Does crown, root, and bone visualization in a clear aligner virtual setup impact treatment decisions?

INTRODUCTION: Clear aligner technology based on a machine learning algorithm is currently available for orthodontic treatment. Treatment planning on the basis of 3-dimensional crown, root, and bone imaging is claimed to provide accurate diagnosis and better treatment outcomes for adult patients with complex needs. This study aimed to answer the following questions: (1) would practitioners modify their original treatment plan once provided with the crown, root, and bone view? and (2) does practitioner satisfaction regarding treatment outcomes change once the crown, root, and bone view is provided? METHODS: An online questionnaire was emailed to members of the American Association of Orthodontists (n = 2300) and the Virginia Orthodontic Education and Research Foundation (n = 211). The survey consisted of videos of 4 patients shown in 2 presentations: crown-only and crown, root, and bone views, generated by artificial intelligence-driven treatment planning software (3D Predict aligner system; 3D Predict, New York, NY). Respondents were asked to answer treatment-related questions and rate the treatment outcomes using a visual analog scale. Statistical analyses were completed to determine the significance of crown, root, and bone view on treatment planning with clear aligners. RESULTS: A total of 70 orthodontists participated in the survey. There were significant differences in responses when viewing patients in crown-only and crown, root, and bone presentations. Across the 4 patients, 33%-43% of practitioners changed their sentiment toward the treatment plan (P <0.001). When rating satisfaction on the 100-point scale, average ratings changed by 10.6 to 21.0 points; both increases and decreases in satisfaction were seen across the patients (P <0.001). CONCLUSIONS: When given 3-dimensional information on the position of a patient's crowns, root, and bone coverage, orthodontists are likely to change their clear aligner treatment plan. This study showed that a confirmation of dehiscence and fenestrations using the root and bone view resulted in practitioner dissatisfaction despite an initial satisfaction with the crown-only view.

Selective BET inhibitor RVX-208 ameliorates periodontal inflammation and bone loss.

AIM: To determine the effects of RVX-208, a selective bromodomain and extra-terminal domain (BET) inhibitor targeting bromodomain 2 (BD2), on periodontal inflammation and bone loss. MATERIALS AND METHODS: Macrophage-like cells (RAW264.7) and human gingival epithelial cells were challenged by Porphyromonas gingivalis (Pg) with or without RVX-208. Inflammatory gene expression and cytokine production were measured by reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. RAW264.7 cells were induced to osteoclast differentiation. After RVX-208 treatment, osteoclast differentiation was evaluated by histology, tartrate-resistant-acid-phosphatase (TRAP) activity and the expression of osteoclast-specific genes. The effect of RVX-208 on osteoclast transcriptome was studied by RNA sequencing. Periodontitis was induced in rats by ligature and local RVX-208 treatment was administered every other day. Alveolar bone loss was measured by micro-computed tomography. RESULTS: RVX-208 inhibited inflammatory gene expression and cytokine production in Pg-infected cells. Osteoclast differentiation was inhibited by RVX-208, as evidenced by reduced osteoclast number, TRAP activity and osteoclast-specific gene expression. RVX-208 displayed a more selective and less profound suppressive impact on transcriptome compared with pan-BET inhibitor, JQ1. RVX-208 administration prevented the alveolar bone loss in vivo. CONCLUSIONS: RVX-208 regulated both upstream (inflammatory cytokine production) and downstream (osteoclast differentiation) events that lead to periodontal tissue destruction, suggesting that it may be a promising 'epi-drug' for the prevention of periodontitis.

The effect of crowding on the accuracy of 3-dimensional printing.

INTRODUCTION: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) printed aligners compared to conventional vacuum-formed thermoplastic aligners with varying levels of dental crowding. METHODS: Digital intraoral scans of 10 cases were assigned to their respective groups (n = 10, each, 30 total) as follows: no crowding (control), moderate crowding, and severe crowding. Digital images of these models were created in standard tessellation language (STL) file format using 3Shape software and randomly 3D printed. The STL files of each case were also sent to a dental laboratory to fabricate vacuum-formed samples, the current technology used for manufacturing aligners. The intaglio surfaces of fabricated aligners in both groups were scanned using cone beam computed tomography to create STL files, which were then compared to the original STL files of the cases using Geomagic Control X software. Absolute deviations from the original file and root mean square values were recorded. A Kruskal-Wallis test was conducted to analyze the difference in average deviation, and a t-test was repeated for the RMS measure. The significance level was set at 0.05. RESULTS: The crowding did not affect the trueness of aligners manufactured using 3D printing or conventional vacuum-forming techniques (P = 0.79). 3D-printed aligners showed less deviation than the vacuum-formed samples (0.1125 mm vs 0.1312 mm; P <0.01). Aligners manufactured with the vacuum-forming technique had significantly higher variation than those with the 3D printing process (P = 0.04). CONCLUSIONS: 3D aligners printed directly from an STL file exhibited better precision and trueness than those fabricated using the conventional vacuum-forming technique. Since accuracy is defined as a combination of precision and trueness, it is concluded that direct printing from an STL file can be used to manufacture aligners.

Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: A multicenter, single-blind randomized clinical trial.

INTRODUCTION: Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment. METHODS: The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance. RESULTS: Forty patients (74 teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P <0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P = 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P = 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors. CONCLUSIONS: Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion. TRIAL REGISTRATION: This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353). PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.

The Impact of Dental Operatory Color on Anxiety in Committed Youth.

Purpose: To examine the impact of dental operatory room color on the level of anxiety in committed youth at a juvenile correctional center. Methods: A randomized controlled trial was conducted at a juvenile correctional center using an approved continuous quality assurance survey. The dental assistant collected self-reported anxiety scores from 164 individuals alternating between two dental operatory rooms. One dental operatory room was painted with color while the other dental operatory room was unaltered (white). Repeated measures linear models were used to test for associations between visit type, visit number and operatory. Results: For 65 percent of visits, little to no anxiety was reported. Among the remaining visits, anxiety scores were on average 1.13 points higher across all appointment types in the non-colorful operatory room but were not statistically significant (P=0.1373, 95 percent confidence interval [95% CI] = -0.37 to 2.63). Anxiety scores were, on average, 1.7 points higher in the non-colorful room when selected for more anxiety- inducing restorative or emergency appointments (P=0.4371, 95% CI = -1.37 to -4.82), which indicated some clinical significance but was not statistically significant. Conclusion: The color of a dental operatory room did not have a statistically significant effect on lowering the level of anxiety in incarcerated youth but may have a clinically significant effect that should be further researched.

Investigating correlations between the PAT and three hand-skill exercises to performance in preclinical laboratory courses.

OBJECTIVES: Perceptual ability test (PAT) is a valid determinant for spatial perceptions. However, proven psychomotor skill tests for dentistry do not currently exist. This study aimed to determine whether performance on the PAT, Operation game, mirror tracing, and wax carving exercises correlate to preclinical laboratory performance in Dental Anatomy and Restorative Dentistry courses. METHODS: First-year dental students (n = 96) participated in the study. Final laboratory grades were obtained from course directors of preclinical Restorative Dentistry and Dental Anatomy courses. Admissions committee provided participants' PAT results. Participants completed a wax carving exercise by carving a cube and a semicircle into a wax block using the wax subtraction method. Two calibrated faculty graded the carvings as Ideal (5), Satisfactory (3), or Unsatisfactory (1). Time to complete the Operation game and number of infractions were recorded. Participants traced the six-pointed star pattern on the Auto Scoring Mirror Tracer instrument in both clockwise and counterclockwise directions. Completion times and number of instances outside the pattern were recorded. Spearman Rank Correlations were used to determine associations at 0.05 confidence interval. RESULTS: Mean PAT score was 21.7; mean times to complete the Operation game and mirror tracing exercise were 4:20 and 1:30, respectively. Mean score on the wax carving exercise was 3.19. Correlations between the independent and dependent variables were minimal to weak. The wax carving exercise was the most reliable predictor of performance. CONCLUSIONS: When PAT scores are striated into low (less than 20), middle (21-22), and high (23-30), it was possible to predict performance in both preclinical laboratory courses.

Clear aligner therapy in the mixed dentition: Indications and practitioner perspectives.

INTRODUCTION: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors. METHODS: An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n = 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents' demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs. RESULTS: One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P <0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P <0.0001). Perceived compliance was similar for CAMD and FAs (P = 0.5841), but perceived oral hygiene was significantly better with CAMD (P <0.0001). CONCLUSIONS: CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD.

Adaptations in orthodontics for current and future coronavirus disease 2019 best practices.

INTRODUCTION: This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic. METHODS: An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n = 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic. RESULTS: The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P = 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P <0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances. CONCLUSIONS: The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use.

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI).

OBJECTIVE: Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education. METHODS: The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy. RESULTS: When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513). CONCLUSION: Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.

Perceived efficacy of extrusion of maxillary lateral incisors with aligners.

INTRODUCTION: This study aimed to assess the perceived efficacy of aligners (Invisalign; Align Technology, Santa Clara, Calif) at performing extrusive movements of maxillary lateral incisors and to evaluate and compare differences in treatment planning protocols and other interventions used when required between orthodontists and general dentists with various degrees of experience. METHODS: An original 18-question survey was sent by mail to a randomized and geographically proportionate selection of orthodontic specialists (N = 400) and general dentists (N = 400) listed as providers on the Invisalign Web site. The data were analyzed using analysis of variance and chi-square tests. RESULTS: One hundred twenty-six providers responded to the survey (15.8% response rate), including 36 general dentists and 90 orthodontists. Overall, the average perceived efficacy was 4.71 out of 10 (95% confidence interval, 4.28-5.14). The threshold for identification of tracking issues was significantly associated with provider type (P = 0.0305). General dentists were significantly more likely to prefer an optimized attachment (P = 0.0001), whereas orthodontists were significantly more likely to prefer a gingivally-beveled horizontal rectangular attachment (P <0.0001). A refinement scan was the most common intervention method, followed by the bootstrap technique. CONCLUSIONS: The average perceived efficacy for extruding maxillary lateral incisors with aligners was 4.71 out of 10. Orthodontists had a lower tolerance than general dentists for tracking issues. A refinement scan was the most common method of intervention. General dentists and orthodontists differed in their treatment planning preferences and timing of intervention.

The In Vitro Effect of Laser Irradiation (Er:YAG and CO2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria.

(1) Lasers have been used for the treatment of dentinal hypersensitivity and bacterial reductions in periodontology. The purpose of this in vitro study was to evaluate the effect of Carbon Dioxide (CO2) and Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers with chlorhexidine (CHX), hydrogen peroxide (H2O2), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on the viability of oral bacteria associated with root caries. (2) Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis were grown in Brain Heart Infusion (BHI) broth, diluted to an OD660 of 0.5, and treated with antiseptics with or without simultaneous irradiation with the Er:YAG and CO2 lasers for 30 s repeated three times. The treatment groups consisted of 1: no treatment, 2: 0.5% H2O2 alone, 3: 0.5% NaOCl alone, 4: 0.12% CHX alone, 5: 2% NaF alone, 6: laser alone, 7: laser with 0.5% H2O2, 8: laser with 0.5% NaOCl, 9: laser with 0.12% CHX, and 10: laser with 2% NaF for both lasers. The microbial viability was determined through plating and viable colonies were counted, converted into CFU/mL, and transformed into log form. The statistical analysis was performed using a two-tailed paired t-test. (3) The use of CO2 and Er:YAG lasers alone failed to show statistically significant antibacterial activity against any of the bacteria. The only effective monotreatment was CHX for S. mutans. The combined treatment of 0.5% NaOCl with Er:YAG produced the greatest reduction in overall viability. (4) The combination of the Er:YAG laser with 0.5% NaOCl resulted in the largest reduction in bacterial survival when compared to monotherapies with antimicrobial solutions or lasers.

Practice makes perfect? Association between students' performance measures in an advanced dental simulation course.

PURPOSE: This study examines the relationship between student performance measures during practice and exams using advanced dental simulation. METHODS: Data from 11 classes of first-year dental students were extracted from Advanced Simulation software (DentSim™) related to Class I and Class II preparations including: total number of practice sessions, average practice score, exam scores, average time preparing teeth during practice/exam, and average time self-evaluating preparations during practice/exam. Comparisons of average practice and exam scores were examined using paired t-test. Relationships between practice/exam measures and exam scores were determined with multiple linear regression. RESULTS: Practice mean and exam scores were significantly associated; exam scores were significantly higher in both procedures. Class I: a significant positive relationship exists between both practice and exam measures: The average practice score was significantly associated with exam score (p < 0.001); time spent preparing the exam tooth was negatively associated with the exam score (p < 0.001); conversely, time spent self-evaluating the exam tooth was significantly associated with an increase in exam score (p = 0.0135). Class II: exam score was significantly associated with two practice measures but neither of the exam measures: exam score for Class II mesioocclusal preparation was significantly associated with average practice score (p < 0.001) and the number of practice attempts (p = 0.025). CONCLUSION: This study emphasizes the predictive value of novice learners' deliberate, repetitive practice using advanced dental simulation, which enhances self-assessment in early stages of psychomotor skill development. Future studies are needed to demonstrate the translation of these skills into a patient care setting.

Comparison of Accuracy and Time for Four Implant Placement Techniques Supporting Fixed-Partial Denture.

Various guiding methods are used to place implants. This ex vivo pilot study used a convenience sample to examine time and accuracy for placement of 2 dental implants supporting a 3-unit fixed prosthesis on a simulation model using freehand and 3 guided placement techniques. Four operators with no prior implant placement experiences were randomly assigned placement of 2 maxillary or mandibular implants for a fixed prosthesis. Techniques included dynamic navigation (DN), static guide (SG), template-based guide (TBG), and freehand placement (FH). Preoperative and operative times were recorded. Discrepancies between the planned and placed implant positions were assessed by superimposing preoperative and postoperative cone beam computerized tomography scans. Data were analyzed with repeated-measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). Dynamic navigation was associated with the longest operative time (13.5 minutes vs 5-10.2, P = .0001) but overall fastest when incorporating preoperative time (32.1 minutes vs 143-181.5, P < .0001). All deviation measures were significantly associated with the placement method (P < .05) except apex vertical deviation (P = .3925). Implants placed by SG had significantly lower entry 2-dimensional deviation than the other methods, particularly on the mandible. The DN and SG methods had significantly lower Apex 3D and overall angle deviations, again particularly on the mandible. The mandible had significantly higher deviations than maxilla. Within limitations of this study, implant placement by novice operators is more accurate when using dynamic and static guidance compared to freehand and template-based techniques.

In Vitro Study of Laser-Assisted Prefabricated Ceramic Crown Debonding as Compared to Traditional Rotary Instrument Removal.

This study compared the laser and rotary removals of prefabricated zirconia crowns in primary anterior and permanent posterior teeth. Sixty-two extracted teeth were prepared for prefabricated zirconia crowns cemented with resin-modified glass-ionomer cement. Specimens underwent crown removals by a rotary handpiece, or erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Pulpal temperatures, removal times, and scanning electron microscopy (SEM) examinations were compared. The average crown removal time for rotary and laser methods was 80.9 ± 19.36 s and 353.3 ± 110.6 s, respectively, for anterior primary teeth; and 114.2 ± 32.1 s and 288.5 ± 76.1 s, respectively, for posterior teeth (p < 0.001). The maximum temperature for the rotary and laser groups was 22.2 ± 8.5 °C and 27.7 ± 1.6 °C for anterior teeth, respectively (p < 0.001); and 21.8 ± 0.77 °C and 25.8 ± 0.85 °C for the posterior teeth, respectively (p < 0.001). More open dentinal tubules appeared in the rotary than the laser group. The rotary handpiece removal method may be more efficient than the laser with lower pulpal temperature changes. However, the laser method does not create noticeable tooth or crown structural damage compared to the rotary method.

Effect of print angulation on the accuracy and precision of 3D-printed orthodontic retainers.

INTRODUCTION: The study aimed to (1) compare the accuracy and precision of 3-dimensional (3D) printed retainers at various angulations and (2) evaluate the effect of angulation on printing time and the amount of resin consumed. METHODS: Using a stereolithography 3D printer, 60 clear retainers were printed at 5 angulations (n = 12, each): 15°, 30°, 45°, 60°, and 90°. Samples for each group were randomly printed in a batch of 6 retainers at all print angulations as print 1 and print 2 cycles. Digital images of the original and printed samples were superimposed. Discrepancies on 8 landmarks were measured by 2 independent examiners, and 0.25 mm was set as the clinically acceptable threshold to determine the accuracy of the retainers. RESULTS: Deviations ranged from 0.074 mm to 0.225 mm from the reference retainer at the cusp tips and incisal edges at all angulations, falling within the threshold of clinical acceptance. However, smooth surface measurements with deviations up to 0.480 mm were deemed clinically not acceptable. Three-dimensional printing at 15° was estimated to be the most time-efficient, whereas 3D printing at 45° was shown to be the most cost-effective setting. CONCLUSIONS: Three-dimensional printed retainers, using a stereolithography printer, were found to be accurate within 0.25 mm at all print angulations at the cusp tips and incisal edges compared with the digital reference file. Smooth facial surfaces did not meet clinical acceptability. Print angulations were shown to affect the cost and amount of resin used.

Oral Health Knowledge, Barriers to Dental Care, and Awareness of a Medicaid Pregnancy Dental Coverage Among Reproductive-Age Women.

Objectives: Oral health is an integral part of women's health, yet many women face barriers and go without necessary dental care. The objectives of this study were to (1) examine and compare pregnancy-related oral health knowledge and barriers to dental care access during pregnancy among women with private and public insurance and (2) estimate awareness of available Medicaid pregnancy dental benefit among Medicaid-enrolled women and explore associated factors. Methods: A cross-sectional survey was administered to a convenience sample of 21- to 45-year-old women (n = 187) visiting a large urban academic health center in Virginia. Data on pregnancy-related oral health knowledge, barriers to dental care access, Medicaid dental benefit awareness, health insurance, socio-demographics, health information source, and last dental visit were collected. Chi-square tests, t-tests, and multivariable regression were used to examine associations at p ≤ 0.05. Results: More than half of the women reported private insurance (52.4%), 40.3% reported Medicaid, and 8.3% reported being uninsured. Medicaid-enrolled women reported a lower prevalence of a routine dental checkup in the past year (44% vs. 71%, p = 0.002), lower knowledge scores (2.9 vs. 3.6, p < 0.001), and more barriers to accessing dental care during pregnancy compared with privately insured women. One in every three Medicaid-enrolled women (34%) was unaware of the Medicaid pregnancy dental benefit. Benefit awareness was associated with the receipt of health information from a health care source (p = 0.030) and a high oral health knowledge score (p = 0.018). Conclusions: There was a significant gap in dental care use and knowledge between Medicaid-enrolled and private-insured women in our study sample. Targeted programs should be developed to educate women about the importance of oral health and share information about available Medicaid dental coverage to reduce barriers to dental care during pregnancy.

Dental faculty well-being amid COVID-19 in fall 2020: A multi-site measure of burnout, loneliness, and resilience.

PURPOSE/OBJECTIVES: This study aimed to understand the impact of the COVID-19 pandemic on dental school faculty's self-reported burnout, loneliness, and resilience. METHODS: A 34-item questionnaire composed of three previously validated scales - adapted Copenhagen Burnout Inventory, the brief resilience scale, and a short loneliness scale - and demographic information was sent by email to dental school faculty in four dental schools across the US during the sixth and seventh months of the COVID-19 pandemic. RESULTS: Two-hundred sixteen (19.63%) of faculty invited to participate completed the survey. On a scale of five, with five indicating extreme burnout and one indicating no burnout, the average personal burnout was 2.7 (SD = 0.83), and work-related burnout (WRB) was 2.8 (SD = 0.83). Personal and WRB decreased with increasing age. WRB was significantly higher among full-time faculty, females, and those living alone. Faculty who lived alone experienced more loneliness than those who lived with others. Resilience was not a statistically significant difference across demographic groups. Regarding the impact of COVID-19 pandemic on their burnout, loneliness, and resilience on a scale ranging from "Never" (scored as 1) to "A great deal" (scored as 5), the average response for burnout was 3.3 (SD = 1.01), loneliness was 2.6 (SD = 1.10), and resilience was 2.8 (SD = 0.99). CONCLUSION(S): While self-reported burnout and resilience scores did not show a significant increase during the pandemic, the rates of burnout and loneliness remain higher than the public. Dental education has real challenges and opportunities to explore individual and organizational interventions to combat burnout and loneliness and enhance resilience among faculty.

Teledentistry Implementation in a Private Pediatric Dental Practice During the COVID-19 Pandemic.

Purpose: (1) Implementation of teledentistry in a private pediatric practice during COVID-19 pandemic, (2) Evaluate dental care that was assessed and managed during the COVID-19 pandemic. Methods: Urgent dental care provided during the recommended deferment of elective dentistry (3/16/20-5/17/20) was documented. Encounters were documented by type and management (conventional vs. teledentistry). Results were summarized using descriptive statistics. Associations were compared with Chi-squared or Fisher's exact test. Results: There were 137 emergency patient encounters during the study period. The types were: orthodontics (32 percent), caries (22 percent), eruption concerns (18 percent), trauma (16 percent), "other" (12 percent) (i.e., ankyloglossia, aphthous ulcers). Almost half (48 percent) were managed with teledentistry. The highest utilization of conventional dentistry was caries (70 percent), and for teledentistry was "Other" (75 percent) and eruption concerns (60 percent). Conclusion: Nearly half of emergency encounters in this sample were managed with teledentistry. Teledentistry was a necessary modality of care during the beginning of the COVID-19 pandemic and has uses and implications beyond the triage of acute dental emergencies.

Perceptual ability tests correlate to performance on a rudimentary dental anatomy laboratory exercise.

PURPOSE: Objective of this study was to determine if perceptual abilities test (PAT), quantitative reasoning (QR), and academic average (AA) scores predict performance in a rudimentary dental anatomy laboratory exercise. METHODS: First-year dental students (n = 88) completed two identical wax carving exercises during the first and last weeks of the dental anatomy course. After being given detailed instructions and a wax block, students carved a cube and a semilunar shape using the wax subtraction technique. Using a rubric, students self-assessed their work as unsatisfactory, satisfactory, or ideal in the following areas: finish, sharpness, symmetry, and accuracy. Two calibrated and blinded faculty graded the exercise using the same rubric as the students. Cohen's kappa coefficient assessed faculty interrater reliability and student-faculty reliability. Changes in scores between the two exercises were evaluated using Wilcoxon signed rank and paired t-tests. Spearman's correlation coefficient and repeated measures analysis assessed the association between shape carving scores and DAT, QR, and AA scores. RESULTS: Faculty interrater reliability ranged from 0.2554 to 0.4186 for the assessed criteria over the two exercises. Student-faculty rater reliability ranged from 0.1299 to 0.4461. Only PAT scores correlated significantly to higher scores for the four grading criteria for both exercises. Student self-assessment improved with the second exercise. CONCLUSIONS: This rudimentary exercise was useful to identify students early in their dental education who may require more guidance in other manual dexterity courses. Faculties require additional training and calibration. Self-assessment is a life-long process of critical thinking that students are just beginning to learn.

In Vitro Comparison of Time and Accuracy of Implant Placement Using Trephine and Conventional Drilling Techniques Under Dynamic Navigation.

The aim of this randomized in vitro study was to compare the time and accuracy of implant-site preparation and implant placement using a trephine drill versus a conventional drilling technique under dynamic navigation. In total, 42 implants were placed in simulation jaw models with the 2 drilling techniques by 2 operators who had previous experience with dynamic navigation. The timing of each implant placement was recorded, and horizontal, vertical, and angulation discrepancies between the planned and placed implants were compared. There was no significant difference in time or accuracy between the trephine and conventional drilling techniques. Implant-site preparation with a single trephine drill using dynamic navigation was as accurate under in vitro experimental conditions as a conventional drilling sequence.