Multimodal teaching methods for students in dentistry: a replacement for traditional teaching or a valuable addition? A three-year prospective cohort study.

BACKGROUND: This student-centred prospective cohort study evaluated the impact of multimodal teaching methods on student performance in the theoretical domain of dental studies. METHODS: Dental students answered anonymous questionnaires indicating their preferences and opinions three times over three consecutive academic years. Data collected included gender, course, year of study and most frequent and preferred learning modality. Survey responses from Google Forms were analysed with SPSS 20.0 software (IBM Company, Chicago, IL, USA). Scale responses were tested with the Mann-Whitney U test against gender, program and year of study. Grades obtained from structured examinations held in the third academic year were analysed using the Wilcoxon Signed Rank Test according to the teaching method employed. The level of statistical significance was set at p < 0.05. RESULTS: The response rate was high (> 80%) throughout the study. Acceptance of online modalities increased over time (Kruskal-Wallis test, p < 0.001) and 75% of students requested that online teaching modalities be maintained. Significant differences in gender, program of study, year of study and discipline taught were observed (Mann-Whitney test, p < 0.05). Females differed from males by favouring online modalities and face-to-face lectures, respectively, and clinical year students opted to retain pre-recorded online lectures. Recorded lectures resulted better for teaching core knowledge (Wilcoxon Signed Rank Test, p = 0.034), while face-to-face lectures were better for teaching applied knowledge (Wilcoxon Signed Rank Test, p = 0.043). Student responses to open-ended questions identified the need for a blended approach with in-person lecturing as an opportunity to socialise and avoid mental health issues. Although preferences varied, students showed a willingness to influence their learning and changes in curriculum, a predilection for self-directed learning and the need for freedom in engaging with resources and content. CONCLUSIONS: In the context of this study, online teaching modalities resulted in comparable examination performance and improved student satisfaction. This highlights the need for a blended approach to teaching.

The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre randomized clinical trial.

TRIAL DESIGN: This was a randomized, controlled trial designed to compare outcomes between the use of dental and skeletal anchorage, using the Face mask/Alternate Rapid Maxillary Expansion and Contraction (FM/Alt-RAMEC) protocol. METHODS AND PARTICIPANTS: The study was carried out at Mater Dei Hospital, Malta and included prepubertal skeletal Class III malocclusion patients where the aetiology was primarily maxillary hypoplasia. INTERVENTIONS: Two groups were assigned. Group I was treated with FM/Alt-RAMEC and group II was treated with skeletally anchored FM/Alt-RAMEC. Wear-time (WT) of the FM was monitored using TheraMon microsensors. Patients were instructed to wear the FM for 12-14 hours/day for 9 months. Changes were evaluated with lateral cephalograms and analysed with Wilcoxon and Mann-Whitney U tests. ANOVA was used to analyse the effect of gender on compliance parameters. Spearman's correlation coefficient was used to assess the correlation between compliance and skeletal changes. OBJECTIVE: To compare the skeletal and dentoalveolar changes in patients treated with these two protocols. OUTCOMES: The primary outcome was to assess skeletal and dentoalveolar outcomes in patients treated with skeletally anchored FM/RME and tooth-borne FM/RME; utilizing Alt-RAMEC protocol. The secondary outcome was compliance rate and adherence to FM wear among patients. RANDOMIZATION: Randomizer software and the sealed envelope technique were used to randomly allocate patients 1:1 into either group I (tooth-borne FM/Alt-RAMEC) or group II (skeletally anchored FM/Alt-RAMEC). BLINDING: It was not possible to blind to treatment allocation, but blinding was used when assessing the outcomes. RESULTS: Numbers randomized and analysed. Thirty-five patients were allocated. Group I consisted of 18 subjects and group II consisted of 17 subjects. One patient in group I dropped out due to illness, so 17 subjects in each group completed the study. OUTCOMES: Post-treatment changes in group I showed significant increases in SNA (2.10°), ANB (3.90°), Wits (4.70 mm), and overjet (5.40 mm). Group II showed significant increases in ANB (3.10°), Wits (3.20 mm), and overjet (4.50 mm). Wearing time for group I patients was 7.87 ± 2.88 hours/day and for group II was 6.98 ± 2.68 hours/day, with no significant difference between the groups. LIMITATIONS: Lack of long-term follow-up post-treatment, making the conclusion applicable only in the short term. HARMS: No harm was observed in both groups. CONCLUSION: Despite the large difference between the measured and the patient-reported daily WT, both tooth-borne and skeletally anchored FM/Alt-RAMEC showed positive, similar, skeletal and dental effects. CLINICAL TRIAL REGISTRATION: ISRCTN12197405.

Effect of varying levels of expertise on the reliability and reproducibility of the digital waxing of single crowns: A preliminary in vitro study.

STATEMENT OF PROBLEM: The digital waxing of single crowns can be affected by the quality of intraoral scans and use of computer-aided design (CAD) software programs. However, clinical outcomes of the resulting crowns are also affected by computer-aided manufacturing (CAM) methodologies. Studies on the effect of different levels of expertise on digital waxing are lacking. PURPOSE: The purpose of this in vitro study was to assess the impact of different levels of expertise on the reliability and reproducibility of margin outlining during digital waxing. MATERIAL AND METHODS: Thirty analogs of implant stock abutments (Ø4.8×4 mm) were embedded into resin blocks. To simulate different clinical situations, abutments were divided into 3 groups: 10 abutments (group GOS) received artificial gingiva and were scanned with an open system intraoral scanner, while 10 abutments with (group GIS) and 10 abutments without artificial gingiva (group IS) were scanned with an intraoral scanner within an integrated CAD-CAM system. All resulting standard tessellation language (STL) files were used by 2 different observers (an experienced CAD professional and a clinician with basic CAD knowledge) to digitally design a left mandibular central incisor in the same software program. All resulting digital crown designs were exported to STL files to assess crown margin accuracy at the coupling interface by superimposition with the control STL file of the scan body designed for the same abutment by the manufacturer. For this purpose, a CAD software program was used to automatically calculate median, minimum, and maximum deviations of margins in millimeters. Statistically significant pairwise differences among groups and between observers were assessed with the Wilcoxon signed-rank test (α=.05). RESULTS: For the CAD professional, median deviations between designed crown STL files and the control STL of the scan body were 0.08 mm (range: 0.04 to 0.15) for group GOS; 0.10 mm (range: 0.06 to 0.18) for group GIS; and 0.05 mm (range: 0.03 to 0.08) for group IS. For the clinician, median deviations were 0.08 mm (range: 0.04 to 0.12) for group GOS; 0.11 mm (range: 0.07 to 0.17) for group GIS; and 0.05 mm (range: 0.04 to 0.11) for group IS. There were no significant differences between observers (P>.05). However, statistically significant differences were found between group IS and the other 2 groups (P=.001) but not between groups GOS and GIS (P>.05). CONCLUSIONS: The present findings suggest that a digital wax pattern made with a dental CAD software program is not affected by varying levels of expertise but might be affected by subgingival margins.

Risk prediction models for erosive wear in preschool-aged children: a prospective study.

BACKGROUND: Despite increasing prevalence, age-specific risk predictive models for erosive tooth wear in preschool-age children have not been developed. Identification of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specific risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed. METHODS: A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis. RESULTS: Risk factors for the 3-year-old cohort (N = 336) included erosive wear (χ2(1, 92) = 12.829, p < 0.001), district (χ2(5, 92) = 17.032, p = 0.004) and family size (χ2(1, 92) = 4.547, p = 0.033). Risk factors for the 5-year-old cohort (N = 441) also included erosive wear (χ2(1, 144) = 4.768, p = 0.029), gender (χ2(1, 144) = 19.399, p < 0.001), consumption of iced tea (χ2(1, 144) = 8.872, p = 0.003) and dry mouth (χ2(1, 144) = 9.598, p = 0.002). CONCLUSIONS: Predictive risk factors for 3-year-old children are based on demographic factors and are distinct from those for 5-year-old children based on biological and behavioural factors. Erosive wear is a risk factor for further wear in both age cohorts.

Use of free CAD software for 3D printing individualized face masks based on face scans.

AIM: To describe a method of digitally customizing 3D-printed face mask designs using 3D face scans and free software. MATERIALS AND METHODS: The procedure of creating customized face masks initially involved importing and aligning STL files of face scans and mask components in free CAD software. The imported mask described in this article is composed of three different STL files (body, filter structure, and grid). The body of the mask was then edited to fit precisely into the face scan STL by using the software's offset tool, followed by adjustments and smoothening of the surfaces of the edges. The resulting customized body of the mask plus the filter and grid STL files were exported and 3D printed with polylactic acid (PLA) filament using a fused deposition modeling (FDM) 3D printer. For the purposes of comparison, a conventional 3D-printed mask (from the original STL files, without being customized for the face scan) was also 3D printed from the original STL files. Both face masks were tested on the same two volunteers. RESULTS: The customized 3D-printed face mask presented a higher adaptation compared with the conventional face mask. The area of facial contact matched the one digitally designed in the software. The 3D-printed grid could clip exactly into the filter, which in turn could be precisely screwed into the body of the face mask. CONCLUSION: Within the limitations of this technical report, the present findings suggest that customized 3D-printed face masks with enhanced adaptation can be digitally designed using face scans and free CAD software.

Surface Microstructural Changes and Release of Ions from Dental Metal Alloy Removable Prostheses in Patients Suffering from Acid Reflux.

PURPOSE: To investigate the surface microstructural changes and the release of ions from metal alloys used in removable dental prostheses and the potential effects of acidic reflux found in patients suffering from gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: Thirty-seven (37) patients were recruited. Data were gathered through a questionnaire and clinical examination. Samples of metal alloy from the dentures and patient's saliva were collected. GERD was confirmed using the GerdQ questionnaire. Denture samples were characterized using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS), while salivary samples were tested for trace metal ions using inductively coupled plasma (ICP). RESULTS: Characterization of denture samples revealed the presence of nickel, cobalt, and chromium. Nickel-chromium exhibited an etched surface appearance, while cobalt-chromium exhibited no noticeable surface microstructural changes. Higher mean salivary levels of chromium and cobalt in patients wearing any metal alloy-based denture and of chromium and nickel in patients wearing Ni-Cr prostheses were found to be significant. No differences were found in salivary metal ion levels of patients suffering from GERD. CONCLUSIONS: Nickel-chromium alloy is prone to acid etching in the oral cavity, while cobalt-chromium alloy appears to be more resistant. Cobalt, chromium, and nickel are leached in saliva of patients using cast removable prostheses. The impact of gastric acid on metal ion release from dental metal alloys deserves further investigations. CLINICAL SIGNIFICANCE: This preliminary study suggests that metal-based removable prostheses leach trace metal ions in saliva. Nickel-chromium-based dentures exhibit an etched appearance unrelated to GERD.

The impact of school-based social media and online technology on oral health education for individuals with disability.

AIM: To evaluate the impact of school-based online communication methods on the oral health-related behavirs of individuals with disability. METHOD: A prospective interventional study was conducted on 154 students (age 3-22 years) with various disabilities attending educational centers. A clinical examination was carried out before and after a school-based online educational program. Online in-person sessions were held for the participants, and educational videos were shared with parents and teachers over social media. The clinical examination included the Special Olympics HAS form, (1) Oral Hygiene Index-Simplified (OHI-S) (2) and the Modified Frankl Behavior Index. (3) Dietary and oral hygiene habits were collected via parent-administered questionnaires. RESULTS: Improvements in behavior in a dental setting (p < .001), oral hygiene levels (p < .001) and dietary choices (p < .001) were observed throughout the study. CONCLUSION: Oral health education online modalities can be used effectively by dental professionals to educate individuals with disabilities and their carers regularly, thus helping improve oral health and rapport with dental professionals.

Comparison of 3D-Printed Single Crown Outcomes Among Different Computer-Aided Design Software Programs.

PURPOSE: Low-cost resin 3D printers have been used to produce affordable interim single crowns in public and private dental practices. The purpose of this study was to assess the impact of different computer-aided design (CAD) software programs on 3D trueness, microscopic marginal and internal gaps, time to design, and interproximal contacts of low-cost 3D-printed single crowns. MATERIALS AND METHODS: This in vitro study was performed on a total of 90 standardized resin-prepared teeth adapted to a dental manikin. For comparison among CAD software programs, 45 tooth preparations received 3D-printed crowns designed with one of three CAD software programs by an experienced technician and identified as groups TRIOS (n = 15), EXOCAD (n = 15), and ZZ (Zirkonzahn; n = 15). To assess interoperator reproducibility, 15 additional crowns were designed by a dental clinician (group ZZ-DENT) and 15 by a dental prosthetic technician (group ZZ-PROS), both with basic 1-week CAD/CAM training. Finally, as a control group, 15 crowns were milled using a high-end five-axis milling device (group ZZ-CONTROL). Statistically significant differences for 3D trueness, microscopic gaps, time to design, and interproximal contacts among groups were assessed with the Kruskal-Wallis test. RESULTS: No statistically significant differences in 3D trueness or marginal or internal gaps were found, either among different software programs or CAD operators (P > .05). However, Group TRIOS took significantly longer to design than EXOCAD and ZZ groups (P = .001). Less-experienced operators were significantly outperformed in time and interproximal contacts (P = .001) by the CAD technician using the same software program. Finally, control milled crowns (ZZ-CONTROL) significantly outperformed the respective 3D-printed copies (ZZ) in all assessed variables (P < .001). CONCLUSIONS: Different CAD software programs may affect the time required to design, but they do not significantly affect clinical outcomes of low-cost 3D-printed resin crowns if designed by an experienced CAD technician.

Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic.

Aim: To assess oral hygiene and dietary patterns in school children participating in a school-based preventive oral health program during the COVID-19 pandemic. Materials and methods: In this cross-sectional study, an anonymous questionnaire exploring oral hygiene and dietary patterns during the COVID-19 pandemic was completed by parents of school children. Data were compared among different schools, school years, and between genders using nonparametric tests. Associations among further nominal and categorical variables related to oral hygiene and dietary habits were also assessed using the chi-square test. Results: Only 26% (n = 32) of parents reported that their children brushed their teeth the recommended amount of twice or more per day during the pandemic. In addition, 17.2% of the parents reported less brushing than before the pandemic. A total of 40 parents (32.8%) reported that their child consumed unhealthy beverages once a day or more. Comparison between genders revealed that male participants were drinking significantly unhealthier than female (p = 0.038). Sugary foods were consumed once a day or more by 63.1% of children. No significant differences were found between public and church schools. Significant direct associations were found between changes in dietary habits and brushing frequency (p = 0.017), between parental concern regarding the interruption of the school program and decreased brushing frequency (p = 0.005), and negative changes in dietary habits (p = 0.013). Clinical significance: Within the limitations of this study, the present significant findings observed during the pandemic support the importance of school programs in promoting oral hygiene and healthy dietary habits of children. How to cite this article: Agius A-M, Gatt G, Cortes ARG, et al. Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic. Int J Clin Pediatr Dent 2023;16(2):205-210.

Effect Of Different Milling Devices On Marginal Fit Of CAD-CAM Zirconia Copings On Implant Stock Abutments.

PURPOSE: To compare the marginal fit and internal surface roughness of CAD/CAM zirconia copings milled with 3- and 5-axis milling devices. MATERIALS AND METHODS: Forty titanium implant stock abutments (4.8 mm in diameter, 4 mm in height) screwed to dental implants (4.1 mm in diameter) embedded in resin were considered phantoms and included in this in vitro study. All 40 phantoms were scanned with the same intraoral scanner, from which images of the virtual wax-up of zirconia copings were obtained and exported as standard tessellation language (STL) files. From each resulting STL file, two copings were milled: one using a 3-axis milling device, and the other using a 5-axis milling device. After milling, zirconia copings underwent high-speed sintering before being analyzed for marginal fit (ie, marginal gap measurement), and internal surface roughness was assessed with a scanning electron microscope (SEM). Statistical comparisons between groups were assessed with Mann-Whitney test. RESULTS: Median marginal gap values were 34.80 µm (95% CI: 0.00 to 173.98) for the 5-axis milling device group and 141.97 µm (95% CI: 82.13 to 163.46) for the 3-axis milling device group. A statistically significant difference in marginal gap was found between both milling device groups (P = .039). In addition, qualitative SEM analysis indicated higher internal surface roughness for the 3-axis milling device group. CONCLUSION: Within the limitations of this study, the present findings suggest that 5-axis milling devices outperform 3-axis milling devices for milling CAD/CAM zirconia copings from intraoral scans of implant stock abutments.

Patient Reported Outcomes on Different Occlusal Schemes in Complete Denture Wearers.

PURPOSE: To compare patient-reported outcomes among balanced, lingualized, and monoplane occlusal schemes in relation to edentulous jaw classifications. MATERIALS AND METHODS: This randomized controlled trial was conducted in edentulous patients receiving new complete dentures using balanced, lingualized, or monoplane occlusal schemes. Demographic variables, bone ridge quantity, number of adjustments required after denture insertion, and satisfaction and quality of life (QoL) indices (ie, the Denture Satisfaction Questionnaire [DSQ] and General Oral Health Assessment Index [GOHAI], respectively) were assessed at 1, 2, 4, 8, 12, and 52 weeks. Within-group comparisons at different time points were carried out with Brunner-Langer nonparametric analysis. Furthermore, Kruskal-Wallis test was used to compare distributions of ordinal or continuous variables among the three occlusal scheme groups. RESULTS: A total of 60 subjects (mean age: 68.1 ± 11.1 years; 56.7% men and 43.3% women) were analyzed. All three groups presented significant improvements in DSQ and GOHAI scores between denture insertion and the 1-year follow-up appointment (P < .001). There were no statistical differences in the distribution of demographic variables (eg, age, gender, years edentulous, and age of existing dentures) or of bone ridge classifications among the three groups. Similarly, there were no statistical differences in ridge classifications or in the DSQ and GOHAI values among the three groups for both the maxilla and mandible (P > .05) over the 52-week follow-up. On the other hand, the number of cases requiring denture adjustments was significantly lower in the lingualized scheme group, as compared to the two other groups (P = .034). CONCLUSION: Within the limitations of this study, the present findings suggest that the occlusal scheme for posterior teeth did not influence patient-reported subjective outcomes. However, the lingualized occlusal scheme required significantly fewer adjustments.

Self-reported dental student stressors and experiences during the COVID-19 pandemic.

OBJECTIVE: To compare the influence of coronavirus disease 2019 (COVID-19) pandemic on the student reported outcomes among dental students reading/studying different courses offered in the only dental school in Malta. MATERIALS AND METHODS: An anonymous questionnaire consisting of 13 closed-ended and open-ended questions was sent to all students (n = 97) at the Faculty of Dental Surgery at the University of Malta. Emergent themes from open-ended questions were identified and tallied. Since data were classified as categorical ranks, nonparametric tests were used to compare variables among the different courses, years of study, preclinical/clinical students, and gender categories. RESULTS: Dental technology students were significantly less stressed about contracting COVID-19 (P = 0.005) and regarding lack of preparation due to inability to physically go to the library (P = 0.019). Female students reported significantly more anxiety for the following factors: "feeling anxious all the time" (P = 0.033), "worried about contracting COVID-19'" (P = 0.012), "worried that a family member may contract COVID-19'" (P = 0.048), "more anxious about exams this year because of the challenges we are facing" (P = 0.029), and "concern about losing manual dexterity skills" (P = 0.038). Qualitative data gathered show considerable stress reported by students regarding changes in examination processes and formats and lack of timely communication. CONCLUSION: Students were greatly affected by the COVID-19 pandemic and this caused fear of losing their manual dexterity skills, anxiety related to its consequences on their long-term plans, and anxiety related to the examinations. Dental schools in turn should adapt rapidly and customize changes that are specific to the individual student cohort and their stage of training.

Patient-based outcomes with conventional or mini-implants immediately loaded with locator-retained mandibular overdentures: A cohort study.

BACKGROUND: Little is known on the effect of varying implant diameters, especially with mini implants (ie, less than 3 mm in diameter), on oral health-related quality of life (OHrQoL). PURPOSE: To compare OHrQoL and satisfaction in patients with mandibular overdentures immediately retained by either two conventional or two mini-implants. MATERIALS AND METHODS: Edentulous patients receiving immediately loaded overdentures retained by Locators on either two conventional diameter (4.1 mm) or two mini (2.9 mm or less) implants were selected based on available buccal-lingual ridge width in the intraforaminal area. Two questionnaires were used (Oral Health Impact Profile-14 [OHIP-14]; and Denture Satisfaction Questionnaire [DSQ]) to determine OHrQoL and overall denture satisfaction. Questionnaires were filled out at six different time points up to a 1-year follow-up. Mann-Whitney U test was used for group comparisons. Friedman and Wilcoxon tests were used to identify changes within group along the time points. Correlation between OHIP-14 and DSQ was assessed with Spearman test. RESULTS: A total of 48 patients were analyzed and equally distributed to each group. The conventional group presented a significantly smaller change of OHIP functional score from the baseline to the first week of follow-up after surgery (P = .017). In addition, total DSQ scores were significantly higher for the conventional group at 12 weeks (P = .022) and there was a significant difference between groups in satisfaction with mandibular prosthesis at 24 weeks (P = .034). Correlation between OHIP-14 and DSQ was not significant (P > .05). Individual results of each group (ie, within group analysis) over all assessed time points revealed a significant OHrQoL (P = .001 for conventional, P = .006 for mini-implants) and satisfaction (P < .001 for both groups) improvement in both groups. CONCLUSION: Mandibular overdentures retained by two conventional or mini-implants lead to a significant and comparable improvements in OHrQoL and satisfaction over a 1-year follow-up.

Maintenance and risk factors for fractures of overdentures using immediately loaded conventional diameter or mini implants with Locator abutments: A cohort study.

BACKGROUND: Fractures in mandibular implant-retained overdentures are a common complication. However, little is known on the related risk factors and outcome differences when using two conventional diameter or two mini implants. PURPOSE: The purpose of this study was first, to evaluate the required maintenance and complications with the overdentures and second, to analyze risk factors for overdenture fractures. MATERIALS AND METHODS: This cohort study was conducted in edentulous patients with complete dentures. Patients received either two conventional (4.1 mm in diameter) and two mini (2.9 mm or less in diameter) implants, based on available buccal-lingual ridge width. All implants were immediately loaded with mandibular overdentures retained by Locator abutments. The number of prosthodontic after care visits (scheduled and unscheduled) were recorded and compared between the two implant diameter groups. Fracture occurrence was the primary outcome variable. Risk estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The ORs were adjusted for potential clinical confounders (ie, necessity of relining, matrix recapture, abutment loosening, implant diameter, height of the Locator, and retention force). RESULTS: A total of 50 edentulous patients were analyzed. One conventional diameter and three mini implants failed within a 1-year follow-up period. Prosthetic maintenance requirements for overdentures on both implant diameter groups were comparable. A total of 12 overdenture fractures (four in the mini implant group and eight in the conventional diameter group) occurred. Adjusted OR (AOR) analysis showed a significant association between abutment loosening and overdenture fracture (AOR = 12.00, 95% CI = 1.11-129.45; P = .041). CONCLUSION: Within the limitations of this study, the present findings suggest that implant diameter does not affect number of prosthetic maintenance and complications, and that abutment loosening is a risk factor for overdenture fractures, regardless of the implant diameter used.

Immediately loaded mini-implants supporting mandibular overdentures: A one-year comparative prospective cohort study.

BACKGROUND: Little is known about differences between mini-implants and conventional immediately loaded implants for overdentures. OBJECTIVES: To compare clinical outcomes using two immediately loaded conventional or mini-implants for mandibular overdentures. MATERIALS AND METHODS: Edentulous patients receiving either conventional (4.1 mm) or mini-implants (2.9 mm or less), based on available bone width were analyzed. All implants were immediately loaded with mandibular overdentures installed using locator attachments. Digital periapical radiographs for measuring marginal bone loss and clinical outcomes (ie, periodontal probing, plaque, and bleeding indices) were assessed at 1, 3, 6, and 12-month follow-up periods. RESULTS: Fifty patients (25 receiving conventional implants-12 females, mean age of 65.3 ± 7.3 years; and 25 receiving mini-implants-11 females, mean age of 66.8 ± 8.1 years) was analyzed. Peak insertion torque (P = .001) and bone loss (P = .02), as well as change in plaque (P = .02) and bleeding (P = .04) indices at 12 months differed significantly between groups. Furthermore, linear regression revealed the height of the locator as a risk factor for bone loss (P = .038). CONCLUSIONS: The present findings suggest that two mini-implants are significantly more susceptible to bone loss after immediate loading, for which the height of locator might be considered a risk factor.

Temporomandibular joint disorders during HIV infection: a case report.

Temporomandibular disorders (TMD) is a term reflecting chronic, painful, craniofacial conditions usually of unclear etiology with impaired jaw function. Human immunodeficiency virus (HIV)-infected patients often report chronic pain and pathologies targeting body joints during retroviral therapy. Although both conditions may share similar secondary disorders, no conclusive cause-effect relationship has been found linking the TMD to the HIV-antiviral treatment. This report describes a case of TMD associated with HIV infection during active retroviral therapy. Clinicians should be aware that treatment of an HIV-infected patient with TMD requires an interdisciplinary team approach.

WASP (Write a Scientific Paper): Writing an academic research proposal.

A research study cannot commence without a proposal. This paper highlights the preparatory steps and details the individual sections of a research proposal. The importance of the proposal toward the research project and the eventual writing of a thesis or dissertation is also emphasised. The implications of using human subjects are also discussed.

A cost analysis of a long-term prospective study of patients treated with immediately loaded implant-supported mandibular overdentures.

BACKGROUND: The economic burden for patients seeking treatment with implant-supported prostheses has not been given adequate attention. PURPOSE: To document long-term costs from a prospective trial on edentulous patients treated with mandibular implant-supported overdentures and 2 loading protocols. MATERIALS AND METHODS: The direct clinical and time costs for 35 patients receiving an immediate-loading protocol (ILP) and 40 patients with a conventional-loading protocol, over 14 years of observation, were analyzed in 2016 Canadian dollars as a base year. Quality of life (QoL) for the ILP was measured using the OHIP-20 questionnaire. RESULTS: The ILP was associated with higher complication costs ($870.77 ± 692.24 vs $85.73 ± 133.14) with resultant higher maintenance costs ($1746.37 ± 892.68 vs $853.04 ± 276.21) (P < .05). OHIP results showed a sustained improvement in QoL through the first 5 year of follow-up. A worsening of QoL, specifically the functional-related OHIP scores, was noted at 14 years. Incremental cost-effectiveness ratios indicated that the accrued maintenance costs for the ILP made the treatment less cost-effective over time. CONCLUSIONS: This long-term study confirmed that ILP is associated with higher maintenance costs and varying subjective QoL measurements. Clinical treatment protocols should be evaluated over a long period and address different perspectives.

An evaluation of oral health-related quality of life in orthodontic patients treated with fixed and twin blocks appliances.

OBJECTIVE: To study the impact of orthodontic treatment on the quality of life in two patient groups, one treated with the twin block appliance and the other with fixed appliances. MATERIALS AND METHODS: Ninety-eight patients, aged between 10 and 16 years, were recruited in the fixed (20 males and 29 females) or functional (29 males and 20 females) treatment groups. The oral health-related quality of life (OHRQoL) was measured before treatment and followed up at the end of the treatment. The instrument used to measure OHRQoL was a modified self-administered short version of the English Oral Health Impact profile (OHIP-16[E]) questionnaire. RESULTS: OHRQoL worsened at the initial stages of the treatment. The overall score of OHRQoL reduced significantly at the end of the treatment in both groups. Both groups showed comparable improvements in OHRQoL as the treatment progressed (analysis of variance test P = 0.05). CONCLUSIONS: The OHRQoL patterns, during the treatment with fixed and twin block appliances, were very similar. This suggests that the functional appliance's impact on the QoL may be overestimates by clinicians. OHRQoL improved significantly with both fixed and functional appliances by the end of the treatment. The OHRQoL trends observed during the study can be communicated to patients and used to increase patients' compliance since they are made aware of the whole treatment process.

The Oral Health-Related Quality of Life in State Institutionalized Older Adults in Malta.

PURPOSE: The objective of this study was to determine the oral health-related quality of life in state institutionalized older adults and correlate it to their oral health status. MATERIALS AND METHODS: A group of 278 older adults (average age: 83.5±6.5 years) from 9 state institutions in Malta was randomly selected. Participants were clinically examined and answered three questionnaires (Oral Health Impact Profile [OHIP-14], Geriatric Oral Health Assessment Index [GOHAI], and Denture Satisfaction). RESULTS: Oral health-related quality of life measurements were significantly associated with pocket depth (OHIP-14 and GOHAI, P<.05); decayed, missing, or filled teeth (OHIP-14 and GOHAI, P<.05); carious teeth (OHIP-14 and GOHAI, P<.05); number of missing teeth (OHIP-14 and GOHAI, P<.05); and maxillary and mandibular dentures (OHIP-14 and GOHAI, P<.0001). Denture satisfaction was associated with denture age (P=.010) and types of prostheses (P<.05). CONCLUSION: Institutionalized older adults have high levels of oral disease. Although oral health-related quality of life is generally good, those participants with a poorer oral health-related quality of life had significant associations with poor oral health. However, the extent varies with the individual's perception of good health.