Medical history complexity of patients attending dental student restorative treatment clinics compared with dental emergency clinics.

INTRODUCTION: Dental students should graduate from undergraduate programmes with the knowledge and skills to safely manage patients. This requires exposure to patients with a range of medical needs, which may impact the planning and delivery of care. AIMS AND OBJECTIVES: We wished to establish the medical history complexity of patients presenting to student restorative clinics and compare them to patients attending a dental emergency clinic. MATERIALS AND METHODS: We recorded the medical history data of 200 anonymised patients attending student restorative clinics and compared them to previously collected data from 200 dental emergency clinic patients. We collected basic demographic data (age/gender) and noted the number of medical disorders, amount of comorbidity and the number and types of medications for each patient. RESULTS: The age and medical complexity of patients were different, with fewer young patients seen in the dental restorative clinics. Patients attending restorative clinics were more likely to have multiple comorbidities and took greater numbers and types of medications than those seen in dental emergency clinics. CONCLUSIONS: For patients seen in student restorative clinics, medical histories are taken once at the beginning of care and the subsequent treatment plan is delivered over many appointments accounting for that medical history. Emergency clinic patients attend for single treatment episodes and their medical complexity is immediately relevant to the treatment offered. Students have multiple, single encounters with patients in emergency clinics. In both clinics, dental treatment plans need to be adjusted to account for patients' drugs and diseases, providing opportunities to consolidate human disease learning.

Restoration with a posterior CAD/CAM onlay after failure of a direct resin-based composite restoration: a case report.

A conservative approach to restoration assists in preserving the remaining tooth structure of extensively destroyed vital teeth. This case report describes a single-appointment chairside technique for placement of ceramic restorations in posterior teeth. A patient presented for treatment of her mandibular right first molar, which had a fractured resin-based composite restoration. Due to the presence of vital pulp, extent of the restoration, and presence of caries in the tooth, the following treatment plan was proposed: placement of a lithium disilicate glass-ceramic onlay fabricated with a computer-aided design/computer-aided manufacturing workflow. After the dentist removed the restoration and performed selective caries removal, structural analysis guided the reduction of the buccal cusps. Immediate dentin sealing was performed with a 2-step self-etching adhesive system, and a 1-mm-thick layer of flowable resin-based composite was placed as a resin coating. A digital impression was obtained, the onlay restoration was designed, and a lithium disilicate block was milled and subsequently crystallized. When the onlay was completed, the tooth preparation was sandblasted, selectively etched, and coated with a universal adhesive. The intaglio surface of the onlay was cleaned and primed, the onlay was bonded with dual-cure resin cement, and occlusal adjustments were completed. Follow-up examinations at 1 and 4 months revealed the clinical success of the case. From start to finish, it takes approximately 2.5 hours to produce a single-appointment chairside restoration. The technique used in this case offers a fast-paced workflow that is comfortable and practical for the patient and provides a predictable clinical outcome without the need for a temporary restoration.

Comparison of occlusal contact errors of 6 chairside CAD/CAM crowns: a self-controlled clinical study.

OBJECTIVES: The purpose of this self-controlled clinical study was to evaluate the trueness of occlusal contacts of chairside CAD/CAM crowns fabricated using different ceramic materials. MATERIALS AND METHODS: Ten volunteers (8 females, 2 males, average aged 20-30) were recruited in this study registered in the Clinical Trials Registry (#NCT05346744). After tooth preparation on tooth 36 or 46, an optical scan unit (CEREC Omnicam, Sirona Dental Systems, Germany) was utilized to perform the intraoral scanning. For each volunteer, 6 crowns were fabricated via the chairside CAD/CAM process (CEREC, Sirona Dental Systems, Germany) using the following materials: InCoris TZI (ZIR), Celtra Duo (CD), e.max CAD (EMA), UP.CAD (UP), Enamic (ENA) and Hyramic (HY). The microhardness of the milled surfaces was measured through a Vickers hardness Tester (HVS-50Z, Trojan, China). Together with the amount of occlusal adjustment, the occlusal contact trueness at both milling and postprocessing stages were quantitatively analyzed by using a high-precision scanner (ATOS, GOM Technologies, USA) and a reverse engineering software (Geomagic Control, 3D Systems, Rock Hill, SC). The times of chairside occlusal adjustment were also recorded. Data were analyzed by one-way analysis of variance (ANOVA) and ANOVA with randomized block design followed by Bonferroni test (p = 0.05). RESULTS: Significant differences were found in surface microhardness of the materials tested (CD > EMA ~ UP > ENA > HY > ZIR, p < 0.05). Regarding the occlusal contact trueness at milling stage, ZIR showed the lowest (p < 0.05), while no significant difference was found among others (p > 0.05). At postprocessing stage, except for ENA, the occlusal contact trueness of ZIR was significantly lower than that of others (p < 0.05). As for occlusal adjustment amount, ZIR was lower than CD and ENA (p < 0.05). In addition, ENA, HY and ZIR required fewer times of occlusal adjustment than EMA, UP and CD. CONCLUSIONS: The type of chairside CAD/CAM ceramic materials affected the occlusal contact trueness throughout the process of manufacturing and the amount of clinical occlusal adjustment as well. Zirconia exhibited the worst occlusal contact trueness at both milling and postprocessing stages, while the amount of occlusal adjustment was the least, which recommended the least occlusal compensation. CLINICAL RELEVANCE: For better trueness, different negative occlusal offsets are suggested to be applied in the design process, so as to suit the material of the restoration.

Precision periodontal care: from omics discoveries to chairside diagnostics.

The interface of molecular science and technology is guiding the transformation of personalized to precision healthcare. The application of proteomics, genomics, transcriptomics, and metabolomics is shaping the suitability of biomarkers for disease. Prior validation of such biomarkers in large and diverse patient cohorts helps verify their clinical usability. Incorporation of molecular discoveries into routine clinical practice relies on the development of customized assays and devices that enable the rapid delivery of analytical data to the clinician, while the patient is still in session. The present perspective review addresses this topic under the prism of precision periodontal care. Selected promising research attempts to innovate technological platforms for oral diagnostics are brought forward. Focus is placed on (a) the suitability of saliva as a conveniently sampled biological specimen for assessing periodontal health, (b) proteomics as a high-throughput approach for periodontal disease biomarker identification, and (c) chairside molecular diagnostic assays as a technological funnel for transitioning from the laboratory benchtop to the clinical point-of-care.

Randomized controlled pilot study assessing efficacy, efficiency, and patient-reported outcomes measures of chairside and labside single-tooth restorations.

OBJECTIVES: To test whether or not a chairside workflow (CHAIR) is similar to a labside workflow (LAB) in terms of efficacy (primary outcome) and efficiency (secondary outcome). MATERIAL AND METHODS: Eighteen subjects in need of a single-tooth restoration in the posterior region of the maxilla or mandible were consecutively recruited and randomly assigned to the CHAIR or LAB workflow. Patient-reported outcome measures (PROMs; efficacy) were assessed using a questionnaire with visual analog scale. The white AEsthetic score (WES) was applied to evaluate the AEsthetic outcome objectively. The clinical and laboratory time (efficiency) were recorded. Nonparametric methods were applied for the group comparisons. RESULTS: The overall median AEsthetic evaluation after treatment was 10 (interquartile range = IQR: 9.5-10) in group CHAIR and 10 (IQR: 9.5-10) in-group LAB (Mann-Whitney [MW] test p = 1.000). The WES amounted to 4 (IQR: 3-5) (CHAIR) and to 8 (IQR: 7-9) (LAB) (MW test p < 0.0001). The median total working time for the clinician in-group CHAIR was 49.9 min. (IQR: 40.9-63.7) and 41.4 min. (IQR: 37.2-58.2) in-group LAB (MW test p = 0.387). CONCLUSIONS: Subjective PROMs of single-tooth supported restorations fabricated in a CHAIR or LAB workflow led to similar scores of patients' satisfaction and a moderate negative correlation for the objective evaluation of the clinician in the LAB workflow. CLINICAL SIGNIFICANCE: PROMs can be considered a key element in the decision-making process for restoring single-tooth restorations. The patients' perception of AEsthetics was similar for the CHAIR or LAB workflows. The additional efforts undertaken with the LAB workflow did not result in a patient benefit when compared to a CHAIR workflow.

Consolidating human disease learning in the Dental Emergency Clinic.

INTRODUCTION: Dental undergraduates typically learn and are assessed on aspects of human disease (HD) in the early part of their programme, but it is not until later in the programme that their HD knowledge is put into practice when they provide courses of treatment for numerous patients over multiple visits. The teaching of HD provides core knowledge on medical conditions and medications and is therefore essential in allowing newly graduated dentists to provide safe treatment for medically compromised patients or those taking medications. We wanted to examine the medical complexity of patients attending a university hospital dental emergency clinic to determine whether this was a suitable group that would help students to consolidate their HD learning in the context of a single visit where treatment was also provided. MATERIALS AND METHODS: We examined the medical history of 200 patients attending the dental emergency clinic in the University Dental Hospital, Cardiff, using a previous study as a benchmark. Anonymous data were collected using the medical history proforma, and included age, gender, medications, types and number of medical conditions/disorders. RESULTS: Patients attending the clinic were more medically complex than those in the comparator study and the demographics reflect wider population data showing increasing numbers of older patients with greater medical morbidity. DISCUSSION/CONCLUSIONS: The emergency dental clinic is the place where most patients are new to the hospital, have a dental history, medical history, investigations, diagnosis and treatment in a single visit, and offers excellent opportunities for consolidating HD learning in a one-stop clinical treatment episode, guided by suitable instructors.

Implant position and guided placement for in-house-produced CAD/CAM restorations with titanium (Ti)-bases.

Digital dentistry has contributed to the evolution and simplification of dental implantology over the last decade. The incorporation of intraoral scanners, CBCT, 3D implant-planning software, and CAD/CAM systems makes prosthetically driven implantology a straightforward process. Such digital resources for treatment planning and execution, following evidence-based concepts, have the ability to improve the long-term esthetics and function of implant-supported restorations as well the long-term survival of dental implants. Dental implants are frequently considered as the first treatment option for replacing failing or missing teeth. However, their use in the esthetic zone remains a challenge for many clinicians. The present article provides clinical guidelines for ideal implant positioning employing computer-guided surgery and chairside CAD/CAM-fabricated provisional and definitive restorations with titanium (Ti)-bases for successful prosthetic outcomes, optimizing gingival architecture, and decreasing overall treatment duration. (Int J Comput Dent 2023;26(1):75-0; doi: 10.3290/j.ijcd.b3818287).

Comparison of efficacy between MBT preadjusted edgewise appliance and clear aligner therapy among class I crowding cases: A randomized controlled trial.

Background: To compare the efficacy of McLaughlin Bennett Trevisi (MBT) appliance and Clear Aligner Therapy (CAT) among nonextraction Class I crowding cases. Methods: The study sample (60 patients) was allotted into two equal groups (30 patients each) using block randomization wherein Group 1: treated with 0.018" MBT appliance and Group 2: treated with CAT for correction of malocclusion. At the end of treatment (T1), treatment duration, chairside time, laboratory time, number, and type of appointments were noted from treatment record cards. For comparing the acceptability among patients treated with both modalities at T1, the patients were interviewed regarding the comfort and ease of using an appliance with a questionnaire-based survey. Results: The median number of nonscheduled/emergency and finishing stage appointments was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The median duration of treatment at the scheduled, finishing, and overall appointments, was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The median chairside time of all appointments was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The experience with treatment and overall acceptability was significantly higher in Group 2 compared to Group 1 (P-value <0.001). However, mean laboratory time per aligner fabrication in Group 2 was 30.26 ± 3.45 min against no laboratory time consumed in Group 1. Conclusions: CAT significantly reduces treatment duration, chairside time, number of nonscheduled/emergency, and finishing stage appointments in nonextraction Class I crowding cases. Prospective studies with 3D aligner systems are recommended to add further evidence in this regard. Clinical Trials Registry-India Registration No: CTRI/2018/04/013301.

A digital workflow for accurately and rapidly creating an immediate provisional restoration with natural emergence profile using extracted tooth.

To describe a digital workflow for creating a provisional restoration by using an extracted tooth rapidly, finally fixing the provisional restoration in the targeted position precisely and preserving the natural emergence profile from the time of provisional restoration to final restoration. CLINICAL CONSIDERATIONS: The use of extracted tooth as an immediate provisional restoration is an effective method for preserving the shape of the emergence profile. However, the existing methods for creating a provisional restoration by using natural tooth are time-consuming and there is no reliable method to precisely attach tooth to temporary abutment. This case demonstrates a new method for using patient's natural tooth as an immediate provisional restoration under a sequence of guides, which significantly reduces the chair-side time and inconvenience for clinicians and patients. Immediate provisional restoration contributes to preserving the soft tissue architecture after post-extraction implant placement, especially when using the patient's tooth as a provisional restoration. Digital technology can help to improve the chair-side clinical efficiency of dentist. CLINICAL SIGNIFICANCE: Maintaining the natural soft tissue architecture is a huge challenge in dental implantology. Use of the extracted tooth as a provisional restoration is likely to achieve an optimal outcome. And digital technology is helpful to the efficiency and accuracy of treatment.

Clinical Performance of CAD/CAM Monolithic Lithium Disilicate Implant-Supported Single Crowns Using Solid or Predrilled Blocks in a Fully Digital Workflow: A Retrospective Cohort Study With Up To 33 Months of Follow Up.

PURPOSE: To assess the clinical performance of CAD/CAM monolithic implant-supported restorations manufactured using a fully digital workflow and two different types of ceramic blocks. MATERIALS AND METHODS: One hundred and one patients received single-unit implant-supported restorations at a University predoctoral clinic. All restorations were designed and fabricated using either a predrilled LS2 block (group P, n = 59) or a conventional solid LS2 block with an occlusal opening drilled manually prior to crystallization (group M, n = 42). The mean follow-up time after restoration delivery was 18.4 ± 4.8 months (range 12 to 33 months). Patients with less than a 12-month follow-up were excluded. Electronic health records were reviewed to identify number and type of complications during the follow-up time. Clinical outcomes were classified as success, survival, and failure of the restoration. Chi-square tests were used to identify differences in success and survival rates between the groups. Nonparametric Mann-Whitney U tests were used to identify differences in the number of major and minor complications as well as the total number of complications that were observed among groups. RESULTS: Overall success and survival rates were 80.2% and 97%, respectively. Seventy one restorations (70.3%) were complication-free. There were no significant differences between the groups with regards to the number of complications or success and survival rates. CONCLUSIONS: Single-unit CAD/CAM monolithic implant-supported restorations that are fabricated in a fully digital workflow present relatively high complication rates and moderate short-term clinical outcomes. Clinical studies with longer follow-up times are needed to evaluate long-term outcomes of these restorations.

Effectiveness of a Chairside Acrylic Adjustment Cabinet in Reducing Dental Acrylic Debris and Aerosols.

PURPOSE: Chairside prosthesis adjustment procedures generate contaminated acrylic particle debris that include visible splatter (particles >50 µm) as well as invisible aerosols (<50 µm). The purpose of this study was to evaluate the effectiveness of a chairside acrylic adjustment cabinet (CAAC) in reducing airborne aerosol particles (<10 µm) and visible acrylic debris, time required for airborne aerosols to return to baseline levels after an acrylic adjustment procedure, and the effect on operatory turnover time. MATERIALS AND METHODS: A total of 40 acrylic adjustment procedures were carried out in a simulated setting with (experiment) and without (control) a CAAC. Standardized acrylic samples of self-polymerized, and heat polymerized polymethylmethacrylate resins, Triad™ and Fastray™ custom tray materials were evaluated. Airborne aerosol measurements were done using a handheld Lase.r Particle Counter for absolute particle counts of sizes 0.3, 0.5, 1.0, 2.5, 5.0, and 10.0 µm before, during, and immediately after adjustment and 10 minutes postadjustment. Spread of aerosols was assessed at three distinct locations within the dental operatory specific to the provider, the patient, and the caregiver/guest. Visible acrylic debris and operatory turnover time were evaluated immediately postadjustments by a blinded investigator. Repeated measures ANOVA was used to estimate group effect, time effect and interaction between group and time for air particle analysis. Independent samples T-tests were used for group differences between operatory turnover time, and time for aerosols to return to baseline. Chi-square test was used for visible surface analysis. RESULTS: In the control group, total aerosol particle counts increased from 6542.7 ± 162.6 particles at baseline to 598378.7 ± 586363.2 and 367569.9 ± 432220.8 particles during and immediately postadjustment, respectively. Adjustments made in the experiment group led to significantly reduced aerosol counts during (97738.9 ± 97866.5) and immediately postadjustment (19786.5 ± 14004.9; F = 17.8, p = 0.006). Similar trends were noted for the patient and guest positions. Time for aerosol particles to return to baseline was significantly lower in the experiment group (20.56 ± 14.5 minutes) compared to the control group (37.9 ± 31.96 minutes; p = 0.03). Visible acrylic debris analysis showed a significant decrease of 78% in the experiment group (p < 0.001). No significant differences were noted in operatory turnover time between the two groups (p = 0.61). CONCLUSIONS: Acrylic adjustment procedures generated aerosols of particle sizes less than 10 µm and were measured in significant quantities throughout the dental operatory for up to 115 minutes. Chairside acrylic adjustment cabinets significantly decreased airborne aerosols, visible acrylic particle debris, and reduced the time for airborne aerosols to return to baseline levels.

Surface Evaluation of Resilient CAD/CAM ceramics after Contouring and Polishing.

OBJECTIVE: This in-vitro study measured the differences in surface roughness for computer assisted design/computer assisted manufacturing (CAD/CAM) resilient ceramic and CAD/CAM composite materials. MATERIALS AND METHODS: The materials included Lava Ultimate (3 M), Cerasmart (GC America), Vita Enamic (Vita Zahnfabrik), and Brilliant Crios (Coltene). One calibrated operator polished each material with three polishing sytems: spiral polishers (Diacomp FeatherLite/Brasseler), rubbercup polishers (Enhance/DentsplyCaulk), and brush-paste (Diashine/VH Technologies). Surface roughness was assessed using a confocal laser microscope (Lext OLS4000/Olympus). RESULTS: A two-way ANOVA revealed statistically significant differences in mean surface roughness values (Sa) among materials and polishers. Tukey multiple comparisons showed that mean Sa values for Lava Ultimate, Enamic, Cerasmart and Brilliant Crios polished with brush-paste as well as Lava Ultimate and Cerasmart values polished with spiral polishers were not significantly different from each other. CONCLUSIONS: The finished surfaces were significantly smoother than milled surfaces for all materials. The brush-paste polishing technique created the lowest surface roughness values for all CAD/CAM materials and values were comparable to what was achieved by spiral polishers for Lava Ultimate and Cerasmart. Rubber polishers did not provide a clinically smooth surface for CAD/CAM resilient ceramic/composite materials. CLINICAL SIGNIFICANCE: The results of the study indicate that polishing creates smooth surfaces for CAD/CAM resilient ceramic and CAD/CAM composite restorations.

Chairside quadrant rehabilitation: material selection in conditions with limited space.

The significantly faster fabrication technique of chairside restorations with the aid of the Cerec Primemill milling unit makes it possible to restore an entire quadrant in a reasonable amount of time. Furthermore, the procedure described in this article made it possible to use a new type of medium-strength ceramic that achieved a very good esthetic result overall.

Clinical Applications of Intraoral Scanning in Removable Prosthodontics: A Literature Review.

PURPOSE: This review aimed to identify the reported intraoral scanning applications in fabricating different types of removable prostheses in the field of prosthodontics. METHODS: A comprehensive electronic search was performed using the PubMed and MEDLINE databases. This review included in vitro studies and clinical reports published between January 2013 and March 2021. The main keywords were as follows: intraoral scanning, digital impression, computerized digital impression, removable prosthesis, chairside computer-aided design/computer-assisted manufacturing, digital complete denture, digital immediate complete denture, digital interim complete denture, digital removable partial denture, digital removable overdenture, digital obturator, digital occlusal splints, and digital maxillofacial prostheses. RESULTS: In total, 33 papers (22 clinical reports, 8 papers focused on dental techniques, and 3 clinical studies) were included in the final analysis. CONCLUSIONS: The efficiency of using intraoral scanning in the field of removable prosthodontics was documented. However, there is a need for more clinical studies to identify intraoral scanning-usage protocols and to yield reliable and valid data.

A Digital Chairside Technique for an Accurate Evaluation of the Taper of the Prepared Teeth for the Restoration of Crowns and Fixed Partial Dentures.

AIM: The aim of the article was to provide a digital chairside method for the objective evaluation of the taper of prepared abutment teeth retaining a fixed partial denture (FPD). BACKGROUND: According to research, the taper of the abutment teeth supporting an FPD has a direct effect on both retention and stress transmission to the abutment teeth. However, no approaches have been documented in the literature that objectively quantify the taper of the prepared teeth chairside, in a simple and cost-effective manner. TECHNIQUE: The proposed technique utilized an intraoral camera with an on-the-go (OTG) connection, and a silicone dental bite block. The images of the prepared teeth were captured using this camera from the facial aspect. An indigenous program was developed using the MATLAB (Matrix Laboratory 2013) software for the analysis of the images and the taper of each abutment tooth was calculated in degrees using the software. CONCLUSION: The novel, chairside, digital technique utilizes an intraoral camera and a computer-generated software package to quantify and evaluate the taper of abutment teeth efficiently. This, in turn, can help minimize the errors in the treatment of FPD and improve the retention of the prosthesis. CLINICAL SIGNIFICANCE: The current technique enables the clinician to avoid over-preparation of the abutment teeth by assessing its taper chairside. This digital technique can be a beneficial alternative to the existing procedures for an accurate assessment of taper, especially for the inexperienced operator. Hence, the quality of retention, and thereby the long-term success of the crowns and FPDs, can be enhanced. This article was presented as a postgraduate paper titled "Scan and Plan" on March 6, 2020, at 22nd IPS (Indian Prosthodontic Society) PG Convention, Kochi, India.

Chairside measurement of the marginal and internal fit of crowns: a new intraoral scan-based approach.

OBJECTIVES: To investigate the marginal and internal fit of crowns, a new intraoral scanner-based digital approach for chairside measurement (D-IOS) was systematically analysed and compared with the conventional silicone replica technique (CV-SR) and digital 3D analysis software (D-GOM). MATERIALS AND METHODS: Two models, representing different clinical situations, were constructed, and the first molar was prepared for a full-coverage crown. On the basis of an intraoral scan (Trios 3), copings of three different materials (non-precious alloy, zirconium dioxide, and resin composite) with two different cement spaces (80 µm, 50 µm) were manufactured. The fit of the copings was investigated by all three methods (CV-SR, D-IOS, D-GOM). Therefore, the cement space was visualized with low-viscosity silicone and digitalized with a second intraoral scan. Evaluation of fit by the D-IOS-method was measured in the intraoral scanner software, whereas for analysis by D-GOM, both intraoral scan datasets were transferred to 3D analysis software (GOM Inspect). The CV-SR-method was used as a control group. For all copings, the measurements were repeated five times. The data were analysed with ANOVA. RESULTS: No significant differences between the three evaluation methods and the coping materials were shown. However, in the occlusal area, the internal gap was significantly higher compared to the internal gap in the marginal and axial areas regardless of the cement space setting (p < .05). The target parameter of the cement spaces did not match the actual measured internal gaps. CONCLUSIONS: All three evaluation methods and coping materials can be used for the measurement of fit within different clinical situations. CLINICAL RELEVANCE: The digital chairside measurement implemented in the intraoral scanner software enables an easy, applicable evaluation of fit of crowns without additional laboratory devices or special software applications.

Marginal and internal fit of full ceramic crowns milled using CADCAM systems on cadaver full arch scans.

BACKGROUND: Chairside systems are becoming more popular for fabricating full-ceramic single restorations, but there is very little knowledge about the effect of the entire workflow process on restoration fit. Therefore, this study aimed to compare the absolute marginal discrepancy (AMD) and the full internal fit (FULL) of all-ceramic crowns made by two chairside systems, Planmeca FIT and CEREC, with detailed and standard mill settings. METHODS: One upper molar was prepared for an all-ceramic crown in human cadaver maxilla. Full-arch scans were made by Emerald or Omnicam four times each. Twenty-four e.max crowns were designed and milled by the Planmill 30s or 40s or CEREC MCXL mills with either detailed or standard settings. The cadaver tooth was extracted, and each crown was fixed on it and scanned by a high-resolution microCT scanner. The AMD and FULL were measured digitally in mesio-distal and bucco-lingual 2D slices. The actual and predicted times of the milling were also registered. RESULTS: No differences were observed between detailed or standard settings in either system. The AMD was significantly higher with CEREC (132 ± 12 µm) than with either Planmill 30s (71 ± 6.9 µm) or 40s (78 ± 7.7 µm). In standard mode, the FULL was significantly higher with CEREC (224 ± 9.6 µm) than with either Planmill 30s (169 ± 8.1 µm) or 40s (178 ± 8.5 µm). There was no difference between actual and predicted time with the two Planmeca models, but with CEREC, the actual time was significantly higher than the predicted time. The 30s had significantly higher actual and predicted times compared to all other models. Across all models, the average milling time was 7.2 min less in standard mode than in detailed mode. CONCLUSIONS: All fit parameters were in an acceptable range. No differences in fit between Planmeca models suggest no effect of spindle number on accuracy. The detailed setting has no improvement in the marginal or internal fit of the restoration, yet it increases milling time.

Exploration of constructive feedback practices in dental education chairside teaching: A case study.

BACKGROUND: Chairside teaching is one of the teaching-learning methods in clinical dental education in which direct care is provided to patients. When students have been deemed competent in carrying out procedures on a dental phantom, they need clinical experience on patients, with guidance and constructive feedback from clinical teachers. Constructive feedback is an important learning platform in helping students analyse the strong and the weak aspects of their performance in order to identify required improvements. This study aimed to explore the practice of giving constructive feedback in chairside teaching. METHOD: A qualitative method with a case study design. Data were collected through in-depth interviews and focus group discussions (FGDs) with clinical teachers and students in clinical rotation. Data triangulation was carried out by observing the practice of giving constructive feedback in chairside teaching and document analysis from January to April 2019. Results of the in-depth interviews and FGDs were transcribed verbatim and analysed using a thematic analysis approach. RESULT: In-depth interviews with five programme coordinators and FGDs with two groups of clinical teachers (N = 8 and N = 6) and two clinical student groups (N = 8 each). Three main themes emerged in this study: ways to provide feedback, challenges on feedback provision and challenges on feedback follow-up. CONCLUSION: Differences in perception between clinical teachers and students were identified, influenced by students' interactions with the learning environment. Interventions are to be encouraged that involve teachers, students and institutions, and the interactions amongst the three.

Clinical Performance of Short-fiber-reinforced Resin Composite Restorations vs Resin Composite Onlay Restorations in Complex Cavities of Molars (Randomized Clinical Trial).

BACKGROUND: Short-fiber-reinforced resin composite (SFRC) is a direct bulk fill resin composite specially indicated in large complex cavities. It is characterized by having high fracture toughness and load bearing capacity to decrease the incidence of fracture of the restoration. MATERIALS AND METHODS: In two parallel groups (n = 38 restorations), 76 participants having complex proximal cavities with asymptomatic vital pulp were randomly enrolled in this trial and received either SFRC (Ever X Posterior, GC, Japan) covered by Gaenial posterior (GC, Japan) or chairside indirect restorations (Grandioso inlay system; VOCO, Germany) fabricated on a silicon die. Materials were applied according to the manufacturer instructions with the corresponding adhesive system. Only 67 participants completed the trial, which was assessed using the modified United States Public Health Service (USPHS) criteria by two independent blinded assessors at 6 months and 1 year follow-up visits. STATISTICAL ANALYSIS: Fisher's exact and Cochran's Q tests were used to analyze inter- and intragroup comparisons, respectively. The significance level was set at p ≤ 0.05. RESULTS: No statistically significant difference was observed between both tested groups for all USPHS criteria at different follow-up periods except for marginal integrity favoring the SFRC at 12 months when the difference became significant (p < 0.001), and color match favoring the nanohybrid indirect resin composite restorations with significant difference in scores at all follow-up intervals (p < 0.001) was found. Cochran's Q test showed significant differences within the same technique during the follow-up period for some criteria. CONCLUSION: Direct SFRC and indirect nanohybrid resin composite complex proximal restorations showed an acceptable clinical performance along the 1 year follow-up period. CLINICAL RELEVANCE: Direct SFRC restorations could be a viable treatment option for complex restorative cases.

Prevalence of undiagnosed diabetes and pre-diabetes in chronic periodontitis patients assessed by an HbA1c chairside screening protocol.

OBJECTIVES: The objective of the present study was to implement a chairside diabetes screening strategy for the identification of undiagnosed hyperglycaemia in periodontal patients. MATERIALS AND METHODS: Measurement of HbA1c was performed in patients (n = 139) diagnosed with periodontal disease to determine possible unknown hyperglycaemia. Patients fulfilled the criteria for screening according to the questionnaire by the Centers for Disease Control and Prevention (CDC). The Cobas® b101 in vitro diagnostic system was used for the measurement of glycosylated haemoglobin (HbA1c) in capillary blood. Body mass index (BMI) and waist circumference were also measured to determine splanchnic obesity. Periodontal parameters were assessed with an automated probe and included probing depth, clinical attachment loss, bleeding on probing and presence/absence of plaque. RESULTS: Most patients had moderate periodontitis. Almost 25% of the subjects tested were found to have unknown hyperglycaemia while 80.5% of them had splanchnic obesity. A significant association was found between HbA1c and BMI (Mann-Whitney test; p = 0.0021) as well as between HbA1c and waist circumference (Spearman rho test; p = 0.0007). No differences were observed regarding periodontal parameters between subjects exhibiting HbA1c ≥ 5.7% and those with HbA1c < 5.7% (Mann-Whitney test; p > 0.05) although those with HbA1c ≥ 5.7% displayed higher proportions of sites with clinical attachment loss > 5 mm (z test with Bonferroni corrections; p < 0.05). CONCLUSIONS: Periodontal patients, especially those with a bigger than normal BMI and waist circumference, are a target group worth screening for diabetes. CLINICAL RELEVANCE: The dental practitioner can contribute significantly to the worldwide effort of health care professionals in diabetes screening and referring for early diagnosis of the disease.