Expanding beyond endoscopy: A review of non-invasive modalities in Barrett’s esophagus screening and surveillance

Barrett’s esophagus (BE) is a condition that results from replacement of the damaged normal squamous esophageal mucosa to intestinal columnar mucosa and is the most significant predisposing factor for development of esophageal adenocarcinoma. Current guidelines recommend endoscopic evaluation for screening and surveillance based on various risk factors which has limitations such as invasiveness, availability of a trained specialist, patient logistics and cost. Trans-nasal endoscopy is a less invasive modality but still has similar limitations such as limited availability of trained specialist and costs. Non-endoscopic modalities, in comparison, require minimal intervention, can be done in an office visit and has the potential to be a more ideal choice for mass public screening and surveillance, particularly in patents at low risk for BE. These include newer generations of esophageal capsule endoscopy which provides direct visualization of BE, and tethered capsule endomicroscopy which can obtain high-resolution images of the esophagus. Various cell collection devices coupled with biomarkers have been used for BE screening. Cytosponge, in combination with TFF3, as well as EsophaCap and EsoCheck have shown promising results in various studies when used with various biomarkers. Other modalities including circulatory microRNAs and volatile organic compounds that have demonstrated favorable outcomes. Use of these cell collection methods for BE surveillance is a potential area of future research.     

Human-eye versus computerized color matching

This project compared the difference in color matching between human-eye assessment and computerized colorimetry. Fifty dental personnel were asked to color match Vita Lumin shade tabs to seven different randomly arranged test tabs from the Z100 shade guide. All evaluators were blinded to the shades of the test tabs and were asked to match only body shade of the Vita Lumin tab to the middle third or body of each test tab. The results obtained were subsequently computed into L*a*b* values and compared with results obtained by computerized colorimetry. Results indicate that the difference in color matching between human-eye assessment and computerized colorimetry is shade dependent. Discrepancy was significant for b* coordinates for shades A1 and B2 and L* and b* coordinates for shade C4. For all shades evaluated, color difference between human-eye and computerized color matching is perceivable under clinical settings, as delta E values are greater than 3. There is a need for correction factors in the formal specification of the color-matching software due to the discrepancy between human-eye and computerized colorimetric color matching.     

Wear behavior of new composite restoratives

This study investigated the wear resistance of recently introduced nanofill (Filtek Supreme [FS], 3M-ESPE) and ormocer (Admira [AM], Voco) composites and compared their wear characteristics to microfill (Filtek A110 [AO], 3M-ESPE]), minifill (Esthet X [EX], Dentsply; Filtek Z250 [ZT], 3M-ESPE) and polyacid-modified (Dyract AP [DY], Dentsply) composites. Six specimens were made for each material. The specimens were conditioned for one week in distilled water at 37 degrees C and subjected to wear testing at 20 MPa contact stress against SS304 counter-bodies using reciprocal compression-sliding wear instrumentation. Distilled water was used as lubricant. Wear depth (microm) was measured using profilometry every 5,000 cycles up to 20,000 cycles. The results were analyzed using ANOVA/Scheffe's test (p<0.05). Wear of the materials was cycle and fatigue dependent. Although no significance in wear was observed between materials after 5,000 cycles of wear testing, significant differences were observed at 10,000 cycles and greater. After 20,000 cycles of wear testing, ranking was as follows: ZT > DY >AM > AO > FS > EX. Wear ranged from 39.90 microm for EX to 113.32 microm for ZT. The wear resistance of ZT and DY was significantly lower than AO, FS and EX In addition, ZT experienced significantly more wear than AM. Under the conditions of this in-vitro study, the wear resistance of nanofill and ormocer composites was comparable or superior to polyacid-modified, microfill and minifill composites.     

Effectiveness of composite cure associated with different light-curing regimes

This study investigated the use of various light-curing regimens with standardized light energy density on the effectiveness of cure of a visible light activated resin composite (Z100, 3M-ESPE). A light-cure unit (Variable Intensity Polymerizer (VIP), BISCO Inc) which permitted individual control over time and intensity, was used. The five light-curing modes investigated include Pulse Delay (PD), Pulse Cure (PC), Soft-start (SS), Turbo (T) and Control (C). Effectiveness of cure was established by measuring the top and bottom Knoop hardness of 2-mm thick composite specimens using a digital microhardness tester (n=5, load=500g; dwell time=15 seconds) immediately and at one-day post-polymerization. Data obtained was analyzed using one-way ANOVA/Scheffe's post hoc test and Independent Samples t-tests (p<0.05). Top KHN observed immediately after polymerization with C was significantly lower than PD. At one day post-polymerization, the top KHN obtained with C was significantly lower than PD, SS and T. No significant difference in bottom KHN was observed among the different curing modes immediately after curing. At one day post-polymerization, the bottom KHN obtained with C was significantly lower than SS and T. Regardless of curing regimens, top and bottom values at one day were significantly higher than those observed immediately after light polymerization. No significant difference in mean hardness ratio was observed among the different curing regimens immediately and one day later. Effectiveness of the cure at the bottom surfaces of composites may be increased by soft-start and turbo polymerization regimens.     

Short-term fluoride release from various aesthetic restorative materials

The short-term fluoride release of a giomer (Reactmer), a compomer (Dyract AP), a conventional glass ionomer cement (Fuji II Cap) and a resin-modified glass ionomer cement (Fuji II LC) was evaluated and compared. Specimen discs (6 +/-0.2 mm diameter and 1 +/- 0.2 mm thick) were prepared for each material using custom molds. Each disc was placed in 1 ml of deionized for 24 hours at 37 degrees C. After one day, the water was extracted and analyzed. The specimen discs were then re-immersed into another 1 ml of fresh deionized water. The procedure of removing and refilling the water was repeated for 28 days. Sample solutions taken during the first seven days and at days 14, 21 and 28 were introduced into a capillary electrophoresis system using field amplified sample injection (FASI) to determine fluoride release. Data was analyzed using factorial ANOVA/Scheffe's post-hoc test at significance level 0.05. An initial fluoride "burst" effect was observed with glass ionomers. Both compomer and giomer did not show an initial fluoride "burst" effect. With the exception of the compomer, fluoride release at day one was generally significantly greater than at the other time intervals. The glass ionomers released significantly more fluoride than the compomer and giomer at day one. Although fluoride release of the giomer was significantly greater than the other materials at day seven, it became significantly lower at day 28.     

Properties of a new root-end filling material

The purposes of this investigation were 2-fold: to study the physical properties and sealing ability of Viscosity Enhanced Root Repair Material (VERRM); and, to compare them with Mineral Trioxide Aggregate (MTA). VERRM has a composition similar to mineral trioxide aggregate, with handling characteristics and consistency similar to commercially available materials such as IRM and Super EBA. The pH, setting times, solubility, radiopacity, dimensional change upon setting, and apical sealing ability of VERRM were evaluated and compared to that of ProRoot MTA (GMTA) and ProRoot MTA (Tooth Colored Formula) (WMTA). The results showed that VERRM had physical properties similar to WMTA. VERRM and WMTA showed significantly greater dye penetration than GMTA (p < 0.05) when used as a root-end filling material. There was no significant difference in depth of dye penetration between VERRM and WMTA. Further development of VERRM is indicated to produce a biocompatible root-end filling material with superior handling characteristics.     

Color perception among different dental personnel

This study investigated the differences in color perception among distinct groups of dental personnel. Four groups of dental personnel (10 dental technicians, 15 final-year dental students, 15 general practitioners and 10 prosthodontists) were asked to match seven test tabs of shades A1, A4, B2, B3, C2, C4 and D3 (Z100 shade guide, 3M Dental Products, St Paul, MN 55144, USA) against a standard Vita shade guide under similar lighting conditions. The results obtained were computed into L*a*b* values using a small-area colorimeter (Dental Colorimeter, Minolta Camera Pte Ltd). The data were analyzed using one-way ANOVA/post-hoc Scheffe's test at significant level p<0.05. The results showed significant differences in deltaE (color difference) between the dental technicians and the clinicians for shade C4. The significant difference that was observed in deltaE for dark shades between dental personnel was mainly contributed to a disparity in L* values. A significant difference in deltaL* was observed between dental technicians and prosthodontists for shade C4.