Influence of thermal aging on the marginal integrity of computer aided design/computer aided manufacturing fabricated crowns.

Background/purpose: The adaptation and marginal integrity of computer-aided designed and computer-aided manufactured (CAD/CAM) crowns after exposure to thermal aging need to be investigated. The present in-vitro study was designed to investigate the marginal integrity of CAD/CAM fabricated crowns cemented on extracted teeth after thermocycling aging. Materials and methods: Twenty-six newly extracted human premolars were prepared for full-coverage CAD/CAM crowns and were divided into two groups (leucite-reinforced glass-ceramics and lithium disilicate glass-ceramics). Both crowns' groups were cemented using dual curing resin cement. All specimen margins were measured for marginal integrity using an imaging system 24 h post cementation; then after 1, 3, and 5 estimated clinical years (10,000, 30,000, and 50,000 thermocycles). Two-way ANOVA analysis were used to determine whether the mean value difference is significantly different (ɑ = 0.05). Results: The average margin gaps recorded for leucite-reinforced glass-ceramic crowns were: 82.61 µm initial, and 91.02 µm after 5 estimated clinical year). For the lithium disilicate glass-ceramic crowns, the average margin gaps recorded were: 100.01 µm initial, and 120.21 µm after 5 estimated clinical year. During all measuring intervals, the leucite-reinforced glass-ceramic crown group had a lower marginal discrepancy. No statistically significant difference between the two groups was recorded. Conclusion: After being subjected to thermocycling, both CAD/CAM ceramic crowns, exhibited an increase in their marginal discrepancy; the difference was within the accepted clinical range.

Further development of the reflective practice questionnaire.

Background: This article provides an update of the Reflective Practice Questionnaire (RPQ). The original RPQ consisted of 40-items with 10-sub-scales. In this article, the RPQ is streamlined into a 10-item single reflective practice construct, and a 30-item extended version that includes additional sub-scales of confidence, uncertainty/stress, and work satisfaction. Methods: A total of 501 university students filled out an online questionnaire that contained the original Reflective Practice Questionnaire, and two general measures of reflection: The Self-Reflection and Insight Scale, and the Rumination-Reflection Questionnaire. Results: Based on factor analysis, the RPQ was streamlined into a brief 10-item version, and an extended 30-item version. Small positive correlations were found between the RPQ reflective practice measure and the two measures of general reflection, providing discriminant validity evidence for the RPQ. The RPQ was found to be sensitive to differences among industries, whereas the general measures of reflection were not. Average reflective practice scores were higher for health and education industries compared to retail and food/accommodation industries.

The Dental Educational Environment of Online and Blended Learning during COVID-19, and the Impact on the Future of Dental Education.

Blending face-to-face and online learning should create a focused environment that supports deep and meaningful teaching and learning that engages learners in a more active and collaborative educational experience. The present study aimed to evaluate students' online and blended learning educational environment self-perception at the Faculty of Dentistry, Kuwait University, during the COVID-19 pandemic. METHODS: Undergraduate dental students who participated in blended learning with online lectures were invited to participate. The sample was a non-probability convenient sample, which included all clinical dental students invited to participate, who were enrolled in the fifth, sixth, and seventh (clinical year) years. All 69 students in these three clinical years were invited to participate. Electronic consent to participate and a self-administered questionnaire of two parts were completed. Part one of the questionnaire utilized the five subscales of the Dundee Ready Educational Environment Measure (DREEM) questionnaire; part two was developed in addition to evaluate the online teaching and learning subscales. RESULTS: Descriptive statistics and analyses of variance were performed; Pearson correlations were made between the additional supplemental online teaching subscale and the original DREEM subscales. The mean students' perception of the teacher was high, followed by the academic self-perception and then the learning perception. Students' social self-perceptions had the lowest reported scores. Students' perceptions varied by year of education in all subscales except for the online domain. In comparing all domains (DREEM and the online component), graduating students (final year) had a more favorable perception than other students. CONCLUSIONS: Within the limitations of the present study, online and blended learning were positively perceived, excluding the social self-perception and the perception that the online teaching time was not well used.

Molar Incisor Hypomineralization: Awareness among Postdoctoral Dental Residents: A Cross-Sectional Study.

BACKGROUND: Molar incisor hypomineralization (MIH) is the presentation of an enamel defect, where incisors and one (or more) molars are affected. Identifying MIH is significant in restoring its visual defect and avoiding pain or other consequences of this condition. The present cross-sectional study aimed to evaluate the awareness, ability, and confidence in identifying MIH among postgraduate residents in the state of Nevada. METHODS: This cross-sectional study was conducted among postdoctoral dental residents at the School of Dental Medicine, University of Nevada, Las Vegas. This cross-sectional study used images of cases of MIH and a survey to collect the data. The survey included demographics, educational background, and basic knowledge of MIH. RESULTS: The response rate to the invitation to participate was 91%. The confidence in identifying MIH was 100%, 50%, and 33.3% for pediatric, orthodontic, and general practice residency (GPR). A total of 70% were aware of this anomaly from their predoctoral dental education and indicated the need for further related education. There was 33% confusion with fluorosis and 16.6% with amelogenesis imperfecta. A total of 66.6% of the participants indicated that they require further education relating to MIH. CONCLUSION: Within the limitations of the present investigation, MIH awareness among the investigated groups varied but was highest amongst the pediatric residents.

Perspectives of Orthodontists of the Diagnosis, Prevention, and Management of White Spot Lesions: A Qualitative Study.

Aims: Several factors influence the development of white spot lesions (WSLs), and one of these is fixed orthodontic appliances. This study aims to evaluate the awareness, preventive strategies, and management of WSLs among a group of Orthodontists. Materials and Methods: A qualitative methodology was applied; four focus groups made up a purposive sample from Orthodontists with various training backgrounds while working within the same healthcare services. Results: Three main themes emerged: awareness and ability to diagnose WSLs, perceived influences on the development of WSLs, and prevention and management strategies and barriers to care delivery. All focus groups agreed that there is a need for continuous prevention and preventive strategies of WSLs, particularly among orthodontic patients. There was also a consensus that orthodontic treatment should be delayed until WSLs are managed appropriately. Conclusions: Within the limitation of this study, WSLs were collectively agreed to be a significant issue during fixed orthodontic therapy, and continuous professional development for Orthodontists should include risk factors evaluation, diagnosis, prevention, and management of WSLs.

The motivation and confidence in choosing dentistry as a career amongst dental students: A mixed-methods study.

OBJECTIVES: An insight into students' motivation and confidence in the choice of entering and remaining in dental education is essential. The understanding of how choices are made can help universities in the planning of admission policies. This study aimed to evaluate the career choice influences, motivation and confidence in the choices made into dental education. METHODS: A mixed-method design was employed, using both quantitative and qualitative data. One hundred seventy-three questionnaires were distributed to all registered dental students, with a response rate of 85%. The questionnaire explored students' demographics and factors that influenced their career choice. Seven focus groups were facilitated with related data recorded and transcribed verbatim. RESULTS: The quantitative data revealed the desire to help others, and socioeconomic factors were influential, whilst for parents' influence, the mother's influence was statistically significant. Qualitatively, results converged and complemented quantitative data; there was a balance between helping others and socioeconomic and familial influences. There was an increase in confidence in the choice made as students advanced in their dental education. The results indicate that informed awareness of the dental programme structure is essential before embarking on a dental career. CONCLUSIONS: The factors that impacted on choice were helping others, socioeconomic factors and the influence on choice from family. They were generally satisfied with their choice and were confident in the choice they made. This confidence, however, was not reflected until the more advanced clinical stages of their dental education.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis.

INTRODUCTION: Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development. MATERIALS AND METHODS: Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes. RESULTS: Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate. CONCLUSIONS: The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

Patients' Perspectives of Grafting Materials in Implant Dentistry: A Qualitative Analysis.

AIMS: The aim of this study was to evaluate the cultural, psychological, and religious influences on the choice of autografts, allografts, xenografts, and synthetic bone products for the grafting procedure and with implant placement. MATERIALS AND METHODS: A qualitative methodology was employed, using the principles of the constant comparative method of the grounded theory; to investigate how people perceive and understand their experiences regarding the graft materials in implant dentistry. The data were collected using detailed qualitative interviews, till saturation was achieved, from 10 patients. RESULTS: The three main themes that emerged in the analysis were: (a) grafting material preference, (b) religious and psychological influences, and (c) trust the doctor and cost influences. The three themes that emerged seemed to be interrelated. There were many statements of preference or rejection of choice based on religious, cultural, and psychological influences. CONCLUSIONS: Within the limitations of this study, three themes emerged and they indicated that the influence on the grafting material's choice is unique to every individual; it also shares similarities, based on common religious and cultural values.

The impact of impression coping geometrical design on accuracy of implant impressions: an experimental study.

AIM: This in vitro study aimed to evaluate the effect of implant impression coping geometrical designs on the accuracy of open and closed impression techniques and in the parallel and nonparallel implant positions. MATERIAL AND METHODS: Three custom-made acrylic resin models of three tested implant systems (Straumann®, SIC Invent®, and Osstem®) with diverse coping geometrical designs were evaluated in simulated cases of two parallel and two nonparallel implants. The horizontal and vertical discrepancies were measured and analyzed. RESULTS: No statistically significant differences between the two impression techniques in either parallel or nonparallel implants were observed. The high retentive design of the Osstem system showed a statistically significant difference. CONCLUSION: The geometrical design of the impression copings did not affect the accuracy for either the open and closed tray techniques. However, the high retentive coping design of the Osstem implant affected the accuracy in the open tray technique.

A prospective clinical study on implant impression accuracy.

BACKGROUND: An accurate impression is crucial to the long-term success of dental implants. This investigation evaluated the accuracy of the open and closed implant impression techniques in partially edentulous patients who received two adjacent implants. MATERIAL AND METHODS: Forty patients received Osstem Implants (Osstem Implant System, Seoul, Korea). Two impressions were made for each patient, one using an open tray and a second with a closed tray technique. The horizontal distances between two impression copings were measured and compared to similar measurements on the master casts. Also, under a stereomicroscope (AmScop14370, Myford Road, #150, Irvine, CA 92606 USA) at a 50-fold magnification, the presence or absence of the marginal discrepancies was evaluated. RESULTS: There were no statistically significant differences regarding horizontal measurements and in the marginal relationship for the two impression techniques, except between the anterior and posterior regions, for the closed tray technique. There were also no statistically significant differences in the impression accuracy between maxillary and the mandibular arches. In addition, there were no statistically significant differences for the intraoral horizontal distances, compared to similar horizontal measurements on master casts, between the open and closed tray techniques. CONCLUSIONS: Within the limitations of the present study, there were generally no differences in the impression accuracy between the open and closed tray techniques in partially edentulous patients with two adjacent implants.

Implant impression accuracy of parallel and non-parallel implants: a comparative in-vitro analysis of open and closed tray techniques.

BACKGROUND: The outcome of the evaluation of impression techniques accuracy may improve the selection criteria for an ideal technique. The aim was to evaluate the accuracy of the open and closed tray techniques for implant impressions, in a partially edentulous maxilla, replaced with a three-unit fixed partial denture, as well as to assess the effect of implants parallelism on accuracy. MATERIAL AND METHODS: This is an experimental in vitro study to evaluate impressions accuracy of a simulated area restored with an implant retained FPD, using the open and closed tray implant impression techniques. The effect of implant position angulation, parallelism, and implant systems (Straumann, SIC Invent, Osstem) was also evaluated. Three custom-made acrylic resin test models were prepared with two parallel and two non-parallel implants, on either side of a maxillary arch. One hundred and ninety-two impressions were made using monophase VPS impression material. Their master casts were obtained and evaluated for the horizontal and vertical discrepancy. The casts were scanned using a model scanner. The distances between the two reference points were measured. RESULTS: The Straumann and SIC Invent implants showed no statistically significant differences (Mann-Whitney U test), regarding accuracy for both the open and closed tray impression techniques (P = 0.667 and P = 0.472). There were no significant differences for the parallel and non-parallel implants (P = 0.323 and P = 0.814), respectively, while the Osstem system showed statistically significant differences for both the open and closed tray impression techniques (P = 0.035) and between the parallel and non-parallel implants (P = 0.045). For the vertical discrepancies, significant differences were detected (chi-square test) between the open and closed tray impression techniques (P = 0.037). CONCLUSIONS: Within the limitations of this study, there were generally no significant differences between open and closed, although better results were obtained for the open tray techniques. On the use of the non-parallel implants, the open tray technique provided a better result than the closed tray technique.

Patient-dentist relationship and dental anxiety among young Sudanese adult patients.

OBJECTIVE: To evaluate the effects of the patient-dentist relationship on dental anxiety among young adult Sudanese patients. MATERIALS AND METHODS: In this cross-sectional study, 864 patients attending outpatient dental clinics of the governmental dental hospitals in Khartoum, Sudan were recruited; 51.2% were males and 48.8% were females, with an age range of 18-24 years. The questionnaire used evaluated the socio-demographics, education levels, economic status, patient experience, and also included the Dental Anxiety Scale, Corah (J Dent Res 1969 48: 596). RESULTS: High dental anxiety was reported by 22.2%, 29.5% reported moderate dental anxiety, and 48.3% reported low or no dental anxiety. There were statistically significant associations between dental anxiety and gender, time lapse since the previous dental visit (P < 0.004) and the reason for the previous visit (P < 0.001). In addition, the dental clinic environment (P < 0.002), the time waiting before seeing the dentist (P < 0.001) and the overhearing of pain expressed by other patients (P < 0.001) were also statistically significant. Negative comments by the treating dentist also had a statistically significant impact (P < 0.032). In contrast, a clear explanation of related dental care (P < 0.008), as well as the allowance of adequate time to discuss oral health (P < 0.006), had significantly positive effects. CONCLUSION: The study showed that the patient-dentist relationship had a significant association with dental anxiety, and may be an important target for improving the delivery and standards of oral health in dentally anxious patients in this region.

Gender and arch effects on the use of non-opioid analgesics for post endodontic pain reduction.

This study aimed to evaluate the secondary outcomes of gender and arch and their impact on pain reduction following initial endodontic therapy. 185 medications, including placebo were prepared, and 170 participants completed the trial. Group 1, received a single dose of Paracetamol alone (G-1), Group 2 received combined Ibuprofen/Paracetamol (G-2). Group 3 received combined Mefenamic acid/Paracetamol (G-3), group 4 received combined Diclofenac K/Paracetamol (G-4) and Group 5 received a placebo (G-5). There were no statistically significant differences in pain reduction between males and females whilst there were statistically significant differences between them and the placebo group. All combinations of Paracetamol performed better in pain reduction than the placebo among females, while there were no statistically significant differences among males. In conclusion, there were no differences in pain reduction between males and females, and arch for the tested analgesics taken immediately following initial endodontic therapy in teeth with irreversible pulpitis.

A prospective study of the performance of resin bonded bridgework in patients with hypodontia.

UNLABELLED: Congenital absence of teeth presents a number of clinical challenges in young patients, and little is known about the success rate of restorative dental treatment in these patients. The aim of this study was to conduct a prospective clinical study of the performance of resin bonded bridges in patients with hypodontia. METHODS: A prospective clinical observation study was undertaken in Cork Dental School and Hospital, Ireland. Forty patients (22 males, 18 females; age range 18-21 years) with a confirmed diagnosis of hypodontia rated as mild (n=26), moderate (n=8) or severe (n=6) participated. Following completion of the orthodontic phase of care, all patients had missing teeth restored with resin bonded bridgework (RBB) using a standardised protocol (48 FF; 17CL design). Patients were followed up for 24 months, with recall visits at 6, 12 and 24 months following provision of RBBs. RESULTS: 65 RBBs were provided, 49 in the maxilla and 16 in the mandible; 43 bridges replaced anterior teeth and 22 replaced posterior teeth. After 24 months, 63 bridges were still in function and deemed to satisfy the preset criteria for success and survival. Two posterior bridges had failed due to repeated debond, and this was attributed to occlusal overload. 20% of the patients demonstrated some evidence of post orthodontic relapse, but this did not require further intervention. CONCLUSION: In the short to medium term, resin bonded bridgework provides a reliable and minimally invasive solution for replacing missing teeth in patients with hypodontia.

Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of Post-endodontic Pain.

INTRODUCTION: The present clinical trial aimed to evaluate the efficiency of paracetamol alone and in combination with 3 different nonsteroidal anti-inflammatory drugs for control of post-endodontic pain. METHODS: The inclusion criteria were moderate to severe pain of irreversible pulpitis, by using the Verbal Rating Scale and a 4-10 score on the Numerical Rating Scale, on anterior or premolar teeth, as well as the absence of signs and symptoms of apical periodontitis. One hundred eighty-five trial medications with placebo were prepared, and 170 participants completed the trial. There were 5 groups. P-group received 4 gelatinous capsules of a single dose of paracetamol alone. The IP-group received similar capsules of a single dose of combined ibuprofen/paracetamol. MP-group received combined mefenamic acid/paracetamol, and DP-group received combined diclofenac K/paracetamol. A Plb-group received doubled gelatinous capsules with no medications as a single dose, which had the same weight and appearance as the medicated capsules, to be the placebo. RESULTS: Pain intensity was measured after initial endodontic therapy and instrumentation by using the Verbal Rating Scale and Numerical Rating Scale. IP-group (ibuprofen/paracetamol) had the most pain reduction, followed by DP-group (combined diclofenac K/paracetamol), then MP-group, followed by P-group, whereas Plb-group had the least pain reduction (P < .05). CONCLUSIONS: The combination of ibuprofen/paracetamol, taken immediately after initial endodontic therapy and root canal preparation in teeth with irreversible pulpitis, reduced post-endodontic pain (ClinicalTrials.gov no.: NCT02417337).

Periodontal Manifestations of Chronic Atypical Neutrophilic Dermatosis With Lipodystrophy and Elevated Temperature (CANDLE) Syndrome in an 11-Year-Old Patient.

INTRODUCTION: Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) is an autoinflammatory syndrome caused by an autosomal recessive gene mutation. This very rare syndrome has been reported in only 14 patients worldwide. A number of clinical signs have been reported, including joint contractures, muscle atrophy, microcytic anemia, and panniculitis-induced childhood lipodystrophy. Additional symptoms include recurrent fevers, purpuric skin lesions, periorbital erythema, and failure to thrive. To the best of the authors' knowledge, this is the first reported case of periodontal manifestations associated with CANDLE syndrome. CASE PRESENTATION: An 11-year-old boy was referred to Cork University Dental School and Hospital, Cork, Ireland, with evidence of severe periodontal breakdown. The patient's medical condition was managed in Great Ormond Street Children's Hospital, London, United Kingdom. The patient's dental management included initial treatment to remove teeth of hopeless prognosis, followed by prosthodontic rehabilitation using removable partial dentures. This was followed by additional non-surgical periodontal treatment and maintenance. In the long term, the potential definitive restorative options, including dental implants, will be evaluated in discussion with the patient's medical team. CONCLUSIONS: Periodontitis as a manifestation of systemic disease is one of seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. A number of systemic diseases have been associated with advanced periodontal breakdown, including diabetes mellitus, leukemia, and Papillon-Lefèvre syndrome. In the case described, treatment necessitated a multidisciplinary approach with input from medical and dental specialties for a young patient with severe periodontal breakdown associated with CANDLE syndrome.

Motivational interviewing for dental clinicians.

Motivational interviewing (MI) is a patient-centred, directive, therapeutic approach that supports patients' readiness to change by exploring their ambivalence about doing so. This increases the patients' motivation and helps them to commit to the process of change. In relation to dentistry, MI has been effectively used to: promote oral health behaviour; facilitate smoking cessation; and, alter health behaviours.

Impact of resin bonded bridgework on quality of life of patients with hypodontia.

OBJECTIVES: To determine the impact of hypodontia on the quality of life of adolescent and young adult patients, and, to assess the impact of restoring tooth spaces with resin bonded bridgework on quality of life of patients with hypodontia. METHODS: In a prospective study, 82 patients with a confirmed diagnosis of hypodontia participated. The primary outcome was oral health related quality of life (OHRQoL) and this was measured using the OHIP-49 prior to treatment. The pre-treatment sample was then divided into two groups: the test group (n=40 patients) who had completed orthodontic treatment and had tooth spaces restored with resin bonded bridgework, and, a control group (n=42 patients) who were still in the process of orthodontic treatment. All patients completed a follow-up OHIP-49, and between and within group comparisons made. RESULTS: The pre-treatment sample included 43 females and 39 males, age ranged from 16 to 34 years (median age 19). Forty-three patients had more than 4 congenitally missing teeth and thirty-nine had ≤ 4 congenitally missing teeth. There were no differences between the groups prior to treatment. For the test group, there was a significant improvement in median OHIP summary scores (p<0.001) after treatment. OHIP scores deteriorated to a significant degree for control subjects (p=0.002). The effect sizes for the pre-post treatment change in both groups were moderate to large. CONCLUSIONS: Hypodontia has a significant impact on oral health related quality of life. Provision of resin bonded bridges has a positive impact on oral health related quality of life of patients with hypodontia.

Periodontics: 10. Maintenance in periodontal therapy.

UNLABELLED: Maintenance periodontal therapy is essential for the long-term stabilization of periodontal disease. An individualized programme of maintenance requirements, based on patient risk assessment for disease progression, is important, as is the need for teamwork in long-term patient management. CLINICAL RELEVANCE: Maintenance or supportive therapy is an essential requirement in the management of periodontal therapy. Patients should be informed at their first visit that part of the management of their disease is regular maintenance visits.