Dental Students' and Dental School Graduates' Practical Skills: An International Survey of Perceptions of National Dental Associations in Europe.

PURPOSE: Dental students learn knowledge and practical skills to provide oral health care to the population. Practical skills must be maintained or continuously developed throughout a professional career. This cross-sectional survey aimed to evaluate the perception of practical skills of dental students and dental-school graduates by national dental associations (NDAs) in international comparison in the European Regional Organization of the FDI World Dental Federation (ERO-FDI) zone. MATERIALS AND METHODS: A questionnaire of 14 items collected information on pre-/postgraduate areas. RESULTS: A total of 25 countries participated (response rate: 69.4%), with 80.0% having minimum requirements for practical skills acquisition and 64.0% starting practical training in the 3rd year of study. In countries where clinical practical work on patients begins in the 2nd year of study, practical skills of graduates are perceived as average, starting in the 3rd year of study as mainly good, starting in the 4th as varying widely from poor to very good. In total, 76.0% of respondents feel that improvements are needed before entering dental practice. Improvements could be reached by treating more patients in dental school (32.0%), increasing the quantity of clinical training (20.0%), or having more clinical instructors (12.0%). In 56.0% of the countries, it is possible to open one's own dental practice immediately after graduation, and in 16.0%, prior vocational training is mandatory. CONCLUSIONS: All participating countries in the ERO-FDI zone reported practical training in dental school, most starting in the 3rd year of study. The perception of practical skills of dental students and dental-school graduates among NDAs is very heterogeneous. Reasons for the perceived deficiencies should be further explored.

Class II Malocclusion in Adult Patients: What Are the Effects of the Intermaxillary Elastics with Clear Aligners? A Retrospective Single Center One-Group Longitudinal Study.

Aim: To evaluate the dental effects of the treatment with clear aligners and intermaxillary elastics in adult patients with Class II malocclusion. Material and methods: A sample of 20 Class II patients treated with Invisalign aligners (5 M and 15 F; mean age of 27.6 ± 6.3 years) was included in this single-center one-group longitudinal study. Dental cast and cephalometric records were analyzed before (T0) and after treatment (T1). Data were analyzed with a t-test for paired data (p < 0.05). Results: There was a significant reduction of the Overjet (OVJ= −1.4 ± 0.2; p ≤0.001) and a retroposition of upper incisors (U1-NPo = −1.3 ± 1.7; p < 0.001). Furthermore, distalization of upper molars with an improvement of molar class (U6-PT Vertical = −0.93 ± 0.97; p < 0.001; Molar Relation = −0.75 ± 0.45; p < 0.001) was observed. A good control of the lower and upper incisor inclination was present, highlighted by the non-significant changes in these values (L1-GoGn = −0.12 ± 5.4; p = 0.923; U1-AnsPns = −1.1 ± 8.1; p = 0.551). In the lower arch, an increase in the intermolar diameter (0.6 ± 1.0; p = 0.01) was present. Finally, there were no statistically significant changes in all the skeletal variables (ANPg = 0.005 ± 0.687; p = 0.974; SN/MP = −0.47 ± 1.9; p = 0.298). Conclusions: Treatment with Invisalign aligners shows a reduction of the Overjet, a retroposition of the upper incisors, good control of the lower incisors, and an improvement of the molar relationship.

Treatment of mild Class II malocclusion in growing patients with clear aligners versus fixed multibracket therapy: A retrospective study.

OBJECTIVE: To compare the dental and skeletal effects of intermaxillary elastics on the correction of mild Angle's Class II division 1 malocclusion with clear aligner treatment (CA) versus fixed multibracket (FMB) in growing patients. SETTINGS AND SAMPLE POPULATION: The study sample consisted of 49 consecutively patients (mean age ± SD 12.9 ± 1.7 years), 32 females and 17 males referred from the School of Orthodontics of the University of Bratislava Comenius (Slovakia). All patients were treated with a non-extraction orthodontic treatment, 25 with FMB and 24 with CA. METHODS: The cephalometric analysis was performed at the beginning (T0) and the end of the treatment (T1). The t test for unpaired data was carried out to compare cephalometric values at T0 and changes at T1-T0 between the two groups. The level of significance was set as P < .0035. RESULTS: The two groups showed no statistically significant differences (ANPg = -0.1°; P = .762) in the correction of the sagittal intermaxillary relation. The analysis of vertical skeletal changes showed no statistically significant effects on mandibular inclination (SN/MP = 0.1°; P = .840). The two treatments had a statistically significant and clinically relevant difference in controlling the inclination of the lower incisors (L1/GoGn = 4.8°, CAG = -0.5°± 3.9°; FMB = 4.3°± 5.8°; P < .001). CONCLUSIONS: Class II elastics combined with CA and FMB produce a similar correction on sagittal discrepancies in growing patients. CA presented a better control in the proclination of the lower incisors. CA and elastics might be a good alternative in the correction of mild Class II malocclusion in cases where a proclination of lower incisors is unwanted.

Treatment of ankylosed deciduous molars with or without permanent successors in children and adolescents: a systematic review.

INTRODUCTION: The aim of this systematic review was to provide guidelines for decision-making during orthodontic treatment planning of infra-occluded deciduous molars with or without their successors in children and adolescents. EVIDENCE ACQUISITION: Computerized search was conducted on Medline via PubMed, and Cochrane Library. Articles published until 2020 in English language were analyzed following the Preferred Reporting Items for Systematic Reviews (PRISMA) Checklist. Observational and interventional longitudinal studies reporting the treatment of ankylosed deciduous molars with or without successor tooth in 3 to 15-year-old patients were included. EVIDENCE SYNTHESIS: In case of ankylosis with presence of successor, exfoliation took place in 77% of teeth, while extraction involved 23%. Infra-occlusion happened in 53% of teeth (worsening in 52%), alveolar bone loss in 37%, mesial tipping of first permanent molar in 5%, and over-eruption of antagonist in no cases (after exfoliation and eruption of successor). In case of ankylosis without successor, exfoliation took place in 1% of teeth, progression of infra-occlusion in 42%, progression of root resorption in 58%, development of mesial tipping of first permanent molars in 25%, while no case of antagonist over-eruption was reported. CONCLUSIONS: When the permanent tooth is present and the ankylosed tooth is slightly or moderately infra-occluded, observation is appropriate. In case of severe infra-occlusion or absence of successor, tooth extraction may be considered together with orthodontic space closure, transplantation, or prosthetic replacement. Alternatively, nonextraction and a prosthetic build-up may be considered.

A Deep Learning-Based Approach for the Detection of Early Signs of Gingivitis in Orthodontic Patients Using Faster Region-Based Convolutional Neural Networks.

Computer-based technologies play a central role in the dentistry field, as they present many methods for diagnosing and detecting various diseases, such as periodontitis. The current study aimed to develop and evaluate the state-of-the-art object detection and recognition techniques and deep learning algorithms for the automatic detection of periodontal disease in orthodontic patients using intraoral images. In this study, a total of 134 intraoral images were divided into a training dataset (n = 107 [80%]) and a test dataset (n = 27 [20%]). Two Faster Region-based Convolutional Neural Network (R-CNN) models using ResNet-50 Convolutional Neural Network (CNN) were developed. The first model detects the teeth to locate the region of interest (ROI), while the second model detects gingival inflammation. The detection accuracy, precision, recall, and mean average precision (mAP) were calculated to verify the significance of the proposed model. The teeth detection model achieved an accuracy, precision, recall, and mAP of 100 %, 100%, 51.85%, and 100%, respectively. The inflammation detection model achieved an accuracy, precision, recall, and mAP of 77.12%, 88.02%, 41.75%, and 68.19%, respectively. This study proved the viability of deep learning models for the detection and diagnosis of gingivitis in intraoral images. Hence, this highlights its potential usability in the field of dentistry and aiding in reducing the severity of periodontal disease globally through preemptive non-invasive diagnosis.

Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons.

Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic surgery.A retrospective case series of patients who underwent custom alloplastic TMJ reconstruction concurrent with orthognathic surgery between 2014 and 2019 was completed. Functional, aesthetic and orthodontic outcomes as well as complications were recorded.Seven TMJs in 5 skeletally mature patients (4 female, 1 male, ages 16-30) (2 bilateral, 3 unilateral) were replaced. All but 1 patient had previous attempts at reconstructive surgery with poor results. All cases were prepared using virtual surgical planning and underwent concomitant maxillomandibular orthognathic surgery. All patients demonstrated improved post-operative occlusions. Four of 5 patients achieved >30 millimeters of post-operative MIO. Complications included ear canal perforation and facial nerve dysfunction.There were no infections or other implant-related complications. Mean follow up was 2 years and 15 days. Alloplastic TMJ reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects is an alternative to existing management options. Further long-term prospective outcomes studies are ongoing.

Resistance to sliding in orthodontics: misconception or method error? A systematic review and a proposal of a test protocol.

Resistance to sliding (RS) between the bracket, wire, and ligature has been largely debated in orthodontics. Despite the extensive number of published studies, the lack of discussion of the methods used has led to little understanding of this phenomenon. The aim of this study was to discuss variables affecting RS in orthodontics and to suggest an operative protocol. The search included PubMed©, Medline©, and the Cochrane Library©. References of full-text articles were manually analyzed. English-language articles published between January 2007 and January 2017 that performed an in vitro analysis of RS between the bracket, wire, and ligature were included. Study methods were analyzed based on the study design, description of materials, and experimental setup, and a protocol to standardize the testing methods was proposed. From 404 articles identified from the database search and 242 records selected from published references, 101 were eligible for the qualitative analysis, and six for the quantitative synthesis. One or more experimental parameters were incompatible and a meta-analysis was not performed. Major factors regarding the study design, materials, and experimental setup were not clearly described by most studies. The normal force, that is the force perpendicular to the sliding of the wire and one of the most relevant variable in RS, was not considered by most studies. Different variables were introduced, often acting as confounding factors. A protocol was suggested to standardize testing procedures and enhance the understanding of in vitro findings.

Tooth loss caused by displaced elastic during simple preprosthetic orthodontic treatment.

The use of elastics to close a diastema or correct tooth malpositions can create unintended consequences if not properly controlled. The American Association of Orthodontists recently issued a consumer alert, warning of "a substantial risk for irreparable damage" from a new trend called "do-it-yourself" orthodontics, consisting of patients autonomously using elastics to correct tooth position. The elastics can work their way below the gums and around the roots of the teeth, causing damage to the periodontium and even resulting in tooth loss. The cost of implants to replace these teeth would well exceed the cost of proper orthodontic care. This damage could also occur in a dental office, when a general dentist tries to perform a simplified orthodontic correction of a minor tooth malposition. The present case report describes a case of tooth loss caused by a displaced intraoral elastic, which occurred during a simple preprosthetic orthodontic treatment.

Practical Implementation of Evidence-Based Dentistry Into Daily Dental Practice Through a Short Time Dependent Searching Method.

INTRODUCTION: Despite the fact that the benefits of implementation of Evidence-Based Dentistry (EBD) into clinical practice is increasingly being highlighted, there are still clear limitations in its implementation into daily dental practice. One potentially important barrier to effective implementation into practice is the perception of EBD as a time-consuming process. The aim of the present study is to increase the familiarity of dental practitioners with the benefits of different time-dependent 'practical' search strategies important to EBD using a clinical question from the field of dental implantology as an example. MATERIALS AND METHODS: The PICO (population, intervention, comparison, outcome) question used in this study was: "In young adults with anterior single-tooth implant what is the effect of immediate or delayed loading on success?" A bibliographic search according to the Haynes 5S pyramid, together with 3 different time-dependent strategies (5-min, 30-min and more than 60-min), were applied. RESULTS: Both the Haynes 5S Pyramid and time-dependent search strategies revealed promising results for enhancing decision-making for determining the feasibility of immediate or conventional loading of anterior single dental implants. Results clearly showed that selection of the loading protocol would be case (patient)-specific and also indicated high primary implant stability and bone quality as the most important prerequisites for a successful immediate/early loading. From among the 3 different time-dependent strategies (5 min, 30 min and more than 60 min), the 60+ min search results were quite comparable with the Haynes pyramid search results. CONCLUSION: It is likely that the different time-dependent search strategies may have the potential to support the clinical decision making process and may improve the implementation of EBD into daily dental practice. Increased time spent searching naturally seems to increase the extent of this support. However, even with short time-dependent searches, busy dental clinicians may get an improved idea/opinion regarding a clinical question.

Rapid palatal expander vs. quad-helix in the orthodontic treatment of cleft lip and palate patients.

BACKGROUND: The purpose of this study was to compare the results obtained using the rapid palate expander (RPE) and the quad-helix (QH) in the treatment of cleft lip and palate (CLP) patients in mixed dentition. METHODS: In this retrospective clinical trial 28 CLP patients in mixed dentition were enrolled and divided into a group RPE, consisting of 11 patients, and a group QH, consisting of 17 patients. Plaster models before and after treatment were scanned and measurements were made using the software Ortho Analyzer. Measurements, obtained with a digital gauge on plaster models, were regarded as the gold standard and compared with those on digital models. Measurement error was assessed using the Dahlberg formula and the reliability and accuracy of the measurements were evaluated by the interclass coefficient (ICC). The unpaired t-test was used to compare the group RPE with the group QH. RESULTS: Measurement error found with Dahlberg's method was 0.36. ICC values indicated a strong repeatability of the evaluator's measurements on digital models and an almost perfect repeatability on plaster models, with a value of 0.79 and 0.93, respectively. The ICC for the accuracy of the measurements on digital models was equal to 0.74, indicating a strong agreement with measurements realized on plaster models. Patients in the QH group presented a gain of the anterior palatal diameter significantly greater than those in the RPE group. CONCLUSIONS: The use in mixed dentition of the quad-helix allows obtaining a greater gain of the anterior palatal diameter and a greater symmetry of the dental arch.

Implementation of evidence-based dentistry into practice: analysis of awareness, perceptions and attitudes of dentists in the World Dental Federation-European Regional Organization zone.

Based on evidence-based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation-Federation Dentaire Internationale)-European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, 'The Relationship Between Dental Practitioners and Universities', was developed by the FDI-ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they 'know what it is' (32.8%) and 'they practice' (32.1%). Most respondents believed that 'EBD is beneficial' (89.1%); however, they had different thoughts regarding 'who actually benefited from EBD'. Of the participants, 60% believed that 'dentists experience difficulties in implementing EBD'. Although lack of time, lack of education and limited availability of evidence-based clinical guidelines were among the major barriers, there were differences among countries (P<0.05). Significant differences were also observed between countries regarding certain questions such as 'where EBD needed to be taught' (P<0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P<0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists' knowledge and use of EBD in everyday practice and a specific role for the NDAs.

Systems for the provision of oral health care in the black sea countries. Part 12: Ukraine.

This paper is part of a series describing systems for the provision of oral health care in countries that surround or are near to the Black Sea. It starts by outlining the country and its population structure. It then provides a description of the general and oral public and private health care systems in Ukraine. It describes the dental workforce (dentists, oral hygienists, dental specialists and dental technicians) and its education, setting out the numbers of dentists and other dental workers. A section on dental education at undergraduate, specialist, and continuing levels follows. Finally, the paper gives some information on the oral epidemiology and costs of oral care in Ukraine.