The Effect of Brand, Thickness, and Abutment Substrate on the Masking Ability of Monolithic Zirconia Cera The goal of the present study was to determine the minimum thickness of monolithic zirconia required to achieve an acceptable masking ability and to examine how brand, thickness, and abutment substrate influenced that masking ability (∆E). Seventy-two A2-shade monolithic zirconia disc specimens in various thicknesses (1.0, 1.5, and 2.0 mm) were fabricated using three brands: Nacera® Pearl 1, DD cubeX2 and XTCERA TT. A spectrophotometer was used to determine the CIELab values of the specimens, which were placed on a D4-shade resin composite and white acrylic (control) substrates. The ∆E was calculated and compared with the acceptable (AT = 5.5) and perceptible (PT = 2.6) tolerance thresholds. Further investigation was conducted on 72-disc specimens from the monolithic zirconia brand with the best masking ability on D3-shade resin composite and semi-precious alloy. Using two-way ANOVA, the interaction of thickness, brand, and abutment substrate on ∆E was investigated. Nacera® Pearl 1 at 1.5 mm thickness was sufficient to achieve AT on a D4-shade resin composite substrate, whereas 2.0 mm of DD cubeX2 and XTCERA TT were required. Nacera® Pearl 1 further testing on two other substrates requires thicknesses of 1.5 mm and 1.0 mm, respectively. Only the Nacera® Pearl 1 group achieved PT on D3- and D4-shade resin composite (2.0 mm) and semi-precious alloy substrates (1.5 mm). Brand, thickness, and abutment substrate influenced the ∆E (p < 0.001). To achieve an acceptable masking ability, the minimum thickness of monolithic zirconia tested on D3- and D4-shade resin composite and semi-precious alloy should be around 1.5 mm to 2.0 mm.

Prosthetic rehabilitation offers an alternative to surgical procedures for repositioning implant-retained auricular prosthesis. This report illustrates a prosthetic rehabilitation of a 15-year- old male with a unilateral microtia who presented with an unfavorable implant-retained left auricular prosthesis. The implants placed seven years ago were drifted posterosuperior away from the ideal ear canal position. The fabrication of a new prosthesis on the existing bar-clip attachment using a custom acrylic base was planned to correct the location. A skin-colour perforated custom acrylic base was fabricated and designed to extend anteriorly, therefore, shifting the prosthesis forwards into a more natural location. The custom base was able to relocate the prosthesis’ position without compromising its retention whilst engaging the existing implant attachment. This in turn enhanced prosthesis acceptability and improved the patient’s confidence. The custom acrylic base serves as a viable option to reposition the prosthesis influenced by age related growth and development.

Objective: To analyse the clinical characteristics of patients with morbidly adherent placenta (MAP). Findings of this study will be used to identify patients at risk of MAP and to outline the best management strategy to deal with this devastating condition. Methods: Delivery records in Hospital Sultanah Nur Zahirah, Terengganu from 1st. January 2016 until 31st. December 2016 were reviewed and analysed. Results: Out of the 15,837 deliveries, eight cases of MAP were identified. Six out of eight patients had previous caesarean scar with concomitant placenta praevia, the other two patients had previous caesarean scar with history of placenta praevia in previous pregnancies. Seven out of eight cases were suspected to have MAP based on risk factors. Correct diagnosis was made by ultrasound in five patients, all with histologically confirmed moderate/severe degree of abnormal placentation. The other two cases of ‘unlikely MAP’, demonstrated segmental MAP intra-operatively with histologically confirmed milder degree of abnormal placentation. Total intraoperative blood loss ranged from 0.8 to 20 litres. Prophylactic internal iliac artery balloon occlusion was associated with significantly less blood loss. Conclusion: Antenatal diagnosis is essential in outlining the best management strategy in patients with MAP. Ultrasound may not be accurate in ruling out lower degree of MAP. Apart from having a scarred uterus with concomitant placenta praevia, history of having placenta praevia in previous pregnancy is also a risk factor for MAP. Prophylactic internal iliac artery balloon occlusion is associated with significantly less blood loss and should be considered in cases suspected with MAP.