Shaping tomorrow's dentists: a multi-institutional survey of undergraduate dental students' perceptions towards interprofessional education.

BACKGROUND: Interprofessional education (IPE) is essential to foster collaboration among healthcare professionals for holistic patient care. However, Malaysian dental education remains discipline-centric, hindering multidisciplinary learning approaches. Hence, this study aimed to explore Malaysian undergraduate dental students' perceptions of IPE. METHODS: The present cross-sectional study employed convenience sampling to survey undergraduate dental students from four Malaysian institutions using a modified questionnaire with 20 close-ended and 2 open-ended questions. The questionnaire covered three domains (effectiveness, preference, importance) to assess students' perceptions using a five-point Likert scale. Psychometric validation was performed to assure validity and reliability of the modified questionnaire. Quantitative analysis (descriptive and inferential statistics), and qualitative analysis (content analysis) were subsequently performed. RESULTS: 397 students responded, and positive perceptions were generally noted with mean scores ranging from 4.13 to 4.35 across all domains. Questions 2 and 3, assessing the improvement in understanding the roles and responsibilities, and communication among healthcare professionals, received the highest mean scores. Meanwhile, Question 15 concerning the incorporation of IPE into educational goals received the lowest mean score. Regression analysis identified gender and clinical phase as significant factors, with females and preclinical students exhibiting more favourable perceptions. Motivators for IPE included a keen interest in diverse perspectives and recognising the importance of teamwork, while barriers encompassed tightly packed schedules, lack of understanding about IPE, misconceptions regarding dental education, and students' nervousness and fear of participation. CONCLUSION: This study produced a valid and reliable instrument to measure undergraduate dental students' perceptions towards IPE. Strategic planning, such as overcoming logistical challenges, improving awareness, and creating a supportive learning environment are crucial for successful IPE integration into existing curricula, especially in resource-constrained developing countries like Malaysia.

Integrating hands-on practical and reflective feedback in teaching dental materials science to undergraduate dental students.

INTRODUCTION: This study aimed to develop a module that incorporates hands-on and reflective feedback in teaching dental materials science and subsequently analyse undergraduate dental students' learning experiences with the module. MATERIALS AND METHODS: The module was developed based on the ADDIE (Analyse, Design, Develop, Implement, Evaluate) model. First, a need analysis was conducted, followed by designing the module to address the needs. Next, the module sought experts' feedback and was piloted. The revised module was implemented among all second-year undergraduate dental students. Finally, a validated questionnaire (5-point Likert scale items and open-ended questions) was used to evaluate students' learning experiences. The questionnaire Likert scale items were analysed descriptively, whereas open-ended responses were analysed using content analysis. RESULTS: In the analysis phase, a slight misalignment in cognitive competency levels was observed, alongside a need for the inclusion of more hands-on activities. In the design phase, learning objectives and resources were listed. Subsequently, a module consisting of four teaching sessions (3 h each) was developed, and the pilot test showed favourable feedback. The module was then implemented in small groups of 10-12 students. In the evaluation phase, 72 students (97% response rate) completed the questionnaire. The majority of students agreed with all items, with mean scores ranging from 4.53 to 4.72. Open-ended responses highlighted that hands-on activities and reflective feedback sessions were useful. CONCLUSION: Students demonstrated positive learning experiences after participating in the module, advocating for dental educators to consider more hands-on activities and reflective feedback sessions in teaching dental materials science.

Unravelling the impact of dental workforce training and education programmes on policy evolution: a mixed-method study protocol.

BACKGROUND: The dental workforce plays a crucial role in delivering quality oral healthcare services, requiring continuous training and education to meet evolving professional demands. Understanding the impact of dental workforce training and education programmes on policy evolution is essential for refining existing policies, implementing evidence-based reforms and ensuring the growth of the dental profession. Therefore, this study protocol aims to assess the influence of dental workforce training and education programmes on policy evolution in Malaysia. METHODS: A mixed-method research design will be employed, combining quantitative surveys and qualitative interviews. Stakeholder theory and policy change models will form the theoretical framework of the study. Participants from various stakeholder groups will be recruited using purposive sampling. Data collection will involve surveys and one-on-one semi-structured interviews. Descriptive statistics, inferential analysis and thematic analysis will be used to analyse the data. Integration of quantitative and qualitative data will be used to provide a comprehensive understanding of the data. DISCUSSION: This study will shed light on factors influencing policy decisions related to dental education and workforce development in Malaysia. The findings will inform evidence-based decision-making, guide the enhancement of dental education programmes and improve the quality of oral healthcare services. Challenges related to participant recruitment and data collection should be considered, and the study's unique contribution to the existing body of knowledge in the Malaysian context will be discussed.

Curriculum mapping of a dental materials science course: a reality check and way forward.

BACKGROUND: Dental materials science is an important subject, but research on curriculum mapping in preclinical dental materials science courses is still scarce. The present study aimed to conduct a curriculum mapping in analysing elements and suggesting recommendations for an institutional dental materials science course. METHODS: Curriculum mapping was conducted for the Year 2 undergraduate dental materials science course (Bachelor of Dental Surgery programme) in a Malaysian dental school. Based on Harden's framework, the following steps were used to map the curriculum of the institutional dental materials science course: (1) scoping the task; (2) deciding the mapping format; (3) populating the windows, and (4) establishing the links. Two analysts reviewed the curriculum independently. Their respective analyses were compared, and discrepancies were discussed until reaching a consensus. A SWOT analysis was also conducted to evaluate the strengths, weaknesses, opportunities, and threats associated with the curriculum. RESULTS: Course learning outcomes, course contents, levels of cognitive and psychomotor competencies, learning opportunities, learning resources, learning locations, assessments, timetable, staff, curriculum management and students' information were successfully scoped from the institutional dental materials science course. The present curriculum's strengths included comprehensiveness, alignment with standards, adequate learning opportunities, well-defined assessment methods, and sufficient learning resources. However, the identified weaknesses were repetition in curriculum content, limited emphasis on the psychomotor domain, dependency on a single academic staff, and limited integration of technology. The SWOT analysis highlighted the opportunities for curriculum improvement, such as revising repetitive content, emphasising the psychomotor domain, and incorporating advanced teaching strategies and technology. CONCLUSIONS: The present dental materials science curriculum demonstrated several strengths with some areas for improvement. The findings suggested the need to revise and optimise the course content to address gaps and enhance student learning outcomes. Ongoing monitoring and evaluation are necessary to ensure the curriculum remains aligned with emerging trends and advancements in dental materials science.

Impact of calcium hydroxide and 2-hydroxyisocaproic acid on the microhardness of root dentine: an in vitro study.

To evaluate and compare the effect of calcium hydroxide [Ca(OH)2] and 2-hydroxyisocaproic acid (HICA) on the microhardness of root dentine. Fifty-one matured maxillary central incisors with straight root and type I canal configuration were decoronated to a standardized length of 16 mm. The root canals were cleaned and shaped using rotary instruments up to size F5. The tooth samples were then randomly assigned into three groups (n = 17) based on the intracanal medicament placed. Group A: control group with no intracanal medicament, Group B: root canals placed with Ca(OH)2, and Group C: root canals placed with HICA. After 1 week, the intracanal medicaments placed within the root canals were removed and the canals were dried. Subsequently, the specimens were split longitudinally into two halves and subjected to the Vickers microhardness test with indentations made at the coronal, middle, and apical-third root regions. The data were analyzed using one-way ANOVA and Tukey's post hoc tests. The control group showed significantly highest microhardness value (P < 0.001), followed by HICA and finally, Ca(OH)2 at the coronal, middle, and apical-third root regions, respectively. Nonetheless, there were no statistically significant differences in microhardness values across different root regions within each group. HICA was found to have a significantly lesser reduction in root dentine microhardness which could be a potential alternative to Ca(OH)2. Nevertheless, future studies are warranted to verify the present outcomes in the clinical setting.

The use of feedback in teaching undergraduate dental students: feedback sandwich or Ask-Tell-Ask model?

BACKGROUND: Feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on students' academic learning. The present study aimed to evaluate and compare students' perceptions of the use of two feedback models, namely feedback sandwich and Ask-Tell-Ask (ATA), in teaching dental materials science courses. METHODS: All undergraduate second-year dental students were invited to participate in the dental materials science practical session and were randomly allocated into two groups: Group 1 (feedback) sandwich and Group 2 (ATA). The session began with the teacher giving a short briefing on the commonly used dental materials, followed by a short demonstration of the manipulation of those materials. Students were then allowed to mix and manipulate the materials, and teachers provided feedback accordingly. At the end of the session, 16 close-ended (five-point Likert scales) and an open-ended questionnaire were distributed to students to evaluate their perceptions of the feedback given. Internal reliability of the questionnaire items was evaluated using Cronbach's alpha. Mean feedback scores were analysed using an independent t-test with ANCOVA for controlling gender and ethnicity. Thematic analysis was used to code the qualitative data. RESULTS: Sixty-nine students participated in the present study with the majority being females (72.5%) and Chinese (79.7%). Cronbach's alpha analysis suggested removing three Likert-scale items, with the remaining 13 items being accepted. Generally, no significant difference was noted between the two groups (p = 0.197), but three items were found to be significant (p < 0.05), with higher mean scores in the feedback sandwich group. Moreover, no significant difference was noted between the two feedback models (p = 0.325) when controlling gender and ethnicity. The open-ended question showed that students in the feedback sandwich group expressed greater positive perceptions. CONCLUSION: Although students generally had positive perceptions of both feedback models, they tended to favour the feedback sandwich. Neither gender nor ethnicity affected the students' perceptions of the two feedback models.

A phenomenological study on East and Southeast Asian dental educators: perceived importance, challenges, and strategies in teaching dental materials science.

BACKGROUND: Effective teaching of dental materials science is crucial for dental students to develop a comprehensive understanding of materials used in clinical practice. However, literature on educators' views on teaching this subject is still scarce. This qualitative study aimed to explore the lived experiences of dental educators in teaching dental materials science subjects, thereby addressing potential gaps and enhancing teaching practices. METHODS: Thirteen dental educators from East and Southeast Asian countries (Malaysia, China, Indonesia, Thailand, South Korea, and Japan) participated in the present study. The present study adopted a transcendental phenomenological approach. One-to-one semi-structured online interviews were conducted. Interviews were recorded and transcribed verbatim. Thematic analysis was employed to identify patterns in the educators' experiences. RESULTS: Three themes emerged from the present study. First, perceptions of the importance of dental materials science, highlighting its relevance in clinical practice, patient care, and lifelong learning. Second, the challenges faced in teaching dental materials science include limited instructional time, complex content, and insufficient resources. Third, specific strategies, such as applying interactive teaching methods, integrating clinical scenarios, and promoting critical thinking skills have been suggested to enhance teaching and learning. CONCLUSION: Understanding dental educators' experiences can improve dental materials science education, curriculum development, teaching methods, and faculty training programmes, ultimately enhancing the knowledge and skills of dental students in this field.

Identifying relevant topics and their competency levels for dental materials science: a fuzzy Delphi study.

BACKGROUND: Dental materials science is an important core course in undergraduate dental programs which integrates foundational concepts of chemical engineering and materials science into clinical dentistry. The present study aimed to identify relevant dental materials science topics for Malaysian undergraduate dental curricula and to determine their appropriate competency levels in terms of cognitive and psychomotor taxonomies. METHODS: Potential dental materials science topics were drafted in alignment with the revised national competency statement. The list of topics was further amended after comparing it with those recommended topics in the literature. Fuzzy Delphi method was applied. Experts were selected based on the different inclusion criteria. They ranked the topics using a five-point Likert scale and recommended the appropriate cognitive and psychomotor levels. Next, fuzzy evaluation was performed. Consensus was deemed for a topic to be included if (a) the average expert agreement was ≥ 75%, (b) the d-construct threshold value for each topic was ≤ 0.2 and (c) the average fuzzy number was ≥ 0.5. RESULTS: Sixty-two experts participated in the study. They accepted 33 out of 36 potential dental materials science topics. The average Likert score and fuzzy number ranged from 3.63 to 4.92 and 0.526 to 0.784, respectively. Furthermore, "Endodontic materials" was ranked as the most significant topic. Meanwhile, many topics required dental students to demonstrate a cognitive level of "Apply" and a psychomotor level of "Guided response". Based on mean scores, "Impression materials" was rated as the most cognitively demanding topic, whilst "Temporary restorative materials" was the most demanding topic for psychomotor taxonomy. CONCLUSION: The present study has identified relevant dental materials science topics and their appropriate cognitive and psychomotor levels using the Fuzzy Delphi approach. The findings of the present study form the basis for future studies to develop measurable learning outcomes, design corresponding innovative pedagogy and propose assessment criteria for each topic.

Revolutionising dental technologies: a qualitative study on dental technicians' perceptions of Artificial intelligence integration.

BACKGROUND: The integration of artificial intelligence (AI) in dentistry has the potential to revolutionise the field of dental technologies. However, dental technicians' views on the use of AI in dental technology are still sparse in the literature. This qualitative study aimed to explore the perceptions of dental technicians regarding the use of AI in their dental laboratory practice. METHODS: Twelve dental technicians with at least five years of professional experience and currently working in Malaysia agreed to participate in the one-to-one in-depth online interviews. Interviews were recorded, transcribed verbatim and translated. Thematic analysis was conducted to identify patterns, themes, and categories within the interview transcripts. RESULTS: The analysis revealed two key themes: "Perceived Benefits of AI" and "Concerns and Challenges". Dental technicians recognised the enhanced efficiency, productivity, accuracy, and precision that AI can bring to dental laboratories. They also acknowledged the streamlined workflow and improved communication facilitated by AI systems. However, concerns were raised regarding job security, professional identity, ethical considerations, and the need for adequate training and support. CONCLUSION: This research sheds light on the potential benefits and challenges associated with the integration of AI in dental laboratory practices. Understanding these perceptions and addressing the challenges can support the effective integration of AI in dental laboratories and contribute to the growing body of literature on AI in healthcare.

Expert consensus on relevant topics for undergraduate paediatric dental curriculum using the fuzzy Delphi method: a new direction for Malaysian dental education.

BACKGROUND: Paediatric dentistry is a branch of dental specialty that focuses on dental care for children from infancy through adolescence. However, there is no standardised national undergraduate paediatric dental curriculum in Malaysia. The present study aimed to identify relevant topics for undergraduate paediatric dental curricula and to determine the appropriate cognitive and psychomotor levels for each topic based on the consensus among paediatric dental experts. METHODS: Potential relevant undergraduate paediatric dentistry topics were initially drafted and revised according to the revised national competency statement. The final draft included 65 topics clustered under 18 domains. A fuzzy Delphi method was used and experts who fulfilled the inclusion criteria were invited to anonymously ranked the importance of relevant topics using a five-point Likert scale and proposed suitable cognitive and psychomotor levels for each topic. Fuzzy evaluation was then performed, and experts were considered to have reached a consensus if the following three conditions were achieved: (a). the difference between the average and expert rating data was ≤ 0.2; (b). the average expert consensus was ˃70%; and (c). the average fuzzy number was ≥ 0.5. Subsequently, the mean ratings were used to determine the cognitive and psychomotor levels. RESULTS: 20 experts participated in the survey. 64 out of 65 paediatric dentistry topics were deemed acceptable. The average fuzzy number ranged from 0.36 to 0.85, while the average Likert score ranged from 3.05 to 5.00. The topic "Dental amalgam" was rejected based on expert consensus since the average fuzzy number was 0.36. The most significant topic was "Pit and fissure sealant", followed by "Preventive advice", "Early childhood caries", "Dental caries in children & adolescent", "Management of dental caries in paediatric patients", and "Consent" which were equally ranked as the second most important topics. According to Bloom's and Simpson's taxonomies, most of the paediatric dentistry topics were rated adequate for undergraduate students at the cognitive level of "Apply" (C3) and a psychomotor level of "Guided response" (P3). CONCLUSION: The current study successfully identified relevant undergraduate paediatric dentistry topics using the fuzzy Delphi method, which can facilitate future educators to improve existing Malaysian undergraduate paediatric dental curricula.

A new attempt of applying hybrid team-based and case-based learning approach in dental materials science: Does it work?

INTRODUCTION: Limited studies have been conducted on the use of a hybrid team-based learning (TBL) and case-based learning (CBL) approach in dental education. The present study aims to evaluate students' experience of the hybrid TBL-CBL in learning dental materials science subjects. METHODS: All second-year undergraduate Bachelor of Dental Surgery (BDS) students were invited to participate in a TBL-CBL session. These participants were randomly allocated to six different groups of 10-12 students, and the session was conducted by one lecturer as the facilitator. A 23-item questionnaire assessing four domains (perceptions of effectiveness, teacher, team interaction and learning environment) was administered at the end of the TBL-CBL session. RESULTS: The response rate was 91.9% (n = 68). Mean scores for the questionnaire items ranged from 4.13 to 4.60 suggesting a positive perception among the students towards the hybrid TBL-CBL approach. Regarding the open-response questions, students emphasised that the TBL-CBL session was effective for team interaction and group discussions. However, students wished to have a better venue for future sessions. CONCLUSION: Positive perceptions of the students encourage future educators to consider the use of TBL-CBL approach in teaching dental materials science and to avoid the reliance on standalone conventional lectures. Future research could consider examining its effects on students' academic achievement as well as the perspectives of teachers regarding its adoption in different dental specialities.

Comparison of Malaysia's Bachelor of Dental Technology curriculum with three other countries: Proposing a basic curriculum framework.

INTRODUCTION: A dental technologist is one of the most essential allied dental health professionals and the dental technology curriculum should be comprehensively reviewed on a regular basis. This study aims to compare the only existing Bachelor of Dental Technology (BDT) curriculum in Malaysia with BDT programmes offered by other well-established universities, and map out the similarities and differences, as well as to explore future recommendations and propose a new curriculum framework. MATERIALS AND METHODS: A descriptive analysis was carried out using Laurie Brady's four-stage strategy. First, available curriculum materials were collected from four different institutions' electronic webpage: AIMST (Malaysia), GU (Australia), UO (New Zealand) and CMU (United Kingdom), and then compared based on three key domains: curriculum contents, teaching and learning strategies and assessments. Following that, the similarities and differences between various curricula were identified. Future recommendations and a curriculum framework were then proposed. RESULTS: The core BDT curriculum content is concurred upon by all four universities, with an emphasis on basic sciences, laboratory materials, practical sessions and research projects. However, the credit weightage for each course or module varied across the four institutions, with some offering unique subjects and implementing different teaching methods and assessments. A simple BDT curriculum framework with a proposed syllabus was designed based on the three key domains and future recommendations for curriculum improvement were explored. CONCLUSION: The present study identified several areas for Malaysian BDT curriculum development and improvement. The proposed framework can be a guide for Malaysian dental schools in designing a comprehensive dental technology programme.

An Insight into the Role of Marine Biopolymer Alginate in Endodontics: A Review.

Alginate is a natural marine biopolymer that has been widely used in biomedical applications, but research on its use as an endodontic material is still sparse in the literature. This pioneer review aims to summarize the emerging roles of alginate and to outline its prospective applications as a core biomaterial in endodontics. Ten electronic databases and five textbooks were used to perform a search of English-language literature on the use of alginate in endodontics published between January 1980 and June 2022. The risk of bias (RoB) of each included study was assessed using the Office of Health Assessment and Translation (OHAT) tool. Subsequently, studies were categorized into three tiers to represent the overall risk. Qualitative analysis was performed, and the articles were sorted into different thematic categories. An initial search yielded a total of 1491 articles, but only 13 articles were chosen. For most domains, all the studies were rated with 'probably low' or 'definitely low' RoB, except for domains 2 and 6. All included studies fall in the Tier 1 category and were either in vitro, in vivo, or ex vivo. Four thematic categories were identified: endodontic regeneration, intracanal medicament, filing material, and chelating agent. Based on the available evidence, alginate has emerged as a cell carrier and scaffold in regenerative endodontics, a microcapsule delivery system for intracanal medicaments, a chelating agent reinforcing material, and a root canal sealer. More well-designed experiments and clinical trials are needed to warrant the promising advent of this hydrogel-based biomaterial.

Vertical root fracture resistance and dentinal crack formation of root canal-treated teeth instrumented with different nickel-titanium rotary systems: an in-vitro study.

To compare the vertical root fracture (VRF) resistance of root canal-treated teeth instrumented with four different nickel-titanium (NiTi) rotary file systems and examine the dentinal crack pattern and direction using a new classification. Eighty mature mandibular premolars were selected and decoronated, leaving 13 mm of the root. The root samples were mounted in acrylic resin and divided randomly into five groups of different NiTi file systems: Group 1-control, Group 2-T-Pro, Group 3-HyFlex CM, Group 4-TG6 and lastly Group 5-ZenFlex. Samples in Group 2 and Group 3 were instrumented up to size 25/0.04, whereas Group 4 and Group 5 were instrumented up to size 25/0.06. Obturation was performed with AH Plus sealer and gutta-percha using single cone technique. Subsequently, all samples were subjected to occlusal compressive force until they were fractured. The force (N) needed to cause root fracture was recorded. The crack patterns and directions were also inspected under magnification and classified using a new and simple classification. The highest (VRF) resistance was noted in the control group (453.15 ± 92.23 N), followed by T-Pro (387.43 ± 76.81 N), HyFlex CM (381.88 ± 52.73 N), ZenFlex (369.15 ± 89.41 N) and finally TG6 (346.05 ± 72.08 N), but there was no significant difference between T-Pro and HyFlex (P = 0.438). A significantly higher prevalence (P = 0.001) of Type 1 crack pattern was observed, especially in samples instrumented with TG6. Majority of the cracks ran buccolingually except in some samples instrumented with ZenFlex (P = 0.898). Smaller file taper increased the VRF resistance of root canal-treated teeth. Majority of the dentinal crack exhibited Type 1 pattern and ran buccolingually.

Is pulpotomy a promising modality in treating permanent teeth? An umbrella review.

Emerging evidence suggests the use of less invasive therapy such as pulpotomy in treating permanent teeth with pulp exposure and signs of pulpitis. Hence, this umbrella review aims to evaluate the available systematic reviews on pulpotomy treated permanent teeth. Articles published between January 1970 and May 2021 were searched in ten electronic databases and five textbooks. Only systematic reviews published in English that examined the use of pulpotomy on either carious or traumatic pulpal exposed in mature or immature permanent teeth with signs of pulpitis were selected. The Corrected Covered Areas (CCAs) were calculated to identify the overlap in primary studies, whereas the AMSTAR 2 assessment tool was used to analyze the risk of bias in each included review. Nine systematic reviews were chosen of which two systematic reviews focused solely on coronal pulpotomy, one on partial pulpotomy, and the remaining focused on both coronal and partial pulpotomies. Overall, only two reviews were rated as 'High Quality'. Umbrella analyses showed that both coronal and partial pulpotomies revealed overall high success rates ranging from 88.5% to 90.6%. However, the currently available evidence on the effects of different pulpal medicaments and restorative materials on the success rate of pulpotomy were still inconclusive. Pulpotomy can be regarded as a promising modality in treating mature and immature permanent teeth with carious pulpal exposure or signs of pulpitis. Nonetheless, further high-quality clinical trials with long-term follow-up and better control of confounding factors are warranted in the future.

Novel dental composite resin derived from rice husk natural biowaste: A systematic review and recommendation for future advancement.

OBJECTIVES: This review aimed to summarize contemporary evidence related to dental composite resin derived from rice husk biowaste and its potential future advancement. This review paper included the techniques for synthesis, characterization, and preparation of rice husk composite resin. Focus was also given to the flexural strength and modulus, compressive strength, wear rate, hardness, surface roughness, color stability, polymerization shrinkage, degree of conversion, and their application onto root canal treated teeth. MATERIAL AND METHODS: A search of English peer-reviewed literature (January 1960-February 2021) was conducted from electronic databases (PubMed Central, Cochrane, LILACS, Science Direct, Web of Science, SIGLE, EMBASE, EBSCO, Medline, and Google Scholar). RESULTS: 11 articles and a book section were finally selected for qualitative analysis. Studies concluded that the physicomechanical properties and the color stability of rice husk dental composites showed comparable results to conventional dental composites. Incorporation of zirconia nanopowder into rice husk dental composite increased the compressive strength and hardness values, associated with lower shrinkage, a high degree of conversion, and improved fracture strength when applied on root canal treated teeth. CONCLUSIONS: Due to its low cost, eco-friendliness, and acceptable clinical performances, rice husk dental composite resin can be considered as an alternative to conventional composites. CLINICAL SIGNIFICANCE: Dental composite resin derived from rice husk silica demonstrated excellent performance, which could potentially substitute currently available composite resins. This review will give new insight to clinicians and researchers on the usage of natural biowaste mass in the field of dental restorative materials.

Awareness, Knowledge, Attitude, and Practice of Teledentistry among Dental Practitioners during COVID-19: A Systematic Review and Meta-Analysis.

Background and Objectives: This systemic review aims to appraise and analyse the awareness, knowledge, attitude, and practice of teledentistry among dental practitioners during COVID-19. Materials and Methods: This review was registered in the PROSPERO database (CRD42021283404). Cross-sectional articles on dental practitioners' perceptions towards teledentistry published between March 2020 and September 2021 were searched in ten online databases (PubMed, Google Scholar, Web of Science, ScienceDirect, Cochrane, EMBASE, SIGLE, EBSCO, LILACS, and Open Grey). The Joanna Briggs Institute critical appraisal tool was employed to analyse the risk of bias (RoB) of each article, whereas the Oxford Centre for Evidence-Based Medicine recommendation tool was used to evaluate the level of evidence. Data were analysed using the DerSimonian-Laird random effect model based on a single-arm approach. Results: Six studies were included and demonstrated Level 3 evidence. A single-arm meta-analysis revealed that dental practitioners had a high level of awareness (70.4%) and attitude (72.5%) towards teledentistry during the COVID-19 pandemic, but their knowledge level (57.9%) was moderate with a poor practice level (35.8%). A substantial heterogeneity was observed with the overall I2 ranging from 90.78% to 98.21%. Furthermore, meta-regression indicated that the sample size of each study had a significant (p < 0.05) impact on the degree of data heterogeneity. Conclusions: Despite their high degree of awareness and attitude, dental practitioners demonstrated moderate knowledge and relatively poor practice of teledentistry during the COVID-19 pandemic. More well-designed studies are warranted to investigate the alternatives for enhancing dental practitioners' knowledge and practice of teledentistry interventions.

EFFECTIVENESS OF RESIN INFILTRATION IN CARIES INHIBITION AND AESTHETIC APPEARANCE IMPROVEMENT OF WHITE-SPOT LESIONS: AN UMBRELLA REVIEW.

OBJECTIVES: Resin infiltration technique is a minimal interventive approach to manage white-spot lesions. The present umbrella review aimed to comprehensively appraise the previously published systematic reviews on the effectiveness of resin infiltration in arresting caries progression and improving the aesthetic appearance of white-spot lesions. MATERIAL AND METHODS: Ten electronic databases were searched between January 1960 and May 2021. Only systematic reviews published in English on the use of resin infiltration in primary or permanent teeth were included. The degree of overlap across each review was calculated using the Corrected Covered Areas method and their evidence quality were assessed using A MeaSurement Tool to Assess systematic Reviews 2 assessment tool. Umbrella meta-analysis was carried out using a random-effects model. RESULTS: Thirteen systematic reviews were chosen, but only eight were eligible for an umbrella meta-analysis. The overall Corrected Covered Areas value was very high (19.8%), whereas only three studies were classified as 'High Quality'. Qualitative synthesis suggested that resin infiltration demonstrated acceptable aesthetic results, whereas quantitative analysis showed favourable outcomes in minimizing the risk of caries progression (RR: 0.32; 95% CI: 0.29-0.36). White-spot lesions treated with resin infiltrant in permanent teeth demonstrated a lower risk of caries progression (P < .001) than primary teeth. Overall, low data heterogeneity was observed (I2: 0%-20%). However, quantitative umbrella analysis on the aesthetic outcome was unable to perform due to limited data. CONCLUSION: Resin infiltration can be regarded as an effective treatment modality in minimizing the risk of caries progression and improving the aesthetic appearance of white-spot lesions. Future well-designed high-quality systematic reviews with long-term follow-up and more control of confounding variables are warranted.

The existence of butterfly effect and its impact on the dentinal microhardness and crack formation after root canal instrumentation.

To compare the microhardness and crack formation in root dentine presented with butterfly effect in lower premolars. Sixty mature lower premolars were selected and divided into the control and experimental groups. Teeth in the experimental group were instrumented up to size 30/.04. The roots were cut horizontally into twelve parts of 1-mm-thick cross-section and were numbered accordingly. They were divided into coronal, middle, and apical root sections. Sections were then viewed under a microscope to determine the presence of butterfly effect and subsequently scored. 8 teeth from both control and experimental groups with the highest and lowest score were selected. Crack formation was inspected and classified into four different types of cracks. Microhardness test was performed using a Vickers hardness test. Higher frequency of butterfly effect was found in the apical root section and root dentine with butterfly effect were harder mesiodistally. The middle and apical root sections with butterfly effect were harder than the coronal section. No significant difference of dentine hardness between the control and experimental groups. Cracks only occurred in the experimental group and presented in buccolingual direction with a higher rate of Type 1 and Type 2 cracks. Prevalence of butterfly effect in lower premolars increased from coronal to apical with increased hardness mesiodistally. More buccolingual cracks were found in radicular dentine with butterfly effect and most of them exhibited Type 1 and Type 2 cracks. Roots of lower premolar with butterfly effect may be susceptible to a higher rate of vertical root fracture in buccolingual direction, especially after root canal treatment. Thus, special attention should be given not to overload instruments during root canal preparation.

Dislodgement resistance and adhesive pattern of different endodontic sealers to dentine wall after artificial ageing: an in-vitro study.

To compare the dislodgement resistance and the adhesive pattern of four different endodontic sealers to root dentine walls. Ninety lower premolars were assigned to five groups (n = 18), Group 1: no sealer (control); Group 2: EndoRez (ERZ); Group 3: Sealapex (SPX); Group 4: EndoSeal MTA (ESA) and Group 5: BioRoot RCS (BRS). They were instrumented up to size 30 taper 0.06 and obturated using single cone technique with matched-taper gutta-percha cones and one of the mentioned sealers. Six teeth from each group were then randomly subjected to 100, 1000 and 10,000 thermocycles, respectively. 1 mm slice of mid root region, measuring 6 mm from the apical foramen was prepared and subjected to push-out test under a Universal Testing Machine. Adhesive patterns of sealers were assessed using a stereomicroscope at 20 × magnification and classified using a new system. Statistical analyses were performed using two-way ANOVA, complemented by Tukey HSD and Chi-square tests. ESA and BRS showed significantly higher (p < 0.05) push-out bond strength, followed by SPX, ERZ and lastly the control, but no significant difference was noted between ESA and BRS (p > 0.05) at 100, 1000 and 10,000 thermocycles, respectively. Both ESA and BRS exhibited a significant higher rate (p < 0.05) of Type 3 and Type 4 adhesive patterns as the thermocycles increased. ESA and BRS demonstrated higher bond strength and better adhesive pattern to root dentine wall than SPX and ERZ, especially after artificial ageing.