curing resin-matrix cement resulting in the integrity of the interface properties. The light-curing process of resin-matrix cements is also affected by the shade, chemical composition, and microstructure of zirconia and resin cement. Optimal conditions of light-curing are required to reach the threshold intensity of light and energy for polymerization of resin-matrix cements. Conclusions The increase in zirconia veneer thickness negatively affects the degree of conversion of resin-matrix cements. Also, shade and microstructure are key factor to improve the light curing of resin cements. Clinical relevance Clinicians should consider the zirconia thickness on resin-based cementation since a higher veneer thickness can negatively affect the light irradiation intensity towards the dual-curing resin-matrix cement. Thus, the degree of conversion of the resin-matrix cement can decrease leading to a low chemical stability (e.g., color instability) and poor mechanical properties.

Purpose The main aim of the present study was to carry out a scoping review on the differences in degree of conversion of monomers regarding several types resin cements, indirect restorative materials, and light-curing procedures used in dentistry. Method A bibliographic review was performed on PubMed using the following search items: “degree of conversion” OR “filler” AND “resin cement” OR “inorganic cement” AND “organic” OR “radiopacity” OR “refractive” OR “transmittance” OR “type” AND “resin composite.” The search involved articles published in English language within the last thirteen years. A research question has been formulated following the PICO approach as follow: “How different is the degree of conversion of monomers comparing several types of resin-matrix cements?”. Results Within the 15 selected studies, 8 studies reported a high degree of conversion (DC) of the organic matrix ranging from 70 up to 90% while 7 studies showed lower DC values. Dual-cured resin-matrix cements revealed the highest mean values of DC, flexural strength, and hardness when compared with light- and self-polymerized ones. DC mean values of resin-matrix cements light-cured through a ceramic veneer with 0.4 mm thickness were higher (~ 83%) than those recorded for resin-matrix cements light-cured through a thicker ceramic layer of 1.5 mm (~ 77%). Conclusions The highest percentage of degree of conversion of monomers was reported for dual-cured resin-matrix cements and therefore both chemical and light-induced pathways promoted an enhanced polymerization of the material. Similar degree of conversion of the same resin-matrix cement were recorded when the prosthetic structure showed a low thickness. On thick prosthetic structures, translucent materials are required to allow the light transmission achieving the resin-matrix cement. Clinical relevance The chemical composition of resin-matrix cements and the light-curing mode can affect the polymerization of the organic matrix. Thus, physical properties of the materials can vary leading to early clinical failures at restorative interfaces. Thus, the analysis of the polymerization pathways of resin-matrix cements is significantly beneficial for the clinical performance of the restorative interfaces.

Objective The aim of this study was to perform an integrative review on the layer thickness and microstructure of resin-matrix cements around custom-made or standard teeth root intracanal posts. Materials and methods An electronic search was conducted on the PubMed using a combination of the following scientific terms: intraradicular post, root intracanal post, resin cement, thickness, adaptation, endodontic post, layer thickness, fit, shape, and endodontic core. The literature selection criteria accepted articles published in the English language, up to May 2021, involving in vitro analyses, meta-analyses, randomized controlled trials, and prospective cohort studies. Results The search identified 154 studies, of which 24 were considered relevant to this study. The selected studies provided important data considering cement layer thickness, tooth preparation, endodontic post, and type of resin-matrix cement. The anatomical variability of root canal systems, such as the oval- or C-shaped, represents a challenge in dental restoration with tooth root intracanal posts. The fitting of intracanal posts to different root regions is variable resulting in thick and irregular layers of resin-matrix cement. Defects like pores, micro-cracks, and micro-gaps were detected in the resin-matrix cement microstructure and represent spots of stress concentration and fracture. Custom-made tooth root intracanal posts provide a proper fitting and decrease the layer thickness of resin-matrix cement. Conclusions In fact, the layer thickness of resin-matrix cements depends on the fitting of endodontic posts to tooth root canals. An increase of resin cement thickness causes the appearance of defects like pores, micro-cracks, and micro-gaps that can induce stress concentration and fractures at interfaces. Clinical relevance The fitting of the endodontic post into the teeth root canal determine the layer thickness of the resin-matrix cement to establish an adequate retention. However, the increase in the thickness of the resin-matrix cement layer can lead to a high number of defects like pores or cracks and therefore decrease the strength of the interface.

BackgroundEndodontically treated teeth usually can reveal an extensive loss of dental structure and require the use of intraradicular posts to provide adequate support and retention. Retention of the post depends on the surface treatment of the endodontic post itself and on the root canal dentin as well as on the type of resin-matrix cement.PurposeThe main aim of this study was to conduct an integrative review on the influence of different surface treatment methods of glass fiber-reinfored resin composite (GFRC) posts on their push-out bond strength to resin-matrix cements in endodontically treated teeth rehabiliation.MethodA literature search was performed on PubMed (via National Library of Medicine) regarding articles published within the last 10 years, using the following combination of search terms: “intracanal post” OR “endodontic post” OR “root canal post” OR “intraradicular post” OR “glass fiber” AND “resin cement” AND “adhesion” OR “bond strength” OR “shear bond strength” OR “push out”.ResultsResults from the selected studies recorded the highest push-out bond strength around 22.5 MPa) on GFRC posts to resin-matrix cements when the surfaces were pre-treated by grit-blasting with silicate followed by silane conditioning. However, high values of push-out bond strength (21.5 MPa) were also noticed for GFRC posts after etching with hydrogen peroxide followed by silance conditioning. Thus, the highest values of bond strength of endodontic posts to the resin-matrix cements were recorded when a combined physico-chemical approach was assessed. Non-treated surfaces showed the lowest bond strength values between 5 to and 9 MPa. Surface analyses of GFRC posts showed an increased roughness after grit-blasting or etching that promoted a mechanical interlocking of the adhesive and resin-matrix cements.ConclusionThe combined treatment of glass fiber-reinforced resin composite post surfaces by physical and chemical methods can promote the increase in roughness and chemical functionalization of the surfaces prior to cementation., That results in a high mechanical interlocking of the resin-matrix cements and a stable retention of the teeth root intracanal posts.Clinical relevanceCombining chemical and physical modification methods of surfaces can provide the most promising adhesion-enhancing pathways of GFRC posts to resin-matrix cements, that can decrease the risk of clinical failures by fracture and detachment of endodontic posts.

The objective of this study was to develop a replica method for producing zirconia-reinforced bioactive glass (ZRBG) porous structures for bone repair. Four different types of porous structures were produced: zirconia (G1), 58S BG-coated zirconia (G2), zirconia-reinforced BG (G3) and 58S BG-coated zirconia-reinforced BG (G4). A complete characterization of the specimens was performed via SEM-EDS, Archimedes method, 3D X-ray micro-tomography, micro-indentation, compressive strength tests and SBF immersion tests. G3 and G4 specimens presented a BG matrix (~ 33% glassy phase) with dispersed zirconia particles. The porosity of the specimens ranged from 86% up to 93%. BG58S-zirconia groups G3 and G4) exhibited lower YM (38.76 ± 11.20 GPa and 43.49 ± 2.16 GPa) than that of G1 monolithic zirconia specimens (94.39 ± 12.62 GPa), which were more compatible to that of the bone. No significant difference in compressive strength between BG58S-zirconia (G3: 0.41 ± 0.20 MPa; G4: 0.45 ± 0.11 MPa) and zirconia (G1: 0.32 ± 0.11 MPa) was detected observed (p > 0.05). In vitro SBF tests showed a potential bioactivity for ZRBG porous structures.

Background Crowding has been a longstanding issue in emergency departments. To address this, a fast-track system for avoidable patients is being implemented in the Paediatric Emergency Department where our study is conducted. Our goal is to develop an optimized Decision Support System that helps in directing patients to this fast track. We evaluated various Machine Learning models, focusing on a balance between complexity, predictive performance, and interpretability. Methods This is a retrospective study considering all visits to a university-affiliated metropolitan hospital’s PED between 2014 and 2019. Using information available at the time of triage, we trained several models to predict whether a visit is avoidable and should be directed to a fast-track area. Results A total of 507,708 visits to the PED were used in the training and testing of the models. Regarding the outcome, 41.6% of the visits were considered avoidable. Except for the classification made by triage rules, i.e. considering levels 1,2, and 3 as non-avoidable and 4 and 5 as avoidable, all models had similar results in model’s evaluation metrics, e.g. Area Under the Curve ranging from 74% to 80%. Conclusions Regarding predictive performance, the pruned decision tree had evaluation metrics results that were comparable to the other ML models. Furthermore, it offers a low complexity and easy to implement solution. When considering interpretability, a paramount requisite in healthcare since it relates to the trustworthiness and transparency of the system, the pruned decision tree excels. Overall, this paper contributes to the growing body of research on the use of machine learning in healthcare. It highlights practical benefits for patients and healthcare systems of the use ML-based DSS in emergency medicine. Moreover, the obtained results can potentially help to design patients’ flow management strategies in PED settings, which has been sought as a solution for addressing the long-standing problem of overcrowding.

The analysis of the beampattern is the base of sparse arrays design process. However, in the case of bidimensional arrays, this analysis has a high computational cost, turning the design process into a long and complex task. If the imaging system development is considered a holistic process, the aperture is a sampling grid that must be considered in the spatial domain through the coarray structure. Here, we propose to guide the aperture design process using statistical parameters of the distribution of the weights in the coarray. We have studied three designs of sparse matrix binned arrays with different sparseness degrees. Our results prove that there is a relationship between these parameters and the beampattern, which is valuable and improves the array design process. The proposed methodology reduces the computational cost up to 58 times with respect to the conventional fitness function based on the beampattern analysis.

This work provides a guide to design ultrasonic synthetic aperture systems for non-grid two-dimensional sparse arrays such as spirals or annular segmented arrays. It presents an algorithm that identifies which elements have a more significant impact on the beampattern characteristics and uses this information to reduce the number of signals, the number of emitters and the number of parallel receiver channels involved in the beamforming process. Consequently, we can optimise the 3D synthetic aperture ultrasonic imaging system for a specific sparse array, reducing the computational cost, the hardware requirements and the system complexity. Simulations using a Fermat spiral array and experimental data based on an annular segmented array with 64 elements are used to assess this algorithm.