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This, in turn, could have important clinical applications, such as the HEP and gastric-alpha PAC both serving as biomarkers of negative body image. The lack of standardization regarding the loading piston material used in fatigue tests could limit the interpretation of study findings. The purpose of this invitro study was to evaluate the effect of the piston material on the fatigue behavior of a lithium disilicate glass-ceramic. Plate-shaped, 1.2-mm-thick, lithium disilicate glass-ceramic specimens were cemented onto a dentin analog sub