General dental practitioner opinions on Selection criteria for dental radiography: a qualitative focus group study.

Introduction In the UK, general dental practitioners are exposed to multiple sets of clinical guidelines, including those relating to selection of x-ray examinations. A focus group was convened to explore issues around current guidelines and how a future edition might be improved.Method A purposive sample of seven general dental practitioners in the North West of England took part in a focus group. A sound recording was transcribed and analysed by thematic content analysis.Results Nine themes arose from the discussion: awareness of the Selection criteria for dental radiography(SCDR); utility of the latest edition; presentation of a new edition; the format of a new edition; evidence base; practice standards and evidence levels; the General Dental Council and Care Quality Commission; radiation doses; and dissemination.Discussion Awareness of theSCDRwas high, although participants were not aware of its full contents. The document was regarded as practitioner unfriendly and participants preferred accessible flowcharts available online and through mobile devices. Participants assume that appraisal of evidence has been done appropriately and accounted for in producing recommendations. Participants used clinical guidelines to protect themselves from the threat of legal action and investigation by the regulator.Conclusion The authors make ten recommendations for the future production of guidelines.

Effectiveness of hard inserts in sports mouthguards: a systematic review.

Objectives To improve the protective capacity of conventional ethylene-vinyl acetate mouthguards, some authors have suggested reinforcement with a hard material to distribute impact energy more widely. The research question for this systematic review was: 'does the inclusion of a hard insert in mouthguards improve the protection of anterior teeth from a direct blow?'Data sources Three bibliographic databases (PubMed/Medline, Ovid/Embase and the Cochrane CENTRAL databases) were searched up to 20 February 2021. Additional searches included hand searching of key articles and journals.Data selection A systematic search of the literature included studies where the intervention was the incorporation of hard material into sports mouthguards and where the comparator was conventional mouthguard material. Eligibility required the use of anatomical specimens or anatomical analogues which included or represented anterior maxillary teeth. Twelve eligible publications were identified.Data extraction Data extraction was first carried out independently by two reviewers. Discrepancies were resolved by discussion.Data synthesis Results of individual studies were conflicting and methodological diversity created difficulty in making a synthesis of results. All studies employed low-energy impacts that did not represent the potentially high-energy impacts encountered in sport.Conclusion The efficacy of hard inserts in sports mouthguards has not been demonstrated.

Questionnaire surveys - sources of error and implications for design, reporting and appraisal.

Questionnaire surveys of dentists are a commonly used research method which can yield important results. Nevertheless, in order to give reliable information, surveys must be carefully designed to avoid bias. The challenge of planning, designing and implementing a questionnaire study is often underestimated. While headline response rate is commonly used as an indication of survey quality, there are four potential areas of survey error. These are coverage, sampling, measurement and response. These four areas of error are discussed, with examples from the current literature, to assist readers in critically appraising questionnaire studies. We make 12 key recommendations to researchers to help avoid bias in their research; approaches to response enhancement are also considered. Reporting guidelines for questionnaire studies are suggested which improve transparency and assist in understanding of research methodologies and results. We have termed these guidelines: Reporting Items for Surveys and Questionnaires (RISQ). In conclusion, there is no single solution that can guarantee a successful study. Conversely, failure to pay careful attention to any one of many crucial aspects of survey design can be the downfall of an otherwise robust study.

Potential neurovascular damage as a result of dental implant placement in the anterior maxilla.

Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.

Restoration of Endodontically-Treated Anterior Teeth.

Detailed consideration of a case involving the restoration of an endodontically-treated maxillary canine tooth provides opportunity to review the many different considerations and treatment options in such situations. The restoration of endodontically-treated anterior teeth must be patient-centred, applying materials and techniques best suited to achieve a successful clinical outcome.

Restoration of Endodontically-Treated Posterior Teeth.

A case study provides opportunity to discuss treatment planning and the selection of materials and techniques to provide a replacement restoration of an endodontically-treated molar tooth. The discussion highlights treatment options along with the strengths and weaknesses of the alternative approaches to achieving a successful clinical outcome.

Preoperative radiological evaluation of missing single teeth: A review.

AIMS: Missing single teeth can be treated in several ways and preoperative radiological evaluation varies accordingly. The main area of controversy relates to the need for cross-sectional imaging in the context of implant treatment. In this context, the aim of the systematic component of this review was to determine whether the use of additional cross-sectional imaging has any impact on diagnostic thinking, treatment planning or outcome, compared with conventional imaging alone. An additional aim was to present information relating to diagnostic efficacy, dose of radiation, economic aspects of imaging and selection criteria. MATERIALS AND METHODS: PubMed/MEDLINE, OVID/Embase and the Cochrane central register of controlled trials were searched up to and including June 2015. Studies were eligible for inclusion if they compared the impact of conventional and cross-sectional imaging when placing implants. Quality assessment of studies was performed. Synthesis was qualitative. RESULTS: Twelve studies were included, all of which had a 'before-after' design. Only three of these were limited to single implant treatments with none limited to immediate implants. There were methodological problems with most of the studies and results were sometimes contradictory regarding the impact of cross-sectional imaging. CONCLUSIONS: It is tentatively suggested that cross-sectional imaging may not be required in straightforward, unchallenging, cases of missing single teeth being considered for implant treatment. Beyond this, no strong evidence exists to inform the choice of imaging. Existing guidelines on preoperative imaging for missing single teeth are not unanimous in their recommendations, either for implant or non-implant treatments.

Subjective image quality assessment of cross sectional imaging methods for the symphyseal region of the mandible prior to dental implant placement.

OBJECTIVES: A three dimensional appreciation of the form of the anterior mandible is required to place dental implants safely in the region. This study compared the subjective image quality of four available methods of cross sectional imaging of the symphyseal region, the lateral cephalometric view, cone beam computed tomography (CBCT), spiral tomography and the transymphyseal X-ray view. METHODS: An experimental water phantom was developed to reproduce human soft tissue around the mandible. Images were taken of four mandibles by the four X-ray techniques. Three different CBCT machines were included. The source of each image was disguised by displaying all images in the same format on the same computer screen. A protocol was developed to process the images for viewing whilst preserving their image quality. A panel of observers of ten dentists viewed the images and rated their image quality by recording their agreement with six statements on a five point Likert scale. RESULTS: The results showed a statistically significant difference in image quality between imaging methods. There were clear differences in the ratings between the three cone beam computed tomography machines. Small volume, high resolution CBCT provided images with the highest scores for subjective image quality. CONCLUSIONS: Within the limitations of this study, significant differences in subjective image quality were found between imaging systems used for cross sectional imaging for the symphyseal region of the mandible prior to dental implant placement.

A transymphyseal X-ray projection to assess the anterior edentulous mandible prior to implant placement.

The provision of an implant-retained overdenture with two implants in the canine regions is a well established treatment modality. Assessment of the form of the anterior mandible is essential in order to avoid surgical complications. Cross-sectional imaging gives ideal images but has radiation and economic costs. A panoramic radiograph supplemented by a lateral cephalometric radiograph is commonly used in these cases, but the latter is not widely available in dental practices. A transymphyseal radiographic technique is presented, using equipment and materials readily available in general dental practice, which may be used as an alternative to the lateral cephalometric radiograph.