Search

BackgroundMultiple myeloma (MM) is the second-most common cancer among hematological malignancies. Patients with active disease may experience several comorbidities, including renal insufficiency and asthma, which may lead to treatment failure. The treatment of relapsed or refractory MM (RRMM) has been associated with multiple factors, causing a decline in progression-free survival as well as overall survival with subsequent lines of therapy. Data about the characteristics of this group of patients in the Greater Gulf region are lacking. ObjectiveThe primary objective of this study is to describe the disease characteristics and various treatment approaches or regimens used in the management of patients with RRMM in the Greater Gulf region. MethodsWe will conduct a regional, retrospective study collecting real-world and epidemiological data on patients with MM in countries of the Greater Gulf region. Medical records will be used to obtain the required data. Around 150 to 170 patients’ records are planned to be retrospectively reviewed over 6 months without any cross-sectional or prospective intervention. Cases will be collected from Saudi Arabia, the United Arab Emirates, Kuwait, Oman, and Qatar. Descriptive as well as analytical statistics will be performed on the extracted data. The calculated sample size will allow us to estimate the percentages of RRMM cases with acceptable precision while complying with the challenges in light of data scarcity. We will obtain a comprehensive description of the demographic profile of patients with MM; treatment outcomes; the proportion of patients with MM with renal impairment and asthma, chronic obstructive pulmonary disease, or both at the time of diagnosis and any subsequent point; and data related to treatment lines, regimens, and MM-associated morbidities. ResultsPatient medical records were reviewed between June 2022 and January 2023 for eligibility and data extraction. A total of 148 patients were eligible for study inclusion, of whom 64.2% (n=95) were male and 35.8% (n=53) were female. The study is currently in its final stages of data analysis. The final manuscript is expected to be published in 2024. ConclusionsAlthough MM is a predominant hematological disease, data on its prevalence and patients’ characteristics in the Greater Gulf region are scarce. Therefore, this study will give us real-world insights into disease characteristics and various management approaches of patients with MM in the Greater Gulf region. International Registered Report Identifier (IRRID)DERR1-10.2196/49861

Objectives: The oral microbiological environment may be implicated in the corrosion of orthodontic metals. This study aimed to examine the prevalence of sulfate-reducing bacteria (SRB) in orthodontic patients undergoing fixed appliance treatment. Methods: Sixty-nine orthodontic and 69 healthy non-orthodontic participants were enrolled in the study. Supragingival and subgingivaloral biofilm were collected and tested for the presence of SRB. The DNA extraction, polymerase chain reaction (PCR), and 16sRNA Sanger sequencing method was performed from the SRB-positive samples. The sequenced PCR products were analysed and compared with databases to identify the bacterial genus. Results: Amongst 69 orthodontic patients, characteristic black precipitates developed in 14, indicating the presence of iron sulfides which demonstrates the likelihood of SRB. Alternatively, 2 out of 69 showed the presence of SRB in healthy non-orthodontic participants (controls). Desulfovibrio spp was confirmed by analyses of 16sRNA sequencing, which revealed that the SRB prevalence was 20% in the examined participants with orthodontic appliances. Conclusions: The prevalence of SRB was found to be significantly higher amongst orthodontic patients compared to non-orthodontic participants. Presence of stainless steel in the oral environment may have facilitated the colonisation of SRB.

Background: Worldwide, carpal tunnel syndrome (CTS) is the most common peripheral neuropathy due to compression. A minimally invasive endoscopic carpal tunnel release (ECTR) procedure is available to treat this condition. This study aims to identify and compare the different types of anesthesia in ECTR, particularly in terms of functional outcomes, patient satisfaction, and operative time. Methods: PRISMA guideline was used to design and conduct this systematic review. MEDLINE, Cochrane, and EMBASE databases were searched systematically from inception to May 2022. For the search, MeSH terms such as ECTR, general anesthesia, local anesthesia (LA), and regional anesthesia were used. Results: As a result of reviewing the literature, 198 publications were reviewed. After implanting our criteria, 12 studies were included. We included 14589 patients who underwent ECTR. LA has a higher satisfaction rate and a shorter operative time than general anesthesia. LA had a mean operative time of 20.1 min, compared to 45 min and 51 min for regional anesthesia and general anesthesia. The number of patients with postoperative ECTR surgical complications was 2.7% (95%CI). After ECTR with LA, 95% of patients are back to their daily routine within six months. Conclusion: All the reported methods were effective, with LA being the most commonly used. Furthermore, it showed a shorter operative time and a higher satisfaction rate than other types of anesthesia. Due to the heterogeneity of the data, we recommend future randomized controlled trials to highlight the differences in anesthesia types used in ETCR. Level of evidence: III, risk/prognostic study

Chronic lymphocytic leukemia (CLL) typically occurs in the elderly and has a highly variable clinical course. Infectious complications have been known to be a major cause of morbidity and mortality in CLL patients. The management of hematological malignancies, including CLL, during the COVID-19 pandemic is challenging. Here we describe two patients with CLL who got infected with SARS-COV-2 as confirmed by positive nasopharyngeal swab PCR. The 1st patient, who was receiving treatment for CLL-associated autoimmune hemolytic anemia, was hospitalized with mild COVID-19 symptoms. The 2nd patient, who was on active treatment for CLL, had asymptomatic COVID-19 infection and was not hospitalized. Both patients recovered from COVID-19 without related complications.

Reinfection with SARS-CoV-2 is a rare phenomenon. To date, there has been some cases reported from countries such as United States, Ecuador, Hong Kong, the Netherlands and Belgium. This case report presents the first case of reinfection from Saudi Arabia, and probably the first dental student to have been re-infected with COVID-19. A 24-year-old male dental student presents with reinfection after a period of three months since he was first infected with COVID-19. The signs and symptoms reported by the patient were similar in both instances, except that he developed fever only at the time of reinfection. The infection and reinfection were confirmed with a RT-PCR test reports. This report highlights how it is necessary to continue to observe all the prescriptions recently indicated in the literature in order to avoid new contagion for all health workers after healed from covid-19 or asymptomatic positive, since as seen sometimes the infection does not ensures complete immunity in 100% of cases.

This study compared tooth color and enamel and dentinal thickness between orthodontically treated and untreated individuals. (1) Methods: A matched case–control study was conducted. The sample included 26 patients who had received orthodontic treatment and 31 matched controls. The color assessment was performed subjectively using the VITA 3D-Master (VM) shade guide and objectively using the VITA Easyshade (VE) spectrophotometer. Differences in L*, a*, and b* (lightness, red/green, and blue/yellow) were calculated. The color change was evaluated using ΔE*ab and the whiteness index (WID). Tooth structure thickness (labiolingual, labial enamel, and labial dentin) was evaluated using cone-beam computerized tomography. The correlations between overall tooth color and tooth structure thickness were evaluated. (2) Results: A total of 228 teeth were evaluated. Color assessment using VM showed significant differences between orthodontically treated and untreated teeth (p < 0.001), while VE revealed no significant differences. Both groups showed no difference in tooth enamel and dentinal thickness. Significant differences in tooth color (p < 0.05) were observed between genders. Both VM and VE showed weak to moderate correlations with tooth color and enamel and dentinal thickness (p < 0.05). (3) Conclusions: Orthodontic treatment may demonstrate visually perceptible but acceptable and clinically undetectable tooth color alteration.

Abstract Objectives To evaluate the dental and skeletal effects that occur in the correction of anterior open bite with clear aligners. Materials and method In this single-center retrospective study, the mechanism of anterior open bite closure using clear aligners (Invisalign, Align Technology, Santa Clara, CA, USA) was evaluated by cephalometric superimposition based on records of patients consecutively treated by a single, experienced Invisalign provider. Inclusion criteria consisted of anterior open bite (overbite < 0.5 mm), adult patients (18+) at the beginning of treatment, consecutive records, and good quality pre- and post-treatment records, where the required landmarks were clearly visible. Results A total of 45 patients were included for data analysis with a mean age of 30.73 ± 8.0 years and initial open bite of − 1.21 ± 1.15 mm. During treatment, the upper incisors showed significant (p < 0.05) retraction [U1-SN′(°) = − 10.91 ± 6.95°], [U1-SN′perp(mm) = − 2.57 ± 1.75 mm] and extrusion [U1-SN′(mm) = 1.45 ± 0.89 mm]. The lower incisors also showed significant retraction [IMPA(°) = − 3.73 ± 4.91°), (ΔL1-MP′perp (mm) = − 1.08 ± 1.59] and extrusion (ΔL1-MP′(mm) = 0.53 ± 0.74). Regarding molar position, no significant changes were noted in the anteroposterior position of the upper [ΔU6-SN′perp(mm) = 0.01 ± 1.08 mm] and lower molar [ΔL6-MP′perp(mm) = 0.03 ± 0.87 mm]; however, there was a statistically significant intrusion of the upper [ΔU6-SN′(mm) = − 0.47 ± 0.59 mm] and lower molar [ΔL6-MP′(mm) = − 0.39 ± 0.76 mm]. Conclusion Open bite closure with clear aligners occurred due to a combination of maxillary and mandibular incisor extrusion and maxillary and mandibular molar intrusion, with slight mandibular auto rotation. Significant retraction of maxillary and mandibular incisors was also observed with treatment. Clear aligners are effective in reducing/controlling the vertical dimension in open bite patients.

Introduction: Alteration of the centrifugation time and protocol may impact the release of platelet-rich fibrin (PRF) scaffolds. The current study purpose was to investigate the released levels of fibroblast growth factor-2 (FGF-2) in standard PRF (S-PRF) and low-speed centrifugation concept known as advanced PRF (A-PRF and A-PRF+). Measurements were done at five times interval over 42 days. The aim was to assess the FGF release and the relation between initial platelet counts and the concentrations of FGF-2 release using the following technique: (1) S-PRF, (2) A-PRF, and (3) A-PRF+. Materials and Methods: Twenty-four blood samples were taken from eight random Saudi Arabian national healthy subjects enrolled in the investigation. Blood samples were processed using S-PRF, A-PRF, and A-PRF+ centrifugation protocols. Protein quantification was performed using enzyme-linked immunosorbent assay at 1, 7, 14, 28, and 42-day intervals. Results and Discussion: A statistically significant difference in the mean of FGF-2 measurement between protocols at the 7th day where both S-PRF and A-PRF were significantly higher than A-PRF+ (P < 0.012). Initial platelets' significant count for S-PRF, A-PRF, and A-PRF+ was on day 1, day 7, and 7th day, respectively. Both protocols S-PRF and A-PRF yielded significantly higher release of the FGF-2 when compared to A-PRF+ in Saudi healthy subjects.

Background: Hydrocephalus is a worldwide disorder characterized by abnormal flow or rarely excessive production of cerebrospinal fluid, leading to the widening of the cerebral ventricles system due to the accumulation of the cerebrospinal fluid in the brain. Previous researches have shown that knowledge about the disorder is limited among healthcare providers and the population, affecting attitudes toward patients, as well as patient outcomes. Aim: To investigate healthcare providers and population's knowledge and attitudes towards hydrocephalus in Saudi Arabia. Methodology: A descriptive cross-sectional study was conducted through an electronic questionnaire. The survey was self-constructed in Arabic and English by the research team and inspired by other awareness questionnaires and validated before use by three experts. Results: There were 444 participants in this study, aged between 17 and 73 years with a mean age of 32.60 ± 10.98. Most of the participants were from the general population (74.8%). More than half of the participants had a bachelor's degree (60.1%). 38.4% of healthcare providers had negative knowledge while 61.6% had positive knowledge. In addition, 82.5% of the general population had negative knowledge, although 17.5% had positive knowledge. Moreover, it was observed that 17.0% of the healthcare providers had a bad attitude while 83.0% had a good attitude. In addition, 60.2% of the general population had a bad attitude, whereas 39.8% had a good attitude. Conclusion: This study revealed that the level of knowledge and attitude towards hydrocephalus among healthcare providers was good on both aspects, while it was poor among the general population.

Adult patients with severe vertical growth pattern, skeletal class III malocclusion and open bite anteriorly are difficult orthodontic cases to treat. An orthognathic surgical treatment plan may benefit adult patients with such types of complex malocclusions, however in certain cases, the patient’s medical history may contraindicate the surgical treatment plan. A male patient aged 17 years presented with a prognathic mandible, Angle’s class III malocclusion on a class III skeletal base with proclination in upper incisors, retroclination of lower incisors, and reduced facial convexity. Patient gave history of asthma and complex cardiac diseases including arrhythmia, irregular heartbeat, and pacemaker. This case report describes a non-surgical approach of distalization of mandibular and maxillary arches performed with the help of miniplates to achieve an improvement in the facial balance without surgery.

Anaplastic large-cell lymphoma is an aggressive non-Hodgkin lymphoma of T cell/null cell origin. It rarely affects the gastrointestinal tract. We present the case of a 58-year-old patient diagnosed with anaplastic lymphoma of the stomach in association with Kaposi’s sarcoma of the skin.

Background: To qualitatively and quantitatively review the reliability of palatal rugae as a tool for personal identification following orthodontic treatment. Methods: Cross-sectional retrospective studies assessing the accuracy of matching palatal rugae pattern pre- and post-orthodontic treatment were identified from PubMed and SCOPUS databases. The title and abstract of the articles identified in the search were screened for potential duplicates and relevancy to the topic of interest. The full text of the articles selected in the screening was analyzed using the inclusion and exclusion criteria. Quantitative analysis of the studies representing coherent data in terms of age and treatment choice was performed using RevMan software. Results: Out of 64 screened articles, only 18 articles fulfilled the eligibility criteria and were included in the systematic review. Out of these 18 articles, only 3 studies had data compatible with the quantitative analysis. Significant changes were noted in lateral first rugae in transverse bilateral direction (p = 0.02) and between second and third lateral rugae of the left side in the anteroposterior direction (p = 0.04). Despite the dimensional changes, observers in most studies were able to accurately (>90%) match the palatal rugae pre- and post-orthodontic treatment through visual observation. Conclusion: The accuracy of the visual matching, despite the significant dimensional changes, indicates that morphology could have potentially been the major matching factor. Thus, a combination of dimensional and morphological evaluation of the palatal rugae could potentially increase the accuracy of personal identification.

Congenital pulmonary airway malformation (CPAM) is a developmental anomaly of the lower respiratory tract. We document a case of primary Hodgkin Lymphoma of lung occurring in a 13-year-old boy who had an incidental diagnosis of CPAM at the same time. Keywords: Hodgkin lymphoma, Lung, CPAM

Hodgkin’s lymphoma is a B-cell neoplasm, which usually presents with painless lymphadenopathy. Its presentation with autoimmune hemolytic anemia (AIHA) is rare, although the association of AIHA with other lymphoproliferative disorders is well known. Here, we report a case of a patient with warm AIHA who presented in a critical condition to hospital and was diagnosed with HL.

Introduction: Sickle cell disease (SCD) is an inherited genetic disorder characterized by various complications, including thrombosis. Increased levels of circulating microvesicles (MVs) and tissue factor (TF)- bearing MVs have been reported in SCD. Objectives: The present study compares the levels of circulating MVs and TF- bearing MVs in steady state SCD children with age- and gender- matched healthy controls using an indirect ELISA. Citrated whole blood was collected from 54 SCD patients homozygous for sickle haemoglobin (HbSS) (aged from 2 to 12 years-old) and 34 healthy controls. Results: SCD patients showed significantly higher levels of MVs in their plasma as compared to the controls (P = 0.0095). Although the TF activity on MVs was low in both groups, there was a significant difference between them P

Objective: To compare outcomes in terms of the Bleeding index, Gingival Index and Orthodontic Plaque Index with videographic and plaque disclosing tablets versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment. Methods: This randomized control study was conducted at King Khalid University, Dept. of Orthodontics. Adult orthodontic patients are recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and total 60 participants were randomly allocated to three groups. Subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last month were excluded. The outcomes in terms of the Bleeding Index, Gingival Index, and Orthodontic Plaque Index with videographic and plaque-disclosing tablets(PDT) versus verbal instructions' were recorded using a standardized technique. Data were analyzed using SPSS version 26.00. Results: The study involved 60 participants with a maximum mean age of 21.15 ± 6.27 in the verbal respondent group with higher proportion of men. There was no significant difference found between the three groups and genders for baseline and after-treatment mean scores for Bleeding Index, Gingival Index, and Orthodontic Plaque Index. However, pre-and post-interventional changes were evaluated using a paired t-test, which produced statistically significant results for the verbal, video, and PDT groups in lower jaw as well as the video and PDT groups in the upper jaw. Simple linear regression model suggests that video plays a significant role in improving oral hygiene, and the video group is more effective in educating about oral hygiene. Conclusion: In conclusion, videographic and PDT methods appear to be effective in improving oral hygiene outcomes in adult orthodontic patients undergoing fixed appliance treatment.

Objective: To compare outcomes in terms of the Bleeding index, Gingival Index and Orthodontic Plaque Index with videographic and plaque disclosing tablets versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment. Methods: This randomized control study was conducted at King Khalid University, Dept. of Orthodontics. Adult orthodontic patients are recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and total 60 participants were randomly allocated to three groups. Subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last month were excluded. The outcomes in terms of the Bleeding Index, Gingival Index, and Orthodontic Plaque Index with videographic and plaque-disclosing tablets(PDT) versus verbal instructions' were recorded using a standardized technique. Data were analyzed using SPSS version 26.00. Results: The study involved 60 participants with a maximum mean age of 21.15 ± 6.27 in the verbal respondent group with higher proportion of men. There was no significant difference found between the three groups and genders for baseline and after-treatment mean scores for Bleeding Index, Gingival Index, and Orthodontic Plaque Index. However, pre-and post-interventional changes were evaluated using a paired t-test, which produced statistically significant results for the verbal, video, and PDT groups in lower jaw as well as the video and PDT groups in the upper jaw. Simple linear regression model suggests that video plays a significant role in improving oral hygiene, and the video group is more effective in educating about oral hygiene. Conclusion: In conclusion, videographic and PDT methods appear to be effective in improving oral hygiene outcomes in adult orthodontic patients undergoing fixed appliance treatment.

Objective: To compare outcomes in terms of the Bleeding index, Gingival Index and Orthodontic Plaque Index with videographic and plaque disclosing tablets versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment. Methods: This randomized control study was conducted at King Khalid University, Dept. of Orthodontics. Adult orthodontic patients are recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and total 60 participants were randomly allocated to three groups. Subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last month were excluded. The outcomes in terms of the Bleeding Index, Gingival Index, and Orthodontic Plaque Index with videographic and plaque-disclosing tablets(PDT) versus verbal instructions' were recorded using a standardized technique. Data were analyzed using SPSS version 26.00. Results: The study involved 60 participants with a maximum mean age of 21.15 ± 6.27 in the verbal respondent group with higher proportion of men. There was no significant difference found between the three groups and genders for baseline and after-treatment mean scores for Bleeding Index, Gingival Index, and Orthodontic Plaque Index. However, pre-and post-interventional changes were evaluated using a paired t-test, which produced statistically significant results for the verbal, video, and PDT groups in lower jaw as well as the video and PDT groups in the upper jaw. Simple linear regression model suggests that video plays a significant role in improving oral hygiene, and the video group is more effective in educating about oral hygiene. Conclusion: In conclusion, videographic and PDT methods appear to be effective in improving oral hygiene outcomes in adult orthodontic patients undergoing fixed appliance treatment.

Pitaya, sometimes called dragon fruit, is a tropical fruit crop that has become more well-known recently because of its distinct flavor and beneficial properties. However, it has only been cultivated in tropical and subtropical areas, and nothing is known about whether it can thrive in arid climates. This study considers various pitaya plant types' morphological, physiological, and agronomic aspects to assess their viability for cultivation in desert regions. This study investigated the growth and development of two cultivars of pitaya plants, S. undatus and S. costaricensis, in the Asir region of Saudi Arabia. Different fertilisation treatments were applied to determine the most effective approach for promoting growth and productivity. Results showed that the Klebak fertiliser, which contains marine algae rich in auxins and amino acids, was the most effective treatment for S. undatus. For S. costaricensis, the Klebak fertiliser was also effective, but treating tree leaves with volcanic stone was also beneficial. The volcanic stone helped to preserve moisture in the soil and promote good drainage, while the leaves provided important organic nutrients for growth. In addition, S. costaricensis was found to be more resistant and responsive to cultivation, likely due to its original habitat in the temperate climate of Mexico. These findings can help inform the cultivation of pitaya plants in similar climatic conditions. They may have implications for other areas seeking to promote the growth and productivity of this important crop.

The coronavirus (COVID-19) outbreak around the world has caused public health concerns and changes in peoples’ behaviors and psychological distress. The pandemic impacts on human behavior, emotions, and cognition, leading to diverse reactions in relation to awareness of the disease. However, there is little understanding around the psychological impacts of the pandemic and strategies to overcome this impact. This study aimed to examine individuals’ reactions toward the COVID-19 pandemic in relation to their psychological hardiness, their degree of awareness toward the pandemic, and precautionary measures taken. Individuals living in Saudi Arabia were invited to complete an online questionnaire which included demographic items, psychological responses to the pandemic, awareness of COVID-19, and measures of psychological hardiness. A total of 1272 individuals were recruited into the study, with the majority being female (85%). Results indicated that the average psychological responses to the COVID-19 pandemic in the study sample were 75.85%. This indicates that the sample generally has a high level of positive psychological responses to the COVID-19 pandemic. The awareness of COVID-19 among Saudi was 91.50%. This indicates a high level of awareness among the study sample.

Objective: The aim was to compare the fracture strength of Molar endocrowns fabricated from different all-ceramic materials and various preparation designs. Materials and methods: Ninety extracted human molar teeth were root canal treated and randomly divided into three groups according to the all ceramic materials used for fabrication of the endocrowns ( n = 30): (1) Lithium disilicate (IPS e.max Press); (2) Polymer infiltrated ceramic (Vita Enamic); (3) High translucency zirconia (Ceramill Zolid HT). Each group was subdivided into 3 subgroups ( n = 10) according to the preparation design as 2 mm occlusal reduction, 4.5 mm occlusal reduction, and 4.5 mm occlusal reduction with 2 mm radicular extension. The endocrowns from each material were fabricated and surface treated according to the manufacturer’s recommendations. After cementation with self-adhesive resin luting cement, the specimens were stored in a humid environment for 72 hours and subsequently subjected to 5000 thermal cycles. After, a compressive, static-axial load was applied using a universal testing machine until failure. Load-to-failure was recorded (N) and the specimens were examined under a stereomicroscope to determine the failure type. The data was statistically analyzed using One-way ANOVA and Tukey HSD tests at p < 0.05. Results: The Lithium Disilicate endocrowns recorded the higher mean fracture strength for 4.5 mm occlusal thickness and 2 mm radicular extension at 3770.28 N and 3877.40 correspondingly. The High translucency zirconia endocrowns at conventional 2 mm thickness showed the highest mean fracture load (3533.34 N). Even though polymer infiltrated ceramic endocrowns displayed comparatively lesser fracture load; they recorded the predominantly favorable fractures. Conclusions: Increased occlusal thickness showed a significant improvement in fracture strength of lithium disilicate and polymer infiltrated ceramic molar endocrowns. Although the 2 mm radicular extension had the substantial enhancement of fracture strength in high translucency zirconia, it resulted in more unfavorable failure types.

Endocrowns are primarily recommended in a molar region with a standardized preparation design. The aim of the study was to evaluate the effect of different occlusal preparation depths, pulp chamber-radicular extension, and all-ceramic materials on the fracture resistance of premolar endocrowns. Ninety human premolar teeth were root canal treated, randomly divided into three main groups according to all-ceramic material used for fabrication as Lithium Disilicate (LD) ceramic, Polymer infiltrated ceramic (PIC) and High translucency zirconia (HTZ). They were further subdivided into three subgroups (n = 10) according to preparation design of 2 mm occlusal reduction, 4.5 mm occlusal reduction and 4.5 mm occlusal reduction with 2 mm radicular extension. The endocrowns from respective restorative materials were fabricated, surface conditioned, and cemented with self-adhesive resin cement. All samples were thermocycled for 5000 cycles and subjected to compressive static load at 45° angluation with the cross-head speed of 0.5 mm/minute until the fracture. The mean fracture resistance of LD ceramic at 2 mm, 4.5 mm thickness and radicular extension was 62.55 MPa, 45.80 MPa, 74.27 MPa respectively. The corresponding values for the PIC and HTZ ceramics were 26.30 MPa, 21.65 MPa, 25.66 Mpa and 23.47 MPa, 27.30 MPa, 37.29 MPa respectively. The LD ceramic and greater extension inside the pulp chamber had higher fracture resistance.