Successful pregnancy in a woman with Herlyn-Werner-Wunderlich syndrome: A case report and literature review.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital condition characterized by renal agenesis, uterine didelphys, and obstructed hemivagina. This report presents the case of a 19-year-old woman who reported lower abdominal pain and offensive vaginal discharge. Imaging revealed a didelphys uterus, two vaginas, two cervixes, hematocolpos, and an absent right kidney. Surgical intervention involved draining the hematocolpos and excising the uterine septum. After surgery, the patient successfully conceived and had a full-term pregnancy, delivering via cesarean section without complications. This case highlights the importance of early diagnosis and surgical management in preventing complications such as endometriosis and infertility. Prompt recognition and treatment are crucial for preserving fertility in patients with HWW syndrome.

Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth.

AIM: In comparing the effectiveness and efficiency of different types of post removal systems in removing different types of fiber posts (FPs), this study aims to shed light on the success of removal by currently available drill systems. MATERIALS AND METHODS: A total of 200 maxillary first molars, were root canal treated and prepared to receive posts. The molars were divided into four groups corresponding to four different FPs: Group RX, Radix FP; Group RF, Reforpost Glass Fiber; Group HI; Hi-Rem Endodontic Post; and Group DT, D.T. Light-Post Illusion X-RO. Fiber posts were done with luting by Gradia Core (GC America, Inc.). Groups were again divided into five subgroups corresponding to the technique by which the FP was removed into as follows: Subgroup P, PD-25-1.1 Drill; subgroup G, GC FP Drill; subgroup E, EasyPost Precision Drill; subgroup R, Reaccess Carbide Double Taper Kit; and subgroup H; H-Endodontic Drill. After posts were removed, effectiveness and efficiency were documented. Data were tabulated and statistically analyzed. RESULTS: Strong significant differences regarding efficiency among groups (FP type) and subgroups (drills used) (p = 0.00) were shown by the one-way analysis of variance (ANOVA) test. Subgroup DT-G scored the longest mean removal time (20.9 minutes) while Subgroup RX-R scored the shortest mean removal time (1.4 minutes) Regarding effectiveness, strong significant differences among groups (p = 0.00) and subgroups (p = 0.00) were shown by one-way ANOVA. Subgroup RF-G scored the highest scale (5.2) whereas subgroup HI-R scored the lowest mean scale (1.2). CONCLUSION: The difference was strongly significant between tested post-removal kits and between tested FPs. Re-access Carbide Double Taper Kit performed superiorly in both effectiveness and efficiency, followed by PD-25-1.1 Drill. Hi-Rem post showed the best retrieving results among other FPs. CLINICAL SIGNIFICANCE: Knowing the best technique and tools for post removal could spare the practitioner any unwanted complications during post removal. How to cite this article: Sayed M, Alahmad AM, Alhajji KS, et al. Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth. J Contemp Dent Pract 2024;25(1):72-78.

The use of objective structured clinical examination in dental education- a narrative review.

The Objective Structured Clinical Examination (OSCE) is a performance-based assessment intended to assess medical students' clinical competency in a simulated, standardized environment. Because it measures the student's ability to use clinical knowledge, diagnostic skill, and decision-making, the OSCE is thought to be more objective than traditional tests. OSCE exams have been increasingly employed in dentistry schools, particularly in the last decade, and it is crucial to investigate instructors' and dental students' experiences with this evaluation approach.

Comparison of Fracture Resistance between Different Treatment Modalities of Mutilated Endodontically Treated Teeth Using Polyether Ether Ketone.

AIM: To compare fracture resistance of multiple treatment modalities intended for mutilated teeth using polyether ether ketone (PEEK) and zirconia materials. MATERIALS AND METHODS: The study was divided into four groups according to treatment modality adopted (n = 14): fiber post (F), Nayyar core (N), endocrown (E), and Richmond crown (R). Each group was further subdivided into two groups (n = 7) according to the type of material used: zirconia (Z) and PEEK (P). Using computer-aided design/computer-aided manufacturing, restorations were constructed from both materials following tested treatment options and manufacturer direction. Finished restorations were then tried, seated, and cemented to their corresponding acrylic teeth. All specimens were tested for fracture resistance in universal testing machine with cross head speed of 0.5 mm/min speed until failure, which was confirmed by a sudden drop in the measurements of the testing machine. Results were recorded, tabulated, and statistically analyzed. Shapiro-Wilk normality tests were considered to evaluate the normality of the data distributions. One-way analysis of variance (ANOVA) followed by Tukey's post hoc analysis was conducted to analyze the fracture resistance significant differences. RESULTS: Descriptive statistics of the restoration material revealed statistically a higher mean value for PEEK material (3609 ± 188.1) than zirconia (2404 ± 425.6). One-way ANOVA revealed statistically significant differences between zirconia group (p < 0.0001). Regarding zirconia group statistical significance was detected between fiber post vs endocrown (p = 0.0299), fiber post vs Richmond crown (p < 0.0001), and Nayyar core vs Richmond crown (p = 0.0004). However, there was no statistically significant difference between PEEK group (P = 0.1614). CONCLUSION: Polyether ether ketone could present a reliable treatment option in endodontically treated teeth. CLINICAL SIGNIFICANCE: Using one-piece Richmond crowns constructed of PEEK could present a viable treatment option against conventional treatment options of root canal treatment (RCT) single-rooted teeth.

Effect of Novel Low-intensity Pulsed Ultrasound Stimulation on Accelerated Implant Osteointegration in Canine.

AIM: To evaluate the effect of low-intensity pulsed ultrasound (LIPU) application on dental implant accelerated osseointegration in the two-stage implant protocol. MATERIALS AND METHODS: A total of 20 implants were placed in 10 mature mongrel dogs, two implants for each dog replacing the lower 3rd premolars bilaterally. After 3 months of extraction, implants were placed. After 24 hours of implantation, the right sides received LIPU for 20 mins/day, continuously for 20 days. The left sides didn't receive LIPU (control). Standardized radiographs were taken before LIPU and after 10 and 20 days for both sides. After 20 days of LIPU application, second-stage surgery was performed and provisional crowns were placed on each implant. Implants were subjected to functional occlusal loading for 4 weeks. Standardized radiographs were taken after 2 and 4 weeks of loading and analyzed to assess the peri-implant bone density changes. All data were collected, tabulated, and statistically analyzed. RESULTS: All tissues appeared clinically normal, with the absence of inflammation and peri-implant radiolucency. The survival rate was 100%. The LIPU group showed a statistically significantly higher percentage increase in mean bone density after 10 LIPU sessions, 20 LIPU sessions, and 2 and 4 weeks of loading, than a control group. CONCLUSION: The LIPU stimulation radiographically increased the bone density around implant area and accelerated osseointegration in the two-stage implant protocol. CLINICAL SIGNIFICANCE: Low-intensity pulsed ultrasound stimulation could be beneficial in accelerating osseointegration and thus shortening the waiting period for final prosthetic delivery.

Gender representation in animal-related proverbs: Algerian vs. Jordanian Arabic.

Introduction: This study explores the connotative meanings in animal-related proverbs used to describe the behavior of men and women in Algerian and Jordanian societies. Methods: A questionnaire with 46 Algerian and 45 Jordanian animal-related proverbs was distributed to 30 native Arabic speakers enrolled at the University of Jordan. The analysis focused on adapted categories with a gender perspective, including inferiority, weakness, stupidity, ill-nature, objectification, ugliness, positivity, and shrewdness. Results: Both Algerian and Jordanian animal-related proverbs exhibited diverse connotative meanings. Women were predominantly associated with derogatory connotations in both languages, portraying characteristics such as weakness, stupidity, inferiority, cunningness, and trickery. Similar characteristics were present in descriptions of men, but women in Arab cultures were consistently depicted as subordinate and denigrated. Conversely, men were portrayed with authority, control, superiority, and strength over women. Additionally, positive depictions included animals like gazelles, peacocks, partridges, cats, and horses to symbolize the beauty of women. Men's positive characteristics, such as strength, courage, and superiority, were associated with horses, camels, and lions. Discussion: This study highlights the prevalent connotations in animal-related proverbs used to describe men and women in Algerian and Jordanian societies. It reveals derogatory portrayals of women, reinforcing their subordinate status, while men are depicted with authority and power. However, positive representations emerged, attributing beauty to women and highlighting admirable qualities in men. These findings shed light on the complex dynamics of gender portrayal within cultural proverbs, emphasizing the need for further examination of these linguistic expressions.

The Effect of Cement Space Parameters on the Marginal Adaptation of Milled Endocrowns: An In Vitro Study.

Background Cement film space plays a significant role in achieving good adaptation of indirect restorations. The objective of this study is to investigate the effect of cement space parameters on the marginal adaptation of computer-aided design (CAD)/computer-assisted manufacturing (CAM) endocrowns. Methodology The coronal part of 10 freshly extracted human mandibular molars was reduced to a level of 1.5 mm above the cementoenamel junction (CEJ); then, root canal treatment was performed. On each tooth, four lithium disilicate endocrowns with different cement space parameters (40, 80, 120, and 160 µm) were designed and fabricated using CAD/CAM. Endocrowns were seated to their prepared teeth, and the vertical marginal gap was measured in 20 equidistant points for each endocrown using a stereomicroscope on 90× magnification. The mean marginal gaps of the four groups were compared using a one-way analysis of variance (ANOVA) and the Tukey honestly significant difference (HSD) test considering p<0.05 as the cutoff for statistical significance. Results The mean marginal gap of the 40 µm, 80 µm, 120 µm, and 160 µm groups were 46.25±21.20 µm, 21.75±11.10 µm, 15.94±06.62 µm, and 13.10±07.08 µm, respectively. One-way ANOVA showed a significant difference in the marginal gaps between groups (p<0.001). The Tukey post hoc test showed a statistically significant mean difference between 40 µm and each of the other three groups (p<0.001). Conclusion The cement space parameter variation affects the marginal adaptation of endocrowns. The cement space of 40 µm resulted in a higher marginal gap than cement spaces of 80, 120, and 160 µm.

Comparison between Distal Extension Attachment-retained Removable Partial Prostheses with Integrated and Conventional Reciprocation Designs: A Clinical Trial.

AIM: To compare marginal bone level (MBL) around the abutments in integrated and conventional reciprocation designs in attachment-retained removable partial prosthesis (A-RPP). MATERIALS AND METHODS: Around 14 participants were indiscriminately selected and separated into two groups. For every group, an A-RPP with one of the studied reciprocation types was fabricated and assessed. Group I received A-RPP with integrated reciprocation and group II received A-RPP with conventional reciprocation. MBL around the crowned primary and secondary abutments was assessed on the day of A-RPP insertion, at 6 and at 9 months of denture use. RESULTS: Comparison of MBL values at the primary and secondary abutments within each group showed no statistical difference from time of delivery and throughout the study. After using the A-RPP for 6 and 9 months, group I revealed lower mean values of MBL than group II which were statistically significant. CONCLUSION: Distal extension A-RPP with integrated and conventional reciprocation designs were associated with raise in bone loss. Integrated reciprocation design revealed a lesser amount of bone loss than the conventional reciprocation design and therefore, it is considered as more preferable to be used. CLINICAL SIGNIFICANCE: Distal extension A-RPP with integrated reciprocation is superior in terms of periodontium preservation around abutment teeth as compared to distal extension A-RPD with conventional reciprocation.

Effect of pulp chamber depth on failure load and mode of failure of CAD/CAM endocrowns.

AIM: The present study aimed to investigate the effect of pulp chamber depth on the failure load and mode of failure of CAD/CAM endocrowns. MATERIALS AND METHODS: Thirty mandibular molars were sectioned above the cementoenamel junction (CEJ), followed by root canal treatment. Teeth were sectioned at a level of 1.5 mm above the CEJ, arranged from the lowest to the highest depths, and divided into three groups (n = 10): group SE: Shallow pulp chamber (1.42 to 2.17 mm); group IE: Intermediate pulp chamber (2.25 to 3.17 mm); group DE: Deep pulp chamber (3.33 to 5.17 mm). CAD/CAM endocrowns were fabricated by milling lithium disilicate ceramic blocks and were cemented using resin cement. Teeth were embedded in acrylic resin at 2 mm below the CEJ, and a compressive load was applied to create a 45-degree angled functional loading simulation until the occurrence of failure. RESULTS: The mean failure loads were highest in group DE (1893.75 ± 496.08 N) compared with groups IE (1103.71 ± 254.59 N) and SE (1084.63 ± 240.92 N), with statistically significant differences between group DE and both groups IE and SE (P < 0.001). Pearson correlation coefficient (PCC) revealed a strong positive correlation between the pulp chamber depth and failure load of the endocrowns. The failure mode for all samples was catastrophic failure. CONCLUSION: The pulp chamber depth affected the failure load of the teeth restored with endocrowns. The failure loads were higher in teeth with a greater pulp chamber depth. (Int J Comput Dent 2023;26(1): 31-0; doi: 10.3290/j.ijcd.b3818295).

Failure loads of heat-pressed versus milled lithium disilicate endocrowns.

OBJECTIVES: This study aimed to compare the failure load of heat-pressed versus milled lithium disilicate endocrowns. MATERIALS AND METHODS: Twenty extracted mandibular molars were sectioned 1.5 mm above the CEJ. Root canal treatment and endocrown preparation were done for all teeth. Samples were then divided into two groups: heat-pressed glass ceramic endocrowns (HP group) (n = 10) and milled endocrowns (CAD group) (n = 10). Cementation was done using self-adhesive resin cement, and a compressive load was applied on the occlusal surface of the specimens until failure occurred. RESULTS: The mean failure loads were significantly higher in the HP group (2546.5 ± 339 N) compared to the CAD group (1759.9 ± 114.2) (p < 0.05), and majority of failures were due to fracture of the restoration. CONCLUSIONS: Failure loads of heat-pressed lithium disilicate endocrown are superior to milled endocrown. CLINICAL RELEVANCE: Molars restored with lithium disilicate endocrowns have higher failure loads than the maximum human bite force regardless of the fabrication method. Although heat-pressed endocrowns have superior failure loads to milled ones, both are indicated for restoring endodontically treated molar teeth.

In vivo Evaluation of Shade Replication of Different Generations of Zirconia to Natural Teeth Using Digital Color Determinations.

AIM: The color difference between the final shade of restorations milled from different zirconia blocks, and the control teeth in the esthetic zone is yet uncertain. MATERIALS AND METHODS: For eight patients who required a singular maxillary central incisor restoration, twenty-four crowns made of zirconia were created. These were grouped into three categories based on the shade and nature of zirconia (Zr) utilized (white core, colored core, and monolithic high-translucency (ht) Zr crowns). The difference in color (ΔE) between the three zirconia crowns and the neighboring teeth was calculated by the use of Easyshade spectrophotometer. Two shades of resin luting cement were used. The measured ΔE values were evaluated based on a clinically acceptable color difference of 1.6ΔE, which is not visible to the human eye. RESULTS: Among the three groups, no differences of statistical significance were observed in terms of ΔE with different Zr types and resin cement color. CONCLUSION: Within the limits of this study, the usage of different shades of zirconia blanks and resin cements did not display a statistically significant effect on the final color of the crown. CLINICAL SIGNIFICANCE: Changing the shade of resin cements does not appear to add value to the final shade of crown. In addition, the generation of zirconia does not influence the shade of the crown. Crowns made of zirconia can be cemented with opaque or transparent cement with no effect on the final color.

Effect of Cement Type on Fracture Resistance and Mode of Failure of Monolith vs Bilayered Zirconia Single Crowns.

AIM: To compare the fracture resistance and the mode of failure between monolith second-generation zirconia and bilayered first-generation zirconia single crowns cemented by resin cement and glass ionomer cement (GIC). MATERIALS AND METHODS: A total of 36 maxillary first premolar crowns (5 mm in length × 4 mm in cervical diameter, with a base of 6 mm) were computer-aided design-computer-aided manufacturing (CAD-CAM) milled. They were divided into the following two groups (n = 18) according to the fabrication techniques: Group M - monolith zirconia crown (1-mm axial thickness and 2-mm occlusal thickness) and group B - bilayer zirconia crown (0.5-mm axial thickness and 1-mm occlusal thickness). Each group was further subdivided into the following two subgroups (n = 9) according to the cement used: Subgroup G - cemented using GIC; subgroup R - cemented using resin cement. All crowns were cemented to their corresponding resin dies and stored in distilled water for 72 hours. Each specimen was mounted to the lower member of the universal testing machine with a load cell of 5 kN and a crosshead speed of 0.5 mm/minute. Failure modes were analyzed for fractured parts using scanning electron microscopy (SEM). RESULTS: Subgroup MR recorded the highest fracture resistance mean value (3616 ± 347.2 N) while the BG subgroup recorded the statistically significant lowest fracture resistance mean value (1728.7 ± 115.3 N). One-way analysis of variance (ANOVA) followed by pairwise Tukey's post hoc tests revealed a statistically significant difference (p = 0.0001) between groups M and B. One-way ANOVA followed by pairwise Tukey's post hoc tests also showed a statistically significant difference (p = 0.0297) between the types of cement used (subgroups G and R). CONCLUSION: Monolith zirconia crowns had better mean fracture resistance than bilayered zirconia crowns. Resin cement improved the fracture resistance compared to GIC. Monolith zirconia crowns showed bulk fracture while bilayered zirconia crowns showed chipping fracture. CLINICAL SIGNIFICANCE: Monolith zirconia crowns present a good prosthetic alternative overcoming the veneer chipping drawback of bilayered zirconia crowns. In addition, resin cement could increase the fracture resistance of zirconia crowns.

Comparison of Fracture Resistance between Implant-supported Bis-acryl Interim 3-unit FDPs Using Six Different Strengthening Mechanisms: An In Vitro Study.

AIM: To investigate six different strengthening mechanisms for three-unit implant-supported provisional restorations. MATERIALS AND METHODS: Six techniques of provisional fixed prostheses (PFP) reinforcement were investigated and were assigned to different groups (n = 10): group (ZP) zirconia powder, group (SK8) silk thread wrapped as a figure-of-8 pattern around middle third of abutment, group (RC8) size 00 retraction cord wrapped as a figure-of-8 pattern around middle third of abutment, group (RF8) Resin impregnated glass fiber ribbon wrapped as a figure-of-8 pattern around abutment, group (KV8) Kevlar 29 cord wrapped as a figure-of-8 pattern around middle third of abutment, group (KV) Kevlar 29 strands incorporated in resin mix. Compared against unenforced bis-acryl as control group (CL). Seventy Metal Dies were 3D printed having Soft Tissue Gingiva Mask. Using a custom-made silicone Index, 70 PFP were fabricated (10 of each group) and were cemented to their corresponding metal dies using zinc polycarboxylate cement. All specimens were thermal cycled for 1000 cycles using order of 20 seconds at 55°C and 20 seconds at 5°C with 10 seconds transport. Fracture resistance test was done using universal testing machine. All specimens were loaded to failure. Data were collected, tabulated and statistically analyzed. RESULTS: Kolmogorov-Smirnov normality test showed no significant difference between data in each group. So, data are normally distributed in each group. Descriptive statistics showed higher mean values of CL group (780.8 ± 164) followed by RF8 group (614.2 ± 158.2), followed by RC8 group (550.2 ± 339.2), followed by KV8 group (442.1 ± 198.4), followed by KV group (403.9 ± 306), followed by SK8 group (175.9 ± 90.8), and finally ZP group (136.5 ± 135.7). One-way ANOVA revealed significant difference between the tested groups (p = 0.036). CONCLUSION: Bis-acryl provisional restorations had better mean fracture resistance values than all other strengthening mechanisms. Bis-acryl provisional restorations did not gain more strength by any of the added materials. One-way ANOVA revealed significant difference between all tested groups. CLINICAL SIGNIFICANCE: Provisional restorations over implant should be strong enough to serve for the long period of bone and tissue healing. Current materials alone cannot survive for long. It serves as temporization between steps of fixed restorations construction. How to cite this article: Rayyan M, Sayed M, Hujeiry AM et al. Comparison of Fracture Resistance between Implant-supported Bis-acryl Interim 3-unit FDPs Using Six Different Strengthening Mechanisms: An In Vitro Study. J Contemp Dent Pract 2023;24(11):840-846.

Evaluation of Antibacterial Effect of New Sealer "Neoseal" and Two Commercially Used Endodontic Sealers against Enterococcus faecalis: An In Vitro Study.

AIM: To evaluate the antibacterial activity of three endodontic sealing materials, Neoseal, CeraSeal, and AH Plus against Enterococcus faecalis bacteria in vitro. MATERIALS AND METHODS: The antibacterial activity of three endodontic sealing materials including two bioceramic sealers; NeoSEALER Flo (group I), CeraSeal (group II), and one epoxy resin sealer; AH Plus (group III) was investigated against E. faecalis bacteria American Type Cell Culture Collection (ATCC) 29212 (ATCC, Rockville, Maryland, USA). Using modified direct contact test (MDCT). The endodontic sealers were tested in contact with bacterial suspension when unset (20 minutes after mixing) and after setting, assessing the antibacterial activity of aged sealers after 1, 3, 7, and 14 days. Analyzing the collected data has been done with version 25.0 of the statistical package for the social sciences (SPSS) IBM software (SPSS, Chicago, Illinois, USA). Descriptive analyses were calculated using standard deviation (SD) and mean. Shapiro-Wilk test was done to detect the normality of the result values. Kruskal-Wallis test was then performed to test the level of significance between groups. RESULTS: After 20 minutes - Group I showed higher bacterial count mean values (5,500 ± 500) and 0 values for groups II and III groups. After 1 day, the highest bacterial count mean values were in group III (54,333.3 ± 4,041.5) and 0 values for groups I and II. After 3 days - group III again recorded the highest bacterial count mean values (45,000 ± 5,000) and 0 values for I and II groups. After 7 days - Group III still recorded the highest bacterial count mean values (53,333.3 ± 1,527.5) and 0 values for groups I and II. After 14 days - Group III recorded the highest bacterial count mean values (56,000 ± 1,000) followed by group II (6,333.3 ± 577.4), and the least was group I (2,000 ± 500). Kruskal-Wallis test showed significant values between groups in all tested durations, p > 0.05. CONCLUSION: The sealing material AH Plus showed a strong bactericidal effect at the beginning but lost its ability after 24 hours. CeraSeal showed strong bactericidal activity from the beginning till the end of the first week but showed bacterial count at 14 days. Neoseal took 24 hours to show bactericidal effect and similar to CeraSeal showed bacterial count at 14 days; CeraSeal recorded the best results within the study. CLINICAL SIGNIFICANCE: Silicate-based (bioceramic) endodontic sealers can be the best available endodontic sealing material that is clinically beneficial in removing residual microbes which had survived irrigation protocols and chemomechanical preparation. How to cite this article: Basta DG, Reslan MR, Rayyan M, et al. Evaluation of Antibacterial Effect of New Sealer "Neoseal" and Two Commercially Used Endodontic Sealers against Enterococcus faecalis: An In Vitro Study. J Contemp Dent Pract 2023;24(11):871-876.

Stress levels among senior dental students in Saudi Arabia during fixed prosthodontics procedures.

Aims: To investigate self-perceived stress level of senior dental students in Saudi Arabia during different fixed prosthodontics procedures. Also, to explore the possible stress-related factors during each procedure. Settings and Design: A structured, close-ended, and open-ended, anonymous questionnaire was distributed in a website format to senior dental students of 19 dental schools in Saudi Arabia. Materials and Methods: Students were asked to rate the level of stress they feel during different fixed prosthodontics procedures on a scale from 0 to 10. They were also asked to rate the adequacy of their preclinical training in these procedures and how many times they have performed each of the procedures clinically. Statistical Analysis Used: Descriptive statistics were presented in means, percentages, and standard deviation and inferential statistics were performed using One-way ANOVA, independent t-test and Pearson's correlation. Results: About 423 students answered the questionnaire, in which 228 (54%) were females and 195 (46%) were males. Vital tooth preparation (5.27 ± 2.459) and pos space preparation (5.13 ± 2.766) were rated as the most stressful procedures (P < 0.05). Fear of error or mishaps was the most reported reason for stress during these two procedures. Pearson's correlation showed significant but weak negative correlation between stress scores and number of times the student has performed the procedure (P < 0.05). Students who believe that they had adequate preclinical training reported significantly lower stress scores (P < 0.05). Conclusion: Self-perceived stress among dental students is related to the type of procedure they perform in the clinic and how frequent they have been exposed to it during their preclinical training.

Marginal and internal fit of lithium disilicate endocrowns fabricated using conventional, digital, and combination techniques.

OBJECTIVE: To compare the marginal and internal adaptation of endocrowns produced using conventional technique, digital technique, and combination (cast digitization) techniques using microcomputed tomography (micro-CT). MATERIALS AND METHODS: Ten freshly extracted human mandibular molar teeth were prepared for all-ceramic endocrowns. A total of 40 Lithium Disilicate (IPS e.max) endocrowns were fabricated and grouped according to the impression and production technique to four groups: Group (CO): Conventional impression/heat pressed endocrowns (n = 10), Group (CAD): Direct scanning of teeth/CAD-CAM endocrowns (n = 10), Group (COMIO): Combination; Cast digitization using Intraoral scanner/CAD-CAM endocrowns (n = 10), Group (COML): Combination; Cast digitization using laboratory scanner/CAD-CAM endocrowns (n = 10). Micro-computed tomography was used to measure the marginal and internal gaps in 11 predetermined sites. Mean marginal and internal gaps were compared using analysis of variance and Scheffe's post hoc test. RESULTS: CO, CAD, COMIO, and COML groups showed significant differences in the mean marginal gap (150 ± 35 µm, 120 ± 27 µm, 110 ± 24 µm, 120 ± 29 µm, respectively p = 0.013), gap at line angle (280 ± 70 µm, 130 ± 37 µm, 140 ± 54 µm, 130 ± 33 µm, respectively, p < 0.001), gap at cavity wall (210 ± 76 µm, 140 ± 43 µm, 140 ± 52 µm, 150 ± 44 µm, respectively, p = 0.010) and gap at pulpal floor (500 ± 150 µm, 240 ± 58 µm, 260 ± 59 µm, 240 ± 64 µm, respectively, p < 0.001). CONCLUSION: Digitally fabricated endocrowns showed superior marginal and internal fit compared to the conventionally fabricated endocrowns. CLINICAL SIGNIFICANCE: Marginal and internal adaptation are detrimental factors for the success and survival of dental restorations including endocrowns. When compared with the conventional impressions and conventional production techniques, Digital workflow is more predictable and reliable as it reduces errors and improves the accuracy of fit.

Self-reported stress among senior dental students during complete denture procedures.

Aims: Stress is a common problem that can have a considerable impact on student performance and subsequently the quality of treatment given to the patients. This study aimed to investigate the levels and reasons of stress among senior dental students when they perform different complete denture clinical procedures. Settings and Design: A questionnaire was designed and distributed electronically among senior dental students of 19 universities in Saudi Arabia. Materials and Methods: The students were asked to score the levels of stress during five complete denture clinical steps on a scale from zero to ten and report factors contributing to it. Statistical Analysis Used: Descriptive statistics and inferential statistics were carried out by One-way ANOVA and independent t-test to compare stress scores between different procedures. Results: A total of 419 responses were collected, 195 (46.5%) males and 224 (53.5%) females. One-Way ANOVA revealed statistically significant difference in the mean stress scores between the five procedures (P < 0.001). The highest mean stress score was for border molding and final impression procedure (4.06 ± 2.664) and jaw relation (4.20 ± 2.690). Moreover, the Stress scores were significantly higher among females when compared to males in all procedures (P < 0.05) except the placement of final denture (P > 0.05). Conclusion: Border molding, final impression, and jaw relation records cause more stress for dental students than the other complete denture procedures. Difficulty of these two procedures was the most common reported stress provoking factors.

Comparison between Integrated and Parallel Interlock Designs of an Extracoronal Attachment-retained Distal Extension Removable Partial Dentures: A Clinical Trial.

OBJECTIVE: Precision attachments may exert unfavorable stresses on abutments in distal extension bases. This study compared between two reciprocation designs in attachment removable partial dentures (RPDs). MATERIALS AND METHODS: Fourteen patients were allocated into two groups. Each patient received an attachment-retained RPD with one of the two types of attachments being studied. Group I received the integrated interlock type of reciprocation and group II received the parallel interlock type. Abutments were examined for modified plaque index, modified bleeding index, periodontal probing pocket depth, clinical attachment level, and modified papillary bleeding Index. RESULTS: Comparisons of periodontal parameters between mesial and distal abutments within each group revealed no statistically significant difference. Means of these parameters were used for the comparisons. There was a significant difference at P < 0.05 in all parameters between the two groups at time of insertion and at 3, 6, and 9 months of follow-up with values of group (II) higher than group (I). CONCLUSION: RPDs of both designs showed an increase in periodontal parameters. Integrated interlock design showed better scores. It is preferable to use the attachment-retained RPD with integrated interlock instead of parallel interlock design.

Fracture Resistance of Monolithic High-Translucency Crowns Versus Porcelain-Veneered Zirconia Crowns After Artificial Aging: An In Vitro Study.

Purpose To evaluate the fracture resistance and fracture mode of high-translucency monolithic zirconia (HTZ) crowns and porcelain-veneered zirconia (PVZ) crowns. Material and methods A master die was scanned to design and fabricate the HTZ group (n = 10) and PVZ group (n = 10). Both groups were artificially aged before loaded to fracture. The means of fracture loads of the two groups were compared using an independent t-test at a significance level of 0.05. The mode of fracture was determined using a digital magnifier. Results The mean fracture strength for the HTZ group (4,425 ± 177 newtons (N)) was significantly higher than in the PVZ group (1,798 ± 30.9 N) (p-value < 0.001). All crowns in the HTZ group presented core fracture mode. However, crowns in the PVZ group showed both a core and adhesive fracture mode of 60% and 40%, respectively. Conclusion The fracture strength of HTZ crowns is superior to PVZ crowns. The fracture strength of both types surpassed the maximum bite force in the posterior region, which may be deemed clinically adequate.

Comparing student achievement in traditional learning with a combination of blended and flipped learning.

Aim: The aim of this study was to investigate the effectiveness of blended learning with a flipped classroom design on student academic achievement in a Bachelor of Science in Nursing course. Design: A quasi-experimental study. Method: Students were split into an experimental blended learning with a flipped classroom design group and a control group using the traditional, teacher-centred learning method. Data were collected during spring 2018 (13.3 weeks) and student's grades for the registered course and their grade point average (GPA) were recorded. Results: Findings showed statistically significant increases in student grades in the experimental group. Predictability calculations also showed better achievement of learning outcomes if a blended learning with a flipped classroom design is continued to be used in the future.