Evidence-based clinical management of localised tooth wear and a repeatedly dislodged posterior crown utilising the Dahl Concept.

This clinical case report demonstrates the use of the Dahl Concept in the management of the repeated dislodgement of a posterior full coverage crown associated with a reduced restorative space. The described technique harnesses the addition of resin composite and a temporarily cemented provisional full coverage crown to create sufficient restorative space for the cementation of a definitive posterior full coverage crown restoration at the six-month review.

Challenges in differential diagnosis and treatment of cervical root resorption vs. root caries.

External cervical root resorption may be occasionally mistaken for root caries and vice versa. Radiographical and clinical differential diagnoses of cervical root resorption and root caries are essential for correct treatment planning and a successful treatment outcome. This article reviews the contemporary literature and summarises the prevailing professional consensus pertaining to external cervical root resorption. Clinical diagnostics which help distinguish cervical root resorption from root caries are outlined and treatment approaches of external cervical root resorption are discussed.

Primary care dentistry: Past, present and future.

This article examines the past, present and future of primary care dentistry. It provides a historical background of primary care dentistry and describes stages of its evolution. It further reviews the purpose and mission of contemporary primary care dentistry and outlines a vision for the development of primary care dentistry in the future. The type and extent of innovations and technological advances that have impacted - and improved - primary care dentistry revolutionising clinical activities, ranging from early computerised tomography to modern digital systems and workflows are summarised. A discussion of current scientific evidence base pertinent to primary care dentistry highlighting the need for 'effectiveness' rather than 'efficacy' studies is included in order to provide research data pertinent to the primary care dentistry setting where most dental patients receive most of their care most of the time.

A comprehensive review and update on the current state of computer-assisted rehabilitation in implant dentistry.

AIM: This paper provides a comprehensive review of the established concepts and newer developments related to computer-assisted implant rehabilitation. METHODS: Two independent researchers searched the English literature published to 31st December 2023 in the PubMed/Medline database for primary and secondary research and related publications on computer-assisted implant planning, computer-assisted implant placement and computer-assisted implant restoration. RESULTS: A total of 58,923 papers were identified, 198 relevant papers were read in full text and 110 studies were finally included. Computer-assisted implant rehabilitation was found to result in more precise implant positioning than freehand placement. Advantages include reduced trauma and surgery time; disadvantages include reduced primary implant stability and higher cost. CONCLUSION: Computer-assisted surgery is particularly indicated in cases of critical anatomy, but may encounter limitations in terms of cost, restricted mouth opening, visibility and adjustment of the surgical guides and the need for prior familiarisation with the procedure. Nonetheless, this surgical technique reduces the post-implant placement complication rate.

Teaching of posterior composites for the restoration of permanent teeth in undergraduate dental training programmes: Systematic review and meta-analysis.

OBJECTIVES: To systematically assess aspects of teaching of posterior composite restorations (PCRs) in permanent teeth in dental schools. STUDY SELECTION: Quantitative studies reporting on dental schools' teaching regarding the placement of PCRs in permanent teeth. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed based on the Medical Education Research Study Quality Instrument (MERSQI). SOURCES: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in January 2023. DATA: Forty sources reporting on 34 studies having surveyed 1,286 dental schools were included. Overall, 92.7% (95%-CI: 88.2-95.5) of dental schools reported to teach PCRs. PCRs in three-surface Class II cavities are taught by 82.0% (95%-CI: 70.4-89.7). The mandatory use of liners in deep cavities is taught by 78.3% (95%-CI: 68.9-85.5), and 44.0% (95%-CI: 34.3-54.2) reported to teach bulk-fill composites. While most posterior restorations placed by students were composites (56.1%; 95%-CI: 46.0-65.8), 94.7% (95%-CI: 86.6-98.0) of dental schools (still) teach posterior amalgam restorations. The proportion of dental schools teaching PCRs in three-surface Class II cavities increased and the mean proportion of PCRs among all posterior restorations increased over time (padj.≤0.003). CONCLUSIONS: The teaching of PCRs in dental schools around the world reflects the increased use of resin composite in clinical practice, with students in countries where dental amalgam continues to be used, placing more posterior composites than restorations of dental amalgam. The teaching of PCRs, which is anticipated to increase, will continue to be refined with further developments in adhesive materials, devices, instrumentation, and techniques. CLINICAL SIGNIFICANCE: Graduating dentists can be expected to be familiar with the use of resin composites for the restoration of posterior teeth.

Dental Therapists' Role in the Provision of Aesthetic Dentistry in Dental Practice.

Dental therapists have a vital role to play in the provision of dentistry in the UK. This article examines the role of dental therapists in carrying out aesthetic dentistry in the UK dental practice setting. Patient access through collaborative working, especially through a shared care model, referral, and direct access will be discussed. In addition, two clinical cases are presented to demonstrate the provision of aesthetic anterior dental restorations by dental therapists.

Doctors' Drugs and the Dangers of Dental Decay.

Many "anti-something" medications, which are prescribed by medical doctors for older patients, often for dubious reasons, result in a serious reduction in the quantity and quality of saliva. That drug-induced xerostomia can produce dangerous dental decay, particularly in already compromised dentitions.This article suggests that doctors should undertake a personalised "benefits, risks, alternatives, nothing" (BRAN) analysis including an assessment of the possible dental decay risks, especially before prescribing combinations of "anti-" drugs for marginal conditions.Doctors should consider carefully if alternative approaches are feasible which could produce acceptable outcomes without incurring those serious dental decay risks. Alternative approaches may include patients altering their diet and lifestyle to include more physical exercise for controlling conditions such as marginal hypertension, for example, or perhaps prescribing counselling/talking therapies for depression or anxiety.If various "anti-" drugs really do have to be prescribed, this article describes cheap, pragmatic, and effective ways of mitigating the risks of already compromised dentitions developing new decay.

Teaching of composite restoration repair in Brazilian dental schools.

OBJECTIVES: The aim was to investigate aspects of the teaching of restoration repair as a minimally invasive alternative to replacing defective direct composite restorations in undergraduate curricula teaching programs in Brazilian dental schools. METHODS: A 14-item validated survey questionnaire was mailed to directors/coordinators of operative/restorative dentistry teachers of Brazilian Dental Schools. Data were collected on demographic characteristics of the teachers and institutions, together with questions on the teaching of the repair of defective resin-based composite restorations as part of the school curriculum; the rationale behind the teaching; the nature of the teaching (preclinical and/or clinical); how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability and expected longevity of completed repairs. RESULTS: Two hundred and twenty-two (94%) directors/ coordinators of dental curricula in Brazil were contacted. One hundred and thirty-one directors/coordinators (59%) replied, providing the e-mail address from the teacher responsible for the operative/restorative dentistry program in their school. Of these, 104 responded to the questionnaire (79% response rate). Ninety-three (89%) of the participating schools reported teaching composite repairs as an alternative to replacing restorations. Of the theoretical content, 43% was taught at preclinical and clinical levels, whereas most practical experience (53%) was acquired at clinical levels. Eighty-eight schools (95%) reported tooth substance preservation being the main reason for teaching repair techniques. All schools that taught repairs reported high patient acceptability. CONCLUSIONS: The teaching of composite restoration repair as an alternative to restoration replacement is established in undergraduate programs in most of the Brazilian dental schools surveyed. CLINICAL SIGNIFICANCE: The reasons for teaching restoration repair in Brazil were found to be quite unanimous among teachers, especially regarding the preservation of tooth structure. Variations were found in the clinical indications for repair, suggesting the need for further investigations. Monitoring repaired restorations should be encouraged and could contribute to future studies.

Current and future trends in the teaching of removable partial dentures in dental schools in Malaysia: A cross sectional study.

AIMS: To investigate, using a validated questionnaire, the teaching of removable partial dentures (RPDs) in dental schools of Malaysia. MATERIALS AND METHODS: A validated questionnaire to investigating trends in the teaching of RPDs in dental schools in Oceania was emailed (in English version form) to Heads of Restorative/Prosthodontics/course coordinators in the 13 dental schools in Malaysia. Follow-up reminders were sent and participants were given six weeks to complete and return the questionnaire. Data was entered into an Excel spreadsheet and results compiled and analyzed. RESULTS: Completed questionnaires were received from 13 dental school - a 100% response rate. All schools (n = 13) provided a preclinical technical course in RPD design. In most schools (n = 9, 69.2%), course work was supervised by senior lecturers while rest of the institutions made use of associate professor/professors. There were significant differences (p<0.05) between dental schools in terms of the contact hours dedicated to preclinical teaching. Students received an average of 62 h of instruction. Didactic instruction was the primary focus with practical (78 h) and didactic teaching (32 h). All dental schools (n = 13) provided practical surveyor design teaching (8 h). The staff student ratio for formal lectures (1:61), tutorials (1:29) and lab demonstrations (1:12) were recorded. Majority of the schools (n = 11, 84.6%) employed paired teaching in clinical sessions. All schools (n = 13, 100%) emphasized on increased teaching of RPD design and prescription writing in future clinical RPD courses. CONCLUSION: Teaching of RPDs in Malaysia may be considered sufficient and comparable to the teaching in other parts of the world. CLINICAL SIGNIFICANCE: Whilst the teaching of partial dentures at Dental Schools in Malaysia provides the core competencies involved in partial denture design and construction based on sound fundamental, scientific principles they should address the challenges of teaching partial dentures and other areas of dental education including improving working conditions for dental professionals.

Should new operating procedures arising from COVID-19 make us re-think our management of deep caries?

COVID-19 has impacted heavily on the delivery of dental services within the UK, particularly in regards to aerosol generating procedures (AGPs). However, it has created an opportunity to reflect on how operative dental procedures, such as the management of dental caries, are undertaken. In light of recent evidence in favour of speed increasing contra-angle handpieces in combination with an electric micromotor to eliminate the generation of aerosols at certain speeds while still allowing the cutting of hard tooth tissue, albeit at a slower rate than the traditional air-turbine, this article explores the evidence for partial caries removal using the electric micromotor system. Aspects of maintaing the health of the pulpal tissue using this system and adopting a logical approach to placing adhesive direct resin composites to faciliate an optimum outcome for the patient are also explored.