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Background and Objectives: Orthodontics is a field that has seen significant advancements in recent years, with technology playing a crucial role in improving diagnosis and treatment planning. The study aimed to implement artificial intelligence to predict the arch width as a preventive measure to avoid future crowding in growing patients or even in adult patients seeking orthodontic treatment as a tool for orthodontic diagnosis. Materials and Methods: Four hundred and fifty intraoral scan (IOS) images were selected from orthodontic patients seeking treatment in private orthodontic centers. Real inter-canine, inter-premolar, and inter-molar widths were measured digitally. Two of the main machine learning models were used: the Python programming language and machine learning algorithms, implementing the data on k-nearest neighbor and linear regression. Results: After the dataset had been implemented on the two ML algorithms, linear regression and k-nearest neighbor, the evaluation metric shows that KNN gives better prediction accuracy than LR does. The resulting accuracy was around 99%. Conclusions: it is possible to leverage machine learning to enhance orthodontic diagnosis and treatment planning by predicting linear dental arch measurements and preventing anterior segment malocclusion.

The COVID-19 pandemic forced many organizations to move to telework and smart work (SW), and this practice is expected to continue even later in the postpandemic period. Hence, it is very important for managers and organizations to identify the motivating and deterrent factors in adopting smart work and plan to manage them. Therefore, the present study using an innovative methodology tried to identify and prioritize the factors influencing employee SW adoption. In the first stage, the conceptual model of the research was designed, inspired by the literature. In the next step, using structural equation modeling (SEM), antecedents whose effects on employee SW adoption were confirmed were identified. Finally, the output of the SEM model was considered as the input of the multilayer perceptron (MLP) model, which is an artificial neural network model, to determine the importance of each antecedent in the prediction of employee behavior. The present study provides quantitative empirical evidence that perceived value, institutional and technological support, perceived limited communication, and perceived cost are antecedents of employee SW adoption that are, respectively, important in predicting the behavioral intentions of employees in acceptance of SW. The findings of this study contribute to both the SW and the behavioral intention theory literature.

Background: Numerous studies have investigated the applicability of Pont’s index using a variety of selection criteria. The morphology of teeth and the shapes of the face are significantly influenced by racial, cultural, and environmental factors, so the current study focused on these demographics. Methods: This study is a retrospective study and included one hundred intraoral scanned images selected from patients seeking orthodontic treatment. Medit design software was used to obtain the real measurements and compare them to the predicted values from Pont’s index. Paired t tests were used to test the validity of Pont’s index, and regression equations were advocated to predict the inter-molar, inter-premolar, and anterior arch widths via SPSS version 25. Results: There were significant differences between the real anterior, inter-premolar, and inter-molar widths and the predicted values obtained from Pont’s index, and there were weak positive correlations between the real values and the predicted values from Pont’s index. Conclusions: Pont’s index is not reliable to predict the arch widths for the Kurdish population, and new formulas are advocated. Hence, space analysis, malocclusion treatment, and arch expansion therapy should all take into account these results. Therefore, the derived equations may have further positive effects on diagnoses and treatment preparation.

(1) Background: Accurate diagnosis and treatment plans in orthodontics were facilitated by novel technologies. The prediction of occlusal problems is of utmost importance for clinicians. This present study aimed to find any possible correlation between unilateral and bilateral palatally impacted maxillary canine, palatal dimensions, and maxillary arch perimeter using digital measurements and determine the factors that could be used as predictors for maxillary palatal canine impaction. (2) Method: A cross-sectional study was conducted on cone-beam computed tomography images of orthodontic patients aged 15 to 25. Palatal dimensions and maxillary arch perimeter were digitally measured using Materialize Interactive Medical Image Control System. (3) Results: A significant difference was found between the case and the study groups regarding palatal depth, length, and arch perimeter, except for the palatal width. A weak correlation was reported in palatal depth and length with canine impaction, whereas the correlation was moderate concerning the arch perimeter. They can be used as predictors for palatal canine impaction. (4) Conclusion: Palatal dimensions and dental arch perimeter affect maxillary palatal canine impaction. Deficient arch perimeter, palatal depth, and length could be helpful in the prediction of maxillary palatal canine impaction.

Introduction: The dental clinic has for a long time been considered as a risky place for infection dissemination. Due to aerosol generating procedures, the risk of cross-transmission in dental clinics has recently risen. Open dental clinics should undergo present-time reassessment concerning infection control, in particular, to consider the implications of the SARS-CoV-2 pandemic for today’s advanced technological and medical practices. It might be necessary to make urgent and appropriate modifications to the design of air circulation systems in the dental environment to prevent microbial transmission. The Hypothesis: In order to minimise cross-transmission in multi-chair dental operatories, we have designed two model ventilation systems with 12 and 36 air change/hour capacities and with laminar airflow direction. The conditioned air directly blows into the dental treatment units, especially into the aerosol generating area, where the contamination is more concentrated. We hypothesise that these new designs could serve to isolate dental treatment units to function separately like closed dental operatories while keeping them open to each other. Evaluation of the Hypothesis: Thorough physical and biological investigations will be required to determine how these designs can be applied effectively in terms of the required spatial separation of dental treatment units in the open multi-chair dental operatories.

The recognition of various lung sounds recorded using electronic stethoscopes plays a significant role in the early diagnoses of respiratory diseases. To increase the accuracy of specialist evaluations, machine learning techniques have been intensely employed during the past 30 years. In the current study, a new pretrained Convolutional Neural Network (CNN) model is proposed for the extraction of deep features. In the CNN architecture, an average-pooling layer and a max-pooling layer are connected in parallel in order to boost classification performance. The deep features are utilized as the input of the Linear Discriminant Analysis (LDA) classifier using the Random Subspace Ensembles (RSE) method. The proposed method was evaluated against a challenge dataset known as ICBHI 2017. The deep features and the LDA with RSE method provided the best accuracy score when compared to other existing methods using the same dataset, improving the classification accuracy by 5.75%.

Thermal conductivity (TC) of a phase change material (PCM) may be enhanced by distributing nanostructured materials (NSMs) termed nano-PCM. It is critical to accurately estimate the TC of nano-PCM to assess heat transfer during phase transition processes, namely, solidification and melting. Here, we propose Gaussian process regression (GPR) strategies involving four various kernel functions (KFs) (including exponential (E), squared exponential (SE), rational quadratic (RQ), and matern (M)) to predict TC of n-octadecane as a PCM. The accessible computational techniques indicate the accuracy of our proposed GPR model compared to the previously proposed methods. In this research, the foremost forecasting strategy has been considered as a GPR method. This model consists of the matern KF whose R2 values of training and testing phases are 1 and 1, respectively. In the following, a sensitivity analysis (SA) is used to explore the effectiveness of variables in terms of outputs and shows that the temperature (T) of nanofluid (NF) is the most efficient input parameter. The work describes the physical properties of NFs and the parameters that should be determined to optimize their efficiency.

Hard palate is regarded as an important part of the human skull, which contributes to the separation of the oral and nasal cavities. The aims of the study were to investigate the morphology of the hard palate in order to create a general guideline of three-dimensional values of the palate in a Kurdish sample in the city of Sulaimani as well as determining the possible correlations between different palatal parameters in class I malocclusion with the maxillary arch form and perimeter. A retrospective study design was adopted by collecting 100 study models of orthodontic patients aged 16–24 years old attending different private dental clinics in the city of Sulaimani seeking orthodontic management. In this study, three-dimensional palatal measurements including depth, length, and width were measured in an attempt to discover their correlation with each maxillary arch form and perimeter. Additionally, measurements of inter-molar width, inter-canine width, and arch perimeter were carried out. About two-thirds of those seeking orthodontic treatment were females. Nearly 80% of the study sample had narrow palate followed by 15 and 5% of intermediate palate and broad palate, respectively. In regard to arch form, almost 90% of subjects were with tapered maxillary arch form and 10% of them with oval arch form. Males had increased dimensions compared to females, with significant differences, except in palatal depth in the molar area, and palatine height index, in which females showed increased dimensions than males but the differences were statistically non-significant. A strong positive correlation was observed between arch form and canine depth. In regard to arch perimeter, a strong negative correlation was found with molar depth and a medium positive correlation with each of canine depth, palatal width, and palatal length.

Background: Early recognition of volume overload is essential for heart failure patients. Volume overload can often be easily treated if caught early but causes significant morbidity if unrecognized and allowed to progress. Intravascular volume status can be assessed by ultrasound-based estimation of right atrial pressure (RAP), but the availability of this diagnostic modality is limited by the need for experienced physicians to accurately interpret these scans., Objectives: We sought to evaluate whether machine learning can accurately estimate echocardiogram-measured RAP., Methods: We developed fully automated deep learning models for identifying inferior vena cava scans with rapid inspiration in echocardiogram studies and estimating RAP from those scans. The RAP estimation model was trained and evaluated using 15,828 ultrasound videos of the inferior vena cava and coupled cardiologist-assessed RAP estimates as well as 319 RAP measurements from right heart catheterization., Results: Our model agreed with cardiologist estimates 80.3% of the time (area under the receiver-operating characteristic of 0.844) in a test data set, at the upper end of interoperator agreement rates found in the literature of 70 to 75%. Our model's RAP estimates were statistically indistinguishable from cardiologists' ultrasound-based RAP estimates ( P  = 0.98) when compared against the gold standard of right heart catheterization RAP measurements in a subset of patients. Our model also generalized well to an external data set of echocardiograms from a different institution (area under the receiver-operating characteristic of 0.854 compared to cardiologist RAP estimates)., Conclusions: Machine learning is capable of accurately and robustly interpreting RAP from echocardiogram videos. This algorithm could be used to perform automated assessments of intravascular volume status., Competing Interests: Dr Tison has received research grants from 10.13039/100004313General Electric. Dr Avram has received speaker fees from Abbott, Boston Scientific, Boehringer-Ingelheim, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr Abu-Mostafa received research grants from three internal Caltech research endowments: the 10.13039/100023001Merkin Institute for Translational Research (#13520291), The Sensing to Intelligence Initiative (#13520296), and the Gates-Grubstake fund (#101170). Dr Tison received support from the 10.13039/100000002National Institutes of Health (Grants NHLBI K23HL135274, R56HL161475, and DP2HL174046). Dr Padmanabhan received support from the 10.13039/100000002National Institutes of Health (Grant NHLBI K08HL157700), Michael Antonov Charitable Foundation, and 10.13039/100009540Frank A. Campini Foundation. Dr Avram received support from the Fonds de la recherche en santé du Québec (Grant 312758), by 10.13039/100007631CIFAR, by the Montreal Heart Institute Research Centre, the 10.13039/501100012651Montreal Heart Institute Foundation, and by the Des Groseillers-Bérard Research Chair. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript., (© 2024 The Authors.)

Background: There is limited literature available comparing the accuracy of intraradicular impressions made with a novel hybrid impression material using the indirect and direct technique at three different locations., Materials and Methods: For this comparative in vitro analysis, postspace was prepared in 15 recently extracted teeth and impressions made with vinyl polysiloxane, polyether (PE), vinyl polyether silicone (VPES), and pattern resin. Postpatterns obtained were re-seated on the teeth and longitudinally sectioned. A binocular microscope was used to measure apical and lateral discrepancies at three locations (L1, L2, and L3). L1 at the postcore junction, L2 at the middle of the post space, and L3, 2 mm short of the apical end. The data obtained were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) software. One-way analysis of variance (ANOVA) (intergroup) followed by Tukey's post hoc test with P ≤ 0.05 was used., Results: The one-way ANOVA noted a highly significant difference at the apical location. Pattern resin had the highest apical discrepancy (151.93 ± 8.59 µm), whereas the lowest was with vinyl PE silicone (140.31 ± 11.46 µm). At L1, the highest discrepancy was seen with pattern resin (32.09 ± 2.31 µm), whereas the lowest was with the addition silicone (31.94 ± 2.54 µm). At L2, addition silicone (32.88 ± 2.81 µm) showed the highest discrepancy, whereas the lowest was with vinyl PE silicone (30.5 ± 8.79 µm). The PE group had the highest mean at the L3 location (31.38 ± 3.46 µm) and the lowest was with vinyl PE silicone (30.93 ± 2.25 µm). At all lateral locations, no significant difference was noted. Tukey's post hoc comparison showed a significant difference between pattern resin and VPES (11.62 µm) followed by pattern resin and addition silicone (11.47 µm) apically., Conclusion: The indirect technique using VPES or addition silicone is more accurate than the direct technique at the apical location., Competing Interests: The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or non-financial in this article., (Copyright: © 2024 Dental Research Journal.)

Background: CARS (Cardiac Amyloidosis Registry Study) is a multicenter registry established in 2019 that includes patients with transthyretin (ATTR, wild-type and variant) and light chain (AL) cardiac amyloidosis (CA) evaluated at major amyloidosis centers between 1997 and 2025. CARS aims to describe the natural history of CA with attention to clinical and diagnostic variables at the time of diagnosis, real-world treatment patterns, and associated outcomes of patients in a diverse cohort that is more representative of the at-risk population than that described in CA clinical trials., Methods and Results: This article describes the design and methodology of CARS, including procedures for data collection and preliminary results. As of February 2023, 20 centers in the United States enrolled 1415 patients, including 1155 (82%) with ATTR and 260 (18%) with AL CA. Among those with ATTR, wild-type is the most common ATTR (71%), and most of the 305 patients with variant ATTR have the p.V142I mutation (68%). A quarter of the total population identifies as Black. More individuals with AL are female (39%) compared to those with ATTR (13%)., Conclusions: CARS will answer crucial clinical questions about CA natural history and permit comparison of different therapeutics not possible through current clinical trials. Future international collaboration will further strengthen the validity of observations of this increasingly recognized condition., Competing Interests: Disclosures JLG reports consulting fees from Pfizer, Eidos/BridgeBio, Alnlyam, Intellia, Sarepta, and AstraZeneca; Grant support from Pfizer 67656485, Eidos/BridgeBio, Texas Health Resources Clinical Scholarship, and NHLBI R01 HL160892-01A1. MSM reports consulting fees from AstraZeneca, Akcea, Intellia, and Novo-Nordisk; grant support from NIH R01HL139671, Alnylam, Pfizer, Eidos, Prothena, and Ionis. FLR reports consulting fees from Attralus and grant support from Pfizer, Alnylam, and Akcea/Ionis. ARP reports grant support from Pfizer. MGK reports consulting fees from and advisory board membership in Pfizer, Eidos, Alnylam; Grant support: Pfizer, Alnylam, Eidos, Ionis, and Moleculin Biotech and speaker's bureau with Alnylam. YB reports grant support from Pfizer. BMD reports consulting fees from Anylam and Eidos. NMF reports consulting/speaker's fees and bureau/honoraria from Pfizer, Akcea/Ionis, Sobi, Alnylam, Sanofi-Genzyme, AstraZeneca, and Takeda; grant support from Pfizer, Akcea/Ionis, Servier, Takeda, Novartis, and Eidos. HG reports consulting fees from Amgen, Bayer, Merck, Pfizer, and ExpertConnect and grant support from Roche Diagnostics, Jana Care, Ortho Clinical, Novartis, Pfizer, Alnylam, Akcea/Ionis, and Eidos/BridgeBio and stock ownership in Eko; research payments for clinical endpoint committees from Baim INstitute for Clinical Research for Abbott, Siemens and Beckman Coulter and from ACI Clinical for Abbott Laboratories. DJ reports consulting fees from Alexion, Alleviant, Cytokinetics, Novo-Nordisk, Pfizer, Renovacor/Rocket, and Tenaya. JM reports consultingfees from Myocardial Solutions, Abbott, Longer Life Foundation, Children's Discovery Institue, Pfizer, BridgeBio, and Altathera. SSM reports speaker's fees from and Bureau/Advisory Board member of Alnylam. RCM reports consulting fees/honoraria from Pfizer and AstraZeneca. FHS reports grant support from Alnylam and Ionis. BS reports consulting fees from Alnylam and BridgeBio/Eidos and speaker's bureau fees from Pfizer. MU reports grant support from Ionis; advisory board membership with Alnylam, Cytokinetics, BridgeBio/Eidos; speaker's bureau with Pfizer, Alnylam, Akcea. JKP reports grant support from Alexion, Alnylam, AstraZeneca, BridgeBio/Eidos, Novo-Nordisk, and Pfizer; advisory board/speaker's bureau membership with Alnylam, CareDx, Eidos, Ionis, Natera, and Pfizer. All other authors have no financial relationships to disclose., (Copyright © 2023. Published by Elsevier Inc.)

Digital smile design (DSD) plays an essential role in the planning of aesthetic treatments. However, most digital smile designing software programmes are expensive and require specialised training and skill for effective implementation. This paper illustrates the use of Adobe Photoshop and Microsoft PowerPoint, which are economical and user friendly for planning aesthetics in a clinical case.

Background: The effect of trastuzumab therapy on left atrial (LA) function remains largely unknown. Our aim was to assess the changes in LA strain parameters longitudinally in patients treated with trastuzumab., Methods: We retrospectively studied 170 patients with stage I-IV HER2+ breast cancer. All patients had baseline echocardiograms and repeat echocardiograms at 3 months and after 1 year. We measured LA strain at all three time points. Changes in LA strain and strain rate (sr) parameters were evaluated using repeated-measures mixed-effects models. The cohort was stratified according to development of cancer therapeutics-related cardiac dysfunction (CTRCD) during follow-up., Results: The mean age was 52.7 ± 13.8 years, 25.3% had hypertension and 16.0% had metastatic disease. Multiple LA strain parameters (predicted delta value, [95%CI]) showed statistically significant declines in patients who developed CTRCD from baseline to the 3-month follow-up after multivariable adjustment; LA reservoir strain (LAε res ): -4.7%; [-8.1% to -1.3%], p = .007; LA conduit strain (LAε con ): -2.8%; [-5.3% to -.4%], p = .021); and LAε res sr: -.2/s; [-.3/s to -.09/s], p < .001). In patients who did not develop CTRCD, LA strain parameters declined significantly but to a smaller degree than in the CTRCD group (LAε res : -1.7%; [-3.1% to -.3%], p = .020, LAε con : -2.2%; [-3.3% to -1.1%], p < .001, and LA booster pump strain : -2.4%; [-3.5% to -1.4%], p < .001). LA strain rates did not decline significantly in the non-CTRCD group., Conclusion: Trastuzumab treatment was associated with declines in LA strain parameters in patients with breast cancer. The largest declines were observed in patients who developed CTRCD during treatment., (© 2024 Wiley Periodicals LLC.)

Background Postacute sequelae of COVID-19 (PASC) and HIV are both associated with reduced exercise capacity, but whether SARS-CoV-2 or PASC are associated with exercise capacity among people with HIV (PWH) is unknown. We hypothesized that PWH with PASC would have reduced exercise capacity from chronotropic incompetence. Methods and Results We conducted cross-sectional cardiopulmonary exercise testing within a COVID recovery cohort that included PWH with and without prior SARS-CoV-2 infection and people without HIV with prior SARS-CoV-2 infection (controls). We evaluated associations of HIV, SARS-CoV-2, and PASC with exercise capacity (peak oxygen consumption) and chronotropy (adjusted heart rate reserve). We included 83 participants (median age, 54 years; 35% women; 37 PWH): 23 out of 37 (62%) PWH and all 46 controls had prior SARS-CoV-2 infection, and 11 out of 23 (48%) PWH and 28 out of 46 (61%) without HIV had PASC. Peak oxygen consumption was reduced among PWH versus controls (80% predicted versus 99%, P =0.005), a difference of 5.5 mL/kg per minute (95% CI, 2.7-8.2; P <0.001). Chronotropic incompetence was more prevalent among PWH (38% versus 11%, P =0.002), with lower adjusted heart rate reserve (60% versus 83%, P <0.0001) versus controls. Among PWH, SARS-CoV-2 coinfection and PASC were not associated with exercise capacity. Chronotropic incompetence was more common among PWH with PASC: 7 out of 11 (64%) with PASC versus 7 out of 26 (27%) without PASC ( P =0.04). Conclusions Exercise capacity and chronotropy are lower among PWH compared with individuals with SARS-CoV-2 infection without HIV. Among PWH, SARS-CoV-2 infection and PASC were not strongly associated with reduced exercise capacity. Chronotropic incompetence may be a common underrecognized mechanism of exercise intolerance among PWH, especially those with cardiopulmonary PASC.

Background: Mechanisms underlying persistent cardiopulmonary symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (postacute sequelae of coronavirus disease 2019 [COVID-19; PASC] or "long COVID") remain unclear. This study sought to elucidate mechanisms of cardiopulmonary symptoms and reduced exercise capacity., Methods: We conducted cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring among adults >1 year after SARS-CoV-2 infection, compared those with and those without symptoms, and correlated findings with previously measured biomarkers., Results: Sixty participants (median age, 53 years; 42% female; 87% nonhospitalized; median 17.6 months after infection) were studied. At CPET, 18/37 (49%) with symptoms had reduced exercise capacity (<85% predicted), compared with 3/19 (16%) without symptoms (P = .02). The adjusted peak oxygen consumption (VO2) was 5.2 mL/kg/min lower (95% confidence interval, 2.1-8.3; P = .001) or 16.9% lower percent predicted (4.3%-29.6%; P = .02) among those with symptoms. Chronotropic incompetence was common. Inflammatory markers and antibody levels early in PASC were negatively correlated with peak VO2. Late-gadolinium enhancement on CMR and arrhythmias were absent., Conclusions: Cardiopulmonary symptoms >1 year after COVID-19 were associated with reduced exercise capacity, which was associated with earlier inflammatory markers. Chronotropic incompetence may explain exercise intolerance among some with "long COVID.", Competing Interests: Potential conflicts of interest. A. C., B. C. Y., J. W. W., and C. J. P. are employees of Monogram Biosciences, a division of LabCorp. They performed biomarker measurements blinded to participant data. P. Y. H. has received modest honoraria from Gilead and Merck and a research grant from Novartis, unrelated to the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Pulmonary hypertension (PH) is life-threatening, and often diagnosed late in its course. We aimed to evaluate if a deep learning approach using electrocardiogram (ECG) data alone can detect PH and clinically important subtypes. We asked: does an automated deep learning approach to ECG interpretation detect PH and its clinically important subtypes?, Methods and Results: Adults with right heart catheterization or an echocardiogram within 90 days of an ECG at the University of California, San Francisco (2012-2019) were retrospectively identified as PH or non-PH. A deep convolutional neural network was trained on patients' 12-lead ECG voltage data. Patients were divided into training, development, and test sets in a ratio of 7:1:2. Overall, 5016 PH and 19,454 patients without PH were used in the study. The mean age at the time of ECG was 62.29 ± 17.58 years and 49.88% were female. The mean interval between ECG and right heart catheterization or echocardiogram was 3.66 and 2.23 days for patients with PH and patients without PH, respectively. In the test dataset, the model achieved an area under the receiver operating characteristic curve, sensitivity, and specificity, respectively of 0.89, 0.79, and 0.84 to detect PH; 0.91, 0.83, and 0.84 to detect precapillary PH; 0.88, 0.81, and 0.81 to detect pulmonary arterial hypertension, and 0.80, 0.73, and 0.76 to detect group 3 PH. We additionally applied the trained model on ECGs from participants in the test dataset that were obtained from up to 2 years before diagnosis of PH; the area under the receiver operating characteristic curve was 0.79 or greater., Conclusions: A deep learning ECG algorithm can detect PH and PH subtypes around the time of diagnosis and can detect PH using ECGs that were done up to 2 years before right heart catheterization/echocardiogram diagnosis. This approach has the potential to decrease diagnostic delays in PH., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Light chain amyloidosis (AL) is a plasma cell dyscrasia characterized by organ dysfunction, morbidity, and early mortality. Daratumumab in combination with cyclophosphamide, bortezomib, and dexamethasone is now standard frontline AL therapy; however, not all patients are candidates for this intensive regimen. Given the potency of Daratumumab, we evaluated an alternative frontline regimen: daratumumab, bortezomib, and limited-duration dexamethasone (Dara-Vd). Over a 3 year period, we treated 21 patients with Dara-Vd. At baseline, all patients had cardiac and/or renal dysfunction, including 30% of patients with Mayo stage IIIB cardiac disease. Nineteen of 21 patients (90%) achieved a hematologic response with 38% achieving a complete response. The median time to response was 11 days. Ten of 15 (67%) evaluable patients achieved a cardiac response and 7 of 9 (78%) achieved a renal response. The 1-year overall survival was 76%. In untreated systemic AL amyloidosis, Dara-Vd produces rapid and deep hematologic and organ responses. Dara-Vd was well-tolerated and efficacious, even among patients with extensive cardiac dysfunction., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Despite improved life expectancy from a heart transplant, transplant recipients remain at high risk for renal dysfunction and failure, including end-stage kidney disease (ESKD). The onset of ESKD is a poor prognostic marker and is associated with increased mortality in this setting, as in others. There is a need to identify risk factors for ESKD among heart transplant recipients in contemporary settings., Methods: We conducted an analysis of adult heart transplant recipients transplanted between 2008 and 2021 in the Organ Procurement and Transplantation Network database. 22 737 adult recipients of heart transplants alone were included in this analysis. We examined LVEF measured 1 year after transplant, and LVEF updated annually for association with ESKD using multivariate Cox regression models., Results: LVEF at 1-year after transplant was associated with ESKD in multivariate models (Hazard Ratio 1.33 per 10-unit decrease, 95% CI 1.23-1.43, p < .001). In multivariate models using categorized LVEF, mildly reduced ejection fraction (EF 40%-50%) was associated with ESKD (HR 1.76, 95% CI 1.45-2.14, p < .001), as was reduced ejection fraction (EF < 40%, HR 2.86, 95% CI 2.01-4.07, p < .001), relative to individuals with preserved ejection fraction (EF > 50%). These associations were consistent when using annually updated ejection fraction., Conclusions: Post-transplant left ventricular ejection fraction has value in predicting end stage kidney disease among adults who receive heart transplants alone. LVEF is routinely measured as part of contemporary post heart transplant care, and a diminished LVEF should signal to clinicians that a recipient is at increased risk of renal failure., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Pulmonary arterial hypertension (PAH) is a progressive disease characterized by high mean pulmonary arterial pressure (≥ 20 mmHg) and remodeling of the vascular arteries. Approved therapies improve symptoms and delay clinical worsening in the long term, but they do not relieve acute exertional symptoms. RT234, a drug/device combination (Respira Therapeutics, Palo Alto, CA, USA) that delivers the phosphodiesterase 5 inhibitor vardenafil to the lungs via inhalation, has been shown to reduce pulmonary vascular resistance in patients with PAH. This study aims to evaluate whether RT234 can increase oxygen capacity during cardiopulmonary exercise testing (CPET) in patients with PAH., Methods: This prospective, multi-center, open-label, two-cohort, dose-escalation, phase IIb trial in patients with PAH will evaluate the safety and efficacy of RT234 in improving exercise parameters. The trial began in September 2020 and is expected to be completed by early 2024. Patients eligible for enrollment will have a right heart catheterization-confirmed diagnosis of PAH, a 6-minute walking distance of ≥ 150 m, a minute ventilation/carbon dioxide production slope of ≥ 36, and will be on up to three stable oral and/or inhaled (not parenteral) PAH-specific background therapies. The estimated sample size is 86 patients, who will be divided into two dose cohorts. Cohort 1 will receive 0.5 mg RT234, and cohort 2 will receive 1.0 mg RT234. Each cohort will contain two subgroups based on the number of PAH background medications (up to two vs three). The trial will assess patients' changes from baseline in peak oxygen consumption (VO 2 ) during CPET 30 minutes after a single dose of 0.5 mg or 1.0 mg RT234, the change in the 6-minute walking distance, and the pharmacokinetics and safety profile of single doses of RT234., Conclusion: This is the first trial involving an as-needed medication for PAH. The trial will provide insights into the safety and efficacy of as-needed RT234 in treating the acute symptoms of PAH during exercise and will inform the design of further trials., Trial Registration Number: ClinicalTrials.gov identifier NCT04266197., (© 2022. The Author(s).)

Importance: Reduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]). Cardiopulmonary exercise testing (CPET) is the criterion standard to measure exercise capacity and identify patterns of exertional intolerance., Objectives: To estimate the difference in exercise capacity among individuals with and without LC symptoms and characterize physiological patterns of limitations to elucidate possible mechanisms of LC., Data Sources: A search of PubMed, EMBASE, Web of Science, preprint servers, conference abstracts, and cited references was performed on December 20, 2021, and again on May 24, 2022. A preprint search of medrxiv.org, biorxiv.org, and researchsquare.com was performed on June 9, 2022., Study Selection: Studies of adults with SARS-CoV-2 infection more than 3 months earlier that included CPET-measured peak oxygen consumption (V̇o2) were screened independently by 2 blinded reviewers; 72 (2%) were selected for full-text review, and 35 (1%) met the inclusion criteria. An additional 3 studies were identified from preprint servers., Data Extraction and Synthesis: Data extraction was performed by 2 independent reviewers according to the PRISMA reporting guideline. Data were pooled using random-effects models., Main Outcomes and Measures: Difference in peak V̇o2 (in mL/kg/min) among individuals with and without persistent COVID-19 symptoms more than 3 months after SARS-CoV-2 infection., Results: A total of 38 studies were identified that performed CPET on 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 with symptoms consistent with LC. Most studies were case series of individuals with LC or cross-sectional assessments within posthospitalization cohorts. Based on a meta-analysis of 9 studies including 464 individuals with LC symptoms and 359 without symptoms, the mean peak V̇o2 was -4.9 (95% CI, -6.4 to -3.4) mL/kg/min among those with symptoms with a low degree of certainty. Deconditioning and peripheral limitations (abnormal oxygen extraction) were common, but dysfunctional breathing and chronotropic incompetence were also described. The existing literature was limited by small sample sizes, selection bias, confounding, and varying symptom definitions and CPET interpretations, resulting in high risk of bias and heterogeneity., Conclusions and Relevance: The findings of this systematic review and meta-analysis study suggest that exercise capacity was reduced more than 3 months after SARS-CoV-2 infection among individuals with symptoms consistent with LC compared with individuals without LC symptoms, with low confidence. Potential mechanisms for exertional intolerance other than deconditioning include altered autonomic function (eg, chronotropic incompetence, dysfunctional breathing), endothelial dysfunction, and muscular or mitochondrial pathology.

Aim: To evaluate and compare the flexural strength, surface roughness and porosity percentage of acrylic denture base material modified with two antimicrobial agents, Thymoquinone (TQ) and Silver nanoparticles (AgNP)., Materials and Methods: A total of 90 specimens were fabricated and divided into groups A, B and C with 30 specimens each. Of the 30 specimens, 10 specimens measuring 65mmx 10mmx 2.5 mm were used to study the flexural strength, 10 specimens measuring 10 mm × 20 mm × 3 mm to study surface roughness and 10 specimens measuring 10 mm × 20 mm × 3 mm to study porosity percentage. Group A specimens were made of unmodified denture base resin, group B and C were modified with 2.5% AgNP and 1% TQ respectively. The specimens were processed in the conventional manner. A universal testing machine was used to measure flexural strength and a profilometer was used to measure surface roughness. Porosity percentage was evaluated with help of a desiccator. The data obtained was subjected to statistical analyses using One-way ANOVA and the Tukey-post hoc test, with statistical significance at p ≤ 0.05., Results: Addition of 2.5% AgNP and 1% TQ to acrylic denture base resin significantly reduced flexural strength and increased the porosity percentage (p < 0.01) but within clinically acceptable limits. No significant difference was found in the surface roughness between the various groups tested., Conclusions: Heat cured acrylic denture base resins modified with 2.5% AgNPs,1% TQ exhibited clinically acceptable flexural strength and surface properties and could be incorporated into the denture base material as an antimicrobial agent., (© 2022 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to evaluate and compare the peel bond strength of an autopolymerizing acrylic resin and a fiberreinforced composite (FRC) resin to a heat temperature vulcanizing maxillofacial silicone (M511) using two different primers., Settings and Design: In vitro - comparative study., Materials and Methods: Autopolymerizing acrylic resin and FRC resin specimens with a dimension of 75 mm (length) ×10 mm (width) × 3 mm (height) were fabricated. A total of 60 samples were split into six categories based on the substructure material and primers (A330G primer and Sofreliner tough primer) used to bond the maxillofacial silicone to the FRC and acrylic resin specimens. In a universal testing machine, the peel bond strength was conducted at a 10 mm/min crosshead speed until bonding failure occurred., Statistical Analysis Used: The t-test, one-way analysis of variance, and the Tukey's honest significant difference (post hoc test) tests were used to statistically assess the values., Results: The Sofreliner tough primer produced the greatest peel bond strength in both the acrylic resin (0.89690 N/mm) and the FRC resin groups (3.19860 N/mm). Adhesive failures predominated in the acrylic resin group regardless of the primer used. The FRC group showed predominantly cohesive failures with both the A330G primer and Sofreliner tough primer., Conclusion: This study suggests that FRC resin combined with Sofreliner tough primer can significantly enhance the peel bond strength., Competing Interests: None

Purpose of Review: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening disease that disproportionately affects older adults and people of African descent. This review discusses current knowledge regarding racial and ethnic disparities in the diagnosis and management of ATTR-CM., Recent Findings: Historically, ATTR-CM was thought to be a rare cause of heart failure. Recent evidence has shown that ATTR-CM is more common among older adults, men, and people of African descent. In addition, significant geographic variation exists in the identification of amyloid cardiomyopathy. Despite the high burden of ATTR-CM among Black individuals, most clinical data for ATTR-CM are from North America and Europe. Moreover, only a minority of clinical trial participants thus far have been Black patients. In addition to racial differences, socioeconomic disparities may be further compounded by the potentially prohibitive cost and limited accessibility of disease-modifying ATTR therapies., Summary: ATTR-CM is an important cause of heart failure that disproportionately affects people of African descent. Efforts to promote earlier identification of ATTR-CM in general practice will likely improve clinical outcomes for all groups. Future trials should strive to enroll a higher proportion of Black patients. Furthermore, enhanced efforts are warranted to improve treatment accessibility among racial and ethnic minority groups that may be more likely to be affected by ATTR-CM.

Immunotherapies have greatly expanded the armamentarium of cancer-directed therapies in the past decade, allowing the immune system to recognize and fight cancer. Immune checkpoint inhibitors (ICIs), in particular, have revolutionized cancer treatment and have demonstrated survival benefit in numerous types of cancer. These monoclonal antibodies increase anti-cancer immunity by blocking down-regulators of adaptive immunity, including cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand (PD-L1), resulting in anti-tumor activity. As ICIs increase immune system activation, they can cause a wide range of inflammatory side effects, termed immune-released adverse events. Though these toxicities can affect nearly any organ, the most fatal toxicity is myocarditis. Here, we discuss the diverse spectrum of cardiovascular toxicities associated with ICI use. In addition, we provide insight and future directions on mechanisms and treatments for immune-related adverse events (irAEs) involving the myocardium, pericardium, vasculature, and conduction system., (© 2021 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.)

Aim: The aim of this review was to evaluate the survival rate of axial and tilted implants in rehabilitation of edentulous jaws using all on four concept., Setting and Design: Systematic Review., Materials and Methods: A literature review was performed in MEDLINE, PubMed Central (PMC), Google scholar, Embase, Cochrane Central Register of Controlled Trials. Hand searches were conducted of the bibliographic of related journals and systematic reviews. A total of 380 articles were obtained from the intial screening process. Of these articles, 25 articles fulfilled the inclusion criteria. The authors performed evaluation of articles independently as well as data extraction and quality assessment., Statistical Analysis Used: Qualitative analysis., Results: The major prosthetic complication was the fracture of the acrylic prosthesis. The mean cumulative survival rate of implants (72-132 months) were 94% to 98%. The prosthesis survival rate (12 months) was between 99% to 100%. The averaged bone loss was 1.3 ±0.4 mm (12-60 months). No Significant difference was found between survival rates of axial and tilted implants nor between maxilla and mandible., Conclusion: All on four concept can be employed successfully in the edentulous patients with resorbed ridges while improving their quality of life and reducing morbidity. However,randomized clinical trials with large sampling size and long term follow up should be incorporated., Competing Interests: None

Aim: To evaluate the efficiency of two commercially available polishing systems in reducing surface roughness of a monolithic zirconia after clinical adjustment and to compare them to glazed zirconia., Setting and Design: In vitro study., Material and Methods: This in vitro study was conducted on 25 discs (10mm in diameter and 2mm in thickness) using monolithic zirconia (Ceramill Zolid). From 25 specimens, 5 specimens were randomly selected as the positive control. The remaining discs were abraded for 15 secs with a red band diamond finishing bur using an air rotor handpiece. Then the specimens were randomly divided into 5 equal groups of 5 specimens each. Group 1: Roughened, unpolished and unglazed. Group 2 (Positive Control): Glazed without prior roughening,Group 3: Roughened and polished with eZr polishing kit, Group 4: Roughened and polished with Optra fine ceramic polishing kit and Group 5: Roughened and glazed. The surface roughness (Ra) values (μm) were measured quantitatively by a surface analyzer. The mean values were compared using one-way ANOVA and Post Hoc Test. One specimen of each group was evaluated qualitatively under a scanning electron microscope(SEM) for surface topography., Statistical Analysis Used: One-way ANOVA and Post Hoc Test., Results: The lowest Ra value was found in Group 4-Roughened and polished with Optrafine ceramic polishing kit (Ra=0.47μm) as compared to Group 3-Roughened and polished with eZr polishing kit (Ra=0.49μm) and Group 5-Roughened and glazed (Ra=0.59μm). There was no stastistically significant difference between two polishing systems. SEM analysis of surfaces polished with Optrafine polishing kit revealed smoother and regular morphology as compared to surfaces polished with eZr polishing kit., Conclusion: The Optrafine polishing kit created more smoother and uniform surfaces as compared to surfaces polished with eZr polishing kit both quantitatively and qualitatively. Also, lowest surface roughness values were produced by optrafine ceramic polishing kit on monolithic zirconia as compared to glazed monolithic zirconia after their clinical adjustments.Thus Optrafine ceramic polishing kit can be used as alternative to glazing., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 The Journal of Indian Prosthodontic Society.)

Despite limitations in sensitivity and specificity, estimation of the pulmonary artery systolic pressure (ePASP) on echocardiography is used for portopulmonary hypertension (PoPH) screening in liver transplant (LT) candidates. We proposed that alternative echocardiographic models, such as estimated pulmonary vascular resistance (ePVR), may provide improved testing characteristics in PoPH screening. In a retrospective analysis of 100 LT candidates, we found that the formula ePVR = ePASP/VTI RVOT  + 3 if MSN (VTI RVOT  = right ventricular outflow tract time velocity integral; MSN = mid-systolic notching of the VTI RVOT Doppler signal) significantly improves accuracy of PoPH screening compared to ePASP. We determined the optimal ePVR cutoff for PoPH screening to be 2.76 Wood units, as this cutoff provided 100% sensitivity and 73% specificity in screening for clinically significant PoPH. Comparatively, ePASP at a cutoff of 40 mm Hg provided 91% sensitivity and 48% specificity. We devised a new screening algorithm based on the use of ePVR at intermediate ePASP values (35-54 mm Hg), and we confirmed the testing characteristics of this algorithm in a separate validation cohort of 50 LT candidates. In screening LT candidates for PoPH, the ePASP lacks accuracy, leading to unnecessary RHCs and undiagnosed cases of PoPH. A screening algorithm which incorporates the ePVR may be more reliable., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose of Review: Pulmonary hypertension (PH) frequently complicates heart failure and portends a worse prognosis. This review will summarize and discuss recent updates in the classification and management of patients with PH due to left heart disease., Recent Findings: Careful hemodynamic assessment is critical to the classification of patients with PH and heart failure. Two hemodynamic subgroups of PH in heart failure patients have been described: isolated post-capillary pulmonary hypertension and combined post- and precapillary pulmonary hypertension. The cornerstone in management of PH due to left heart disease is the treatment of the underlying left heart pathology; however, ongoing trials have been designed to test pulmonary vasodilators in this cohort. PH-specific therapies have not demonstrated a benefit in patients with pulmonary hypertension due to left heart disease. Understanding the distinct pathobiology of each hemodynamic subgroup may lead to the development of useful biomarkers and effective targeted therapies.

Purpose: To evaluate the effect of chemical disinfection on the color stability of room temperature vulcanizing (RTV) maxillofacial silicone elastomer with and without pigment addition., Materials and Methods: Sixty specimens were obtained from a RTV maxillofacial silicone. The specimens were randomly divided into 6 groups according to pigments and disinfectant to be used (n = 10). NP-DW-nonpigmented silicone specimens to be immersed in distilled water (control). NP-S- nonpigmented silicone specimens to be rubbed with an anti-bacterial soap. NP-CHX-nonpigmented silicone specimens to be immersed in chlorhexidine gluconate solution (2%). P-DW-pigmented silicone specimens to be immersed in distilled water (control). P-S-pigmented silicone specimens to be rubbed with antibacterial soap. P-CHX-pigmented silicone specimens to be immersed in chlorhexidine gluconate solution (2%). Disinfection was conducted 6 times a day for 60 days simulating 1 year of usage. Color was evaluated after 60 days (disinfection period) using a reflectance spectrophotometer. Color alterations were calculated by the CIE L ∗ a ∗ b ∗ system. Data were analyzed by t-test, one-way ANOVA, and Tukey test (α = 0.05)., Results: NP-S and P-S exhibited the highest color alterations, whereas NP-DW and P-DW the lowest color alterations., Conclusion: Disinfection procedures affect the color stability of maxillofacial silicone. Chlorhexidine gluconate solution (2%) can be effectively used as a chemical disinfectant for maxillofacial prostheses. Antibacterial soap produced clinically unacceptable color changes in the silicone, hence is not advisable as a disinfectant., (© 2018 by the American College of Prosthodontists.)

Prosthetic rehabilitation of a completely edentulous patient should never be restricted to the replacement of missing teeth. The ultimate aim of complete denture treatment should be restoration of the full range of oral functions and esthetics. Slumped cheeks are always a concern for esthetically demanding complete denture patients. This article describes a simple, scientific, cost-effective technique to improve facial esthetics in a completely edentulous patient with the help of a cheek plumper. The technique used here implements the concept of neutral zone to precisely determine the amount of space available for the cheek plumper. The simple friction lock attachments that retained the cheek plumpers on the prosthesis were also fabricated after determining the space available in the appropriate areas. Thus an effort was made to keep the cheek plumpers unobtrusive yet effective to ensure complete integration of the prosthesis into the stomatognathic system., (© 2017 by the American College of Prosthodontists.)

The success of removable prostheses ultimately depends on a number of factors such as retention, stability, support, esthetics, and masticatory function. Increased intraoral inter-arch distance leads to an increase in the weight of the prosthesis. This may compromise the retention and resistance, which are key for a successful removable prosthesis. Various methods, techniques, and materials have been reported to minimize the weight of a prosthesis. This article describes a simple, unique, precise single-flask technique for the fabrication of a lightweight maxillary prosthesis using caramel as a 3D spacer, which was "indexed" to obtain a uniform thickness of acrylic around the hollow cavity., (© 2017 by the American College of Prosthodontists.)

Background: Automated cardiac image interpretation has the potential to transform clinical practice in multiple ways, including enabling serial assessment of cardiac function by nonexperts in primary care and rural settings. We hypothesized that advances in computer vision could enable building a fully automated, scalable analysis pipeline for echocardiogram interpretation, including (1) view identification, (2) image segmentation, (3) quantification of structure and function, and (4) disease detection., Methods: Using 14 035 echocardiograms spanning a 10-year period, we trained and evaluated convolutional neural network models for multiple tasks, including automated identification of 23 viewpoints and segmentation of cardiac chambers across 5 common views. The segmentation output was used to quantify chamber volumes and left ventricular mass, determine ejection fraction, and facilitate automated determination of longitudinal strain through speckle tracking. Results were evaluated through comparison to manual segmentation and measurements from 8666 echocardiograms obtained during the routine clinical workflow. Finally, we developed models to detect 3 diseases: hypertrophic cardiomyopathy, cardiac amyloid, and pulmonary arterial hypertension., Results: Convolutional neural networks accurately identified views (eg, 96% for parasternal long axis), including flagging partially obscured cardiac chambers, and enabled the segmentation of individual cardiac chambers. The resulting cardiac structure measurements agreed with study report values (eg, median absolute deviations of 15% to 17% of observed values for left ventricular mass, left ventricular diastolic volume, and left atrial volume). In terms of function, we computed automated ejection fraction and longitudinal strain measurements (within 2 cohorts), which agreed with commercial software-derived values (for ejection fraction, median absolute deviation=9.7% of observed, N=6407 studies; for strain, median absolute deviation=7.5%, n=419, and 9.0%, n=110) and demonstrated applicability to serial monitoring of patients with breast cancer for trastuzumab cardiotoxicity. Overall, we found automated measurements to be comparable or superior to manual measurements across 11 internal consistency metrics (eg, the correlation of left atrial and ventricular volumes). Finally, we trained convolutional neural networks to detect hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary arterial hypertension with C statistics of 0.93, 0.87, and 0.85, respectively., Conclusions: Our pipeline lays the groundwork for using automated interpretation to support serial patient tracking and scalable analysis of millions of echocardiograms archived within healthcare systems.

Restoration of implant crowns with subgingival margins has always been a challenge. If done precisely it leads to better treatment outcomes and prognosis. An incorrect technique and improper execution of the luting procedure are known to cause a high incidence of peri-implant disease due to incomplete elimination of the luting agent. Deep subgingival abutment margins are difficult to recognize, and cement removal in these cases becomes complicated if the sulcus depth is greater than 3 mm. Irrespective of the type of instrument used to remove the excess cement, scratches on the abutment and some cement remnants are consistently noticed. Therefore elimination of excess luting agent before the prosthesis is inserted intraorally is considered an effective technique to prevent complications due to excess luting agent. This article presents a chairside universal technique for cementation of implant crowns on abutments with deep subgingival margins. This technique attempts to minimize the amount of excess cement in peri-implant tissue., (© 2016 by the American College of Prosthodontists.)

The article highlights a new method for the fabrication of an ocular prosthesis by the incorporation of a ceramic scleral veneer. The steps of fabrication include impression making, wax try-in, performing a "cut-back" on a selected stock eye, insertion of the IPS e-max press scleral veneer, finishing and insertion. It also includes a detailed review on non-integrated ocular prostheses.

Introduction: Badly broken or structurally compromised posterior teeth are frequently associated with crown/root fracture. Numerous restorative materials have been used to fabricate indirect full-coverage restorations for such teeth. This study aims to evaluate and compare the effect of restorative materials on the stress distribution pattern in a mandibular first molar tooth, under varying loading conditions and to compare the stress distribution pattern in five commonly used indirect restorative materials., Materials and Methods: Five three-dimensional finite element models representing a mandibular first molar tooth restored with crowns of gold, porcelain fused to metal, composite (Artglass), alumina-based zirconia (In-Ceram Zirconia [ICZ]), and double-layered zirconia-based materials (zirconia core veneered with porcelain, Lava) were constructed, using a Finite Element Analysis Software (ANSYS version 10; ANSYS Inc., Canonsburg, PA, USA). Two loading conditions were applied, simulating maximum bite force of 600 N axially and normal masticatory bite force of 225 N axially and nonaxially., Results: Both all-ceramic crowns allowed the least amount of stress distribution to the surrounding tooth structure. In maximum bite force-simulation test, alumina-based all-ceramic crown displayed the highest von Mises stresses (123.745 MPa). In the masticatory bite force-simulation test, both all-ceramic crowns (122.503-133.13 MPa) displayed the highest von Mises stresses., Conclusions: ICZ crown displayed the highest peak von Mises stress values under maximum and masticatory bite forces. ICZ and Lava crowns also allowed the least amount of stress distribution to the surrounding tooth structure, which is indicative of a favorable response of the underlying tooth structure to the overlying full-coverage indirect restorative material. These results suggest that ICZ and Lava crowns can be recommended for clinical use in cases of badly damaged teeth.