Primary care dentistry: An Australian perspective.

INTRODUCTION: Primary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system. METHODS: This paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns. RESULTS: Primary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups. CONCLUSIONS: Australians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case. CLINICAL SIGNIFICANCE: Australia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

In vitro comparison of guided versus freehand implant placement: use of a new combined TRIOS surface scanning, Implant Studio, CBCT, and stereolithographic virtually planned and guided technique.

Implant placement requires precise planning and execution to avoid collision with critical anatomical structures. Technology advances may improve placement outcomes. The purpose of this study was to trial and measure in an in vitro environment the accuracy of placing a single dental implant in the planned position using a specific guided surgery technique compared with a freehand surgery technique. The dental model of a patient missing tooth 16 was printed 30 times (EnvisionTEC 3Dent). Each print was scanned (TRIOS color scanner) to create a 3D surface model, and radiographed (Gendex CB-500) to create cone beam computed tomography (CBCT) data. The surface data and CBCT data were merged (Implant Studio software), and a Straumann RC bone level Ø 4.1 × 8 mm implant placement was planned. A surgical guide was printed (Stratasys OrthoDesk) for each case (n = 30). Simulated cases were assigned to Group A (guided) or Group B (freehand, where the fabricated guide was discarded). Implants were placed, and the models rescanned (TRIOS). The new data was superimposed on the original data, and the surgical implant location compared with the planned position for each model (Convince software) by a researcher blinded to group allocation. Differences in angulation (degrees); shoulder, apex, and depth displacements (mm); and direction of displacement were assessed with Mann-Whitney U and Fisher exact tests. Data was expressed as medians bounded by interquartile ranges (IQRs). Implant angulation and apical displacement were significantly closer to the planned position in the guided group compared with the freehand group (3.91 degrees: IQR 2.45 to 5.38 degrees vs 8.82 degrees: IQR 4.84 to 9.84 degrees, P = 0.005; and 0.87 mm: IQR 0.53 to 1.11 mm vs 1.48 mm: IQR 1.14 to 1.72 mm, P < 0.001, respectively). Implant shoulder displacement, depth displacements, and direction of displacement did not differ between the groups. Within the in vitro environment, merged 3D surface scan data and 3D CBCT scan data can be used to plan and guide implant placement with greater accuracy than with the freehand technique.