The teaching of geriatric dentistry in South Korean dental schools.

OBJECTIVE: The purpose of this study was to investigate the curriculum of geriatric dentistry for undergraduates in Korean dental schools. BACKGROUND: For development purposes, it was necessary to compare geriatric dentistry education programmes in South Korea to programmes in the United States and Europe. METHODS: The most recent curriculum and related information on geriatric dentistry at the undergraduate level in all 11 dental schools in South Korea were collected by both official letter and e-mail. A symposium for gathering expert opinions to improve geriatric dentistry education in South Korea was also held. The collected data were analysed, and the expert opinions at the symposium were summarised. RESULTS: Six of 11 schools had a didactic course as compulsory and three schools as elective. The course was usually conducted as a form of integrated lectures, and the level of standardisation of lecture content was very low. There were no topics for older people who cannot access dental clinics due to functional frailty or disability. No dental school-affiliated hospitals had an independent department for geriatric dentistry. No schools provided clinical teaching for geriatric dentistry. There were no outreach programmes for geriatric dentistry. CONCLUSIONS: The educational curriculum for geriatric dentistry in South Korea was insufficient to cope with social and demographic changes. Curriculum content should include clinical practice education and needs to be focused on frail and dependent older adult patients. An essential educational curriculum and core competency for geriatric dentistry should be prepared.

Effects of surface treatments on the translucency, opalescence, and surface texture of dental monolithic zirconia ceramics.

STATEMENT OF PROBLEM: Surface polishing or glazing may increase the appearance of depth of monolithic zirconia restorations. PURPOSE: The purpose of this in vitro study was to investigate the effects of surface treatments on the translucency, opalescence, and surface texture of dental monolithic zirconia ceramics. MATERIAL AND METHODS: Forty-five monolithic zirconia specimens (16.3×16.4×2.0 mm) were divided into groups I to V, according to the number of colorings each received. Each group was then divided into 3 subgroups (n=3) according to the surface treatment: N=no treatment; P=polished; and G=glazed. CIElab color coordinates were obtained relative to D65 on a reflection spectrophotometer. The translucency parameter (TP) and opalescence parameter (OP) were calculated. One specimen per subgroups I and V was selected for evaluation of surface roughness (Ra) and was examined with scanning electron microscopy (SEM). Data were analyzed with 2-way ANOVA and pairwise comparisons (α=.05). Statistical powers were verified to evaluate results (α=.05). RESULTS: The interaction effects of surface treatments combined with the number of colorings were significant for TP, OP, and Ra (P<.001), as follows: Ra=partial eta squared [ηp(2)]=.928; OP ηp(2)=.184; and TP ηp(2)=.144. No significant differences between TP were found among surface treatments in most groups (P>.05), whereas glazing significantly decreased OP and Ra in most groups. SEM images demonstrated that surface treatments affected the surface texture of monolithic zirconia ceramics. CONCLUSIONS: Surface treatments combined with coloring strongly affect the surface texture of dental monolithic zirconia ceramics.

Implementation of CAD/CAM program in a nonface-to-face classroom environment due to the COVID-19 pandemic.

PURPOSE/OBJECTIVES: This study aimed to evaluate a nonface-to-face crown designing module in a preclinical dental course. METHODS: Free dental planning software (Blue Sky Plan) was installed on the personal computers of dental college students, and a #46 full veneer crown designing practice was performed individually. An online survey was conducted on the computers' specification and main usage of the students, the practice process, and results. Statistical analysis was conducted to analyze the association between variables, such as "operating system," "central processing unit ," "number of cores," "random-access memory (RAM)," "graphic card," and task performance. RESULTS: Of the D2 students, 75.4% (52 of 69) responded to the survey. Overall, 96% of the respondents used their computers, and all respondents had no problem running the program. Most of the students marked their level of computer literacy as intermediate and had purchased the computers for the purpose of performing light work. The most common specifications of the computer were Intel i5, quad core, 8 GB RAM, and Windows 10. Students had little experience with computer-aided design/computer-aided manufacturing before the class. The relationship between computer specifications and task performance was not statistically significant. CONCLUSIONS: Overall, students with intermediate-level computer literacy used computers with less than the recommended specifications of the program; however, they were able to run the program and individually proceed with modules to submit results. Using an individually available crown designing program can provide an opportunity to diversify curricula and broaden students' perspectives even under circumstances like the COVID-19 pandemic that limits intimate face-to face classes.

A randomized clinical 1-year trial comparing two types of non-submerged dental implants.

OBJECTIVES: This study compared the implant stability and clinical outcomes obtained with two types of non-submerged dental implants that have different thread designs and surface treatments. MATERIALS AND METHODS: A randomized clinical trial with 1 year of follow-up was performed on 56 participants with 75 implants (control group, 36 implants in 28 subjects; experimental group, 39 implants in 28 subjects). The experimental group received the Osstem SSII Implant system; the control group received the Standard Straumann Dental Implant System. The diameter and length of the fixture were uniform at 4.1 mm and 10 mm and all the implants restored the unilateral loss of one or two molars from the mandible. To compare implant stability, the peak insertion torque, implant stability quotient (ISQ), and periotest value (PTV) were evaluated during surgery, and at 4 and 10 weeks after surgery. To compare marginal bone loss, standard periapical radiographs were obtained during surgery, and at 10 weeks and 1 year after surgery. RESULTS: This study showed statistically significant differences between the two groups in peak insertion torque (P=0.009) and ISQ (P=0.003) but not in PTV (P=0.097) at surgery. In contrast, there was no statistically significant difference in the pattern of change of ISQ during the 10 weeks after surgery (P=0.339). For marginal bone loss, no significant difference was observed between the control and the experimental groups before functional loading (P=0.624), but after 1 year of follow-up, a borderline difference was observed (P=0.048). CONCLUSION: The success rate after 1 year of follow-up was 100% for both implant system despite the presence of a significant difference in implant stability during surgery. There was a borderline difference in marginal bone loss after 1 year of follow-up.

A pilot study using machine learning methods about factors influencing prognosis of dental implants.

PURPOSE: This study tried to find the most significant factors predicting implant prognosis using machine learning methods. MATERIALS AND METHODS: The data used in this study was based on a systematic search of chart files at Seoul National University Bundang Hospital for one year. In this period, oral and maxillofacial surgeons inserted 667 implants in 198 patients after consultation with a prosthodontist. The traditional statistical methods were inappropriate in this study, which analyzed the data of a small sample size to find a factor affecting the prognosis. The machine learning methods were used in this study, since these methods have analyzing power for a small sample size and are able to find a new factor that has been unknown to have an effect on the result. A decision tree model and a support vector machine were used for the analysis. RESULTS: The results identified mesio-distal position of the inserted implant as the most significant factor determining its prognosis. Both of the machine learning methods, the decision tree model and support vector machine, yielded the similar results. CONCLUSION: Dental clinicians should be careful in locating implants in the patient's mouths, especially mesio-distally, to minimize the negative complications against implant survival.

Prosthetic reconstruction with an obturator using swing-lock attachment for a patient underwent maxillectomy: A clinical report.

Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth.

Effect of the amount of thickness reduction on color and translucency of dental monolithic zirconia ceramics.

PURPOSE: This study investigated the effect of amount of thickness reduction on color and translucency of dental monolithic zirconia ceramics. MATERIALS AND METHODS: One-hundred sixty-five monolithic zirconia specimens (16.3 mm × 16.3 mm × 2.0 mm) were divided into 5 groups (Group I to V) according to the number of A2-coloring liquid applications. Each group was then divided into 11 subgroups by reducing the thickness up to 1.0 mm in 0.1-mm increments (Subgroup 0 to 10, n=3). Colors and spectral distributions were measured according to CIELAB on a reflection spectrophotometer. All measurements were performed on five different areas of each specimen. Color difference (ΔE(*) ab) and translucency parameter (TP) were calculated. Data were analyzed using one-way ANOVA and multiple comparison Scheffé test (α=.05). RESULTS: There were significant differences in CIE L(*) between Subgroup 0 and other subgroups in all groups. CIE a(*) increased (0.523.7) were obtained between Subgroup 0 and other subgroups. TP values generally increased as the thickness reduction increased in all groups (R(2)>0.89, P<.001). CONCLUSION: Increasing thickness reduction reduces lightness and increases a reddish, bluish appearance, and translucency of monolithic zirconia ceramics.

Biomechanical three-dimensional finite element analysis of monolithic zirconia crown with different cement type.

PURPOSE: The objective of this study was to evaluate the influence of various cement types on the stress distribution in monolithic zirconia crowns under maximum bite force using the finite element analysis. MATERIALS AND METHODS: The models of the prepared #46 crown (deep chamfer margin) were scanned and solid models composed of the monolithic zirconia crown, cement layer, and prepared tooth were produced using the computer-aided design technology and were subsequently translated into 3-dimensional finite element models. Four models were prepared according to different cement types (zinc phosphate, polycarboxylate, glass ionomer, and resin). A load of 700 N was applied vertically on the crowns (8 loading points). Maximum principal stress was determined. RESULTS: Zinc phosphate cement had a greater stress concentration in the cement layer, while polycarboxylate cement had a greater stress concentration on the distal surface of the monolithic zirconia crown and abutment tooth. Resin cement and glass ionomer cement showed similar patterns, but resin cement showed a lower stress distribution on the lingual and mesial surface of the cement layer. CONCLUSION: The test results indicate that the use of different luting agents that have various elastic moduli has an impact on the stress distribution of the monolithic zirconia crowns, cement layers, and abutment tooth. Resin cement is recommended for the luting agent of the monolithic zirconia crowns.

The influence of various core designs on stress distribution in the veneered zirconia crown: a finite element analysis study.

PURPOSE: The purpose of this study was to evaluate various core designs on stress distribution within zirconia crowns. MATERIALS AND METHODS: Three-dimensional finite element models, representing mandibular molars, comprising a prepared tooth, cement layer, zirconia core, and veneer porcelain were designed by computer software. The shoulder (1 mm in width) variations in core were incremental increases of 1 mm, 2 mm and 3 mm in proximal and lingual height, and buccal height respectively. To simulate masticatory force, loads of 280 N were applied from three directions (vertical, at a 45° angle, and horizontal). To simulate maximum bite force, a load of 700 N was applied vertically to the crowns. Maximum principal stress (MPS) was determined for each model, loading condition, and position. RESULTS: In the maximum bite force simulation test, the MPSs on all crowns observed around the shoulder region and loading points. The compressive stresses were located in the shoulder region of the veneer-zirconia interface and at the occlusal region. In the test simulating masticatory force, the MPS was concentrated around the loading points, and the compressive stresses were located at the 3 mm height lingual shoulder region, when the load was applied horizontally. MPS increased in the shoulder region as the shoulder height increased. CONCLUSION: This study suggested that reinforced shoulder play an essential role in the success of the zirconia restoration, and veneer fracture due to occlusal loading can be prevented by proper core design, such as shoulder.

Implant-supported overdenture with prefabricated bar attachment system in mandibular edentulous patient.

Implant-supported overdenture is a reliable treatment option for the patients with edentulous mandible when they have difficulty in using complete dentures. Several options have been used for implant-supported overdenture attachments. Among these, bar attachment system has greater retention and better maintainability than others. SFI-Bar® is prefabricated and can be adjustable at chairside. Therefore, laboratory procedures such as soldering and welding are unnecessary, which leads to fewer errors and lower costs. A 67-year-old female patient presented, complaining of mobility of lower anterior teeth with old denture. She had been wearing complete denture in the maxilla and removable partial denture in the mandible with severe bone loss. After extracting the teeth, two implants were placed in front of mental foramen, and SFI-Bar® was connected. A tube bar was seated to two adapters through large ball joints and fixation screws, connecting each implant. The length of the tube bar was adjusted according to inter-implant distance. Then, a female part was attached to the bar beneath the new denture. This clinical report describes two-implant-supported overdenture using the SFI-Bar® system in a mandibular edentulous patient.

The effect of preparation order on the crystal structure of yttria-stabilized tetragonal zirconia polycrystal and the shear bond strength of dental resin cements.

OBJECTIVES: The purpose of this study was to evaluate the effect of preparation order on the crystal structure of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and the shear bond strength of dental resin cements. METHODS: One-hundred fifty pre-sintered Y-TZP cylinders (Ø 9mm×13.5mm) were prepared and divided into three groups (control group, SBS group and SAS group). Specimens in control group were not treated. Specimens in SBS group were sandblasted and then densely sintered, and specimens in SAS group were sintered in advance, and then sandblasted. The specimens were analyzed by X-ray diffractometry, confocal laser scanning microscopy and Energy dispersive X-ray spectroscopy before and after sandblasting. All specimens were embedded in polytetrafluoroethylene (PTFE) molds using PMMA and each group was divided into five subgroups. The mixed resin cements (Clearfil SA luting cement, Zirconite, Superbond C&B, Rely-X Unicem, and Multilink) were placed onto the Y-TZP surfaces using PTFE molds with Ø 3mm×3mm, followed by storage in distilled water at 37°C for 24h, and thermocycling (5000 cycles at 5°C and 55°C with a 30s dwelling time). All specimens were tested for the shear bond strengths with a universal testing machine, and fractured surfaces were evaluated by SEM. Statistical analysis was performed using one-way ANOVA and Scheffé comparison with α=.05. RESULTS: Sandblasting of the zirconia significantly increased shear bond strength of resin cements, but the preparation order had no significant influence on the shear bond strength in both test groups. In SEM observation, the natures of the surface faceting of the zirconia grains were totally different between SBS and SAS groups. SBS group exhibited less monoclinic structures than SAS group. SIGNIFICANCE: Sandblasting of pre-sintered Y-TZP and then sintering may induce favorable proportion of tetragonal structures. This might have positive effect on the clinical performance of zirconia restorations.

Effect of sandblasting and various metal primers on the shear bond strength of resin cement to Y-TZP ceramic.

OBJECTIVES: This study was designed to evaluate the effect of sandblasting and metal primers on the shear bond strength of three commercial resin cements to Yttria-Tetragonl Zirconia Polycrystal (Y-TZP) ceramics. METHODS: One hundred and twenty Y-TZP ceramic cylinders (Ø7 mm x 12 mm) were embedded in polytetrafluoroethylene (PTFE) molds using PMMA. The specimens were divided randomly into 12 groups (n=10), according to the surface treatments (control; sandblast-only; metal primer-only; sandblast+metal primer) and metal primer-resin cements (Alloy primer - Panavia F 2.0, V-primer - Superbond C&B, Metaltite - M bond) rendered. The mixed resin cements were placed onto the treated zirconia surfaces in cylindrical shape (Ø3 mm x 3 mm) using PTFE molds. All specimens were thermocycled (5 and 55 degrees C, 5000 cycles) and subjected to shear bond strength test by a universal testing machine with a crosshead speed of 0.5 mm/min. All data were statistically analyzed using two-way ANOVA and multiple comparison Scheffé test (alpha=0.05), and SEM images of the fractured areas were used to evaluate the fracture mode. RESULTS: In Panavia F 2.0, the bond strength of the specimens treated with sandblasting and metal primer (Alloy primer) was significantly higher than those of the other subgroups. In Superbond C&B and M bond, sandblasting significantly increased the shear bond strength, but the effect of metal primers (V-primer and Metaltite) was not significant and there was disordinal interaction. SIGNIFICANCE: Metal primers are not always effective for bonding between Y-TZP ceramics and resin cements. Even though a metal primer is not enough to be used alone, combined application with sandblasting seems to be an appropriate pretreatment for improving the bond strength of resin cement to Y-TZP ceramics, especially in Panavia F 2.0.

Comparison of polymer-based temporary crown and fixed partial denture materials by diametral tensile strength.

PURPOSE: The purpose of this study was to investigate the diametral tensile strength of polymer-based temporary crown and fixed partial denture (FPD) materials, and the change of the diametral tensile strength with time. MATERIAL AND METHODS: One monomethacrylate-based temporary crown and FPD material (Trim) and three dimethacrylate-based ones (Protemp 3 Garant, Temphase, Luxtemp) were investigated. 20 specimens (ø 4 mm × 6 mm) were fabricated and randomly divided into two groups (Group I: Immediately, Group II: 1 hour) according to the measurement time after completion of mixing. Universal Testing Machine was used to load the specimens at a cross-head speed of 0.5 mm/min. The data were analyzed using one-way ANOVA, the multiple comparison Scheffe test and independent sample t test (α = 0.05). RESULTS: Trim showed severe permanent deformation without an obvious fracture during loading at both times. There were statistically significant differences among the dimethacrylate-based materials. The dimethacrylate-based materials presented an increase in strength from 5 minutes to 1 hour and were as follows: Protemp 3 Garant (23.16 - 37.6 MPa), Temphase (22.27 - 28.08 MPa), Luxatemp (14.46 - 20.59 MPa). Protemp 3 Garant showed the highest value. CONCLUSION: The dimethacrylate-based temporary materials tested were stronger in diametral tensile strength than the monomethacrylate-based one. The diametral tensile strength of the materials investigated increased with time.