Evaluating the impact of interprofessional forums on dental medicine students' collaborative practice skill perception.

PURPOSE: This study evaluates third-year dental medicine students' perceived competencies related to interprofessional collaborative practice (IPCP) after completing two exposure level experiences with students from other professions across a large academic health center. METHODS: Two cohorts of D3 dental medicine students (2018-2019 and 2019-2020) completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) after participating in in-person 2.5-h Interprofessional (IP) Forums in the Fall and Spring semesters. Self-reported competencies were compared between pre-and post-IP Forum ratings and between Fall and Spring. RESULTS: Prior to the IP Forums, dental medicine students (n = 185) reported perceived skill in the interprofessional competencies to be from Good to Very Good using the ICCAS. After participation in the Fall IP Forum, students' ICCAS scores increased in all ICCAS subscales with large effect sizes. Students reported a perceived decline in these skills in the four months between Fall and Spring IP Forums and restoration of IP skill levels after participating in a second IP Forum (Spring). CONCLUSIONS: Participation in IP Forums has a positive impact on students' IPCP skill perception. Our data suggest that perceived skill level requires repeated IP learning experiences. If dental medicine students are expected to embrace collaborative practice to enhance patient outcomes, then dental school educators must provide opportunities for students to engage in collaborative practice experiences at all levels of their training.

Creating a Film to Teach Health Professions Students the Importance of Interprofessional Collaboration.

Objective. To produce, implement, and evaluate the effectiveness of a film to develop the foundational knowledge and skills of health professions students and teach them the importance of interprofessional collaboration. Methods. An existing interprofessional case study about a Hispanic man suffering from multiple chronic health conditions and the impact his health had on his family served as the basis for the film. To ensure a high-quality production, faculty members partnered with a local theatre company to produce the film. Upon completion, the film was integrated into an annual interprofessional forum and evaluated by both students and faculty members in 2016, 2017, and 2018. Results. The 22-minute film, entitled Meet Fred Santiago: Improving Care Through Interprofessional Collaboration, was shown to 1921 students and 250 faculty members who participated in the interprofessional forum over the three years. Of these, 1858 students and 174 faculty members completed a program evaluation following the forum. The majority (>86%) of student and faculty respondents agreed or strongly agreed that the film presented a realistic view of the challenges faced by people with multiple chronic health problems. The majority of students (>85%) agreed or strongly agreed that the film helped them appreciate the breadth of issues confronting individuals with multiple chronic health problems. Conclusion. The film, Meet Fred Santiago, is an effective tool for introducing health professions students to the complex interrelationship of medical, psychological, and social issues experienced by individuals with chronic health conditions.

Using Standardized Patients to Teach Interprofessional Competencies to Dental Students.

The aims of this study were to develop, implement, and evaluate a novel interprofessional standardized patient exercise (ISPE) with oral-systemic and interprofessional collaborative practice (IPCP) components. Dental students and doctor of nursing practice (DNP) students at one U.S. university participated in the simulation, which was primarily designed to test their teamwork skills. In spring 2014, DNP students worked in the dental clinics with dental students under the supervision of nursing and dental faculty members. To test the teamwork outcomes for both groups of students, a standardized patient (SP) scenario was designed to include multiple chronic medical diagnoses and an oral-systemic component. The exercise was filmed for later review. Outcomes measures included SP and student self-evaluations and faculty evaluation of student documentation. The primary outcome of interest from a dental standpoint was faculty evaluation of IPCP competencies derived from the Core Competencies of Interprofessional Collaborative Practice and were deemed to be observable by faculty when viewing the videotaped scenario. Eight teams of students participated with an SP trained in the scenario. Each team consisted of a DNP student, a fourth-year dental student, and a second-year dental student. All eligible students in the DNP class (n=20) and eight students from each dental class (approximately 110 each) participated. The results showed that the teams scored highest on the role/responsibilities subscale, indicating students were respectful of each other's roles and expertise and effectively engaged each other to develop strategies to meet the patient's needs. Scores on the three other subscales (values/ethics, interprofessional communication, and teams/teamwork) were also high. These findings appeared to support IPCP as a method to foster knowledge and respect for other roles and responsibilities, improve appreciation of teamwork, and encourage better communication among health care providers. The ISPE scenario provided an effective way to evaluate IPCP competencies.

Effectiveness of an infiltrant on sealing of composite restoration margins with/without artificial caries.

AIM: The aim of this in vitro study was to evaluate the effectiveness of a resin infiltrant (ICON) on marginal sealing ability of class II resin restorations with/without-caries. MATERIALS AND METHODS: Forty-eight noncarious human pre-molar teeth were embedded and MO and DO preparations of standard dimensions were prepared. The left side of dentin margins of the cavities were left nonbonded (UB) while the right side were bonded using total etch-bonding agent and all restored with a Nanohybrid composite. The teeth were thermocycled and half of the specimens in the UB and B groups were subjected to an artificial caries process. ICON was applied to caries and noncaries subgroups following the manufacturer's directions. Impressions were made at each step: after the restorations were completed, thermocycling, artificial caries procedures, and infiltrant application and the silicone tag lengths were measured with a stereomicroscope. The specimens were immersed in 0.5% basic fuchsine at 37° C for 24 hours, sectioned and microleakage was evaluated with a stereomicroscope. Selected samples and their replicas were assessed for marginal quality under a stereomicroscope and SEM. Statistical evaluation of the data were made using Kruskal-Wallis, Mann-Whitney U and Wilcoxon Sign Rank tests. RESULTS: While bonding application did not create a meaningful difference, the thermocycling and artificial caries significantly increased the gap length and microleakage (p < 0.05). ICON application was decreased the microleakage, created gap-free margins and closed the gaps which were previously occurred at the same cavities (p < 0.05). CONCLUSION: A resin infiltrant (ICON) application decreased the microleakage, created gap-free margins and closed the gaps, which previously occurred at the same cavities. CLINICAL SIGNIFICANCE: Approximal application of resin infiltrant may increase the success of the class II composite restorations also reduced the risk of needing more complex restoration therapy.

Effect of laser preparation on bond strength of a self-adhesive flowable resin.

The aim of this in vitro study was to evaluate the effect of laser treatment on shear bond strength of a self-adhesive flowable resin composite to human dentin. Eighty extracted sound human molar teeth were used for the study. The teeth were sectioned mesiodistally and embedded in acrylic blocks. The dentin surfaces were ground wet with 600-grit silicon carbide (SiC) paper. They were randomly divided into two preparation groups: laser (Er:YAG laser, with 12 Hz, 350 mJ energy) and control (SiC). Each group was then divided into two subgroups according to the flowable resin composite type (n = 20). A self-adhesive flowable (Vertise Flow) and a conventional flowable resin (Premise Flow) were used. Flowable resin composites were applied according to the manufacturer's recommendations using the Ultradent shear bond Teflon mold system. The bonded specimens were stored in water at 37 °C for 24 h. Shear bond strength was tested at 1 mm/min. The data were logarithmically transformed and analyzed using two-way analysis of variance and Student-Newman-Keul's test at a significance level of 0.05. The self-adhesive flowable resin showed significantly higher bond strength values to laser-prepared surfaces than to SiC-prepared surfaces (p < 0.001). The conventional flowable resin did not show such differences (p = 0.224). While there was a significant difference between the two flowable resin composites in SiC-prepared surfaces (p < 0.001), no significant difference was detected in laser-prepared surfaces (p = 0.053). The bond strength of a self-adhesive flowable resin composite differs according to the type of dentin surface preparation. Laser treatment increased the dentin bonding values of the self-adhesive flowable resin.

Effect of resealing on microleakage of resin composite restorations in relationship to margin design and composite type.

OBJECTIVE: To determine the relationship between margin preparation design and resin-composite type on microleakage with or without re-application of surface-penetrating sealant. METHODS: Class-I resin-composite restorations were completed for 128 extracted human molars. Half of the margins were beveled, the other half, butt-joint. Half of each group was restored with Filtek-Supreme (FS), the other half with Esthet-X (EX) using their respective adhesive systems. Margins were etched and sealed with a surface-penetrating sealant, Fortify. The samples were stored in water 24h, and thermocycled (5,000 cycles, 5°C-55°C). Then, samples were abraded using a toothbrush machine (6,000 strokes). Half of the restorations from each sealant group (n=16) were resealed, and the other half had no further treatment. Thermocycling and tooth brushing were repeated. The samples were sealed with nail polish, immersed in methylene-blue for 8h, sectioned, and magnified digital photographs were taken. Three examiners assessed dye penetration. A 2×2×2 multi-layered Chi-Square analysis, using Cochran-Mantel-Haenszel test was conducted for statistical analysis. RESULTS: No difference was observed between sealed and resealed FS and EX restorations with butt-joint margins. In beveled margins, resealing caused significantly less microleakage (P<.01). No differences were found between restorations either sealed or resealed with bevel margins. In butt-joint margins, at the leakage level deeper than 2/3 of the preparation depth, resealed FS showed less microleakage than EX resealed restorations (P<.01). CONCLUSION: Resealing reduced microleakage in bevel margins, however, in butt-joint margins resealing did not affect the leakage. A significant statistical relationship exists between and within resealing, margin preparation design, type of composite, and microleakage.

Bond strength of one-step self-etch adhesives and their predecessors to ground versus unground enamel.

OBJECTIVE: The aim of this study was to compare the shear bond strength of several self-etch adhesives to their two-step predecessors to ground and unground enamel. METHODS: Seventy-five extracted, non-carious human third molar teeth were selected for this study. The buccal surfaces of each tooth were mechanically ground to obtain flat enamel surfaces (ground enamel), while the lingual surfaces were left intact (unground enamel). The teeth were randomly divided into five groups according to the adhesive systems (n=15): one-step self-etch adhesive - Clearfil S3 Bond, its two-step predecessor - Clearfil SE Bond, one-step self-etch adhesive - AdheSE One, and its two-step predecessor - AdheSE, and a two-step etch-and-rinse adhesive - Adper Single Bond 2(control). After application of the adhesives to the buccal and lingual enamel surfaces of each tooth, a cylindrical capsule filled with a hybrid composite resin (TPH) was seated against the surfaces. The specimens were stored in distilled water at 37°C for 24 hours, followed by thermocy-cling (5°C-55°C/500 cycles). They were subjected to shear bond strength test in a universal testing machine at a crosshead speed of 1.0 mm/minute. The data were compared using a two-way ANOVA, followed by Bonferroni test at P<.05. RESULTS: All adhesives exhibited statistically similar bond strengths to ground and unground enamel except for the etch-and-rinse adhesive that showed significantly higher bond strengths than the self-etch adhesives (P<.05). No significant differences in bond strength values were observed between ground and unground enamel for any of the adhesives tested (P=.17). CONCLUSION: Similar bond strengths to ground and unground enamel were achieved with one-step self-etch adhesives and their predecessors. Enamel preparation did not influence the bonding performance of the adhesives tested.

Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars: glass ionomer versus resin-based sealant.

BACKGROUND: Glass ionomer sealants are an alternative to resin-based sealants, especially for use in partially erupted permanent molars. The authors conducted a study to compare the retention, marginal staining and cariostatic properties of a glass ionomer sealant with those of a resin-based sealant during a 24-month period. METHODS: We included in this study 39 patients aged 5 through 9 years who had bilateral partially erupted first permanent molars. One of us (S.B.) placed a resin-based sealant (Delton Plus FS+, Dentsply Professional, York, Pa.) (group D) on a partially erupted first molar in one quadrant of the maxilla or mandible and a glass ionomer sealant (GC Fuji Triage White, GC America, Alsip, Ill.) (group T) in the other quadrant. Two masked and calibrated investigators (S.A.A., J.C.) evaluated the sealants for retention, marginal staining and carious lesions at three, six, 12 and 24 months. The authors used a multinomial regression for statistical analysis (P < .05). RESULTS: The recall rate was 69.2 percent at 24 months. Two sealants from group D and three from group T were lost completely. Complete retention rates at 24 months were 40.7 and 44.4 percent for groups D and T, respectively. The authors found no statistically significant difference in retention rates between groups at each recall examination (P > .05). For marginal staining, sealants in the resin-based group exhibited statistically higher marginal staining than did sealants in the glass ionomer group (P < .05). Although the authors detected no caries in teeth in group T, teeth in group D in which the sealant was lost completely experienced demineralization. CONCLUSIONS: Resin-based and glass ionomer sealants exhibited similar retention rates at 24 months. However, marginal staining was lower in the glass ionomer group, and the authors found no caries in teeth in this group. Consequently, glass ionomer sealants may be a better choice when salivary contamination is expected. CLINICAL IMPLICATIONS: Sealing during tooth eruption presents a particular challenge owing to difficulty in isolating the tooth. Glass ionomers may be a better material for sealing partially erupted molars.

Comparison of the Er,Cr:YSGG laser with a chemical vapour deposition bur and conventional techniques for cavity preparation: a microleakage study.

The aim of this study was to compare the effects of the Er,Cr:YSGG laser using chemical vapour deposition (CVD) bur cavity preparation with conventional preparation methods including a diamond bur and a carbide bur on the microleakage with two different adhesive systems. A total of 40 extracted human premolars were randomly assigned to four experimental groups according to the cavity preparation technique: group I diamond bur (Diatech); group II carbide bur (Diatech); group III Er,Cr:YSGG laser (Biolase Millennium II); and group IV CVD bur (CVDentUS). Using the different preparation techniques, Class V standardized preparations were performed on the buccal and lingual surfaces with gingival margins on the dentin and occlusal margins on the enamel. Each preparation group was randomly assigned to two subgroups (five teeth, ten preparations) according to the type of adhesive: an etch-and-rinse adhesive (Adper Single Bond), and a single-step self-etch adhesive (AdheSE One). All preparations were restored with a nanohybrid composite resin in a single increment. Following thermocycling (×500; 5-55°C), the teeth were immersed in basic fuchsin and sectioned in the orovestibular direction. Dye penetration was evaluated under a light microscope by two blinded examiners. Data were statistically analysed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). There were no statistically significant differences between the preparation techniques with either of the two adhesive systems (p>0.05). Comparing the enamel and dentin leakage scores within each group, no statistically significant differences were found (p>0.05). The Er,Cr:YSGG laser cavity preparation did not differ from preparation with CVD, diamond or carbide bur in terms of microleakage with the different adhesive systems.

Comparison of the effects of Er,Cr:YSGG laser and different cavity disinfection agents on microleakage of current adhesives.

The aim of this study was to compare the effect of the Er,Cr:YSGG laser and different cavity disinfection agents on microleakage of an etch-and-rinse and a self-etch adhesive. Class V preparations were completed on the buccal and lingual surfaces of 30 extracted noncarious human molars. The occlusal margin was placed on enamel and the gingival margin on dentin. Preparations were randomly divided into five experimental groups (n = 12); (1) 2% chlorhexidine gluconate (CHX), (2) propolis, (3) ozone, (4) Er,Cr:YSGG laser, and (5) control (no treatment). Each group was divided into two subgroups according to the adhesive system: etch-and-rinse (Adper Single Bond 2), and a self-etch adhesive (All-Bond SE). The preparations were bulk-filled with a resin composite (Arabesk). After storage in distilled water for 24 h the restored teeth were subjected to thermocycling (1,000 cycles; 5-55°C). All specimens were immersed in 0.5% basic fuchsin solution for 24 h and sectioned longitudinally through the centre of the restorations and examined under a stereomicroscope at ×25 magnification. The data were analysed using the Kruskal-Wallis and Mann-Whitney U-tests. No difference was observed between the groups either on enamel or dentin when the etch-and-rinse adhesive was used (p > 0.05). In the self-etch adhesive groups, a significant difference was found only between the laser group and the CHX group on enamel and between the propolis group and the control group on dentin (p < 0.05). Comparing the etch-and-rinse and self-etch adhesives within each group, no differences were found on dentin (p > 0.05). On enamel, a statistically significant difference was found only in the CHX group (p < 0.05). There were no differences in microleakage with the laser and the different cavity disinfectant applications when used with etch-and-rinse adhesive. In the self-etch group there were differences in microleakage depending on the disinfection agent used.

Effects of different cavity disinfectants on shear bond strength of a silorane-based resin composite.

AIM: This in vitro study evaluated the effect of different cavity disinfection agents on bond strength of a silorane-based resin composite. MATERIALS AND METHODS: Thirty-six caries-free human third mandibular molars sectioned in mesio-distal direction were mounted in acrylic resin with their flat dentin surfaces exposed. After the dentin surfaces were wet ground with # 600 silicon carbide paper, the teeth were randomly divided into 6 groups of 12 each according to the cavity disinfection agents; chlorhexidine (CHX); sodium hypochlorite (NaOCl), propolis, ozone, Er,Cr:YSGG laser and no treatment (control). After treatment of dentin surfaces with one of these cavity disinfection agents, Filtek Silorane adhesive system was applied. The silorane-based resin composite, Filtek Silorane was condensed into a mold and polymerized. After storage at 37°C for 24 hours, the specimens were tested in shear mode at a crosshead speed of 1.0 mm/minute. The results were analyzed by one-way ANOVA. RESULTS: No statistically significant difference was observed between the groups (p>0.05). CONCLUSION: The use of the tested cavity disinfection agents, chlorhexidine, sodium hypochlorite, propolis, ozone and Er,Cr:YSGG laser did not significantly affect the dentin bond strength of a silorane-based resin composite, filtek supreme. CLINICAL SIGNIFICANCE: Cavity disinfectant applications did not affect the dentin bond strength of a silorane-based resin composite.

Comparison of different finishing/polishing systems on surface roughness and gloss of resin composites.

OBJECTIVES: The aim of this study was to compare four finishing/polishing systems (F/P) on surface roughness and gloss of different resin composites. METHODS: A total of 40 disc samples (15 mm × 3 mm) were prepared from a nanofill - Filtek Supreme Plus (FS) and a micro-hybrid resin composite - Esthet-X (EX). Following 24h storage in 37°C water, the top surfaces of each sample were roughened using 120-grit sandpaper. Baseline measurements of surface roughness (Ra, µm) and gloss were recorded. Each composite group was divided into four F/P disk groups: Astropol[AP], Enhance/PoGo[EP], Sof-Lex[SL], and an experimental disk system, EXL-695[EXL] (n=5). The same operator finished/polished all samples. One sample from each group was evaluated under SEM. Another blinded-operator conducted postoperative measurements. Results were analysed by two-way ANOVA, two interactive MANOVA and Tukey's t-test (p<0.05). RESULTS: In surface roughness, the baseline of two composites differed significantly from each other whereas postoperatively there was no significance. The Sof-Lex F/P system provided the smoothest surface although there were no statistical significance differences between F/P systems (p>0.01). In gloss, FS composite with the EXL-695 system provided a significantly higher gloss (p<0.01). EX treated by Soflex revealed the least gloss (p<0.05). SEM images revealed comparable results for F/P systems but EX surfaces included more air pockets. CONCLUSIONS: Four different finishing/polishing systems provided comparable surface smoothness for both composites, whereas EXL with FS provided significantly higher gloss. SEM evaluations revealed that the EX surface contained more air pockets but F/P systems were compatible.

Thermal safety of Er:YAG and Er,Cr:YSGG lasers in hard tissue removal.

OBJECTIVE: The aim of this study was to compare the thermal safety of Er:YAG and Er,Cr:YSGG lasers with conventional multi-use and single-use diamond burs. BACKGROUND DATA: Thermal effect of tooth preparation is mostly evaluated through the pulp chamber because it is difficult to measure the temperature of the preparation surface. A new in vitro method was introduced to simultaneously evaluate the heat increase of the preparation surface together with the pulp chamber. METHODS: Six laser and bur instrument groups were used to make standardized preparations on buccal surfaces of 60 intact third molars. The preparations removed an equal volume of hard tissue from each tooth (4 mm occluso-gingival x 8 mm mesial-distal x 1.6 mm bucco-lingual). The teeth also included tunnel preparations from the opposite (lingual) surface, exposing the pulpal axial wall (axial dentin wall in contact with the pulp chamber from the preparation surface site). An infrared thermal camera was positioned to capture the preparation surface in direct vision, while the pulpal axial wall was indirectly reflected to the thermal camera via a minimal-energy-loss mirror. Data from both surfaces were analyzed statistically using Nested Least Squares Analysis. RESULTS: The laser groups generated significantly lower heat compared to bur groups on the preparation surfaces. In contrast, both lasers generated greater pulpal heat increase, and the Er:YAG laser group showed significance (p < 0.0001). CONCLUSIONS: Lasers produced less heat on the preparation surface but more on the pulpal axial wall. However the temperature rise was less than the 5.5 degrees C threshold margin of safety.

Should my new curing light be an LED?

The new generation LED curing light units have significantly improved curing performance compared to first generation lights, and even some second generation LED curing light units. This study compared the curing performance of 10 new generation LED light curing units (FLASH-lite 1401, LE Demetron 1, Coltolux, Ultra-Lume 5, Mini LED, bluephase, Elipar FreeLight 2, Radii, Smartlite IQ and Allegro) for depth of cure against a high-powered halogen curing light unit (Optilux 501). Depth of cure measurements were utilized per the ANSI/ADA No 27 standard to detect differences between the lights at three time intervals (10, 20 and 40 seconds). A total of 660 samples were prepared (n=10/group). A full factorial ANOVA and Tukey's HSD test showed FLASH-lite 1401 performed significantly better than the other lights at 10- and 20-second time intervals (p<0.01). This study also demonstrated that an exposure time of 20 seconds or longer assures a better depth of cure, 40 seconds being the optimal polymerization time for all of the curing light units.

Surface protection for newly erupting first molars.

The objective of this study was to compare the retention of GC Fuji Triage glass-ionomer to Delton FS+, a resin-based sealant on saliva-contaminated enamel surfaces. Seventy-two extracted noncarious human permanent molars were divided into 3 groups for sealing using Triage (T), Delton FS+ with Prime & Bond NT (DP), and Delton FS+ (D) alone. After prophylaxis with pumice, Groups D and DP were etched with 38% H3PO4 for 30 seconds. Group T was treated with Cavity Conditioner. A single drop of natural saliva was applied to the occlusal surface with a microbrush. Sealants were then placed according to the manufacturer's directions. Bonding agent was applied and light-cured for 20 seconds before the application of Delton for the DP group. All sealants covered the entire occlusal surface. The groups were further subdivided into 3 time-evaluation intervals: 6 months, 1 year, and 2 years (8 samples each). They were thermocycled (5 degrees C to 55 degrees C, 1 minute dwell time) at 250, 500, and 1,000 cycles, respectively. After each thermocycling period, they were subjected to toothbrush abrasion for their respective times (3,000 strokes, 6,000 strokes, and 12,000 strokes). All samples were finally observed clinically for retention of sealant. Samples with clinically visible loss of material were further evaluated under a scanning electron microscope (SEM) to verify the loss in the pits and fissures. After the first thermocycling period, 5 of the 24 samples (21%) of Group D revealed complete visual loss of sealant. There was no further loss after the second period. After the third period of thermocycling, an additional 4 samples revealed complete visible loss of the sealant material from Group D (total 37.5% failure). SEM evaluation verified the complete loss of sealants. Groups T and DP showed 100% retention after the entire period of aging and toothbrush-abrasion. Both of these groups demonstrated similar wear rates. Therefore, concerning fluoride release and simpler technique, especially with newly-erupting molars, Triage has advantages.