Creation and evaluation of an educational escape room for preclinical training on 3D printing in dentistry.

INTRODUCTION: The benefit of pedagogical escape rooms for dental students' stimulation, interest and knowledge strengthening has been suggested by several studies. However, in previous studies, only a few students were evaluated. This study aims to confirm the purpose of this innovative pedagogical tool in terms of learning consolidation and team building from students' perceptions. We directly incorporated an educational escape game into the fundamental academic formation as a practical-work course for fifth-year dental students. MATERIALS AND METHODS: The present escape game focused on 3D printing, whose implementation fit the different steps of an escape game well. This study was conducted in March 2022. All fifth-year dental students (n = 212) were divided into 5-6 student groups to match the conditions of an escape game. Before entering the room, each student had to complete a cross-sectional knowledge true/false test of 8 questions to assess their general level. Additionally, an 18-question appreciation survey was completed when leaving the room. RESULTS: The students perceived the 3D-printing escape game to be relevant and especially expressed the benefit of being part of a team to exchange and build knowledge. These results suggest knowledge strengthening. The instructional benefit of this process seemed to exceed its mere fun and appealing aspect. CONCLUSION: Our results with a large number of students showed that, from the students' perception, the educational escape game significantly improved knowledge and team-building. It created a supportive learning environment and increased students' motivation. It can provide a fun and effective way to diversify instruction.

Degree of conversion of 3D printing resins used for splints and orthodontic appliances under different postpolymerization conditions.

OBJECTIVES: To measure the degree of conversion (DC) of different 3D printing resins used for splints or orthodontic appliances under different postpolymerization conditions. MATERIALS AND METHODS: Five 3D-printed photopolymer resins were studied. Each resin was analyzed in liquid form (n = 15), and then cylindrical specimens (n = 135) were additively manufactured and postcured with Form Cure (Formlabs) at different times (10, 60, and 90 min) and temperatures (20 °C, 60 °C, and 80 °C). The DC of each specimen was measured with Fourier transform infrared spectroscopy (FTIR). The data were statistically analyzed using a 3-way ANOVA followed by Tukey's post hoc test. RESULTS: The time and temperature of postpolymerization significantly influenced the DC of each resin: when time and/or temperature increased, the DC increased. For all resins tested, the lowest DC was obtained with a postcuring protocol at 10 min and 20 °C, and the highest DC was obtained at 90 min and 80 °C. However, at 80 °C, the samples showed a yellowish color. CONCLUSIONS: With the Form Cure device, the time and temperature of postcuring could have an impact on the DC of the 3D printing resins studied. The DC of the 3D printing resins could be optimized by adjusting the postpolymerization protocol. CLINICAL RELEVANCE: Regardless of the resin used, when using the Form Cure device, postcuring at 60 min and 60 °C would be the minimal time and temperature conditions for achieving proper polymerization. Beyond that, it would be preferable to increase the postcuring time to boost the DC.

Autistic patients: a retrospective study on their dental needs and the behavioural approach.

INTRODUCTION: Autism spectrum disorder (ASD) is a lifelong heterogeneous psychiatric disorder that represents a challenge for dentists. The aim of this retrospective study was to analyse ASD patients' dental needs and to investigate key factors influencing the behavioural management. MATERIALS AND METHODS: One hundred eighteen ASD subjects (levels 2 and 3 of the DSM-5), adults and children, treated at university dental hospital, were included. For each of them, an index card was created to record general and medical information, dental care progress and treatment management. Data were analysed to characterize this specific population in terms of dental needs, technical approach and follow-up. The relationships between care approach and age (ANOVA test), care approach and concomitant pathologies as well as care approach and required treatment (chi-square test) were evaluated. RESULTS: Almost all patients required oral care. No treatment could be provided under conscious conditions. Oral premedication and/or nitrous oxide/oxygen inhalation was significantly more efficient in children and allowed conservative procedures. In adults, general anaesthesia was significantly more employed. Few patients were followed up over a long period. CONCLUSIONS: The variety of autism spectrum disorders complicates the statement of guidelines for dental care. The development of the collaboration between psychiatrics and dentists emerges as a key factor to improve the quality and the success of oral outpatient treatment. CLINICAL RELEVANCE: Oral premedication and/or nitrous oxide/oxygen inhalation at high dose represented a good way to carry out conservative dental cares, with a significant efficiency in children. Nevertheless, in a considerable number of ASD patients, especially in adults, general anaesthesia could not be avoided.

Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review.

BACKGROUND: Children with first permanent molar affected by molar-incisor hypomineralization (MIH) show high treatment failure rate. AIM: To conduct a systematic review on bonding of adhesive materials to MIH-affected enamel, so as to identify all the methods suggested to optimize it and to determine the best bonding protocol(s). DESIGN: An exhaustive literature search was conducted on MEDLINE/PubMed, the Cochrane Library, and Web of Science databases, up to October 2018. Laboratory and clinical studies, involving adhesive restorations bonded to MIH-affected enamel, with at least a comparative group were included. Two authors independently selected studies, collected data, and assessed bias risk. RESULTS: After title and abstract review and duplicate exclusion, 14 articles were selected on the 496 eligible papers. After full reading, 4 articles were excluded. Finally, 10 studies (6 laboratory and 4 clinical studies) were included. CONCLUSIONS: Bond strength of composite was not significantly different when using self-etch compared with etch-and-rinse adhesives. Deproteinization after etching for etch-and-rinse adhesives enhanced bond strength; this could allow to keep MIH-affected enamel. Icon® showed an erratic penetration; however, a preliminary deproteinization after etching could improve bond strength. A study reported no significant differences in sealant retention rate, whereas another recommended to previously apply an adhesive.

Shear bond strength and interface analysis between a resin composite and a recent high-viscous glass ionomer cement bonded with various adhesive systems.

OBJECTIVE: This study investigated the shear bond strength (SBS) and interface between a resin composite and a new high-viscous glass ionomer cement (HV-GIC), a HV-GIC, a resin-modified glass ionomer cement (RM-GIC), a bulk-fill flowable composite, and a regular flowable composite bonded with various adhesive systems. METHODS AND MATERIALS: A resin composite (Filtek Z350) was bonded to a new HV-GIC (EQUIA Forte Fil) using various adhesive systems, including a universal adhesive in self-etch and etch-and-rinse mode (Scotchbond Universal), a two-step etch-and-rinse adhesive (Scotchbond 1-XT), a one-step self-etch adhesive (Optibond All-in-one) tested also after silane application (Monobond Plus), and a coating material (EQUIA Forte Coat). The resin composite was also bonded to a HV-GIC (Fuji IX GP), a RM-GIC (Fuji II LC), a bulk-fill flowable composite (SDR), and a regular flowable composite (Tetric Evo Flow) with the universal adhesive in self-etch mode (Scotchbond Universal). Two-way ANOVA followed by Dunnett's post hoc test was used to investigate the difference in SBS. Failures were analyzed by chi-square test. Bonding interfaces were examined by environmental scanning electron microscopy (E-SEM). RESULTS: SBS to EQUIA Forte Fil was significantly lower with Scotchbond 1-XT than with all other adhesive systems. By using Scotchbond Universal with the self-etch technique, the SBS to EQUIA Forte Fil was significantly higher than the SBS to Fuji IX GP and significantly lower than the SBS to Fuji II LC, SDR, and Tetric Evo Flow. E-SEM images showed an intimate contact at all interfaces examined. CONCLUSION: EQUIA Forte Fil showed satisfactory SBS and interfaces with all adhesives tested. CLINICAL RELEVANCE: Bonding between the resin composite and HV-GIC can be achieved using a universal adhesive in self-etch mode, an easy-to-use adhesive system.

Cleft palate with/without cleft lip in French children: radiographic evaluation of prevalence, location and coexistence of dental anomalies inside and outside cleft region.

INTRODUCTION: Prevalence of dental anomalies in cleft patients is higher than that in general population. The objectives of this study were to assess the prevalence of dental anomalies and their coexistence in French children with cleft and, then, to investigate the relation between the dental anomalies and the cleft type. MATERIAL AND METHODS: Seventy-four non-syndromic cleft patients (6-16 years old) from Lille Regional University and Mondor-Chenevier Hospitals (France) were included. Clefts were classified as right/left unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP) and cleft palate (CP). Dental anomalies were investigated on panoramic radiographs and categorized as agenesis, supernumerary teeth, incisor rotations, impacted canines and shape anomalies. Prevalence and gender distribution of dental anomalies, mean number of affected teeth per patient, agenesis occurrence and location, and coexistence of dental anomalies were analysed by cleft type. RESULTS: 96.0% of patients presented at least one dental anomaly (agenesis 83.8%, incisor rotations 25.7%, shape anomalies 21.6%, impacted canines 18.9%, supernumerary teeth 8.1%). BCLP patients had a higher number of affected teeth, and left UCLP patients had a higher one compared to right UCLP patients. Distribution of inside (45.3%) and outside (54.7%) cleft region agenesis was similar. Adjacent (31.8%) and not adjacent (33.3%) combined dental anomalies were often encountered. CONCLUSIONS: Dental anomalies were localized inside as well as outside cleft region and were often associated with each other. BCLP patients were more affected. CLINICAL RELEVANCE: Early radiographic evaluation allows a comprehensive diagnosis of inside and outside cleft region anomalies, required for the multidisciplinary dental treatment.

Methodological Proposal to Assess Gingival Thickness in Children.

PURPOSE: Inadequate gingival thickness (GT) may lead to gingival recession. Thus, early identification of patients/teeth at risk would be advantageous. In adults, the probe's visibility through the marginal gingiva (reference test) has been considered a reliable criterion to describe a thin gingiva. This study aimed to evaluate in children two more convenient methods: the whitening of the attached gingiva with coronal labial traction (GW test) and the visibility of the gingival blood supply (BS test). MATERIALS AND METHODS: In 69 children, the GT of primary and/or permanent central and lateral incisors, first primary molars and/or first premolars was assessed with the three tests. The sensitivity and specificity of the GW and BS tests and their odds ratio with probing were calculated. RESULTS: According to probing, 39% of children in the studied population had thin gingiva. The GW and BS tests reported different percentages of GT compared to probing, except for primary teeth, maxillary permanent incisors and mandibular first premolars, where the GW test exhibited a comparable percentage. The sensitivity of GW and BS tests was 37% and 19%, respectively, when compared to probing, while the specificity was 84% and 96%, respectively. CONCLUSION: The GW and BS tests could be used for first-line diagnosis of thin gingiva; if the results are negative, probing should be implemented.

Chairside CAD/CAM Composite Onlays for the Restoration Of Primary Molars.

After pulp therapy or with multi-surface caries in primary molars, pre-formed stainless steel crowns are usually placed to ensure tooth longevity. Esthetic alternatives, such as zirconia crowns, have been proposed, but they are invasive. Here we describe two cases of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) technology used to treat extended and/or deep caries on primary molars. A powder-free chairside CAD/CAM system, a milling unit and machinable high-performance composite blocks were used. The tooth preparation consisted of preparing the cavity without undercut, to have supra-gingival margins whenever possible, occlusal reduction of thin walls, and proximal box finishing by ultrasonic tips. After the optical impression, the virtual onlay was designed and adapted (from the morphology of a first permanent molar), then chairside-manufactured out of a composite block and bonded by using a self-adhesive resin cement. This technique combines minimally invasive treatment; high strength, biocompatible and aesthetic material; no gingival trauma; easy execution; and patient and parent satisfaction. However, the equipment is quite expensive and the software still does not include the morphology of primary teeth.

[Dental care for disabled people]. / Soins bucco-dentaires pour les patients handicapés.

CONTEXT: Patients with disabilities represent a population with special needs whose dental care management constitutes a public health problem. This article describes dental care of disabled people in a hospital dental care unit to highlight the difficulties encountered and propose ways to improve this care. METHODS: A retrospective descriptive study was carried out on patients followed between 2010 and 2016 as part of the partnership between the Albert Chenevier Hospital odontology department and the RHAPSOD'IF network. The data collected by means of ?follow-up sheets? described the procedures performed and any medication used. These anonymised records were analysed by Excel software. RESULTS: Dental care sessions for the 434 disabled persons consisted of visits (42 to 57%), restorations and scalings each represented 1/6 of all procedures performed (14 to 19% and 14 to 18%), and surgery and radiography each represented 1/8 of procedures (4 to 12% and 6 to 11%). There were almost no dental prostheses (0 to 1%). Most dental care sessions were performed without premedication (61 to 76%). CONCLUSION: This type of dental care requires training of families and caregivers, a good interpersonal approach and time to build a relationship of trust. Participation in a network is important to help, support, and advise the practitioner and to provide financial support.

Proteomic Analysis of Fibroblasts Exposed to Resin Composite Release.

OBJECTIVE: To investigate the potential effects of products released by a resin composite on the proteome of human gingival fibroblasts. METHODS: Fifteen resin composite cylinders of a Bis-GMA-based resin composite (Tetric EvoCeram, Ivoclar) were made and placed in a culture medium for 24 h. Then, 30 mL of this medium was placed for 72 h in contact with human gingival fibroblasts and a second control group consisted of cells placed in culture medium only. Afterward, cells were collected, washed, and their proteins extracted. Three two-dimensional electrophoresis were performed per condition. Image analysis of the gels was carried out to highlight the differential protein spots. These spots were then analyzed by an ESI/qTOF mass spectrometer. Finally, specific databases provided protein identification, their interactions, and the pathways where they are implicated. RESULTS: Delta2D software allowed the detection of 21 spots of different proteins. The MASCOT identified 28 proteins. Five proteins from four spots were upregulated, 23 proteins from 17 spots were downregulated. The UniProt database showed that all these proteins were involved in cellular architecture, structural modifications and quality control of proteins, cellular homeostasis, and metabolic pathways. The STRING database revealed the interactions between the regulated proteins. The GO enrichment analysis showed that 19 pathways were affected. SIGNIFICANCE: The products released from the resin composite tested led to changes in the fibroblast proteome. Under the conditions of this study, resin composite released products can cause early adverse effects on cells, but without complete inhibition of their cellular functions.

Attitudes of general and specialist French practitioners toward stage III-IV grade C periodontitis with familial aggregation.

The aim of this cross-sectional convenience sample survey was to assess attitudes of French dentists regarding stage III-IV grade C periodontitis in systemically healthy individuals. Among 225 dentists, 85.1% informed patients of the familial nature of periodontitis including 27.3% that recommended a consultation for the family. When dealing with a child who presented with severe periodontitis, 42.2% of the respondents did not advise examination of the parents. In addition, 39.1% of practitioners did not consider it possible to establish a family consultation. Finally, family factors are not often considered by French practitioners in the management of grade C periodontitis.

Full-Mouth Rehabilitation of a 15-Year-Old Girl Affected by a Rare Hypoparathyroidism (Glial Cell Missing Homolog 2 Mutation): A 3-Year Follow-Up.

OBJECTIVE: Familial isolated hypoparathyroidism is a rare genetic disorder due to no or low production of the parathyroid hormone, disturbing calcium and phosphate regulation. The resulting hypocalcemia may lead to dental abnormalities, such as enamel hypoplasia. The aim of this paper was to describe the full-mouth rehabilitation of a 15-year-old girl with chronic hypocalcemia due to a rare congenital hypoparathyroidism. CLINICAL CONSIDERATIONS: In this patient, in the young adult dentition, conservative care was preferred. Onlays or stainless-steel crowns were performed on the posterior teeth, and direct or indirect (overlays and veneerlays) were performed on the maxillary premolars, canines, and incisors, using a digital wax-up. The mandibular incisors were bleached. The treatment clearly improved the patient's oral quality of life, with fewer sensitivities, better chewing, and aesthetic satisfaction. The difficulties were the regular monitoring and the limited compliance of the patient. CONCLUSION: Despite no clinical feedback in the literature, generalized hypomineralized/hypoplastic teeth due to hypoparathyroidism in a young patient can be treated as amelogenesis imperfecta (generalized enamel defects) with a conservative approach for medium-term satisfactory results. HIGHLIGHTS: This study provides new insights into the management of enamel hypoplasia caused by familial isolated hypoparathyroidism, helping to improve patient outcomes in similar cases.

Effects of CAD/CAM restorative materials and thickness on the depth of cure of various light-cured resin composite materials.

The study assessed the depth of cure (DOC) of different resin composites light-cured through different types of CAD/CAM materials of variable thickness. Three CAD/CAM materials (multilayer zirconia, lithium disilicate glass ceramic, composite) of three thicknesses (2-, 3-, and 4-mm) were prepared and their translucency parameter (TP) were measured. A light-curable and a dual-curable resin cement (Variolink Esthetic LC and DC) and a bulk-fill resin composite with a higher Ivocerin concentration (Tetric PowerFill) were used to mimic luting agents. DOC was assessed via Vickers microhardness testing. Increased thickness of CAD/CAM specimen was associated with decreased DOC. The chemical composition of the resin composites affected their curing performance depending on the light curing mode. Tetric PowerFill presented the greater DOC among the other resin composites. Receiver operating characteristic models of curing status appeared to provide better insight in predicting the DOC of luting agent according to TP than linear regression.

Touch-cure activation by marketed universal resin luting cements of their associated primer to dentin.

PURPOSE: The aim of this study was to investigate the dentin shear bond strength (SBS) and bonding interface of three recently developed "universal" resin luting cements based on different modalities. METHODS: The dentin SBS and interfacial analysis of three recently launched "universal" resin luting cements, namely, G-Cem One, RelyX Universal and Panavia SA cement universal, were studied. All bonding protocols, including the previous use of their dedicated primer or universal adhesive in touch-cure mode or light-cure mode were performed. Variolink Esthetic LC used in conjunction with Scotchbond Universal Plus was used as a control group. For each group (n = 9), 10 specimens were tested for dentin SBS and two were examined by scanning electron microscopy. SBS were analyzed by two-way ANOVA followed by Dunnett's test. RESULTS: SBS values showed that the three "universal" resin luting cements tested exhibit different adhesive behaviors. G-Cem One with its touch-cure activated primer had a greater SBS to dentin (25.5 MPa) than that of the control group (22.1 MPa). CONCLUSION: "Universal" resin luting cements have variable efficacy when used in self-curing mode. The touch-curing mode is also of concern but may show high potential for some formulations.

Interdisciplinary full mouth rehabilitation of a patient with amelogenesis imperfecta from childhood to young adult-hood: A 12-year case report.

Treatment of patients with amelogenesis imperfecta extends over many years, from childhood to early adulthood. Their management at any age is complex and has to be adapted in relation to therapies validated in the general population.

In vitro remineralization by various ion-releasing materials of artificially demineralized dentin: A micro-CT study.

OBJECTIVE: The aim of this study was to evaluate the remineralizing properties of ion-releasing restorative materials on pH cycling-induced carious dentin. METHODS: Fifty sound molars were freshly extracted. The occlusal surfaces were abraded using water-cooled sandpaper (800 grit). The residual crowns were embedded in self-cured acrylic resin with the flat dentin surface exposed. A mesio-distal trench was created using a calibrated 0.5 mm deep occlusal reduction burr, and artificial dentin caries were generated by pH cycling. Then, teeth were randomly assigned to five groups according to the ion-releasing material used. For each sample, micro-CT acquisitions were performed at various intervals. Remineralization was assessed by mean gray value (MGV) measurements after registration and segmentation of the region of interest with 3D Slicer software. One-way repeated-measures ANOVA followed by Tukey's post hoc test was used to investigate the difference in MGVs among the various groups. RESULTS: Only Cention Forte showed significantly increased MGVs after 4 weeks compared to demineralized dentin. MGVs were higher, but not significantly, after placement of the restorative materials, including in the resin composite control group. These results can be explained by the radiopacity of the materials. SIGNIFICANCE: Cention Forte, the material with the highest radiopacity, showed a significant increase in the MGVs of artificially carious dentin after 4 weeks. However, the study of dentin remineralization by micro-CT could be impacted by the radiopacity of the restorative materials used. The relevance of this examination for the study of dentinal remineralization should be investigated.

Analysis of Resin-Based Dental Materials' Composition Depending on Their Clinical Applications.

The objective of this study was to detail the monomer composition of resin-based dental materials sold in the market in 2023 and to evaluate the proportion of bisphenol A (BPA)-derivatives in relation to their applications. A search on manufacturers' websites was performed to reference resin-based dental materials currently on the European market (including the European Union (EU) and United Kingdom (UK). Their monomer composition was determined using material-safety data sheets and was completed by a search on the PubMed database. Among the 543 material compositions exploitable, 382 (70.3%) contained BPA derivatives. Among them, 56.2% contained BisGMA and 28% BisEMA, the most frequently reported. A total of 59 monomers, of which six were BPA derivatives, were found. In total, 309 materials (56.9%) contained UDMA and 292 (53.8%) TEGDMA. Less than one third of materials identified contained no BPA derivatives. These proportions vary a lot depending on their applications, with materials dedicated to the dental care of young populations containing the highest proportions of BPA-derivative monomers. The long-term effects on human health of the different monomers identified including BPA-derivative monomers is a source of concern. For children and pregnant or lactating women arises the question of whether to take a precautionary principle and avoid the use of resin-based dental materials likely to release BPA by opting for alternative materials.

Perceptions regarding the use of a three-dimensionally-printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions.

PURPOSE/OBJECTIVES: Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost-effective three-dimensional (3D)-printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures). METHODS: The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross-sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed-rank test. RESULTS: Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction). CONCLUSIONS: The overall educational relevance of the simulator designed herein highlights the fact that 3D-printed educational simulators could enable efficient cognitive-functional learning for clinical IOL/IRL treatment.

Vat Photopolymerization 3D Printing in Dentistry: A Comprehensive Review of Actual Popular Technologies.

In this comprehensive review, the current state of the art and recent advances in 3D printing in dentistry are explored. This article provides an overview of the fundamental principles of 3D printing with a focus on vat photopolymerization (VP), the most commonly used technological principle in dental practice, which includes SLA, DLP, and LCD (or mSLA) technologies. The advantages, disadvantages, and shortcomings of these technologies are also discussed. This article delves into the key stages of the dental 3D printing process, from computer-aided design (CAD) to postprocessing, emphasizing the importance of postrinsing and postcuring to ensure the biocompatibility of custom-made medical devices. Legal considerations and regulatory obligations related to the production of custom medical devices through 3D printing are also addressed. This article serves as a valuable resource for dental practitioners, researchers, and health care professionals interested in applying this innovative technology in clinical practice.