Objective: To evaluate the marginal fit and microleakage of monolithic zirconia crowns cemented with bioactive cement (Ceramir) compared to that cemented with glass ionomer cement and to evaluate the effect of thermocycling on marginal fit. Materials and methods: Twenty sound human molar teeth were prepared to receive a monolithic zirconia crowns. Teeth were divided randomly into two equal groups according to the type of luting cement. Group I: glass ionomer cement and group II: Ceramir cement. After cementation, the vertical marginal gap was assessed by using stereomicroscope before and after thermocycling. Twenty equidistant measurement points were taken for each crown. Leakage assessment was carried out using Fuchsin dye penetration followed by digital photography under a stereomicroscope. Data were analyzed by Mann-Whitney U test to compare between the two luting cements. Wilcoxon signed-rank test was used to evaluate the effect of thermocycling on the marginal fit (P ≤ 0.05)
Results: Whether before or after thermocycling, the results showed no significant difference between the marginal gap values of the two tested groups. For both groups, there was a significant increase in marginal gap values after thermocycling. Also, there was no significant difference between leakage scores of the two tested groups. Conclusions: Similarity in the physical properties and chemical composition of the two cements result in a non- significant effect on the vertical marginal fit and the extent of microleakage of translucent zirconia crowns.  Thermocycling had a negative impact on the vertical marginal gap of the two tested luting agents.

Background: The flat occlusal preparation design (FOD) of posterior teeth offers promising results of fracture resistance and stress distribution, but its application in vital teeth is limited as there may be a danger of pulp injury. Although this danger is omitted in endodontically treated teeth, there is no research work assessing the impact of FOD on the fracture resistance and distribution of stresses among these teeth. The aim of this study was to assess the impact of FOD of endodontically treated molars on the fracture resistance and distribution of stresses among a ceramic crown-molar structure when compared to the two planes occlusal preparation design (TOD). Methods: 20 human mandibular molars were endodontically treated and distributed equally to two groups: Group I (TOD) and Group II (FOD). Ceramic CAD/CAM milled lithium disilicate (IPS e.max CAD) crowns were produced for all preparations and adhered using self-adhesive resin cement. Using a universal testing machine, the fracture resistance test was performed. The fractured samples were examined using a stereomicroscope and scanning electron microscope to determine modes of failure. Stress distribution was evaluated by 3D finite element analysis, which was performed on digital models of endodontically treated mandibular molars (one model for each design). Results: Group II recorded statistically non-significant higher fracture resistance mean values (3107.2± 604.9 N) than Group I mean values (2962.6 ±524.27 N) as indicated by Student’s t-test (t=0.55, p= 0.57). Also, Group II resulted in more favorable failure mode as compared to Group I. Both preparation designs yielded low von-Mises stresses within the factor of safety. However, the stress distribution among different layers of the model differed. Conclusions: FOD having comparable fracture strength to TOD and a more favorable fracture behavior can be used for the preparation of endodontically treated molars.

Objective: This study aimed to evaluate the effect of diode laser irradiation (970 nm) of a one-step self-etch adhesive (Clearfil S3Bond/CS3B) and of the bonding agent of a two-step self-etch adhesive (Clearfil Liner Bond F/CLBF) placed on dentin before polymerization on the shear bond strength.Material and methods: Forty sound premolars were sectioned buccally to obtain flat dentin surfaces. The specimens were divided into 4 groups (n=10): Group (OS) – CS3B + polymerization. Group (OS-L) – CS3B + laser + polymerization. Group (TS) – CLBF (bonding agent only) + polymerization. Group (TS-L) – CLBF (bonding agent only) + laser + polymerization. The diode laser was irradiated through an 8 mm bleaching tip for 10 seconds, (0.4 W, 10 Hz, 4 J). All samples were cemented to composite blocks submitted to 4000 thermal cycles. The samples were tested for shear bond strength in a universal testing machine. Data obtained was analyzed using Two-way (ANOVA) (P ≤ 0.05) and the Bonferroni post-hoc test. Representative samples from each group were analyzed using scanning electron microscopy (SEM). Results: GroupTS-L– (7.43 MPa) displayed statistically significant higher shear bond strength in comparison to that of group TS – (5.13 MPa). No statistically significant difference was found between group OS-L – (6.49 MPa) and group OS – (7.28 MPa). Group TS-L exhibited the highest resin penetration beyond the hybrid layer under SEM. Conclusions: Diode laser irradiation of a bonding agent placed on dentin without prior priming increased the bond strength to dentin and is promising as a new dentin adhesion protocol.

Objective Accurate nationwide epidemiological evidence is vital to study the seasonal, geographic, and ethnic influence on the trends of orofacial cleft prevalence in Kuwait. Design Data obtained from the National Center for Health Information and Ministry of Health Hospital digital records were reviewed retrospectively to identify patients with orofacial clefts (OFC) using the ICD-10 diagnostic codes. The Jonckheere-Terpstra test was used to assess the trend of birth prevalence across the different years. The associations of types of OFC with ethnic and geographic influences were tested with chi-square or Fisher's exact tests, while the strength of that association was tested with multi-nominal logistic regression. Results Birth prevalence in Kuwait ranged from 0.75–2.55 per 1000 live births (0.73- 2.73 among Kuwaitis, 0.60–3.27 among non-Kuwaitis), with no statistically significant change observed during the past 28 years. The risk of unilateral cleft lip and palate was eight times higher during summer compared to Autumn, while the risk of cleft lip and palate remained lower during winter. Jahra (OR-7.76, CI- 1.51–39.80), Farwaneya (OR-6.65, CI- 1.34–33.06), and Hawalli (OR-6.72, CI- 1.26–35.98) governorates had higher odds of bilateral cleft lip when compared to Mubarak Alkabeer. Conclusions The study outcome is an indicator to improve patient care and customize healthcare infrastructure in the Ministry of Health. It also provides insight to develop projections of future needs. Future studies should focus on understanding the factors that might be a potential contributor to the seasonal change observed in the prevalence of OFC.

Background: The flat occlusal preparation design (FOD) of posterior teeth offers promising results of fracture resistance and stress distribution, but its application in vital teeth is limited as there may be a danger of pulp injury. Although this danger is omitted in endodontically treated teeth, there is no research work assessing the impact of FOD on the fracture resistance and distribution of stresses among these teeth. The aim of this study was to assess the impact of FOD of endodontically treated molars on the fracture resistance and distribution of stresses among a ceramic crown-molar structure when compared to the two planes occlusal preparation design (TOD). Methods: 20 human mandibular molars were endodontically treated and distributed equally to two groups: Group I (TOD) and Group II (FOD). Ceramic CAD/CAM milled lithium disilicate (IPS e.max CAD) crowns were produced for all preparations and adhered using self-adhesive resin cement. Using a universal testing machine, the fracture resistance test was performed. The fractured samples were examined using a stereomicroscope and scanning electron microscope to determine modes of failure. Stress distribution was evaluated by 3D finite element analysis, which was performed on digital models of endodontically treated mandibular molars (one model for each design). Results: Group II recorded statistically non-significant higher fracture resistance mean values (3107.2± 604.9 N) than Group I mean values (2962.6 ±524.27 N) as indicated by Student’s t-test (t=0.55, p= 0.57). Also, Group II resulted in more favorable failure mode as compared to Group I. Both preparation designs yielded low von-Mises stresses within the factor of safety. However, the stress distribution among different layers of the model differed. Conclusions: FOD having comparable fracture strength to TOD and a more favorable fracture behavior can be used for the preparation of endodontically treated molars.