Effect of build orientation on the trueness of occlusal splints fabricated by three-dimensional printing.

PURPOSE: Scientific evidence pertaining to the evaluation of trueness of occlusal splints fabricated using different three-dimensional (3D) printers and build orientations compared to subtractive technologies is lacking. METHODS: Overall, one hundred and ten occlusal splints were manufactured using two different 3D printers and a dental mill. Five groups of ten were fabricated using the 3D printers at different build orientations (0, 30, 45, 60, and 90 degrees). In addition, a comparison group of ten occlusal splints was subtractively manufactured using a five-axis dental mill. All occlusal splints were scanned and exported as a standard tessellation language file. Analysis was conducted with metrology software with root mean square estimate average positive deviation and average negative deviation used as the measured outcome. RESULTS: The 0 degree printing orientation was the most accurate for printer one with the root mean square value of 0.05 ± 0.01 mm, and 60 degree printing orientation was most accurate for printer two with the RMS value of 0.11 ± 0.01 mm. Subtractively manufactured occlusal splint had significantly higher trueness with the lowest RMS value of 0.03 ± 0.05 mm. CONCLUSION: Build orientations influence the trueness of additively manufactured occlusal splints while occlusal splints produced by subtractive manufacturing were statistically significantly more accurate.

A 3-year qualitative evaluation of interprofessional team-based clinical education at an Australian dental school.

PURPOSE/OBJECTIVES: This article describes a qualitative evaluation of interprofessional (IP) team-based treatment planning (TBTP) involving dentistry, oral health therapy, dental prosthetics, and dental technology students at the Griffith University School of Dentistry and Oral Health (DOH). Using the same data from a recently published article that looked solely at the quantitative evaluation of TBTP, this article focuses on the qualitative evaluation of TBTP. This evaluation explores the contextual meaning related to the previously published aspects of TBTP that contributed positively toward oral health students' IP clinical learning and identifies themes reflecting students' IP clinical experience. METHODS: Thematic analysis of transcripts from nine focus groups, comprised of 46 final year students and open-ended questions collected from 544 students through an online instrument from 2012 to 2014, explored the question: "What is the contribution of IP student team-based processes on students' perceptions of IP learning and practice at DOH?" RESULTS: Responses from online participants and student focus groups revealed three major themes: useful role learning, communication confidence, and pro-active collaborative teamwork. Throughout each of these themes, students stated they possessed a confidence in collaborating with other oral health students as exhibited through an understanding of profession-specific and IP roles, self-assurance in communicating, and teamwork skills. CONCLUSION: Aspects of TBTP that contributed positively toward students' IP clinical learning and practice were meaningfully identified.

Exploring digital technologies used in the design and manufacture of craniofacial implant surgical guides: A scoping review.

STATEMENT OF PROBLEM: Unlike intraoral implants, digitally planned surgical templates used for guiding the ideal position of the craniofacial implants are not well established, and clear methods and guidelines for their design and construction are lacking. PURPOSE: The purpose of this scoping review was to identify the publications that used a full or partial computer-aided design and computer-aided manufacture (CAD-CAM) protocol to create a surgical guide that achieves the correct positioning of craniofacial implants to retain a silicone facial prosthesis. MATERIAL AND METHODS: A systematic search was conducted in MEDLINE/PubMed, Web of Science, Embase, and Scopus for articles published before November 2021 in the English language. Articles needed to satisfy the eligibility criterion of in vivo articles that created a surgical guide with digital technology for inserting titanium craniofacial implants to hold a silicone facial prosthesis. Articles that inserted implants in the oral cavity or upper alveolus only and articles that did not describe the structure and retention of the surgical guide were excluded. RESULTS: Ten articles were included in the review; all were clinical reports. Two of the articles used a CAD-only approach alongside a conventionally constructed surgical guide. Eight articles described applying a complete CAD-CAM protocol for the implant guides. The digital workflow varied considerably depending on the software program, design, and retention of guides. Only 1 report described a follow-up scanning protocol to verify the accuracy of the final implant positions compared with the planned positions. CONCLUSIONS: Digitally designed surgical guides can be an excellent adjunct to accurately place titanium implants in the craniofacial skeleton for support of silicone prostheses. A sound protocol for the design and retention of the surgical guides will enhance the use and accuracy of craniofacial implants in prosthetic facial rehabilitation.

Overview of incorporation of inorganic antimicrobial materials in denture base resin: A scoping review.

STATEMENT OF PROBLEM: Dental hygiene for institutionalized patients and recurring Candida-associated denture stomatitis remain problematic because of a patient's limited dexterity or inability to eliminate Candida from denture surfaces. Although there has been extensive research into antimicrobial modification of denture base resins with inorganic materials, scoping reviews of the literature to identify knowledge gaps or efficacy of inorganic antimicrobial materials in denture base resins are lacking. PURPOSE: The purpose of this scoping review was to provide a synopsis of the efficacy of the major classes of inorganic antimicrobial materials currently incorporated into denture base resins. MATERIAL AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was applied. Four electronic databases, including Embase, PubMed, Web of Science, and Google Scholar, were accessed for articles in the English language, up to February 2019, without restrictions on the date of publication. RESULTS: From the 53 articles selected, 25 distinguishable inorganic materials were found and divided into 3 subgroups. Forty-three articles evaluated nanomaterials, where mostly silver ion nanoparticles and/or titanium dioxide nanoparticles were incorporated into denture base resins. Fourteen articles examined antimicrobial drugs and medications, including azole group medications, amphotericin-B, Bactekiller, chlorhexidine, Novaron, and Zeomic. Two articles classified as others explored hydroxyapatite- and fiber-incorporated denture base resins. CONCLUSIONS: Although nanotechnology and antimicrobial medications or drugs have been successfully used to reduce Candida-associated denture stomatitis, long-term solutions are still lacking, and their disadvantages continue to outweigh their advantages.

Sources of occupational stress amongst dentistry academics.

BACKGROUND: Dentistry professionals may experience significantly higher occupational stress than other health professionals and dentistry academics may have specific work content and context sources of stress. AIMS: The aim of this study is to identify common sources of occupational stress, and how these are associated with wellbeing, in dentistry academics. MATERIALS & METHODS: A cross-sectional online survey with staff in Dentistry departments in Australia and New Zealand. Assessment included 23 items from five general domains of occupational stress from the NIOSH-Generic Job Stress Questionnaire, a 23-item list of sources of stress and the 22-item Psychological General Well-Being Index. Analyses used descriptive statistics and multiple linear regression. RESULTS: A total of 107 respondents (average age 50 ± 11.7 years, 56.8% men) completed the survey. Leading sources of occupational stress were job future, time pressure at work, work overload, and administration demands. A multiple linear regression model significantly predicted wellbeing, F(8,77) = 13.141, p = .000, adj.R2  = .53, but there were no significant associations for any of the specific sources of stress. CONCLUSION: The combination of time pressure, workload and responsibility, job dissatisfaction, low social support, and uncertain job future was inversely associated with wellbeing amongst these dentistry academics. Future studies should consider the development and evaluation of interventions to address these concerns.

A technical and clinical digital approach to the altered cast technique with an intraoral scanner and polyvinyl siloxane impression material.

This technique digitalizes the clinical and laboratory steps of fabricating removable partial dentures (RPDs) with the altered cast technique. An intraoral scanner was used to capture the mandibular Kennedy class II partially edentulous arch. An RPD framework was fabricated digitally and then combined with a custom tray with a wax occlusal rim. A conventional polyvinyl siloxane altered cast impression was made and then digitalized both intraorally and extraorally, followed by a digital interocclusal record. The resulting scan was modified to produce an additively manufactured cast. The teeth and gingival components were then designed and fabricated with a combination of additive and subtractive manufacturing, followed by the conventional acrylic resin pour technique. The definitive prosthesis was completed with minimal conventional techniques and without the use of gypsum, prefabricated teeth, or a physical articulator. The technique reduces the number of appointments and achieves the functional extension of the prosthesis through border molding, which is not possible with intraoral scanning.

Trueness assessment of additively manufactured maxillary complete denture bases produced at different orientations.

STATEMENT OF PROBLEM: The trueness of the intaglio surface of an additively manufactured maxillary denture base may be influenced by the build orientation and the inclusion of support struts. PURPOSE: The purpose of this in vitro study was to compare the trueness of a photopolymer additively manufactured maxillary complete denture base created at different orientations with different support strut designs. Optimizing the build is critical for adopting best practice when fabricating maxillary complete dentures through additive manufacturing techniques. MATERIAL AND METHODS: Denture bases (N=70) were additively manufactured at 5 different build orientations (0-, 15-, 45-, 60-, and 90-degrees) with 10 specimens per orientation. Another 2 groups of 10 were manufactured by using the optimal printing orientation with and without support struts. The denture bases were scanned after storage in artificial saliva at 37 °C, and the scan data were analyzed with a 3D metrology software program. Statistical differences were determined with 1-way analysis of variance (ANOVA) and the Kruskal-Wallis test (α=.05). Color deviation heat maps were used to determine areas of clinically significant dimensional errors. RESULTS: Significant differences were found among groups for positive mean deviation (F=44.09, P<.001), negative mean deviation (F=11.69, P<.001), and root mean square deviation (F=17.11, P<.001) for the different orientations. One-way ANOVA revealed significant differences with the use of support struts in relation to negative mean deviation (F=3.857, P<.001) and RMSE (F=11.215, P<.001) and positive mean deviation (Kruskal-Wallis H=0.070, P=.007). The color deviation maps showed that a 45- to 90-degree print orientation was truest overall and that the addition of support struts to the cameo and intaglio surfaces improved the trueness of the maxillary denture bases. CONCLUSIONS: The build orientation and inclusion of support struts influenced the accuracy of the intaglio surface of additively manufactured maxillary denture bases. A 45- to 90-degree build orientation with support struts on the cameo and intaglio surfaces resulted in the truest denture base.

A 3-year quantitative evaluation of interprofessional team-based clinical education at an Australian dental school.

PURPOSE/OBJECTIVES: Clinical educational challenges led to the Griffith University School of Dentistry and Oral Health (DOH) introducing interprofessional team-based treatment planning (TBTP). This paper evaluates the interprofessional contribution made to student clinical learning and experience among dentistry, oral health therapy, dental prosthetics, and dental technology students. METHODS: A mixed methodology approach targeting 845 students collected data annually employing a prevalidated online instrument from 2012 to 2014 to answer the question: "What is the contribution of interprofessional student team-based processes on students' perceptions of interprofessional practice at DOH?" RESULTS: A representative study sample with a 64.4% response rate (N = 544) reported TBTP creating a supportive environment for interprofessional clinical learning. Significant improvements in learning shared across disciplines indicated improvements in mutual respect, understanding roles, and constructive communication enhancing teamwork. There were increasing significant correlations between shared learning and positive clinical experiences from 2012 (r = .642, p < .000) to 2013 (r = .678, p < .000) and 2014 (r = .719, p < .000). A combination of TBTP predictors accounted for 53% of the variance in clinical learning and experience in 2014 compared to 40% in 2012. CONCLUSION: Learning with other students, developing teamwork abilities, improved communication skills, and respect for other oral health professions were aspects of TBTP that positively impacted clinical learning and practice at DOH. Further study would assist to determine specific elements that made the greatest contribution to student learning experiences.

Design of a communication skills course in dentistry: Applying active-learning strategies to improve educational outcomes.

PURPOSE/OBJECTIVE: Effective communication, between patient and dentist, is a core clinical skill that commands dedicated pedagogy similar to that of developing scientific knowledge and psychomotor skills. This study aimed to describe active-learning strategies in a dental communication skills course, which sits within a broader foundation dental course and evaluate students' educational outcomes. METHODS: This is a two-phase retrospective, mono-centred study, completed in 2019 at an Australian dental school. Phase I, a case report, describes the Communication Skills for Oral Health (CSOH) course design and its active-learning strategies. Phase II analysed data from the course using Kirkpatrick's evaluation model to objectively measure the impact of the course and provide feedback to education designer. Students' perception (Level 1) was evaluated with an institutional, validated online survey. Descriptive and statistical analysis, included paired tests and Spearman's correlation analyses, used to investigate learning effect (Level 2) and student behaviour change (Level 3). To assess the impact of the CSOH course design (Level 4) the student grades from the course were analysed. RESULTS: The CSOH course encompasses three major topics: Essentials of Communication Skills, Professional-Patient Relationship and Managing Difficult Situations. Each topic included didactic content complimented with a variety of active-learning strategies to teach and assess students. Positive outcomes were recorded across all Kirkpatrick levels. CONCLUSIONS: This study suggests an efficient communication skills course design, which may assist in the development of communication skills courses in other dental education institutions.

Factors patients consider when accessing oral health care.

The aim of this cross-sectional study was to understand patients' perceived importance of clinic- and clinician-related factors and contextual characteristics that shape the importance ratings for factors patients consider when accessing oral health care. This study was conducted at Griffith University Dental Clinic, Gold Coast, Australia. Patients answered a self-administered questionnaire on demographics and perceived need for attendance, which constituted the explanatory variables. In the second part of the questionnaire, patients were asked to rate the importance of 17 items related to the provision and quality of oral health services using a five-point scale. Exploratory factor analysis (EFA) was conducted to determine the dimensionality of the questionnaire. The questionnaire was completed by 298 patients. The importance of some of the clinician-related factors, such as 'concern for patients' and 'access to specialist care', were associated with sex, age and employment status. EFA revealed a two-factor structure, which consisted of items related to clinician characteristics and clinic environment characteristics. Female participants had higher importance scores for clinic environment characteristics (mean (±s.d.) 38.00 ± 4.86 vs 35.45 ± 6.30; P < 0.05) and clinician characteristics (32.39 ± 2.85 vs 31.33 ± 3.39; P < 0.05) than male participants. In conclusion, various clinician- and clinic-related aspects were considered important for the provision and quality of oral health services, with the importance of these factors associated with some contextual characteristics. Application of Andersen's behavioural model of health services use provided a framework that offers important insights into patient beliefs and perceptions towards oral health services and can serve as a baseline for future studies in dental clinics across Australia.

Operators matter - An assessment of the expectations, perceptions, and performance of dentists, postgraduate students, and dental prosthetist students using intraoral scanning.

OBJECTIVE: to assess the expectations, perceptions and performance of different operators with varying backgrounds and training in the use of full-arch intraoral scanning (IOS). METHODS AND MATERIALS: Dentists (DENT), postgraduate dental students (DPG), and student prosthetists (PROS) were invited to join an IOS training workshop. Participants completed a satisfactory scan of a mannikin-mounted typodont with the total scanning time (TST) recorded. They also completed anonymised pre and post-training questionnaires covering their background, and IOS expectations and experience. Statistical analysis was performed using the Mann-Whitney U, Kruskal Wallis, and chi-square tests. Open-ended questions were analysed manually and using Leximancer. RESULTS: Twenty-seven participants were recruited: 10 DENT; 10 PROS; and 7 DPG. Positive expectations of IOS was reported by 93 % of participants. Combined TST was 285 ± 83 s, with the PROS TST significantly longer (p < 0.05, 337 ± 79 s). Further training need was reported by 60 % of PROS and 50 % of DENT versus 14 % of DPG. Positive IOS experience was reported by 96 % of participants, 74 % perceived it to be accurate, and 63 % found it easy to use. Eighty-five percent of all participants stated that cost would influence their decision of adopting IOS in their practice. CONCLUSION: Expectations and perceptions of IOS were overwhelmingly positive, irrespective of operator background and experience. Scanning performance and training needs depended on the operator's background. Cost of IOS remains a barrier to acquiring the technology. CLINICAL SIGNIFICANCE: IOS training must be customised to accommodate the needs of different operators. The cost of IOS needs revision to improve its accessibility.

Incorporation of antimicrobial agents in denture base resin: A systematic review.

STATEMENT OF PROBLEM: Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial. PURPOSE: The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials. MATERIAL AND METHODS: A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis. RESULTS: Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified. CONCLUSIONS: Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively.

Effectiveness of technology-enhanced learning to improve periodontics educational outcomes: A systematic review.

OBJECTIVES: Technology-enhanced learning (TEL) has been suggested as a suitable learner-centered pedagogical approach in dental education. However, the results of TEL effectiveness in periodontics education are controversial. Therefore, this systematic review aimed to evaluate the effectiveness of TEL to improve educational outcomes in the periodontics field compared to traditional learning methods. METHODS: The search comprised randomized controlled trials (RCTs) and crossover studies that were related to periodontics education from the following databases: MedLine, PsycINFO, Eric, Scopus, EMBASE, and Web of Science. Two authors independently performed study selection, data extraction, and assessed risk of bias. Kirkpatrick's 4-level evaluation model was used to evaluate educational outcomes. RESULTS: From 1642 studies, after applying inclusion criteria, 7 studies remained for analysis. On level 1 (Reaction), undergraduate dental students reported positive attitudes related to TEL. On level 2 (Learning), 3 studies found that TEL improved knowledge gain compared to traditional learning methods. Three other studies did not show any difference between TEL and conventional learning methods, and one found that traditional learning methods presented superior results. On level 3 (Behavior), 1 study found that TEL application improved students' performance. On level 4 (Results), 5 studies suggested that the implementation of TEL would improve educational outcomes in periodontics education if combined with traditional learning methods. CONCLUSION: The findings showed that the exclusive use of TEL does not significantly improve periodontics educational outcomes when compared to traditional learning methods. However, the combination of TEL and traditional learning methods can be the key to enhancing periodontics education.

Measuring team-based interprofessional education outcomes in clinical dentistry: psychometric evaluation of a new scale at an Australian dental school.

Previous research on interprofessional education (IPE) assessment has shown the need to evaluate the influence of team-based processes on the quality of clinical education. This study aimed to develop a valid and reliable instrument to evaluate the effectiveness of interprofessional team-based treatment planning (TBTP) on the quality of clinical education at the Griffith University School of Dentistry and Oral Health, Queensland, Australia. A scale was developed and evaluated to measure interprofessional student team processes and their effect on the quality of clinical education for dental, oral health therapy, and dental technology students (known more frequently as intraprofessional education). A face validity analysis by IPE experts confirmed that items on the scale reflected the meaning of relevant concepts. After piloting, 158 students (61% response rate) involved with TBTP participated in a survey. An exploratory factor analysis using the principal component method retained 23 items with a total variance of 64.6%, suggesting high content validity. Three subscales accounted for 45.7%, 11.4%, and 7.5% of the variance. Internal consistency of the scale (α=0.943) and subscales 1 (α=0.953), 2 (α=0.897), and 3 (α=0.813) was high. A reliability analysis yielded moderate (rs=0.43) to high correlations (0.81) with the remaining scale items. Confirmatory factor analyses verified convergent validity and confirmed that this structure had a good model fit. This study suggests that the instrument might be useful in evaluating interprofessional or intraprofessional team-based processes and their influence on the quality of clinical education in academic dental institutions.

Communicating prosthetic prescriptions from dental students to the dental laboratory: is the message getting through?

The aim of this research was to investigate the quality of written prosthetic prescriptions provided by fourth-year dental students to a commercially operated dental laboratory and to ascertain the contribution of interprofessional education to improving prescription quality. Based on guidelines established by the Medicines and Healthcare Products Regulatory Agency of the European Union (Medical Device Directive 93/42/EEC), an audit was conducted prior to and after an educational intervention was delivered by a dental technician to a dental student cohort at one Australian dental school. Prior to the intervention, thirty-nine dental prosthetic prescriptions were collected, analyzed, and audited to determine the clarity of written communication and instructions from dental student to dental technician. Following the intervention, a further forty prosthetic prescriptions were collected from the same cohort of students and were audited. The audit of the initial prescriptions showed that 85 percent (n=33) did not comply with the recommended conventions. After the intervention, the prescriptions that did not meet the guidelines had fallen to 30 percent (n=12) of the total. Improvements in prosthetic prescriptions submitted by these dental students to the commercial dental laboratory suggest there is an advantage to including a prosthetic prescription-writing module in dental school curricula.

Dental students' reflections on clinical placement in a rural and indigenous community in Australia.

Clinical placements away from the dental school are now an integral and important component of dental education internationally. This article presents feedback from students on their experience in a remote rural clinical placement in Australia by year cohorts 2009, 2010, and 2011. An online feedback survey instrument and compulsory reflective journals were analyzed both by calendar year cohort and amongst individual student groups. The information obtained suggests that overall this was a very positive experience for most students and the clinical experience gained was valued highly. Many students wrote positively about their cultural experiences and the knowledge they gained of life in a remote rural area. Many were pleased with the contribution they made to the oral health treatment needs of the community. Concerns related to the lower patient flow and the inferior quality of equipment compared to that in the main university clinic and with delays in maintaining and repairing equipment. While the overall outcome was positive, significant challenges face all stakeholders to maintain and enhance the clinical and social experiences of these future practitioners. The true impact of the placement will only be realized when graduates are confident to venture into clinical practice settings in rural locations.

Traditional and interprofessional curricula for dental technology: perceptions of students in two programs in Australia.

Collaboration between dental technicians and other members of the dental care team is essential to achieve optimal outcomes for patients in prosthetic care. Interprofessional education can be effective in improving attitudes, communication, and practices within such teams. This study compared and contrasted the perceptions of role, responsibilities, communication, and teamworking of dental technology students in a traditional curriculum with those in an interprofessional curriculum, both in Australia. A social demographic questionnaire and two standard self-report measures were used to collect data from each year group of the two programs. Thirty to thirty-two of the thirty-nine students enrolled in a traditional dental technology program and nineteen to twenty-two of twenty-five students enrolled in an interprofessional curriculum completed surveys. Statistical analysis of self-report measures identified a significant difference in professional identity, development of roles, and perception of enhanced opportunities for collaboration of dental technologists with the wider oral health professions in those undertaking the interprofessional curriculum. This study suggests that interprofessional learning can shift traditional attitudes and, potentially, improve opportunities for collaboration between dentists and dental technicians. It also supports the idea that adoption of an interprofessional curriculum can significantly enhance communication and teamwork skills essential for readiness in the workplace.

Dental care provision by students on a remote rural clinical placement.

BACKGROUND: In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural and Indigenous community in Australia. This paper analyses the type of treatment services provided from 2009 to 2011 by year, type of patient and age of patient. METHODS: All treatment data provided were captured electronically using the Australian Dental Association (ADA) treatment codes. Audited reports were analysed and services categorised into six broad treatment types: consultation, diagnostic, preventive, periodontics, oral surgery and restorative services. RESULTS: The bulk of dental care episodes provided over the three-year period were for clinical examinations, restorative and oral surgery services. Preventive and periodontic services generally comprised less than 10% of the care provided. Over time fewer clinical examinations were conducted and restorative dentistry increased in the second and third years of the placement. There were no significant differences in the types of care provided to public and private patients. CONCLUSION: Clinical placement of final-year dental students in remote rural settings has helped address a largely unmet dental need in these regions. IMPLICATIONS: Dental student clinical placement is effective in providing care to communities in a remote rural setting. Student placements are, however, only able to deliver dental care in few remote rural communities, and therefore will make a negligible impact on the level of untreated dental disease in the short term. It is hoped that the experience will lead to more graduates serving some of their professional lives in remote communities.