Rabies control in Bangladesh and prediction of human rabies cases by 2030: a One Health approach.

Background: Bangladesh is making progress toward achieving zero dog-mediated rabies deaths by 2030, a global goal set in 2015. Methods: Drawing from multiple datasets, including patient immunisation record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between 2011 and 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences from GenBank in Bangladesh and other South Asian countries. Findings: The estimated dog population in Bangladesh was determined to be 1,668,140, with an average dog population density of 12.83 dogs/km2 (95% CI 11.14-14.53) and a human-to-dog ratio of 86.70 (95% CI 76.60-96.80). The MDV campaign has led to the vaccination of an average of 21,295 dogs (95% CI 18,654-23,935) per district annually out of an estimated 26,065 dogs (95% CI 22,898-29,230). A declining trend in predicted and observed human rabies cases has been identified, suggesting that Bangladesh is poised to make substantial progress towards achieving the 'Zero by 30' goal, provided the current trajectory continues. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor. Interpretation: Bangladesh's One Health approach demonstrated that an increase in MDV and anti-rabies vaccine (ARV) resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable. Funding: The study was supported by the Communicable Disease Control (CDC) Division of the Directorate General of Health Services (DGHS) of the People's Republic of Bangladesh.

Behavioral neuroscience in zebrafish: unravelling the complexity of brain-behavior relationships.

This paper reviews the utility of zebrafish (Danio rerio) as a model system for exploring neurobehavioral phenomena in preclinical research, focusing on physiological processes, disorders, and neurotoxicity biomarkers. A comprehensive review of the current literature was conducted to summarize the various behavioral characteristics of zebrafish. The study examined the etiological agents used to induce neurotoxicity and the biomarkers involved, including Aß42, tau, MMP-13, MAO, NF-Кß, and GFAP. Additionally, the different zebrafish study models and their responses to neurobehavioral analysis were discussed. The review identified several key biomarkers of neurotoxicity in zebrafish, each impacting different aspects of neurogenesis, inflammation, and neurodegeneration. Aß42 was found to alter neuronal growth and stem cell function. Tau's interaction with tubulin affected microtubule stability and led to tauopathies under pathological conditions. MMP-13 was linked to oxidative assault and sensory neuron degeneration. MAO plays a role in neurotransmitter metabolism and neurotoxicity conversion. NF-Ðšß was involved in pro-inflammatory pathways, and GFAP was indicative of neuroinflammation and astroglial activation. Zebrafish provide a valuable model for neurobehavioral research, adhering to the "3Rs" philosophy. Their neurotoxicity biomarkers offer insights into the mechanisms of neurogenesis, inflammation, and neurodegeneration. This model system aids in evaluating physiological and pathological conditions, enhancing our understanding of neurobehavioral phenomena and potential therapeutic interventions.

Deformation and retentive forces variations of the additively manufactured cobalt-chromium and titanium alloys dental clasps.

This in vitro study aimed to evaluate the additive manufacturing (AM) of cobalt chromium Co-Cr and titanium Ti alloy clasps for clinical use. After scanning the Ni-Cr die of the first molar, Akers' clasps were designed using computer-aided design/ computer-aided manufacturing (CAD/CAM). The clasps were manufactured from Co-Cr-W dental alloy and Ti-6Al-4V alloy powder using AM machines. Then, they were divided into two groups. The initial retentive force of the clasps was measured using a universal testing machine. Cyclic loading of the clasps was carried out by a specially designed insertion-removal testing apparatus in wet condition up to 5000 cycles. Retentive force was measured at 1000, 2000, 3000, 4000, and 5000 cycles. Moreover, the intaglio surface of each clasp was scanned using the scanner; and superimposition between the pre- and post-cycling clasp files was performed to evaluate deformation after cyclic loading. The fitting surfaces of retentive clasp tips were examined with a scanning electron microscope (SEM). Finally, it has been found that the initial retentive force for the Co-Cr group was 10.81 ± 0.37 N, and for the Ti group was 5.41 ± 0.18 N. Additionally, during the testing periods, both Co-Cr and Ti clasps continued to lose retentive force within the cycles of placement and removal. This effect was more prominent in the Co-Cr than in the Ti clasps. The distances between pre- and post-cycling in the retentive arm were -0.290 ± 0.11 mm and -0.004 ± 0.01 mm in Co-Cr and Ti alloys, respectively, and in the reciprocal arm were -0.072 ± 0.04 mm and -0.032 ± 0.04 mm in Co-Cr and Ti alloys, respectively. The retentive force required to remove the Ti clasps was found to be significantly lower than those required to dislodge the Co-Cr clasps. Co-Cr and Ti clasps lost significant amounts of retentive force from the initial use to the 3.5-year periods of simulated clinical use.

The Impact of Repeated Steam Sterilization Cycles on the Efficacy of Chairside Adjustment Kits for Polishing Monolithic Multi-Layered Zirconia Dental Restoration Material.

BACKGROUND Before insertion, chairside adjustment kits are heat sterilized for positioning and polishing dental restorations. This study aimed to evaluate the effects of 2 steam sterilization cycles on the efficacy of polishing highly translucent monolithic zirconia (HTMLZ) dental restoration material. MATERIAL AND METHODS 100 HTMLZ disc-shaped specimens were adjusted (grinding, finishing, polishing) with EVE Diacera kit. Two steam sterilization techniques [standard (Gp S), immediate/flash (Gp (F)] of CAK were further subgrouped based on number of sterilization cycles [cycle 1 (control), cycle 5, 10, 15, and 20 (experimental)] (n=10 each). Each subgroup accordingly was evaluated for average surface roughness (Ra) and root mean square roughness (Rq) using a profilometer. Mean and standard deviation of 5 subgroups were statistically analyzed using one-way ANOVA/post hoc Tukey's test. Scanning electron microscopy complemented Ra, Rq measurements. Statistical differences of P≤0.05 were considered significant. RESULTS HTMLZ specimens in both groups showed increased (Ra/Rq) values after repeated sterilization of EVE Diacera kit, with Gp F showing lesser increase than Gp S (20 cycles). Gp F at 10 cycles and Gp S at 15 cycles showed clinically unacceptable roughness threshold (0.25 µm). Differences between subgroups for Ra and Rq values were significant (P≤0.05) with less differences within groups observed in early cycles (1, 10). Results validate the manufacturer's recommendations of using flash sterilization/10 cycles for EVE Diacera kit. CONCLUSIONS Repeated sterilization reduces efficacy of chairside adjustment kit to produce smooth surfaces on HTMLZ. This study recommends flash sterilization to a maximum of 10 times to get the clinically acceptable results of Ra and Rq.

Minimization of occurrence of retained surgical items using machine learning and deep learning techniques: a review.

Retained surgical items (RSIs) pose significant risks to patients and healthcare professionals, prompting extensive efforts to reduce their incidence. RSIs are objects inadvertently left within patients' bodies after surgery, which can lead to severe consequences such as infections and death. The repercussions highlight the critical need to address this issue. Machine learning (ML) and deep learning (DL) have displayed considerable potential for enhancing the prevention of RSIs through heightened precision and decreased reliance on human involvement. ML techniques are finding an expanding number of applications in medicine, ranging from automated imaging analysis to diagnosis. DL has enabled substantial advances in the prediction capabilities of computers by combining the availability of massive volumes of data with extremely effective learning algorithms. This paper reviews and evaluates recently published articles on the application of ML and DL in RSIs prevention and diagnosis, stressing the need for a multi-layered approach that leverages each method's strengths to mitigate RSI risks. It highlights the key findings, advantages, and limitations of the different techniques used. Extensive datasets for training ML and DL models could enhance RSI detection systems. This paper also discusses the various datasets used by researchers for training the models. In addition, future directions for improving these technologies for RSI diagnosis and prevention are considered. By merging ML and DL with current procedures, it is conceivable to substantially minimize RSIs, enhance patient safety, and elevate surgical care standards.

Morphological and Dimensional Analysis of the Nasopalatine Canal: Insights from Cone-Beam Computed Tomography Imaging in a Large Cohort.

BACKGROUND The nasopalatine canal (NPC), or incisive canal, is located in the midline of the palate, posterior to the maxillary central incisors. Its anatomy is important in prosthetic dentistry procedures. This study aimed to assess the anatomical morphology of the NPC according to age, sex, and dental status using cone-beam computed tomography (CBCT) in 335 patients. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 335 patients were recruited and categorized according to sex, age, and dental status. Individual CBCT images were analyzed in the sagittal, coronal, and axial planes. Also, we recorded the dimensions and morphological shape of the NPC and adjacent buccal bone plate (BBP) under standardized conditions. The associations between sex, age group, NPC shapes and types, and presence of central incisors were assessed. A significance level was set at P<0.05. RESULTS Mean labio-palatal and mediolateral measurements of the incisive foramen were 5.13±1.45 mm and 3.21±0.96 mm, whereas the mean diameter of Stenson foramen was 2.57±1.25 mm, and the total length of the NPC was 11.79±2.50 mm. Funnel, Y, and round-shaped canals were the most prevalent shapes of the NPC in sagittal, coronal, and axial planes. BBP was greater in men, with P=0.011, P=0.000, and P=0.001 at BBP1, BBP2, and BBP3, respectively. CONCLUSIONS NPC and BBP parameter values were slightly higher among male patients. NPC parameters increased with older age. The crest width of BBP decreased with older age and after missing maxillary central incisor teeth.

Oxidative stress-mediated neuroinflammation in Alzheimer's disease.

Reactive oxygen species (ROS) are metabolic by-products that constitute an indispensable component of physiological processes, albeit their heightened presence may proffer substantial perils to biological entities. Such a proliferation gives rise to a gradual escalation of oxidative stress within the organism, thereby compromising mitochondrial functionality and inflicting harm upon various bodily systems, with a particular predilection for the central nervous system. In its nascent stages, it is plausible that inflammation has been a facilitator in the progression of the malady. The precise role of inflammation in Alzheimer's disease (AD) remains somewhat enigmatic, although it is conceivable that activated microglia and astrocytes might be implicated in the removal of amyloid-ß (Aß) deposits. Nonetheless, prolonged microglial activation is associated with Tau phosphorylation and Aß aggregation. Research studies have indicated that AD brains upregulate complementary molecules, inflammatory cytokines, acute phase reacting agents, and other inflammatory mediators that may cause neurodegeneration. In this review, oxidative damage products will be discussed as potential peripheral biomarkers for AD and its early stages. The disordered excretion of pro-inflammatory cytokines, chemokines, oxygen, and nitrogen-reactive species, along with the stimulation of the complement system by glial cells, has the potential to disrupt the functionality of neuronal termini. This perturbation, in turn, culminates in compromised synaptic function, a phenomenon empirically linked to the manifestation of cognitive impairments. The management of neurodegenerative conditions in the context of dementia necessitates therapeutic interventions that specifically target the excessive production of inflammatory and oxidative agents. Furthermore, we shall deliberate upon the function of microglia and oxidative injury in the etiology of AD and the ensuing neurodegenerative processes.

Impact of Auxiliary Features on Retention of Short Dental Crowns: An In-Vitro Analysis of Box and Groove Preparations.

BACKGROUND Several auxiliary features have been proposed to achieve sustainable retention for short-prepared dental crowns; however, achieving retention is challenging. This study aimed to assess the impact of increased total occlusal convergence and auxiliary preparation factors like box and groove on the retention form of short tooth preparations. MATERIAL AND METHODS Eighty resin machine-milled dies with a height of 3 mm and a deep chamfer margin of 1 mm were prepared to mimic the short-prepared molar. Initially, 2 teeth were prepared following the guidelines, and the total occlusal convergence was kept at 10° and 20°, respectively. Auxiliary features such as the proximal box and buccal groove were prepared on separate 20° dies. Eighty dies were prepared with 10 samples each for 10°, 20°, 20° with proximal box and 20° with buccal groove for zirconia (n=40) and metal crowns (n=40). Cementation was done with glass ionomer luting cement, and a pull-off test was conducted. Data were analyzed using one-way analysis of variance and post hoc fisher least significant difference test (P<0.05). RESULTS The highest mean was observed in the proximal box group with the metal crown (14.59), and the lowest in the group with 20° zirconia crowns (9.12). Within groups, the highest retentive values were found for the 20° taper with proximal box preparation; the lowest was for the 20° taper group. CONCLUSIONS Within the study limitations, it could be concluded that incorporating a proximal box or buccal groove in short tooth preparations with an increased total occlusal convergence improved retentive values.

Comparative Accuracy of Intraoral and Extraoral Digital Workflows for Short Span Implant Supported Fixed Partial Denture Fabrication: An In Vitro Study.

BACKGROUND The advent of digital impressions using computer-aided design and manufacturing technology (CAD/CAM) has simplified and improved the fabrication of implant prostheses in dentistry. The conventional impression has several drawbacks, including tray selection, material type, impression technique, impression disinfection, and cast model storage. The inaccuracies caused by distortion and contraction of impression material can be minimized with digital impressions. This study aimed to compare digital dental impressions of 10 working casts made using the Pindex laser removable die system to fabricate parallel drill channels vs 10 working casts made using the Di-Lok plastic tray removable die system. MATERIAL AND METHODS An implant master die with 2 dental implant analogs was fabricated. Ten working casts using the Pindex laser removable die system with parallel drill channels and 10 working casts using the Di-Lok plastic tray removable die system were fabricated. The working casts were scanned using an extra-oral laboratory scanner and the implant master model was scanned with an intra-oral scanner. RESULTS The properties of the casts made using the 2 systems were evaluated and analyzed with ANOVA and post hoc Tukey test. The mean horizontal linear distances between A1B1 (P<0.021), A2B2 (P<0.018), C1D1 (P<0.026), C2D2 (P<0.03), B1C1 (P<0.01), and mean vertical distances between B1A2 (P<0.015), C1D2 (P<0.001), B1B2 (P<0.028), and C1C2 (P<0.001) were significantly different between the Pindex system and Di-Lok tray system as compared to intra-oral scans. CONCLUSIONS Complete digital workflow with intra-oral scans were more than the partial digital workflow with extra-oral scans for the Pindex system and Di-Lok tray systems.

Evaluation of the Milled and Three-Dimensional Digital Manufacturing, 10-Degree and 20-Degree Preparation Taper, Groove and Box Auxiliary Retentive Features, and Conventional and Resin-Based Provisional Cement Type on the Adhesive Failure Stress of 3 mm Short Provisional Crowns.

BACKGROUND This study evaluated the effects of milling (CADCAM), 3D printing, preparation taper angles (10-degree and 20-degree), auxiliary retentive features (groove and box), and provisional cement types (conventional and resin-based) on the adhesive failure stress of 3-mm short provisional crowns (PC). The research was motivated by the need to understand how digital dentistry technologies impact the retention and durability of provisional crowns. MATERIAL AND METHODS A total of 160 working models (3D-printed) and PCs [80 milled (CopraTemp)/80 printed (Asiga)] were fabricated from two 10- and 20-degree typodont master models and two 20-degree 3D-printed master models (groove and box), simulating a 3 mm high all-ceramic short PC. After provisional cementation with conventional (Kerr TempBond) and resin-based (ProviTemp) cements, 16 subgroups (n=10 each) underwent thermocycling (10 000 cycles; 5-55°C) and pull-off tests on a universal testing machine. Statistical analysis was performed using one-way ANOVA and post hoc Tukey test. RESULTS Conventional cement failed at lower stress for milled (47.68 to 73.54) and printed (48.40 to 77.91) as compared to resin cement for milled (104.2 to 137.27) and printed (184.85 to 328.84), respectively, with significant differences. Increased taper and groove decreased failure load except for the printed PC/resin cement combination. Use of proximal box preparation increased retention significantly. Except for 20-degree taper cemented with conventional cement, the differences in auxiliary retentive features for milled and printed provisional crowns were statistically significant at P≤0.05. CONCLUSIONS 3D-printed PC, resin-based cement, 10-degree taper, and proximal box preparation were associated with higher retention than milled, conventional cements, 20-degree taper, and vertical groove.

Influence of Chairside Simulated Adjustment (Finishing and Polishing) Protocol and Chlorhexidine Mouthwash Immersion on Color Stability and Translucency of 2 and 3 Preshaded Multilayered Monolithic Zirconia.

BACKGROUND Preshaded monolithic zirconia (MLZ) is reported to have high translucency. This study aimed to assess the effect of chlorhexidine gluconate (ChG) mouthwash on color and translucency parameter (TP) of 2 different preshaded MLZ dental ceramics after clinical adjustment. MATERIAL AND METHODS Two MLZ disk-shaped specimens [NPM (Nacera Pearl Multi-Shade) (n=72) and CZM (Ceramill Zolid FX Multilayer)] (n=72) were simulated for clinical adjustment, finished, and polished using 2 adjustment kits [recommended kit, third-party kit: Diasynt Plus and SUN (n=12 each)] and later immersed in ChG mouthwash (Avohex) for 2 weeks. Difference in color (ΔE) and TP (Y) were calculated using the CIELab formula after measuring the coordinates (Lab) with a colorimeter. Individual changes in color and TP were assessed on the Clinical acceptance (perceptible) threshold (CAT/CPT) and Translucency perception threshold (TPT), respectively. Differences between the 2 ceramics were assessed using one-way ANOVA and post hoc tests, with all differences considered significant at P<0.05. RESULTS NPM and CZM differed in color at baseline despite having the same Vita shade combination. Between the 2 preshaded MLZ ceramics, NPM showed significant changes in color when adjusted with a third-party kit. Chlorhexidine produced changes in color and TP that were designated as clinically perceptible (ΔE=1.0 to 3.3) on the CAT/CPT and TPT scales, irrespective of the adjustment kit used. ChG produced the least or no changes in glazed MLZ specimens. CONCLUSIONS ChG mouthwash, whenever prescribed for preshaded MLZ restoration, should be adjusted prior to final glazing to avoid clinical adjustments that adversely affects color and translucency of the restoration.

Angiotensin II Type 2 Receptor Agonism Alleviates Progressive Post-stroke Cognitive Impairment in Aged Spontaneously Hypertensive Rats.

Hypertension and aging are leading risk factors for stroke and vascular contributions to cognitive impairment and dementia (VCID). Most animal models fail to capture the complex interplay between these pathophysiological processes. In the current study, we examined the development of cognitive impairment in 18-month-old spontaneously hypertensive rats (SHR) before and following ischemic stroke. Sixty SHRs were housed for 18 months with cognitive assessments every 6 months and post-surgery. MRI scans were performed at baseline and throughout the study. On day 3 post-stroke, rats were randomized to receive either angiotensin II type 2 receptor (AT2R) agonist Compound 21 (C21) or plain water for 8 weeks. SHRs demonstrated a progressive cognitive decline and significant MRI abnormalities before stroke. Perioperative mortality within 72 h of stroke was low. Stroke resulted in significant acute brain swelling, chronic brain atrophy, and sustained sensorimotor and behavioral deficits. There was no evidence of anhedonia at week 8. C21 enhanced sensorimotor recovery and ischemic lesion resolution at week 8. SHRs represent a clinically relevant animal model to study aging and stroke-associated VCID. This study underscores the importance of translational disease modeling and provides evidence that modulation of the AT2R signaling via C21 may be a useful therapeutic option to improve sensorimotor and cognitive outcomes even in aged animals.

Three-Dimensional Virtual Reconstruction Method versus Standard Fluoroscopy as a Guiding Tool for an Optimal Puncture Rout in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Trial Study.

PURPOSE: Three-Dimensional (3D) could help for planning and creating an optimal access route in percutaneous nephrolithotomy (PCNL) procedure by achieving a more accurate approach to the renal collecting system and stone treatment while decreasing the risk of complications. The aim of our study is to compare the efficacy of 3D imaging technique with standard fluoroscopy method as a guiding tool for renal stone location while striving to reduce intra-operative X-ray exposure in the former method. MATERIALS AND METHODS: This randomised clinical trial enrolled 48 PCNL candidates who were referred to Sina Hospital (Tehran, Iran). Participants were divided into two equal groups of intervention (3D virtual reconstruction) and control, using block randomization method. Age, sex, stone type and location, X-ray exposure during the procedure, stone access accuracy rate and the necessity of blood transfusion during surgery were taken into account. RESULTS: The Mean age of participants (n = 48) was 46.4 ± 4.8 years, 34 (70.8%) were male, 27 (56.3%) had partial staghorn stones and all participants had stones within the lower calyx. The radiation exposure time, stone access time and stone size were 2.99 ± 1.81 seconds, 272.3 ± 108.9 seconds and 23.06 ± 2.28 mm, respectively. In the intervention group, the accuracy rate for lower calyceal stone access was 91.5%. Also, X-ray exposure and time to stone access were significantly lower in the intervention group compared to the controls (P < 0.001). CONCLUSION: We concluded that the utilization of 3D technology in the pre-operative location of renal calculi in PCNL candidates may result in a significant improvement in the accuracy and time to access the renal calculi, as well as reduction in X-ray exposure.

Comparative Evaluation of Dimensional and Occlusal Accuracy of Non-Working Antagonist Casts: A Study on Different Impression Materials and 3D Printing.

BACKGROUND The aim of this study was to assess and compare the vertical/horizontal dimensions and occlusal accuracy of non-working/opposing casts obtained from three different impression materials and 3D print cast. MATERIAL AND METHODS Dentulous Master models simulating a case of a fixed dental prosthesis were mounted on an articulator (control group). Opposing mandibular casts obtained from three different impression materialsand 3-dimensional print constituted test groups , ,and , respectively. Three points, anterior vertical (AV), posterior vertical (PV), and anteroposterior (AP) were compared for dimensional accuracy among casts. Occlusal accuracy was analyzed on Medit Link software at 3 teeth (#13, #17, and #27). After calculating means for each group, the differences were calculated at probability value of P≤0.05 using the single-sample t test, ANOVA, and Tukey test. RESULTS The dimensions were significantly different from those of the mounted master models except in Gp AL(E) and Gp AL(F) at AV dimension and Gp AL(E) at AP dimension (P>0.05). A statistically significant difference of the error of means among the 4 tested groupswere detected only at 2 dimensions (AV and PV) between the Gp AL(E) and Gp 3D-C and between Gp AL(F) and Gp 3D-C groups. Other groups showed no significant differences. CONCLUSIONS The opposing casts obtained from the extended-pour alginate and alginate alternative impression materials showed higher occlusal accuracy compared to conventional alginate and 3D printed casts.

Shear Strength of Repaired 3D-Printed and Milled Provisional Materials Using Different Resin Materials with and without Chemical and Mechanical Surface Treatment.

The aim of this study was to assess the shear bond strength of 3D-printed and milled provisional restorations using various resin materials and surface finishes. There were 160 preliminary samples in all, and they were split into two groups: the milled group and the 3D-printed group. Based on the resin used for repair (composite or polymethylmethacrylate (PMMA)) and the type of surface treatment utilized (chemical or mechanical), each group was further divided into subgroups. The specimens were subjected to thermocycling from 5 °C to 55 °C for up to 5000 thermal cycles with a dwell time of 30 s. The mechanical qualities of the repaired material underwent testing for shear bond strength (SBS). To identify the significant differences between the groups and subgroups, a statistical analysis was carried out. Three-way ANOVA was used to analyze the effects of each independent component (the material and the bonding condition), as well as the interaction between the independent factors on shear bond strength. Tukey multiple post-hoc tests were used to compare the mean results for each material under various bonding circumstances. The shear bond strengths of the various groups and subgroups differed significantly (p < 0.05). When compared to the milled group, the 3D-printed group had a much greater mean shear bond strength. When compared to PMMA repair, the composite resin material showed a noticeably greater shear bond strength. In terms of surface treatments, the samples with mechanical and chemical surface treatments had stronger shear bonds than those that had not received any. The results of this study demonstrate the effect of the fabrication method, resin type, and surface treatment on the shear bond strength of restored provisional restorations. Particularly when made using composite material and given surface treatments, 3D-printed provisional restorations showed exceptional mechanical qualities. These results can help dentists choose the best fabrication methods, resin materials, and surface treatments through which to increase the durability and bond strength of temporary prosthesis.

Evaluation of the Effects of Digital Manufacturing, Preparation Taper, Cement Type, and Aging on the Color Stability of Anterior Provisional Crowns Using Colorimetry.

BACKGROUND Replicating the 3-dimensional (3D) color of natural teeth in artificial substitutes is challenging. Fixed dental prosthodontics require aesthetic, color-stable provisional restorations. Recent milling and 3D printing digital manufacturing techniques offer improved outcomes. This study assesses color stability in various digital manufacturing methods, tapers, and aging effects on anterior provisional resin restorations. MATERIAL AND METHODS Two all-ceramic tooth preparations on typodont teeth with 10° and 20° tapers were converted into experimental dies. Forty temporary crowns were manufactured using 3D printing and computer-aided design/computer-aided manufacturing (milling). Within these 2 groups, 10 crowns were cemented using a regular and clear provisional cement. All samples were thermocycled to simulate clinical use of 6 months. Color difference formula (CIEDE2000) indicated changes between before and after cementation (ΔE00) and between after cementation and after thermocycling (ΔE00[II]). The color change was considered significant in terms of clinically perceptible (ΔE00 ≤0.62) and acceptable (ΔE00 ≤2.62) changes. One-way ANOVA (P value of less than 0.05) calculated overall differences, which were established using a Fisher post hoc test. RESULTS Crowns cemented with clear cement showed fewer color changes irrespective of the manufacturing technique or taper. Notably, only the 10° 3D-printed crown with clear cement had an imperceptible color change at the pre-/post-cementation phase. Meanwhile, the 10° and 20° milled crowns with regular cement exhibited unacceptable color changes after thermocycling. CONCLUSIONS For long­term temporization in the aesthetic zone, properly optimized 3D-printed provisional restorations cemented with clear cement had better color stability.

Prosthodontic Rehabilitation's Role in Alleviating Anxiety and Depression in Mucormycosis-Induced Maxillectomy Patients Post-COVID-19.

BACKGROUND The aim of this study was to assess the influence of maxillofacial prosthodontic rehabilitation on anxiety/depression severity in patients with rhino-orbital cerebral mucormycosis (ROCM) after maxillectomy. MATERIAL AND METHODS Sixty post-mucormycotic patients treated with maxillectomy (33 males, 27 females) were divided into 5 groups based on maxillectomy types (unilateral/bilateral, subtotal/total) and treatment given (psychotherapy/obturator/implant/orbital/ocular prosthesis). Anxiety and depression symptoms were assessed using appearance anxiety inventory (AAI) and patient health questionnaire (PHQ9). Data were collected at 4 time intervals [T0 (before prosthesis), T1 (2 weeks after prosthesis), T2 (6 months) and T3 (1 year). Frequency distribution and mean values were determined for individual group/subgroups/total cohort. Differences between groups were determined using one-way ANOVA (single-factor/Friedman's) followed by post hoc correction (Bonferroni) and t test for unequal variance with probability P value being statistically significant at <0.05. RESULTS The mean scores for appearance anxiety were 29.13±4.72 (diagnostic for existing body dysmorphic disorder) at T0, which decreased to 16.88±3.02 at T3 for the total cohort. The differences for the gender-based cohort, its various groups, and respective subgroups were significant (P<0.05) at various time intervals. The mean scores in the total cohort for depression symptom severity were 16.81±4.89 (moderately severe) at T0, which increased to 18.5±4.94 at T1, followed by reduction at T2 (12.0±4.43; moderate) and T3 (7.38±3.37; mild). Gender differences for both variables were found to be statistically significant (P<0.05). CONCLUSIONS Comprehensive rehabilitation that included a diagnosis of psychological symptoms followed by psychotherapeutic/pharmacotherapeutic/prosthodontic intervention reduced the anxiety/depression symptom levels to normal at 1 year.

Internet of Medical Things and Healthcare 4.0: Trends, Requirements, Challenges, and Research Directions.

Healthcare 4.0 is a recent e-health paradigm associated with the concept of Industry 4.0. It provides approaches to achieving precision medicine that delivers healthcare services based on the patient's characteristics. Moreover, Healthcare 4.0 enables telemedicine, including telesurgery, early predictions, and diagnosis of diseases. This represents an important paradigm for modern societies, especially with the current situation of pandemics. The release of the fifth-generation cellular system (5G), the current advances in wearable device manufacturing, and the recent technologies, e.g., artificial intelligence (AI), edge computing, and the Internet of Things (IoT), are the main drivers of evolutions of Healthcare 4.0 systems. To this end, this work considers introducing recent advances, trends, and requirements of the Internet of Medical Things (IoMT) and Healthcare 4.0 systems. The ultimate requirements of such networks in the era of 5G and next-generation networks are discussed. Moreover, the design challenges and current research directions of these networks. The key enabling technologies of such systems, including AI and distributed edge computing, are discussed.

Effect of smokeless tobacco on color stability and surface roughness of CAD/CAM milled, 3D printed, and conventional provisional crown and fixed dental prosthesis materials: An in vitro study.

BACKGROUND: Provisional fixed dental prosthesis (FDP) plays an important role during fixed prosthodontic therapy till the definitive. Discoloration of materials used for provisional FDPs can cause patient dissatisfaction and may create doubt about the color stability of the definitive FDP. Surface roughness is the other major property to be taken into consideration for provisional FDP materials. Smokeless tobacco is reported to affect the color stability and surface roughness of different prosthetic materials. OBJECTIVE: The aim of the current study was to evaluate the effect of two types of smokeless tobacco (black and white) on color stability and surface roughness of 3D printed, CAD/CAM milled, and conventional provisional FDP resin materials. METHODS: A total of 144 disc-shaped specimens were fabricated using four techniques CAD/CAM subtractive technique (milling), CAD/CAM additive technique (3D Printing), and conventional technique using autopolymerized PMMA, and autopolymerized Bis-acrylic resins. Each group was subdivided into three subgroups of twelve specimens each, and were submerged into three solutions (artificial salivary substitute, black smokeless tobacco, white smokeless tobacco). The change in color and surface roughness was evaluated and the data collected were statistically analyzed. RESULTS: It was observed that black smokeless tobacco caused the maximum color change and the effect was highest in autopolymerized PMMA resin specimens (ΔE = 9.343 ± 0.489), followed by 3D printed (ΔE = 7.187 ± 0.391), autopolymerized Bis-acryl (ΔE = 6.464 ± 0.453) and milled (ΔE = 4.978 ± 0.227). White smokeless tobacco was found to cause a maximum change in surface roughness and the effect was highest in autopolymerized Bis-acryl specimens (ΔRa = 0.321 ± 0.015 µm), followed by autopolymerized PMMA (ΔRa = 0.297± 0.015 µm), 3D printed (ΔRa = 0.191 ± 0.019 µm), and milled (ΔRa = 0.168 ± 0.014 µm). Statistically significant (p-value < 0.05) differences were observed among all techniques and solutions. CONCLUSIONS: The change in color and surface roughness were maximum in the case of FDPs prepared using autopolymerizing resins, followed by 3D printed, and CAD/CAM milled reins.