Journal of Health and Translational Medicine (JUMMEC)

DETECTION OF HIGH-FREQUENCY HEARING LOSS AND SPEECH PERCEPTION IMPAIRMENT IN ONLINE LEARNING DURING THE PANDEMIC - BASED ON AN APPLICATION HEARING SCREENING PROGRAM

Khuznita Dasa Novita — 2024-08-01

The education system has undergone significant changes since the COVID pandemic, and there was a notable increase in Personal Listening Devices (PLDs) usage during online learning, which raises concern about potential hearing and speech perception disorders. This study aimed to identify High-Frequency Hearing Loss (HFHL) and speech perception impairment in medical doctor students engaged in online learning during the pandemic. The examination included the relationship between risk factors, such as gender, family history of hearing loss, ear infection, COVID-19 infection, and behavioral patterns of PLD usage. This quantitative, descriptive-analytic observational research
utilized a cross-sectional approach. The respondent were all medical students who underwent the hearing screening program in August 2021, willing to complete questionnaires and conduct self-examinations for hearing screening. The total respondents were 274 students (or 548 ears). Hearing assessment at 2, 4, 6, and 8 kHz was conducted using a hearing app, while speech perception was evaluated with the Digits-in-Noise Test (DIN Test). Data analysis involved Chi-square and Mann-Whitney tests. Suspected HFHL was found in 63 ears (11.5%, 63/548) consisting of 18 male ears (3.3%, 18/548) and 45 female ears (8.2%, 45/548). Speech perception impairment occurred in 125 respondents (45.6%, 125/274). HFHL was significantly correlated with a family history of hearing loss, while speech
perception impairment showed a significant correlation with gender, daily duration usage, and type of PLD (p < 0.05). Additionally, HFHL was significantly correlated with speech perception (p < 0.05). In conclusion, HFHL was suspected in students during online learning in the second year of the pandemic, and the identified risk factors may impact student performance. Confirmatory hearing assessments with an audiometer are recommended to address potential hearing loss.

VALIDATION AND RELIABILITY OF A GUIDED QUESTIONNAIRE (GQ) FOR TYPE 1 DIABETES MELLITUS (T1DM) CHILDREN AND PARENTS ON PERIODONTAL DISEASE (PD)

Zaridah Zainal Abidin — 2024-08-01

The prevalence of PD is notably high in individuals with T1DM. Despite this, there is a limited availability of research on the utilization of questionnaires to evaluate self-perceived PD, patient knowledge, and their perception of PD in T1DM patients. Therefore, our objective was to establish validity and reliability of a bilingual (English-Malay) version of the guided questionnaire (GQ) to be used among pediatric T1DM patients attending Universiti Teknologi MARA (UiTM) Sungai Buloh campus and the Universiti Malaya (UM). This questionnaire focused on self-reported periodontal disease (PD), assessing their knowledge, and understanding of the bidirectional relationship between
PD and T1DM. The dual-language GQ was adapted from the Self-Reported Questionnaire Malay Modified (SRQMM) to suit the targeted participants. Content validation was carried out among five field experts, and face validation was done among pediatric patients in Dental Faculty UiTM. Reliability testing was administered in T1DM patients attending UiTM and UM. The structure and words of the component in GQ were modified to ensure that it was appropriate for the participants. The item-level Content Validity Index (I-CVI) turned out to be valid with an average of 0.98. The subjective measurement of face validation showed satisfactory results after the second revision. Reliability concerning Cronbach’s alpha (α) values was computed relying on all 21 items, which were acceptable
at about 0.777, 0.644, 0.780 in the self-perceived PD assessment domain, knowledge domain and perception domain, respectively. Hence, the adapted dual language paediatrics version of the GQ is a reliable and valid tool for assessing self-perceived PD, knowledge, and perception in T1DM patients on PD and it can be effectively utilized by non-dental healthcare personnel.

RENAL CELL CARCINOMA (RCC) IN YOUNG ADULTS: A CASE REPORT AND LITERATURE REVIEW

Doreen Kher Lee Kiu — 2024-08-01

Pediatric renal cell carcinoma (RCC) is a rare disease entity and found to show significant differences from adult RCC in terms of epidemiological and histological subtypes. Treatment strategies for paediatric RCC were mainly adopted from adult RCC as there’s no internationally recognized standard treatment guideline to date. Data on clinical outcomes are scarce. We hereby report a case of a 14-year-old female diagnosed with advanced clear cell RCC treated with pazopanib with overall survival of 10 months. There are several case reports and case series supporting the use of anti-VEGF in adolescent RCC though not in clear cell RCC. None has incorporated immune checkpoint inhibitors in adolescent RCC. Safety and efficacy in dosing strategies of anti-VEGF in adolescents is another challenge. As cancer care advances, large scale genetic data analysis leads to the emergence of precision and personalized medicine, but its utilisation in pediatric RCC is yet to be addressed.

QUALITY INDICATORS FOR DIABETES MELLITUS: A RAPID EVIDENCE SYNTHESIS

Normaizira Hamidi — 2024-08-01

Diabetes is a serious public health problem in Malaysia with the prevalence of type 2 diabetes at 18.3% among adults above the age of 18, affecting 3.9 million individuals as reported by NHMS (2019). Monitoring of diabetes necessitates a set of quality measures comparable with other countries; thus, identifying meaningful indicators is pivotal. This rapid review aimed to identify the quality of care indicators for adults with type 2 diabetes across the continuum of care. A comprehensive MEDLINE search was conducted using PubMed for relevant studies. This search was supplemented by an examination of relevant government and international organisation websites. Records were included if the paper had quality indicators, complete with its numerator and denominator. Non-English articles
were excluded. Records were screened and data were extracted into a pre-determined data extraction form. We found 130 records using various search techniques. A total of 27 records were eligible to be included for analysis. The collected indicators were then classified using Donabedian’s structure-process-outcome framework, and assigned to six diabetes care categories. The final list of diabetes quality indicators included 65 indicators, with 69% of them being process indicators, 29% outcome indicators and only 2% structure indicators. Two diabetes care categories with the highest number of indicators were risk factors for diabetes complication (n = 14, 22%) and diabetes education (n = 12, 18%). This review aided the establishment of an inventory of international diabetes quality indicators,
complete with numerators and denominators, focusing on different aspects of diabetes monitoring across quality domains and levels of health care. This may facilitate our relevant stakeholders in indicator selections, adoption and adaptation in the local context.

THE EFFECTIVENESS OF MULTI-COMPONENT EXERCISE COMBINED WITH ART THERAPY ON MUSCLE STRENGTH AND DEPRESSION AMONG COMMUNITY-DWELLING OLDER ADULTS: A PILOT STUDY

Azliyana Azizan — 2024-08-01

Background: Physical and psychological declines often accompany aging, negatively impacting quality of life. Multimodal interventions may efficiently address multiple needs, but few studies have examined combined exercise and creative arts programs.

Objective: This pilot study aimed to determine the feasibility and potential impacts of a multi-component exercise plus art therapy intervention for improving muscle strength and depression levels in community-dwelling older adults.

Methods: Thirty-seven adults aged ≥ 55 years were randomized into exercise alone (EG = 12), art therapy alone (AG = 12), or combined exercise-art therapy (CG = 13). The 8-week interventions were performed at home. EG and CG engaged in moderate aerobic, resistance, balance, and flexibility exercises 3x/week. AG and CG also completed biweekly art therapy sessions involving coloring, weaving, stamping, and painting projects. Upper and lower limb muscle strength and depression levels were assessed at baseline and post-intervention.

Results: All groups showed significant pre-to-post improvements in muscle strength and depression. However, there were no significant differences between-group, although CG tended to have the greatest gains.

Conclusions: Home-based exercise and art therapy were feasible and improved outcomes. The combination group showed promising synergistic trends, supporting further research on multimodal interventions to promote successful aging through engaging programs that address both physical and mental health.

A CASE OF UNDERSIZED IABP BALLOON IN A CARDIAC ARREST PATIENT AFTER PERCUTANEOUS CORONARY INTERVENTION: A CASE REPORT

Reynold Siburian — 2024-08-01

Cardiac arrest during percutaneous coronary intervention is a rare but serious complication. Intra-aortic balloon pump (IABP) is often utilized to support hemodynamics after a return of spontaneous circulation (ROSC) due to cardiac problem. However, supply chain issues that arise limit the availability of the optimal balloon size. A 70-yearold-man with angina pectoris, despite optimal medical therapy (OMT), underwent an elective percutaneous coronary intervention (PCI). He developed cardiac arrest and achieved ROSC, but had low blood pressure despite inotropes and vasopressor. IABP support was necessary but ideal balloon size was unavailable due to supply chain problems. An undersized balloon (25 cc) was utilized instead. He was monitored in the ICU and began to improved and was finally discharged. An undersized balloon may still provide some benefit in increasing coronary blood flow and reducing cardiac workload in certain patients who need IABP support, especially when supply chain issues or lack of other circulatory devices limit such options. However, careful individualized assessment is required.

FOE OR FRIEND? SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS AND COVID-19 VACCINATION: A SYSTEMATIC REVIEW

Maureen Miracle Stella — 2024-08-01

Background: In the early year of 2020, SARS-CoV-2 was first diagnosed in Indonesia after an outbreak in Wuhan, China. Later, this disease became a worldwide pandemic. Systemic lupus erythematosus (SLE) patients are more vulnerable to COVID-19. They are also prone to relapse and have lower efficacy for COVID-19 immunization.

Objective: This study aimed to evaluate the antibody seroconversion and disease status after COVID-19 vaccination in SLE patients.

Method: We followed the PRISMA guidelines to systematically search and collect literature in the following databases: ProQuest, PubMed, EBSCOhost, SAGE, JSTOR, and ScienceDirect from 1st January 2019 to 24th April 2023. Titles and abstracts were reviewed for relevance. The inclusion criteria are original articles, written in English, investigated the effects of COVID-19 vaccination in SLE patients. The quality of evidence was evaluated using the Newcastle-Ottawa Scale.

Results and Discussion: From 1,088 studies, we retrieved nine studies for this review. There were cohort studies (n = 5), case-control studies (n = 2), and observational studies (n = 2) published between 2021 and 2022. Vaccines against SARS-CoV-2 are currently widely available and SLE patients should receive vaccination. In a large study involving healthy individuals and healthcare professionals, nearly all of the individuals who received two doses of BNT162b2 developed antibodies to the vaccine. Seroconversion after a first COVID-19 vaccination is delayed in older patients on specific immunosuppressive drugs.

Conclusion: This systematic review found that the overall immunogenicity and safety of COVID-19 vaccines were satisfactory in patients with SLE.

A 22-YEAR-OLD MAN WITH LYMPH NODE TUBERCULOSIS AND ADULT ONSET STILL’S DISEASE: A RARE CASE REPORT

Desta Nur Ewika Ardini — 2024-08-01

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory sickness with an unknown cause that is marked by a spiking fever that frequently exceeds 39o Celsius, evanescent skin symptoms, arthralgia or arthritis, and multiorgan involvement. Many diseases, such as infections, neoplasia, or immune diseases, can mimic AOSD. We found a rare condition lymph node tuberculosis (TB) with AOSD reported from Indonesia. A 22-year-old man had a prolonged fever, joint pain, reddish rash on extremities, and yellow eye membranes one week after taking a fixed combination anti-tuberculosis drug. The patient had a history of TB cervical lymphadenitis. Clinical examination disclosed salmon-colored rash, arthritis on wrists and shoulder, icterus, and hepatosplenomegaly. Laboratory results also revealed elevated leukocyte, bilirubin, c-reactive protein (CRP), and ferritin levels. Abdominal ultrasound found no cholestasis or obstruction. Immunological examinations showed negative antinuclear antibody (ANA), antibody streptolysin O (ASTO), rheumatoid factor, and hepatitis infection. According to Yamaguchi criteria, this patient fits the diagnosis of AOSD. Oral colchicine was also given with corticosteroids and cyclosporine. The treatment improved the patient’s conditions, with normalization of leukocyte, ferritin, and CRP count. The dose of prednisolone was successfully tapered, and remission was achieved in 2 months after oral administration of colchicine. This case highlights the importance of consideration of AOSD as a potential diagnosis in the presence of abnormal liver function tests and that one should not be misled into a diagnosis of drug-induced liver injury (DILI). Colchicine treatment silenced the disease activity of AOSD.

IMMUNE MODULATORY EFFECT OF HYPERTHERMIA DURING TREATMENT OF RECURRENT, METASTATIC OR LOCALLY ADVANCED SOLID ORGAN MALIGNANCIES

Gwo Fuang Ho — 2024-08-01

Background: The use of hyperthermia as an adjunct to improve conventional therapies in multimodal cancer treatment is supported by an increasing body of research. The underlying biological contribution of hyperthermia in modulating the cells of the immune system has been a growing area of interest. This study aims to evaluate the immune modulatory effect of locoregional hyperthermia given with standard of care treatment for patients with recurrent or metastatic solid malignancies. Secondary endpoints were tolerability, change in pain score and quality of life, and tumour control rate.

Methods: A single-centre prospective study, conducted from December 2019 to December 2021 at the University of Malaya Medical Centre, recruited 30 patients with solid organ malignancy at baseline. Alongside standard cancer treatment, patients also received hyperthermia treatment for 2 hours, two or three times a week for up to 16-weeks using REMISSION1ºC hyperthermia-induction device. Flow cytometry for lymphocyte enumeration and immunophenotyping was done on blood samples collected from patients at 4 different time points (Baseline, week 1 post hyperthermia, week 1 post standard therapy, week 4.

Results: In the analysis of lymphocyte subsets, an increase in CD8+ central memory T cells between baseline and week 1 post hyperthermia (Mean: Baseline 3.854, Week 1A 5.818; P = 0.013) was noted. An increase of CD4+ effector memory T cells between baseline and week 4 post hyperthermia in conjunction with standard therapy (Mean: Baseline 33.60, Week 4 39.34; P = 0.022) was recorded. There was also a marked increase in the percentage of CD8+ T cell expressing checkpoint inhibitory marker PD-1 post week 1 hyperthermia treatment (Mean: Baseline 7.439, week 1A 9.757; P = 0.048) as well as post standard treatment (Mean: Baseline 7.439, Week 1B 9.222; P = 0.033) from baseline.

Conclusion: Hyperthermia produced significant effects on the immune cell profiles of cancer patients on treatment. The subset of CD4 effector memory T cells increased significantly, although there was also sign of increased T cells exhaustion. These findings serve as a stepping stone for further research in exploring the mechanisms of hyperthermia in immune modulation and also its translation into clinical practice.

EXPLORING THE COVID-19 PANDEMIC IMPACTS ON MALAYSIAN RURAL SMALLHOLDER FARMERS IN KUCHING, SARAWAK

Whye Lian Cheah — 2024-08-01

The current study aims to explore the Coronovirus 2019 (COVID-19) pandemic impacts on Malaysian rural smallholder farmers in Kuching, Sarawak. Purposive sampling was employed and a qualitative descriptive approach was adopted. This study centred on a group of rural smallholder farmers actively participating in a food assistance programme for impoverished urban communities in Kuching. The farmers played a pivotal role in supplying vegetables and crops for the food assistance programme. The data were collected through semi-structured individual in-depth interviews. A thematic analysis was conducted, which revealed several major themes, namely the challenges encountered by smallholder farmers during the pandemic, the responses to the crisis, the recovery strategies, and subsequent plans. The current study not only enriched the understanding of the challenges encountered by rural smallholder farmers but also determined the underlying issues. The insights could serve as a foundation for developing specific solutions by relevant authorities to address rural smallholder farmers’ respective needs.

OVERVIEW OF THE ANTENATAL DETECTION OF LYMPHATIC MALFORMATION, ITS ASSOCIATED GENETIC FACTORS, AND THE COMPLICATIONS

Nurul Huda Mohd Nor — 2024-08-01

Lymphatic malformation (LM) is a dysfunction of the lymphatic system that is associated with genetic diseases. The clinical manifestation is established, but the outcome concerning genetic abnormalities is still not well understood. This review reports the advancement of technology in detecting LM antenatally, its associated genetic factors, and the complications of LM. Articles which were mainly case reports published from 1983 to 2023 were obtained from the search in Ovid MEDLINE and Scopus using the keywords “gene*”, OR, “DNA”, OR “epigenetic*” AND “lymphatic malformation” OR “cystic hygroma”. The advancement of technology over the years has contributed to the various types of genetic investigations conducted on a foetus with LM, including fluorescence in situ hybridization and multiplex ligation-dependent probe amplification. Poor prognosis indicated by the presence of genetic or karyotype abnormality results in opted termination of pregnancy, intrauterine death, or death at early hours of life. The PTPNII, FOXC2, FOXF1, and SRY genes and various chromosome abnormalities are associated with LM. The complications of LM include bone deformity, cardiac and urinary anomalies, and the worst is foetal hydrops. This critical dysfunction warrants future research directions to identify risk factors or biomarkers to prevent future cases of pregnancy with LM.

EXPLORING THE ROLE OF COMPREHENSIVE NUTRIENT PROFILES OF ANIMAL PROTEINS IN CHILD GROWTH AND DEVELOPMENT, WITH A FOCUS ON ESSENTIAL AMINO ACIDS

Muhammad Habiburrahman — 2024-08-01

Stunting, a condition that can lead to future cognitive and physical disorders in children, remains a significant issue, particularly in developing countries with the burdened with a high prevalence of stunting. The role of amino acid role in reducing stunting is still a subject of debate, contrasting with the previous emphasis on micronutrients, calories, and lipids. This article reviews existing evidence on the benefits of animal proteins, specifically their essential amino acid (EAA) content, in alleviating stunting. It also discusses the potential of animal proteins other than traditional red meat as affordable supplementary foods for children with stunting to support optimal development. When evaluating stunting, EAAs, and animal-source protein, the pieces of evidence indicate that children with stunting exhibit lower levels of circulating AAs. EAAs influence various growth pathways, such as mTORC1 and GCN2, making them crucial targets for addressing stunting. Animal proteins such as cow’s milk, eggs, and fish are rich in EAAs, with cow’s milk being particularly abundant in AA content. Additionally, studies have indicated the potential of alternative, low-cost animal protein sources, such as cow’s milk, eggs, and fish in reducing the risk of stunting and supporting linear and developmental growth. In summary, it is essential for children in developing countries to consume EAAs from animal proteins to address stunting. Future longitudinal studies and randomized clinical trials are recommended to quantify the metabolomic profiles of children. Feasibility studies and cost analyses on public health approaches and nutritional interventions to increase the consumption of other animal proteins in children are also recommended. These studies will help identify and further validate accessible and low-cost animal proteins as nutritional support for children with stunting, particularly in developing countries.

PULMONARY AND SPINAL TUBERCULOSIS IN AN 8-YEAR-OLD BOY: A CASE REPORT

Muhamad Akmal Mohammad — 2024-08-01

Tuberculosis in children is difficult to diagnose. We report a case of an immunocompetent child with persistent back pain and kyphotic deformity, without respiratory symptoms, and no contact with tuberculosis patients. Imaging shows evidence of thoracic vertebral destruction and dense consolidation in the right upper lobe. Tuberculin skin test, Quantiferon TB Gold, and Xpert MTB/RIF Ultra yielded positive results for Mycobacterium tuberculosis infection. The patient was started on and completed one year of antituberculosis therapy, with recovery shown in chest radiograph and a reduction in the static kyphosis angle.

TUI NA THERAPY IN MANAGING CHILDREN WITH RESPIRATORY DISORDER: A LITERATURE REVIEW

Nada Cindya — 2024-08-01

Respiratory disorders pose a significant global health concern, especially affecting children with high morbidity rates. Tui Na, a traditional therapeutic method, has been passed down through generations and is widely used for addressing respiratory issues in children. This article aims to conduct a literature review on Tui Na, exploring its effectiveness in managing respiratory health problems in children. The review follows the PRISMA model approach. Six articles meeting the inclusion criteria were analyzed out of 117 articles published from 2020 to 2022. All studies, conducted in China, focused on applying Tui Na to alleviate symptoms in children with respiratory disorders. The collective findings strongly suggest that Tui Na emerges as a safe and effective therapeutic modality. It significantly contributes to improving the health status, quality of care, and overall satisfaction for both pediatric patients and their families. This research not only adds to the growing body of knowledge on complementary and alternative medicine, but it also highlights Tui Na as a promising intervention for pediatric respiratory disorder.

GOOGLE TRENDS ANALYSIS OF TOOTHACHE-RELATED INFORMATION-SEEKING BEHAVIOURS DURING COVID-19 PANDEMIC IN MALAYSIA

Mohamad Noor Sairi — 2024-08-01

Google Trends (GT) is a primary tool for studying online behaviours and exploring web search trends related to specific topics over time. During the COVID-19 outbreak in Malaysia, several Movement Control Orders (MCO) were implemented, resulting in restricted access to dental care. The public may have searched for online information to manage their dental problems and needs. This study aimed to investigate toothache-related information-seeking keywords via GT and their correlation with different phases of the MCO implementation. A retrospective study was conducted using GT to collect Relative Search Volume (RSV) of toothache-related keywords from 2020 to 2021 in Malaysia. RSV was compared between the various MCO phases which were the First MCO (March-May 2020), Conditional MCO (May-June 2020), Recovery MCO (June 2020-March 2021), MCO by states (March-May 2021), MCO3.0 (May-June 2021) and the National Recovery Plan (NRP) from June 2021 onwards. Data were analysed descriptively using Microsoft Excel and SPSS software. The mean RSV was 74.43 (SD ± 8.46), with a peak of 100 on the week of 25th July 2021. The highest recorded RSV period between May to September 2021 corresponded with MCO3.0 and the early phase of NRP. The most searched toothache-related keyword in Malaysia was “ubat sakit gigi”, with an RSV of 100. All top related search keywords were in the Malay language. States with the highest RSV of toothache-related keywords were Kelantan, Sabah, and Terengganu. There was a positive correlation between RSV of toothache-related keywords and the different phases of MCO, r = 0.206 and p = 0.036 (p < 0.05). MCO implementations and seasonal interest during the COVID-19 pandemic seemed to influence the trend of Google users in Malaysia seeking information about toothaches. These findings may be used as supplementary data to support planning for oral health services and information delivery.

INTERNET ADDICTION AND DEPRESSION AMONG ADOLESCENTS DURING COVID-19 PANDEMIC IN PUNCAK ALAM: A CROSS-SECTIONAL STUDY

Adibah Fathihah Mohd Azhari — 2024-08-01

The global impact of the COVID-19 pandemic has led to substantial disruptions on a worldwide scale. People all over the world were expected to face a variety of mental health issues during this outbreak. Internet addiction may become a serious problem among adolescents, especially during online distance learning. Assessing adolescents' heavy Internet use is crucial for determining their psychological health. Thus, this study aimed to determine the level of internet addiction and depression among adolescents in Puncak Alam, Selangor, during the COVID-19 pandemic. A cross-sectional study was conducted on 174 respondents aged 13 to 17. The convenience sampling method was employed, where respondents completed questionnaires comprising eight items related to demographic information, 19 items based on the Internet Addiction Test (IAT), and 10 items related to the Depression scale, all specific to the COVID-19 pandemic period. The study revealed that 36.8% of respondents exhibited a mild level of Internet addiction, and 45.5% displayed a mild level of depression. A statistically significant (p = 0.01) yet weak positive correlation (r = 0.195) was identified between Internet addiction and depression, indicating that as Internet addiction increases, so does the level of depression, albeit weakly. These findings highlight the presence of mild Internet addiction and depression among adolescents. In the wake of the pandemic, it becomes crucial to tackle these issues through focused interventions and continuous research, aiming to bolster the mental health of young individuals in this digital era.

COLOR STABILITY OF CERAMIC LAMINATE VENEERS: A COMPREHENSIVE IN VIVO ANALYSIS ACROSS MULTIPLE TIME INTERVALS

Haidar Fouad Souleiman — 2024-08-12

Background: The precise selection of ceramic laminate veneers by clinical practitioners is crucial due to their capacity to impart a natural and consistently uniform aesthetic to teeth, accompanied by the assurance of enduring color stability over an extended duration.
Objective: This study aimed to evaluate and compare the clinical color stability of three different manufacturing techniques of ceramic laminate veneer preparation, IPS e.max CAD/CAM, IPS e.max press, and Refractory Die, over a 2-year study period. The study also aimed to assess the average color changes within each technique and differences between them. This study will enhance our understanding of the efficacy of clinical color stability in long-term dental restoration applications.
Methods: The study sample comprised of 17 patients (9 males, 8 females) who received 27 veneers on their anterior teeth. After responding to a questionnaire regarding the potential frequency of consuming pigmented foods and beverages, the patients were divided into three groups. The refractory die technique was applied to 7 patients (11 teeth), while both IPS e.max press and IPS e.max CAD/CAM techniques were applied to 5 patients (8 teeth) each, with a veneer thickness of 0.5 mm for all veneers and luting with light-cured resin cement. Patients were monitored over three time intervals spanning two years. Student and ANOVA tests were employed to compare discoloration)∆Eab) within and between groups.
Results: Our results revealed statistically significant differences in mean ∆Eab between 6 months and both 12 and 24 months in the three groups (P < 0.05). However, comparisons between the 12- and 24-month time point revealed statistical differences only in the refractory die group. No significant statistical differences were observed when comparing the three groups with each other (P > 0.05).
Conclusion: Our study determined that ∆Eab values in all groups were deemed clinically acceptable, with no observable visual changes. Additionally, our investigation highlighted that IPS e.max Press exhibited the least discoloration values compared to other alternative methods.