An In-Vitro Assessment of Operator Accuracy and Inter-Operator Agreement in Recording Shade and Shade Characteristics.

Color assessment remains a challenging aspect of esthetic dentistry. This study aimed to evaluate inter-operator agreement and accuracy in assessing shade parameters and to investigate the effect of different clinical backgrounds of the operators under different lighting conditions. Three veneers with a single shade (VITA VM7, shade 2M2: VITA Zahnfabrik, Bad Säckingen) and different shade characteristics (lustre, translucency and opacity) were assessed by 24 operators with different backgrounds using natural and color-corrected light (Trueshade, Interempresas Media, S.L.U. - Grupo Nova Àgora, Spain). Shade assessment accuracy was only 5.5% using natural light and 9.7% using Trueshade. The majority of operators identified value and hue correctly, although chroma was mostly identified incorrectly. The most accurate assessments were recorded by technicians, and translucency was the characteristic to be least accurately recorded. Inter-operator agreement of shade was better with Trueshade compared without Trueshade, although group agreements of shade characteristics were higher without Trueshade for lustre and opacity, but not for translucency. Operators showed limited agreement and poor accuracy in assessing shade and shade characteristics and the clinical background had an effect on shade selection. Technicians were more reliable in shade assessment. Trueshade could be a promising tool to improve shade assessment outcomes.

Parental perception and acceptance of silver diamine fluoride treatment among Syrian refugees.

OBJECTIVE: Silver diamine fluoride (SDF) is an effective cariostatic agent, although staining associated with treatment is a significant impediment to its acceptability. BASIC RESEARCH DESIGN: A cross-sectional study of Syrian refugees to identify acceptance of SDF treatment. METHODS: Information was collected on: sociodemographics, medical/dental child history, dental status (dmft/DMFT), andperceptions of photographs of SDF-treated teeth. Associations between clinical findings and the acceptability were assessed. RESULTS: Of 258 parents or guardians, 37.8% accepted SDF treatment for their children. Acceptance was related to the location and type of teeth, being higher for primary than permanent teeth, and posterior than anterior teeth in both dentitions. Uncooperative behavior during previous dental treatment, the presence of dental discoloration, history of child dental pain, and number of filled teeth were all associated with better parental acceptance. Acceptance was also related to parental age, level of education, and their relation to the child. CONCLUSION: Parents' acceptance of SDF treatment is low. However, staining on posterior teeth was more acceptable than staining on anterior teeth and on primary more than permanent teeth.

Is Deterioration of Surface Properties of Resin Composites Affected by Filler Size?

PURPOSE: To investigate the effect of filler size on surface gloss and roughness of resin composites using a glossmeter and 3D noncontact surface topography, respectively, before and after tooth-brushing abrasion. MATERIALS AND METHODS: Seven model resin composites and one commercial were tested in the study. All materials were first polished, and then the surface gloss and 2D and 3D roughness parameters were recorded. Materials are then subjected to abrasion in a tooth-brushing simulator. Roughness parameters were recorded after 10,000 cycles, and after 20,000 cycles, both roughness and gloss were recorded. One-way ANOVA and Bonferroni post hoc test (p < 0.05) were used to analyze data. CONCLUSION: Filler size is strongly correlated to gloss and surface roughness retention.

A survey to compare the use and rationale for selection of intra-radicular posts among dental practitioners.

A cross-sectional survey to investigate the use of intra radicular posts in clinical practice was distributed to GDPs attending continuing professional development lectures and delegates of a specialist prosthodontic conference. Fifty-six (51%) GDP's and fifty-three (49%) conference delegates responded. Forty-five percent of GDP's exclusively used metal posts in comparison to 25% of the conference delegates. The findings of this study suggest there are no differences in the use of intra-radicular posts between GDPs and conference delegates. Formal post-graduate training does appear to have a limited influence over the selection of post materials.

Film thickness of dentin desensitizing agents on full crown preparations: influence of product and gravity.

OBJECTIVE: To determine the thickness of resin layer formed when dentin desensitizing agents are applied to teeth prepared for full crown restorations. DESIGN: In vitro measurements of resin layer thickness. METHODS AND MATERIALS: Forty caries-free human premolar teeth were prepared as for a full metal-ceramic crown restoration with a retention groove placed mesiobuccally. Stratified allocation created five groups of eight teeth, which were treated with various desensitizing agents. Four teeth within each group were treated upright, and four were treated while inverted, resulting in a total of 10 experimental groups. Teeth were sectioned and resin layer thickness measured under an environmental scanning electron microscope at certain sites across the section. RESULTS: Analysis was carried out using three-way analysis of variance. On flat tooth surfaces, light-cured resins (Prime & Bond and Seal & Protect) formed layers of 16.2 ± 8.9 µm and 23.4 ± 10.6 µm, respectively. More concave sites had significantly thicker layers (p<0.05) than flat or convex sites. At the internal shoulder angle, mean thicknesses were 84.1 ± 27.8 µm and 104.3 ± 56.6 µm, respectively. At the retention groove, figures were 86.6 ± 3.13 µm and 136.2 ± 72.0 µm. Differences between these two resins were not significant (p>0.05). Light-cured resins formed significantly thicker layers on inverted samples at the occlusal indentation only (p=0.004), with a mean of 66.9 ± 21.6 µm; upright samples had a mean of 36.6 ± 12.4 µm. Self-activating resins (Pain-Free Desensitizer, Viva Sens, and Gluma Desensitizer) formed no consistent layers. CONCLUSION: Within the limitations of this in vitro study, light-cured resins consistently pooled in convex areas of crown preparations. A great portion of retention grooves can potentially become occluded by resin. The self-activating products tested did not form significant layers.

Composite inlays: a systematic review.

The purpose of this study is to review the available literature related to composite inlays. Electronic databases published up to November 2013 were searched. Studies that evaluate composite resin inlays for the restoration of posterior teeth were selected. The studies should compare composite inlays against gold inlays, ceramic inlays and direct composite fillings regarding longevity, aesthetic quality and postoperative sensitivity or comparing the clinical effectiveness of them on premolars versus molars or on 1-2 surface preparations versus multi-surface preparations. Despite the heterogeneity of the available clinical trials composite inlays seem to be an effective method for the restoration of posterior teeth.

A comparison of grades awarded by peer assessment, faculty and a digital scanning device in a pre-clinical operative skills course.

OBJECTIVE: The aim of this study was to compare the grades awarded by two experienced assessors with peer-assessment marks and measurements from a digital scanning device (Prepassistant; KaVo, Biberach, Germany), for full gold crown preparations completed in a pre-clinical operative skills course on typodont teeth. METHODS: Seventy-eight preparations on typodont teeth were randomised and assessed by all three methods. Agreement was measured using weighted kappa statistics, and mean rank scores given by the Friedman test. RESULTS: The highest agreement was seen between the experienced assessors (0.38), closely followed by peer assessment and experienced assessor agreement (0.36, 0.29). Despite this, the results indicate poor levels of agreement. No agreement was seen between any of the assessment methods when compared to the digital scanning device. CONCLUSIONS: The findings of this study could be related to the difficulty of calculating a single grade from the output of the device, in addition to the inability of the machine to assess all the factors necessary for an acceptable preparation. From this study, it can be concluded that this device is not suitable for calculating grades when used in isolation. Further research could explore the role of the Prepassistant in providing student feedback, its potential to enhance the learning experience and the subsequent effect on performance.

Chlorhexidine-impregnated PEM/THFM polymer exhibits superior activity to fluconazole-impregnated polymer against Candida albicans biofilm formation.

Biofilm-associated infections represent a major challenge for biomaterials. Methods to alter the chemical characteristics of biomaterials offer an attractive solution for enhanced microbial control. The aim of this study was to investigate the efficacy of a poly(ethyl methacrylate)/tetrahydrofurfuryl methacrylate (PEM/THFM) acrylic model impregnated with fluconazole (FLU) or chlorhexidine (CHX) in preventing Candida biofilm formation in vitro. PEM/THFM disks impregnated with CHX (n=50) or FLU (n=50) and drug-free control disks (n=50) were infected with Candida albicans ATCC 90028. Disks were incubated for 2, 7, 14, 21 or 28 days at 37 °C and the biofilm biomass and metabolic activity was quantified at each time point using crystal violet staining and XTT [2,3-bis(2-methoxy-4-nitro-5-sulfo-phenyl)-2H-tetrazolium-5-carboxanilide] reduction assay. FLU disks exhibited poor overall biofilm inhibitory characteristics, with mean metabolic and biomass inhibition of 12.6% and 8.8%, respectively. Conversely, CHX disks were highly effective, significantly inhibiting biofilm development by 75% (P ≤ 0.001) and its metabolism by 84% (P ≤ 0.001) for all time points tested. The notable efficacy of CHX against C. albicans biofilms is a promising outcome to overcome the side effects and poor relative activity of conventional antifungal agents against Candida biofilms. These findings indicate that impregnation of PEM/THFM with antimicrobials has potential as a treatment modality for denture stomatitis.

Indirect restorations on teeth with reduced crown height.

Patients may present with a need for indirect restorations (crowns, inlays, etc), but have teeth with short clinical crown height. The management of problems presented by such teeth relates mainly to preventing loss of the restoration and the maintenance of the health of pulp in an already compromised tooth. Traditional techniques for increasing resistance form and retention, together with the option of surgical crown lengthening, will overcome problems associated with short crowns in many cases. However, these methods are not a universal solution. Contemporary techniques, utilizing adhesive dentistry, and the Dahl concept have an increasing place in the management of such cases.

Peer-group assessment of pre-clinical operative skills in restorative dentistry and comparison with experienced assessors.

OBJECTIVE: In order to assess the feasibility of moving away from a tutor-assessed summative assessment to a peer-group marked assessment with more formative value, a study was undertaken to investigate if any differences existed between marks given by a peer group acting as examiner when compared with experienced assessors. The null hypothesis was that no differences in grades would exist between the examiners. METHODS: A total of 130 ivorine teeth set in dentoform models (mounted in phantom heads) were prepared by undergraduate preclinical students. The prepared teeth were randomly allocated for assessment to one of six student groups who met and graded each tooth preparation. Notes on common errors were supplied together with a list of multiple exemplar grades (of the full range of grades) and associated comments, together with a list of grade descriptors (for the five-point scale A-E) and a sectioned silicone index. The same preparations were independently assessed by two experienced restorative academic examiners using the same guidance. RESULTS: The mean rank scores given by a Friedman test did not show any statistically significant difference (P = 0.531). Kappa scores for inter-examiner agreement varied from 0.318 to 0.530. CONCLUSIONS: The data from the present study do not show any significant differences in grades awarded by experienced examiners to those awarded by a peer group. Peer-group assessment may be useful to encourage a greater understanding of concepts and principles underlying the development of operative skills.

Indirect restorations on teeth with reduced crown height.

UNLABELLED: Patients may present with a need for indirect restorations (crowns, inlays, etc), but have teeth with short clinical crown height. The management of problems presented by such teeth relates mainly to preventing loss of the restoration and the maintenance of the health of pulp in an already compromised tooth. Traditional techniques for increasing resistance form and retention, together with the option of surgical crown lengthening, will overcome problems associated with short crowns in many cases. However, these methods are not a universal solution. Contemporary techniques, utilizing adhesive dentistry, and the Dahl concept have an increasing place in the management of such cases. CLINICAL RELEVANCE: The Dahl concept and adhesive dentistry may supplement traditional techniques when providing and retaining indirect restorations.