This paper carries forth the conceptual framework for biophilic design that was first laid out by Cramer and Browning in Biophilic Design (2008), which established three categories meant to help define biophilic buildings – Nature in the Space, Natural Analogues and Nature of the Space – and a preliminary list of “biophilic conditions”. New research and insights from the neurosciences, endocrinology and other fields have since helped evolve the scientific basis for biophilic design. This paper begins to articulate this growing body of research and emerging design parameters in architectural terms, so that we may draw connections between fields of study, highlight potential avenues for future research, evolve our understanding of biophilic design patterns, and capture the positive psychophysiological and cognitive benefits afforded by biophilia in our design interventions.

Clinical RelevanceUsing the Vita 3D-Master shade guide, the accuracy of three experienced clinicians was compared to shade choices using an intraoral spectrophotometer. Compared to the clinicians, the shades chosen by the Easyshade guide were more frequently an exact match. This study indicates shade matching may be improved by using an electronic device. SUMMARYConsistently choosing an accurate shade match is far more difficult than it appears. Recently, several electronic shade-matching devices have been marketed. One device is an intraoral spectrophotometer, Easyshade. The current study compared the accuracy and consistency of the Easyshade (ES) device to three clinicians experienced in tooth whitening trials and trained in the use of the Vitapan 3D Master shade.The maxillary anteriors of 16 participants were matched on three separate occasions one month apart. At each appointment, the three clinicians (R1, R2 & R3) and ES independently chose a single 3D Master tab. A trained research assistant used the Easyshade device to record CIE L*, C* and H* and a shade tab. In addition, color differences between shade tabs were calculated using the Delta E 2000 (∆ e 00) formula. The CIE L*C*H* data were also used to establish standards for the five lightness groups of the 3D Master. An intrarater agreement was evaluated using an intraclass correlation statistic, and an inter-rater agreement was evaluated using a weighted Kappa statistic.The percentages of exact matches were: ES = 41%; R1 = 27%; R2 = 22% and R3 = 17%. Matches within a half-shade were also calculated. This represents a mismatch that is perceptible but acceptable. The percentages of matches within a half-tab were: ES = 91%; R1 = 69%; R2 = 85% and R3 = 79%. In terms of lightness, the intra-rater The mean color difference for the L*, C*, H* data recorded at each evaluation was 1.5, or only slightly greater than the color difference between the same tab on different guides (1.2). The ∆ e 00 data were the most accurate data collected, and they were used to establish a standard to which the tab choices of the four raters were compared. A weighted Kappa statistic was performed and, in terms of lightness, agreement was found to be good for all raters. For chroma, agreement was very good for ES and it was good for the clinicians.In terms of the number of exact matches and matches within a half-shade, the performance of ES was at least comparable to, if not better than, the dentists. Statistically, the same was true in terms of consistency and accuracy when making repeated matches of lightness and chroma using the 3D Master shade guide.

SUMMARYThis placebo-controlled, double-blind randomized clinical trial compared five 10% carbamide peroxide tooth whitening formulations. Three products contained varying concentrations of potassium nitrate as desensitizers. One contained no desensitizers and one was a placebo. During the two weeks of active bleaching, participants used a daily diary to record the number of days of sensitivity from hot, cold, gums, tongue and/or throat. The total number of days of sensitivity experienced by the participants in each group was compared. Participants using the agent with no desensitizers did not experience any more sensitivity than those using the agent containing 3% potassium nitrate. The products that included 0.5% potassium nitrate and 0.5% potassium nitrate and 0.25% sodium fluoride were not associated with any more sensitivity than the placebo group. Clinical RelevanceThe results of this double-blind, placebo-controlled clinical trial have direct relevance to clinical practice and provide evidence that the addition of low levels of potassium nitrate and/or potassium nitrate and fluoride significantly reduce postoperative sensitivity relative to products that do not contain either agent.In addition, the shade tab change from baseline to 11 weeks following cessation of bleaching was compared. Using an active bleaching agent, no difference in color change was noted among the four groups. All four groups were associated with significantly higher color change than the placebo.The addition of a small percentage of potassium nitrate to a 10% carbamide peroxide tooth whitener was shown to significantly reduce postoperative sensitivity without reducing efficacy.

For those using a tooth whitener without a desensitizing agent, this study indicates that a paste containing nano-hydroxyapatite crystal can effectively reduce the duration of tooth sensitivity.

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Although having many potential benefits, composite preheating may not be as clinically effective in delivering resin of predetermined temperature at the time of cure as laboratory experiments would suggest. Despite only moderate composite temperature increase over use of room temperature material, preheating still provides advantages in terms of ease of handling and placement.

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The results from a large group of people are more likely to include a wide cross-section of the population sampled. This data provides practitioners with a better estimate of what their patients are likely to experience. It is estimated that, during 2 weeks of active bleaching, 77% of people will experience 3 or fewer days of sensitivity. On average, sensitivity is short-lived, thus making it is easy to underestimate the importance of discussing sensitivity with patients considering bleaching. However, for some, the duration of sensitivity is much greater and has a very negative impact on satisfaction.