Dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on preclinical skills.

INTRODUCTION: Assessing exemplars as a formative activity is thought to promote students' learning. This study aimed to investigate dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on students' preclinical skills. MATERIALS AND METHODS: In a non-randomised controlled crossover trial with two intervention arms, 92 undergraduates in their first preclinical course self-enrolled in into the intervention group (A1-INT) or control group (B1-CT). The intervention group assessed photographic images of composite restorations before restoring an ivorine premolar with composite while the control group restored the same tooth without assessing the photographic exemplars. Intervention and control groups were swapped 3 days later in a second iteration (B2-INT, A2-CT). Data were analysed in SPSS® version 27 using nonparametric tests. RESULTS: Students who did not complete all activities in the study were excluded. Therefore, 57 out of the 92 student participants were included in the study analysis. No significant differences were observed between intervention and control groups' ability to assess quality of photographic exemplars or restoring a tooth in both iterations. CONCLUSION: Students were able to identify the quality of composite restorations in photographic exemplars. It appears that assessing photographic exemplars did not have an immediate impact on students' ability to restore a tooth with composite.

A systematic review of methodology for the creation of virtual 3D models for use in dental education and a narrative review.

OBJECTIVES: Virtual Reality (VR) technologies can be used as a content-delivery system for the purposes of both entertainment and education. Remote and digital education has become ever so important in a world where global disruptive events such as pandemics and natural disasters can define access to a face-to-face learning environment. An important aspect of VR technologies for dentistry is the creation of digital 3D models. The primary of this review was to answer the focused research question, "What software techniques are used in the creation of digital 3D models for use in dental education." METHODS: This study systematically evaluates current software and techniques used for creating digital 3D models in dental education using the Preferred Reporting Items for Systematic Reviews (PRIMSA). RESULTS: The search strategies did not find any studies specific to the creation of dental-related 3D models. Therefore, this study for the first time provided an overview of common techniques of 3D model fabrication is discussed. Further some examples of methods of creating 3D models relevant to dentistry such armamentarium and anatomical oral structures have been discussed in considerable detail. CONCLUSION: The creation of 3D modelling is a rapidly evolving field with software updates and new programs being continually released. This work highlights fundamental lack of published work in the creation of 3D dental models for educational applications.

Effectiveness of photobiomodulation in reducing pain and producing dental analgesia: a systematic review.

PURPOSE: Photobiomodulation (PBM) is reported in many studies to produce dental analgesia without producing thermal damage to tissues. This systematic review aims to assess in vivo studies to support the statement that PBM can produce dental analgesia. METHOD: A systematic search strategy was constructed, and PubMed, Scopus, and Embase databases were searched. Subsequently, inclusion and exclusion criteria were applied, reference lists were scanned, and hand searched to identify other suitable studies. RESULTS: Five studies met the inclusion criteria. Meta-analysis was not undertaken due to the heterogenous nature of the studies and data. Positive analgesia outcome was obtained in four out of five studies, and one study with no significant results was criticized for poor reporting of laser parameters, small sample size (six). CONCLUSION: In general, all studies were criticized for poor discussion of all covariates that could have modified the results, consequently resulting in poor quality of evidence, moderate risk of bias, and poor internal validity, as well as external validity. The systematic review also discussed the potential implications of all variables to be considered for future trials, including pulsing mode, contact modes, and tooth characteristics.

Bioenergetics of photobiomodulated osteoblast mitochondrial cells derived from human pulp stem cells: systematic review.

Dental pulp cells are a source of multipotent mesenchymal stem cells with a high proliferation rate and multilineage differentiation potential. This study investigated the photobiomodulated bioenergetic effects of mitochondria in osteoblasts that differentiated from human pulp stem cells. The systematic review followed PRISMA guidelines. The PICO question was formulated. Criteria for inclusion and exclusion were established prior to searches being performed on the PubMed/MEDLINE, Embase, and Scopus. Articles were identified and included if published in English within last 10 years; photobiomodulation or low-level laser therapy were discussed; the delivery parameters for dose and time were included and the studies focused on bioenergetics of osteoblast mitochondria. Studies excluded were non-human dental pulp tissue and in vivo studies. A total number of 110 articles were collated, 106 were excluded leaving a total of 4 articles. These studies demonstrated that in vitro use of photobiomodulation was performed using different laser and LED types; InGaAlP; InGaN; and InGaAsP with average wavelengths of 630 to 940 nm. Primary human osteoblastic STRO-1 and mesenchymal stem cell lineages were studied. Three out of four articles confirmed positive bioenergetic effects of photobiomodulation on mitochondria of osteoblasts derived from human pulp cells. This systematic review demonstrated a lack of adequate reporting of bioenergetics of osteoblast mitochondria after photobiomodulation treatment.

The influence of delivery power losses and full operating parametry on the effectiveness of diode visible-near infra-red (445-1064 nm) laser therapy in dentistry-a multi-centre investigation.

The development of protocols for laser-assisted therapy demands strict compliance with comprehensive operating parametry. The purpose of this investigation was to examine the accuracy of correlation between laser control panel and fibre emission power values in a selection of diode dental lasers. Through retrospective analysis using successive systematic review and meta-analysis, it is clear that there is inconsistency in the details, and possible inaccuracies in laser power applied and associated computed data. Through a multi-centre investigation, 38 semi-conductor ("diode") dental laser units were chosen, with emission wavelengths ranging from 445 to 1064 nm. Each unit had been recently serviced according to manufacturer's recommendations, and delivery fibre assembly checked for patency and correct alignment with the parent laser unit. Subject to the output capacity of each laser, four average power values were chosen using the laser control panel-100 mW, 500 mW, 1.0 W, and 2.0 W. Using a calibrated power meter, the post-fibre emission power value was measured, and a percentage power loss calculated. For each emission, a series of six measurements were made and analysed to investigate sources of power losses along the delivery fibre, and to evaluate the precision of power loss determinations. Statistical analysis of a dataset comprising % deviations from power setting levels was performed using a factorial ANOVA model, and this demonstrated very highly significant differences between devices tested and emission power levels applied (p < 10-142 and < 10-52 respectively). The devices × emission power interaction effect was also markedly significant (p < 10-66), and this confirmed that differences observed in these deviations for each prior power setting parameter were dependent on the device employed for delivery. Power losses were found to be negatively related to power settings applied. Significant differences have emerged to recommend the need to standardize a minimum set of parameters that should form the basis of comparative research into laser-tissue interactions, both in vitro and in vivo.

A novel scale to measure students' perceptions of exemplars in a dental school.

INTRODUCTION: Exemplars are an effective strategy for initial cognitive and psychomotor skill acquisition and promoting students' self-regulation. Yet, there is limited evidence about students' use and perception of exemplars in dental education. Therefore, this study aimed to develop a scale to measure students' perception of exemplars in an Australian dental school. MATERIALS AND METHODS: Phase I assessed the relevant literature and students' responses to an interview. Four themes were identified for developing a 19-item questionnaire rated by an expert panel. Phase II piloted the questionnaire amongst a group of 30 students. Phase III analysed psychometric and qualitative open-ended questions data obtained from a large group of students. RESULTS: The principal axis factoring resulted in one single factor that explained over 62% of the variance and had an alpha of .88. The number of questions was reduced from 19 to 6 items with loadings of 0.72 or above for each item. Students reported exemplars are beneficial for their learning and to visually guide them to understand procedures and their intended outcomes. This prompts them to think and mentally prepare before performing. Students further reported using exemplars provided by their courses almost as often as exemplars they search in social media. CONCLUSION: Well-developed exemplars could play a key role in enhancing learning and could assist teaching. Understanding students' use and perception of exemplars will help educators to develop and evaluate appealing exemplars. Therefore, this study developed a new instrument to measure students' perception of exemplars, verified its reliability and validity.

Quality of techniques used to assess clinical outcomes of regenerative endodontic treatment in necrotic mature teeth.

Data sources A preliminary, randomised, prospective, controlled clinical trial of patients managed with two regenerative endodontic procedures, revitalisation and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps.Study selection Twenty patients with mature necrotic anterior teeth with large periapical lesions treated with the blood clot and a PRF-based techniques for revitalisation. Periradicular healing and pulp sensibility was assessed at 6 and 12 months after treatment.Results Significant periradicular radiographic healing and sensibility was reported at 6 and 12 months.

A systematic literature review of assessment feedback in preclinical dental education.

INTRODUCTION: Development of evaluative judgement abilities through assessment and feedback strategies is crucial in students' progress to become self-regulated lifelong learners. Dentists' ability to appraise the quality of treatment provided to their patients starts with development of competences in a simulated preclinical training environment. However, the effectiveness of these assessment and feedback strategies is not well understood. MATERIAL AND METHODS: This literature review aimed to identify the assessment and feedback interventions and their effect on dental students' appraisal and psychomotor skills during preclinical training. A search of the electronic databases PubMed, Ebscohost (Dentistry and Oral Health), Scopus, Web of Science and EMBASE was conducted of studies published until October 2019. RESULTS: Twelve studies met the inclusion criteria. Two studies were randomised controlled trials and ten non-randomised studies. All studies included students' self-assessment and grading criteria as part of their feedback interventions. Feedback utilisation training was reported in 66% of the included studies. Evidence suggests feedback strategies improve psychomotor skills and increase agreement between students' and teachers' awarded grades. However, these improvements vary with the complexity of the task. Only one study shows self-directed learning significantly contributing to students' psychomotor skill improvement. CONCLUSION: Although assessment and feedback are regarded as crucial for developing students' evaluative judgement capabilities to become self-regulated lifelong learners, there is limited empirical evidence of the assessment and feedback conditions that enhance students' judgement abilities, performance and self-regulation. Further research is needed to investigate and compare the effect of different assessment and feedback interventions on students' appraisal skills, their impact on learning and self-regulation.

What is the evidence of outcomes of endodontically treated cracked teeth?

Data sources Ovid, PubMed and Cochrane were searched using the indexed terms. Additional searches were made using endodontic textbooks and endodontic-related journals.Study selection Two independent reviewers screened the titles, abstracts and/or full text for clinical studies evaluating the treatment outcomes of healthy patients over 18 years of age who received root canal treatment with at least one year in occlusal function.Results The study included four articles and reported an overall survival of 84% after 60 months in endodontically treated cracked teeth. The authors reported that teeth with single crack, cracks contained within crowns and teeth with pre-treatment periodontal probing less than 3 mm had a lower risk of being extracted.Conclusion This study reported a moderately high survival rate of endodontically treated cracked teeth.

The effect of photobiomodulation on human dental pulp-derived stem cells: systematic review.

This systematic review assessed if photobiomodulation of human dental pulp tissue improved cell viability, proliferation, and/or differentiation compared with a placebo. This systematic review was conducted in line with PRISMA. PICO question was established; inclusion and exclusion criteria were established before a search had begun. A literature search was conducted through PubMed, Scopus, and Cochrane. Studies were included if published within the last 20 years in English language, or where translation was available; laser parameters were mentioned; human dental pulp tissue was studied in vitro. Studies were excluded if non-human dental pulp tissue was studied and where the study was an in vivo study. Out of the total 121 studies found, 109 were excluded. Of the twelve included studies, three full-text articles were not available despite attempts made to contact the respective authors, leaving nine studies. Four of the included studies reported the use of stem cells derived from human deciduous teeth (SHEDs), and five used those from human permanent teeth (DPSCs). Most included studies utilized InGaAlP laser with wavelengths 660 nm, and one study with 610 nm. Other types of lasers included LED InGaN, and GaAlAs. Out of all included studies, two had a moderate risk of bias, and the rest had a low risk of bias. All studies confirmed positive effects on proliferation. One study also found improved osteogenic differentiation of the stem cells derived from stem cells of deciduous teeth. After assessing SHEDs and DPSCs separately, it is found that photobiomodulation improved cell proliferation in both subgroups. Due to heterogeneity in design protocols and laser parameters, it was not possible to compare the studies together. However, this study indicated that cell viability and proliferation did improve with photobiomodulation.

Is partial pulpotomy in cariously exposed posterior permanent teeth a viable treatment option?

Data sources PubMed, ScienceDirect and Cochrane, Open Grey. Journal of Dentistry; Journal of Endodontics; International Endodontic Journal; Australian Endodontic Journal; and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and EndodonticsStudy selection Two independent reviewers screened the titles, abstracts and/or full-text for randomised clinical trials and prospective clinical studies dealing with the success rate of treating cariously exposed vital human permanent posterior teeth with a partial pulpotomy. The cases were followed up for 6 to 24 months.Results The study included five randomised clinical trials and six prospective studies. The pooled data indicated that partial pulpotomy in carious exposed teeth had a success rate of 98%, 96% and 92% after 6 months and 1 and 2 years of follow-up. However, teeth with a presumptive diagnosis of irreversible pulpitis displayed significantly lower success rates. Interestingly, neither the pulp capping material used nor the status of the root apex (apical root closure) or age of the patient affected the treatment success rate.Conclusion The study reported high 2 year success rates when cariously exposed permanent posterior teeth were treated using a partial pulpotomy procedure.

Efficacy of photobiomodulation on accelerating bone healing after tooth extraction: a systematic review.

Post-extraction healing of the socket may take up to 24 weeks to complete. This systematic review aims to evaluate whether photobiomodulation accelerates bone healing in those sockets. A search strategy was developed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Cochrane Library, and Scopus electronic databases were searched for in vivo studies with restrictions on the year (< 50 years old) and language (English). After applying the inclusion criteria, ten studies were selected for review. Test subjects included humans (3), rats (5), and rabbits (2), either healthy or with specified systemic condition(s). Laser parameters applied varied between studies significantly. Six studies measured bone density or bone trabeculae percentage, while remaining studies measured secondary outcome measures such as osteogenesis markers, patient's self-reported pain scores, and clinical epithelial regeneration. No side effects of photobiomodulation have been reported. Higher concentration of osteogenesis markers Ocn and Runx2 were consistently reported across studies, as well as higher percentage of bony trabeculae and bone density. Within the limitations of this review, improvement in bone repair can be found when using photobiomodulation in extraction sockets.

Evaluation of the evidence of effectiveness of ultrasonic activated irrigation for root canal treatment.

Data sources Cochrane Library, Embase, LILACS, PubMed, SciELO, Scopus databases, endodontic journals and textbooks. Study selection Two independent reviewers screened the titles, abstracts and/or full-text of the both clinical or in vitro studies that used ultrasonic irrigant activation for management of teeth needing root canal therapy. Results The study included three clinical studies and 45 in vitro studies. The study reported no evidence of any benefit of ultrasonic activation over needle irrigation in improving the healing rate of apical periodontitis. While the study reported that the evidence for disinfection of the root canal was inconclusive it did show evidence of the efficacy of ultrasonic irrigation over needle irrigation when removal of pulp tissue remnants and hard tissue debris was assessed. Conclusion The study reported that it was essential that there should be more research into the antimicrobial effect on healing in periapical periodontitis when teeth are treated using ultrasonic activation.

Dispersion of near-infrared laser energy through radicular dentine when using plain or conical tips.

The aim of this study was to investigate the influence of tip design on patterns of laser energy dispersion through the dentine of tooth roots when using near-infrared diode lasers. Diode laser emissions of 810 or 940 nm were used in combination with optical fiber tips with either conventional plain ends or conical ends, to irradiate tooth roots of oval or round cross-sectional shapes. The lasers were operated in continuous wave mode at 0.5 W for 5 s with the distal end of the fiber tip placed in the apical or coronal third of the root canal at preset positions. Laser light exiting through the roots and apical foramen was imaged, and the extent of lateral spread calculated. There was a significant difference in infrared light exiting the root canal apex between plain and conical fiber tips for both laser wavelengths, with more forward transmission of laser energy through the apex for plain tips. For both laser wavelengths, there were no significant differences in emission patterns when the variable of canal shape was used and all other variables were kept the same (plain vs conical tip, tip position). To ensure optimal treatment effect and to prevent the risks of inadvertent laser effects on the adjacent periapical tissues, it is important to have a good understanding of laser transmission characteristics of the root canal and root dentine. Importantly, it is also essential to understand transmission characteristics of plain and conical fibers tips.

Additive Manufacturing: A Novel Method for Fabricating Cobalt-Chromium Removable Partial Denture Frameworks.

Additive manufacturing (AM) often referred to as 3D printing (3DP) has shown promise of being significantly viable in the construction of cobalt-chromium removable partial denture (RPD) frameworks. The current paper seeks to discuss AM technologies (photopolymerization processes and selective laser melting) and review their scope. The review also discusses the clinical relevance of cobalt-chromium RPD frameworks. All relevant publications in English over the last 10 years, when the first 3D-printed RPD framework was reported, are examined. The review notes that AM offers significant benefits in terms of speed of the manufacturing processes however cost and other aspects of current technologies remain a hindrance.

Pulpal response following photo-biomodulation with a 904-nm diode laser: a double-blind clinical study.

The aim of this study was to evaluate pulpal responses in healthy human teeth to photo-biomodulation therapy (PBMT) with 904-nm GaAs diode laser. The study followed a double-blind split mouth design, with a randomly selected maxillary first premolar acting as a sham-irradiated control tooth, and the contralateral tooth receiving active laser treatment. Two coded but otherwise identical laser probes (Irradia™, SpectraMedics Ltd., NC, USA) were used to deliver the sham (placebo) and laser radiation, with both the operator and patient unaware of each probe's identity. The selection of teeth for sham or laser irradiation was randomised for each treatment. Pulpal responses were assessed using electric pulp testing (EPT), 2 min prior to exposure, and immediately after laser irradiation (60 s, 30 mW average power, 25 Hz pulse frequency, 3.6 J/cm2). Treatment effects were analysed using the Wilcoxon-signed rank test. A total of 30 participants provided written informed consent. Majority of the participants (66.7 %) demonstrated an analgesic effect following PBMT (elevated EPT scores); however, nine participants (30 %) reported the lower EPT scores than the control. Both the treatment effects (stimulation and analgesia) were significant compared to the placebo. In most individuals, PBMT of healthy teeth with a 904-nm GaAs diode laser can induce analgesia, as witnessed by elevated EPT scores. A converse effect can occur in a minority of subjects.

Oral Cancer: An Evaluation of Knowledge and Awareness in Undergraduate Dental Students and the General Public.

PURPOSE: To evaluate the knowledge of signs, symptoms and risk factors associated with oral cancer amongst undergraduate dental students and members of the general public. MATERIALS AND METHODS: This study was open for a period of six months (Jan-June, 2013) to all undergraduate dental students in the 4th and 5th year of the dental science programme and dental patients attending the School of Dentistry, Griffith University, Australia. The survey evaluated the knowledge and awareness of clinical signs and symptoms and risk factors of oral cancers. RESULTS: A total of 100 undergraduate students and 150 patients provided informed consent and participated in this survey study. Both patients and dental students were aware of the importance of early detection of oral cancer. With the exception of smoking and persistent ulceration, this study indicated that the knowledge about oral cancer, its signs, symptoms and risk factors was limited amongst participants. CONCLUSION: This study highlights the need to raise awareness and knowledge pertaining to oral cancer, not only in the general community but also amongst those in the dental field. Specific points of concern were the common intraoral sites for oral cancer, erythroplakia as a risk factor, the synergistic action of smoking and alcohol, and HPV (human papilloma virus) as risk factors for oral cancer.

Precision of multi-frequency electronic apex locators.

Data sourcesCochrane Central Register of Controlled Trials, Medline, Embase and Scopus databases.Study selectionStudies that reported the precision of electronic apex locators (EALs) in locating the apical constriction (AC) in primary root canal treatment of human teeth compared with a histologic evaluation of the AC were considered.Data extraction and synthesisData were extracted and quality assessed independently by two reviewers.ResultsTen studies were included, reporting on 1105 EAL measurements. Seven studies were considered to be at high risk of bias and three at low risk. Four different EALs were evaluated; Root ZX (J Morita, Tokyo, Japan), Justy II (Hager & Werken GmbH & Co, Duisburg, Germany), Endy 5000 (Loser Co, Leverkusen, Germany) and Endox (Lysis Co, Milan, Italy). Three EALs, Root ZX, Justy II and Endy 5000 were more accurate than the Endox in determining the distance between the file tip and the apical constriction. Pulp status was only available for 194 (17.55%) of the measurements. The status of the pulp (vital or necrotic) had no significant effect on precision.ConclusionsThe precision of electronic working length measurement depends on the device used and the type of irrigation and is not influenced by the status of the pulp tissue.

Laser-induced agitation and cavitation from proprietary honeycomb tips for endodontic applications.

Cavitation and agitation generated by lasers in fluid-filled root canals create fluid movement and shear stresses along the root canals walls, enhancing removal of the smear layer and biofilm. When used with sodium hypochlorite and EDTA, laser activation of aqueous fluids can increase the efficiency of debridement and disinfection of root canals. However, the use of forward-firing laser fibers with such solutions poses a risk of driving fluid past the root apex, which could cause postoperative complications. The purpose of this study was to evaluate the mechanism of fluid agitation caused by a novel honeycomb tip. Glass capillary tubes filled with distilled water were used to replicate single-tooth root canals. A 980 nm pulsed diode laser was used with 200 µm diameter plain tips, tube-etched conical tips, and honeycomb tips. To record fluid movements, the tubes were backlit and imaged using a digital camera attached to a microscope. The honeycomb tips generated agitation with fluid movement directed onto the walls, while both the conventional plain fibers and the conical tips created fluid movement largely in a forward direction. The use of honeycomb tips alters the pattern of fluid agitation, and this laterally directed effect might lower the risk of fluid extrusion beyond the apex.

Discoloration of roots caused by residual endodontic intracanal medicaments.

AIMS: This study examined the extent to which intervisit corticosteroid-based antibiotic pastes (CAP) medicaments contribute to staining of tooth structure after attempted removal by irrigation techniques. METHODS: A total of 140 roots were prepared and the canals were filled with Ledermix paste (demeclocycline), Odontopaste (clindamycin), and Doxypaste (doxycycline). The pastes were removed after 2 or 4 weeks of storage in the dark using EDTA and NaOCl with either a 27-gauge-slotted needle or an EndoActivator (Dentsply). The roots were then exposed to an intense light source for 30 minutes each week and photographed after a further 1, 3, or 6 months. Digital images were standardized and data for changes in luminosity were analysed using repeated measures ANOVA and a post hoc test. RESULTS: Removal of the medicament did not prevent later discolouration. There was no significant difference between the paste removal methods. Ledermix paste caused the greatest darkening compared to the untreated controls, for both application periods and both methods of removal. Doxypaste and Odontopaste caused less darkening than Ledermix. CONCLUSION: Medicaments that stain teeth may continue to discolour teeth despite best attempts to remove them. This study stresses the importance of material selection and minimising contact of Ledermix within the coronal aspects of teeth.