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Wolff-Parkinson-White syndrome is a cardiovascular disease characterized by abnormal atrio-ventricular conduction facilitated by accessory pathways (APs). Invasive catheter ablation of the AP represents the primary treatment modality. Accurate localization of APs is crucial for successful ablation outcomes, but current diagnostic algorithms based on the 12 lead electrocardiogram (ECG) often struggle with precise determination of AP locations. In order to gain insight into the mechanisms underlying localization failures observed in current diagnostic algorithms, we employ a virtual cardiac model to elucidate the relationship between AP location and ECG morphology. We first introduce a cardiac model of electrophysiology that was specifically tailored to represent antegrade APs in the form of a short atrio-ventricular bypass tract. Locations of antegrade APs were then automatically swept across both ventricles in the virtual model to generate a synthetic ECG database consisting of 9271 signals. Regional grouping of antegrade APs revealed overarching morphological patterns originating from diverse cardiac regions. We then applied variance-based sensitivity analysis relying on polynomial chaos expansion on the ECG database to mathematically quantify how variation in AP location and timing relates to morphological variation in the 12 lead ECG. We utilized our mechanistic virtual model to showcase limitations of AP localization using standard ECG-based algorithms and provide mechanistic explanations through exemplary simulations. Our findings highlight the potential of virtual models of cardiac electrophysiology not only to deepen our understanding of the underlying mechanisms of Wolff-Parkinson-White syndrome but also to potentially enhance the diagnostic accuracy of ECG-based algorithms and facilitate personalized treatment planning.

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The use of 3-dimensional (3D) technology has become increasingly popular across different surgical specialities to improve surgical outcomes. 3D technology has the potential to be applied to robotic assisted radical prostatectomy to visualise the patient's prostate anatomy to be used as a preoperative and peri operative surgical guide. This literature review aims to analyse all relevant pre-existing research on this topic. Following PRISMA guidelines, a search was carried out on PubMed, Medline, and Scopus. A total of seven studies were included in this literature review; two of which used printed-3D models and the remaining five using virtual augmented reality (AR) 3D models. Results displayed variation with select studies presenting that the use of 3D models enhances surgical outcomes and reduces complications whilst others displayed conflicting evidence. The use of 3D modelling within surgery has potential to improve various areas. This includes the potential surgical outcomes, including complication rates, due to improved planning and education.

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INTRODUCTION: Laparoscopic Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) in colon cancer surgery has not been broadly adopted in part because of safety concerns. Pre-operative 3-D virtual modelling (3DVM) may help but needs validation. METHODS: 3DVM were routinely constructed from CT mesenteric angiograms (CTMA) using a commercial service (Visible Patient, Strasbourg, France) for consecutive patients during our CMECVL learning curve over three years. 3DVMs were independently checked versus CTMA and operative findings. CMECVL outcomes were compared versus other patients undergoing standard mesocolic excision (SME) surgery laparoscopically in the same hospital as control. Stakeholders were studied regarding 3DVM use and usefulness (including detail retention) versus CTMA and a physical 3D-printed model. RESULTS: 26 patients underwent 3DVM with intraoperative display during laparoscopic CMECVL within existing workflows. 3DVM accuracy was 96 % re arteriovenous variations at patient level versus CTMA/intraoperative findings including accessory middle colic artery identification in three patients. Twenty-two laparoscopic CMECVL with 3DVM cases were compared with 49 SME controls (age 69 ± 10 vs 70.9 ± 11 years, 55 % vs 53 % males). There were no intraoperative complications with CMECVL and similar 30-day postoperative morbidity (30 % vs 29 %), hospital stay (9 ± 3 vs 12 ± 13 days), 30-day readmission (6 % vs 4 %) and reoperation (0 % vs 4 %) rates. Intraoperative times were longer (215.7 ± 43.9 vs 156.9 ± 52.9 min, p=<0.01) but decreased significantly over time. 3DVM surveys (n = 98, 20 surgeons, 48 medical students, 30 patients/patient relatives) and comparative study revealed majority endorsement (90 %) and favour (87 %). CONCLUSION: 3DVM use was positively validated for laparoscopic CMECVL and valued by clinicians, students, and patients alike.

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INTRODUCTION: Tissue establishments are responsible for processing, testing, preserving, storing, and distributing allografts from donors to be transplanted into recipients. In some situations, a matching process is required to determine the allograft that best fits the recipient. Allograft morphology is a key consideration for the matching process. The manual procedures applied to obtain these parameters make the process error-prone. MATERIAL AND METHODS: A new system to manage bone allograft-recipient matching for tissue establishments is proposed. The system requires bone allografts to be digitalized and the resulting images to be stored in a DICOM file. The system provides functionalities to: (i) manage DICOM files (registered in the PACs) from both allografts and recipients; (ii) reconstruct 3D models from DICOM images; (iii) explore 3D models using 2D, 3D, and multiplanar reconstructions; (iv) take allograft and recipient measurements; and (v) visualize and interact with recipient and allograft data simultaneously. The system has been installed in the Barcelona Tissue Bank (Banc de Sang i Teixits), which has digitalized the bone allografts to test the system. RESULTS: A use case with a femur is presented to test all the viewer functionalities. In addition, the recipient-allograft workflow is evaluated to show the steps of the procedure where the viewer can be used. CONCLUSIONS: The bone allograft-recipient matching procedure can be optimized using software tools with functionalities to visualize, interact, and take measurements.

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Background and Objectives: Dental caries is a preventable, reversible disease in its early stages. This study evaluated the intra-rater agreement of International Caries Assessment and Detection System (ICDAS) scores with Medit i500® and Omnicam® scanners versus traditional clinical examinations and the inter-rater agreement using the Omnicam® among senior dentists and dental students and between these two groups. Materials and Methods: A total of 24 patients aged between 21 and 34 years, randomly selected from dental students and interns, underwent four examinations (three intraoral scans and one clinical examination), and the corresponding ICDAS scores were recorded by a randomly selected rater out of the 31 available examiners. The examination team consisted of dental students, dentists with less than 3 years, and dentists with more than 5 years of clinical experience. The following inter- and intra-rater agreement tests for the ordinal data were chosen: Fleiss' kappa coefficient, Cohen's weighted kappa, and inter-class correlations. Results: For all examination techniques, there was statistically significant agreement for the experienced raters (p < 0.05). The highest positive interclass correlation was obtained for inter-rater agreement tests of 288 observations recorded by senior dentists: ICC = 0.969 (95% CI 0.949-0.981). Conclusions: Intra-rater reliability was excellent for Omnicam compared to clinical exams conducted by senior dentists but moderate for Medit i500. Although inter-rater agreement using Omnicam was poor between students and between senior dentists and students, it was excellent among senior dentists.

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BACKGROUND: Wilms tumor (WT) is the most frequent renal tumor in children. The SIOP-UMBRELLA Guidelines allow for nephron-sparing surgery (NSS) in syndromic patients, as well as in cases of small (<300 mL) non-syndromic unilateral WTs, without lymph node involvement, and with a substantial expected remnant renal function, following neoadjuvant chemotherapy. We present a case of prechemotherapy transperitoneal robot-assisted partial nephrectomy (RAPN) for a unilateral, non-syndromic Wilms tumor. METHODS: A four-year-old child presented with a solid mass measuring 3.6 cm in diameter involving the upper right renal pole, incidentally detected during an abdominal echotomography. CT scan and abdominal MRI revealed no local infiltration or lymph node involvement, suggesting that the exophytic mass could be easily resected via an NSS robotic approach. Preoperative imaging did not strongly suggest WT. A virtual 3D reconstruction of the tumor was performed. RESULTS: After the oncologic board approval, a robot-assisted partial nephrectomy with an intraperitoneal approach was performed. Histopathological analysis confirmed the diagnosis of WT. The patient subsequently received 10 doses of vincristine as adjuvant chemotherapy. A 28-month follow-up showed no tumor recurrence. CONCLUSIONS: Intraperitoneal RAPN may be an option for selected WT and warrants consideration as a challenging but advantageous approach.

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OBJECTIVES: To evaluate the lingual dental arch form types in class I canine and molar relationship based on scanning dental cast models using three-dimensional laser scan and to give a new lingual arch form pattern created on this classification to be used for clinical submission by studying three-dimensional virtual models of the normal occlusion samples. MATERIALS AND METHODS: Maxillary and mandibular casts of 120 young adults (18-24 ± 1.84 years) have normal occlusion that was scanned using a 3Shape E1 laser scanner, and then, the data were analyzed using SPSS software; then, we used K-means cluster to classify the arch form into clusters depending on the measurement of 10 landmarks designated on the lingual surface of the teeth. RESULTS: Many dental arch patterns have been established for both the mandible and the maxilla. CONCLUSION: The minimum sizes were found in the females, and the biggest sizes were found in the male subjects, and three sets were well defined for each sex; three categories for each mandible and maxilla are as follows: narrow, mid, and broad. The lingual arch form can be classified into three groups based on posterior and anterior dimensions, so a template of the three arch forms has been exemplified.

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Introduction: Bolton analysis is used to determine anomalies with respect to the dental mass, for diagnosis and treatment planning purposes, the possibility of using a digital method was introduced and tested to measure the size of the mesiodistal tooth. In this way, digital dental technology has made digital study models become popular in orthodontics. Objective: to evaluate the degree of reliability of the evaluation of the Bolton analysis in three-dimensional virtual models versus plaster models through a review of the literature. Materials and methods: A search was carried out in the primary databases of the international scientific literature on health sciences: Medline, through PubMed, SciELO, Lilacs, and Embase. Review articles published between the year 2000 and October 2021 were included. Results: The desktop scanner was the best option for digitizing dental models, but this does not detract from CBCT and intraoral laser scanners, which are still an option. Reasonable validity for digitizing 3D models with results within the "clinically acceptable" range was found. Conclusions: 3D digital models generated with intraoral and extraoral scanners are reliable and accurate compared to conventional impressions and save time, in most cases statistically significant differences were found, but of little clinical relevance.

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BACKGROUND: Robotic-assisted kidney transplantation (RAKT) has shown solid results as a minimally invasive alternative to the standard open approach (open kidney transplantation [OKT]). However, RAKT is still limited in those cases where the recipient's iliac vessels present atherosclerotic plaques, frequently found in elder patients and in those subjected to long-term hemodialysis. Unlike OKT, where the surgeon can palpate the arterial plaques, in minimally invasive surgery the haptic feedback is missing, making the vascular clamping and arteriotomy unsafe. OBJECTIVE: To employ three-dimensional (3D) imaging reconstruction using augmented reality (AR) to intraoperatively locate the plaques during the crucial steps of kidney transplantation. DESIGN, SETTING, AND PARTICIPANTS: Our study was conducted according to the Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) model for surgical innovation. Three-dimensional virtual models were obtained from high-accuracy computed tomography scan imaging and superimposed on the vessels during RAKT using the Da Vinci console software. SURGICAL PROCEDURE: Three-dimensional AR-guided robotic-assisted kidney transplantation. MEASUREMENTS: The correspondence of virtual models with the real anatomy of patients was assessed comparing vessels' and plaques' measures. RESULTS AND LIMITATIONS: We tested the possibility of using the AR in the setting of vascular surgery by checking the correspondence of the virtual models to the real vessels. During the accuracy assessment, we investigated the anatomy of the iliac plaques and the capacity of the virtual models to correctly represent them. Finally, we tested the efficacy of the virtual model superimposition on the real vessels with plaques during RAKT in the recipients of living donor grafts. The main limitation consists in training needed to correctly superimpose virtual models on the real field. CONCLUSIONS: The employment of 3D AR allowed surgeons to overcome one of the main limitations of RAKT, setting the foundation to expand its indications to patients with advanced atheromatic vascular disease. PATIENT SUMMARY: The use of three-dimensional augmented reality guidance during kidney transplantation (KT) has the potential to "navigate" the surgeon during KT, allowing a safer procedure in patients with atheromatic vascular disease.

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Transcatheter mitral valve-in-valve replacement (TMViVR) in degenerated bioprostheses or valvular rings shows promise as an alternative to surgical MVR in selected high-risk patients. However, these procedures are particularly challenging given the complex anatomy of the mitral valve apparatus and the surrounding structures, potentially causing LV outflow tract obstruction (LVOTO). Preprocedural planning with virtual implantation and planimetric estimation of the neo-LVOT at end-systole is crucial for improving procedural results. In this case, we also include a dynamic evaluation of the neo-LVOT and implement virtual reality imaging for immersive assessment of the implanted valve.

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BACKGROUND: Transcatheter mitral valve replacement (TMVR) may be a valuable treatment option for mitral annular calcification and severe mitral stenosis (MS) in patients at high operative risk. Pre-procedural virtual and printed simulations may aid in procedure planning, device sizing, and mitigate complications such as valve embolization or left ventricular outflow tract (LVOT) obstruction. CASE SUMMARY: We describe a case of TMVR in which multi-detector computed tomography (MDCT) derived, three-dimensional virtual planning and a 3D-printed model of the patients' left heart provided enhanced understanding of an individual patient's unique anatomy to determine feasibility, device sizing, and risk stratification. This resulted in deployment of an adequately sized valve. Post-TMVR LVOT obstruction was treated with LVOT balloon dilatation and percutaneous transluminal septal myocardial ablation. DISCUSSION: Advanced MDCT-derived planning techniques introduce consistent 3D modeling and printing to enhance understanding of intracardiac anatomical relationships and test device implantation. Still, static measurements do not feature haemodynamic factors, tissue, or device characteristics and do not predict device host interaction. Transcatheter mitral valve replacement is feasible in MS when adequately pre-procedurally planned. Multi-detector computed tomography-derived, 3D, virtual and printed models contribute to adequate planning in terms of determining patient eligibility, procedure feasibility, and device sizing. However, static 3D modeling cannot completely eliminate the risk of peri-procedural complications.

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An appropriate presentation of maxillofacial defects and their prosthetic rehabilitation concepts using traditional two-dimensional educational materials is challenging for dental students and prosthodontics residents. This technique article introduces a simple approach to visualize and communicate three-dimensional (3D) virtual models embedded into a portable document format (PDF) file for presenting maxillofacial prosthetics concepts and enhancing students' spatial ability when learning maxillofacial prosthetics. MeVisLab software was used to combine various maxillofacial models and save them as a single 3D model. Adobe Acrobat Pro DC software was used to import the 3D model and create interactive visualization PDF documents. Adobe reader software was then used to visualize the content of the PDF documents. This approach allows educators to develop PDF files with multiple 3D models for teaching maxillofacial prosthetics concepts and communicate them with their students. Students can simply open the PDF file, activate the 3D mode, and interactively manipulate the 3D models to enhance their spatial ability for learning maxillofacial prosthetics.

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BACKGROUND: In the last decade, 3D virtual models have been used for educational purposes in the health sciences, specifically for teaching human anatomy and pathology. These models provide an opportunity to didactically visualize key spatial relations that can be poorly understood when taught by traditional educational approaches. Caries lesion detection is a crucial process in dentistry that has been reported to be difficult to learn. One especially difficult aspect is linking clinical characteristics of the different severity stages with their histological features, which is fundamental for treatment decision-making. OBJECTIVE: This project was designed to develop a virtual 3D digital model of caries lesion formation and progression to aid the detection of lesions at different severity stages as a potential complement to traditional lectures. METHODS: Pedagogical planning, including identification of objectives, exploration of the degree of difficulty of caries diagnosis-associated topics perceived by dental students and lecturers, review of the literature regarding key concepts, and consultation of experts, was performed prior to constructing the model. An educational script strategy was created based on the topics to be addressed (dental tissues, biofilm stagnation areas, the demineralization process, caries lesion progression on occlusal surfaces, clinical characteristics related to different stages of caries progression, and histological correlations). Virtual 3D models were developed using the Virtual Man Project and refined using multiple 3D software applications. In the next phase, computer graphic modelling and previsualization were executed. After that, the video was revised and edited based on suggestions. Finally, explanatory subtitles were generated, the models were textured and rendered, and voiceovers in 3 languages were implemented. RESULTS: We developed a 6-minute virtual 3D dynamic video in 3 languages (English, Spanish, and Brazilian Portuguese) intended for dentists and dental students to support teaching and learning of caries lesion detection. The videos were made available on YouTube; to date, they have received more than 100,000 views. CONCLUSIONS: Complementary pedagogical tools are valuable to support cariology education. This tool will be further tested in terms of utility and usability as well as user satisfaction in achieving the proposed objectives in specific contexts.

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In order to provide restorations and dental prostheses that are esthetically pleasing, functional and in harmony with a patient's occlusion, practitioners must have a thorough knowledge of dental anatomy. Recent studies have shown that virtual three-dimensional (3D) models greatly enhance educational outcomes in dental anatomy courses. This article describes a novel educational technique and uses videos and web-based portals to demonstrate how to create a virtual 3D tooth model from a scan of a natural tooth for use in dental anatomy courses.

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BACKGROUND: Frailty is a common clinical syndrome in ageing population that carries an increased risk for adverse health outcomes including falls, hospitalization, disability, and mortality. As these outcomes affect the health and social care planning, during the last years there is a tendency of investing in monitoring and preventing strategies. Although a number of electronic health record (EHR) systems have been developed, including personalized virtual patient models, there are limited ageing population oriented systems. METHODS: We exploit the openEHR framework for the representation of frailty in ageing population in order to attain semantic interoperability, and we present the methodology for adoption or development of archetypes. We also propose a framework for a one-to-one mapping between openEHR archetypes and a column-family NoSQL database (HBase) aiming at the integration of existing and newly developed archetypes into it. RESULTS: The requirement analysis of our study resulted in the definition of 22 coherent and clinically meaningful parameters for the description of frailty in older adults. The implemented openEHR methodology led to the direct use of 22 archetypes, the modification and reuse of two archetypes, and the development of 28 new archetypes. Additionally, the mapping procedure led to two different HBase tables for the storage of the data. CONCLUSIONS: In this work, an openEHR-based virtual patient model has been designed and integrated into an HBase storage system, exploiting the advantages of the underlying technologies. This framework can serve as a base for the development of a decision support system using the openEHR's Guideline Definition Language in the future.

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The aim of this study was to compare two different methods for evaluation of alveolar bone resorption after the socket preservation procedure. In the current study, 9 patients with a total of nine teeth indicated for extraction were included. Patients received alveolar ridge preservation with allograft (BoneAlbumin™, OrthoSera Dental, Gyor, Hungary) or Platelet-Rich fibrin (PRF). CBCT (Planmeca ProMax 3D, Helsinki, Finland), was taken at 1 week and 4 months after the socket preservation procedure. A 3D scan, obtained with Trios (3Shape, Copenhagen, Denmark) of the alveolar bone of the surgical site and the adjacent teeth at the place of extraction was performed during the surgical procedure, immediately after the graft placement in the alveolar socket, and after 4 months. Virtual study models were generated using the three-dimensional file processing software "Meshlab" (ISTI-CNR Rome Italy). The changes of alveolar height and width were measured and analyzed. Results were taken from both methods. Radiographic examination revealed that the average value of horizontal resorption is 0.6⁻2.4 mm, and vertical resorption is 0.46⁻2.8 mm. On virtual models, the average value for horizontal resorption is 1.92⁻3.64 mm, the vertical resorption value is 0.95⁻2.10 mm. The Trios intraoral scan can provide non-invasive and more accurate quantitative insights into the dimensional changes in the alveolar ridge after the bone remodeling process. More research is needed for verification of these results.

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The head and neck region is one of the most complex areas featured in the medical gross anatomy curriculum. The effectiveness of using three-dimensional (3D) models to teach anatomy is a topic of much discussion in medical education research. However, the use of 3D stereoscopic models of the head and neck circulation in anatomy education has not been previously studied in detail. This study investigated whether 3D stereoscopic models created from computed tomographic angiography (CTA) data were efficacious teaching tools for the head and neck vascular anatomy. The test subjects were first year medical students at the University of Mississippi Medical Center. The assessment tools included: anatomy knowledge tests (prelearning session knowledge test and postlearning session knowledge test), mental rotation tests (spatial ability; presession MRT and postsession MRT), and a satisfaction survey. Results were analyzed using a Wilcoxon rank-sum test and linear regression analysis. A total of 39 first year medical students participated in the study. The results indicated that all students who were exposed to the stereoscopic 3D vascular models in 3D learning sessions increased their ability to correctly identify the head and neck vascular anatomy. Most importantly, for students with low-spatial ability, 3D learning sessions improved postsession knowledge scores to a level comparable to that demonstrated by students with high-spatial ability indicating that the use of 3D stereoscopic models may be particularly valuable to these students with low-spatial ability. Anat Sci Educ 10: 34-45. © 2016 American Association of Anatomists.

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Computer-assisted 3D models are used in some medical and allied health science schools; however, they are often limited to online use and 2D flat screen-based imaging. Few schools take advantage of 3D stereoscopic learning tools in anatomy education and clinically relevant anatomical variations when teaching anatomy. A new approach to teaching anatomy includes use of computed tomography angiography (CTA) images of the head and neck to create clinically relevant 3D stereoscopic virtual models. These high resolution images of the arteries can be used in unique and innovative ways to create 3D virtual models of the vasculature as a tool for teaching anatomy. Blood vessel 3D models are presented stereoscopically in a virtual reality environment, can be rotated 360° in all axes, and magnified according to need. In addition, flexible views of internal structures are possible. Images are displayed in a stereoscopic mode, and students view images in a small theater-like classroom while wearing polarized 3D glasses. Reconstructed 3D models enable students to visualize vascular structures with clinically relevant anatomical variations in the head and neck and appreciate spatial relationships among the blood vessels, the skull and the skin.

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INTRODUCTION: Previous studies have shown that 20-30% of denture users have been dissatisfied with their dentures. AIM: To evaluate the stress pattern under elastic and viscoelastic denture liners using 3-Dimensional Finite Element Analysis (FEA) and its clinical correlation using a questionnaire. MATERIALS AND METHODS: The study had both in-vitro and in-vivo phases. In in-vitro phase fabrication of a virtual parametric model of edentulous maxilla and dentures with overlying mucosa was made. A virtual load of 166N was analyzed at three points (Point A=anterior ridge, Point B=right posterior ridge and Point C=left posterior ridge). For the in-vivo phase, 20 edentulous patients were provided conventional complete dentures (Group-I). The dentures were lined with silicone (elastic) liners (Group-II) and acrylic resins (viscoelastic) liners (Group-III) at regular (2 months) intervals. After each reline, the patients were evaluated using food eating ability and denture assessment questionnaires. The results were statistically analyzed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Other than standard statistical test Analysis of Variance (ANOVA) and Post-Hoc tests (Tukey-HSD) were used. RESULTS: At loading, the in-vitro result for Groups-II and III revealed pressures of 0.074231N and 0.0678364N at Point A, 0.098764N and 0.093642N at Point B, and 0.099876N and 0.093746N at Point C respectively. The in-vivo study revealed that the mean quality of life score for different groups ranged from 23.65±4.00 (Group I) to 33.10±6.15 (Group III). The mean quality of life score for Group II was 29.50±5.08. CONCLUSION: The viscoelastic liner provided the most uniform stress distribution and performed better than an elastic liner with hard, firm and soft foods.