Digitally manufactured partial coverage restorations: is it time to down the impression trays or still a work in progress?

DATA SOURCES: Pubmed, EMBASE, Scopus, Web of Science and Cochrane library databases were used as the data sources for this systematic review. Manual search of the reference lists of the included studies was also conducted. STUDY SELECTION: The aim of the systematic review was to compare a fully digital workflow to a fully conventional workflow in the fabrication of partial coverage restorations. Partial coverage restorations were defined as inlays, onlays, overlays and endocrowns. Four independent calibrated reviewers screened studies that fulfilled a predefined PICOS framework. Population was specified as an abutment tooth requiring a partial coverage restoration. The intervention was a fully digital workflow compared to a fully conventional workflow. Outcomes were accuracy, marginal and internal fit, success, survival, complication rates and patient-reported outcomes. Study design included both clinical and in vitro studies. DATA EXTRACTION AND SYNTHESIS: A total of 23 articles were included in qualitative synthesis ranging from 2007 to 2021. Twenty-one of these were in vitro studies. Two authors independently reviewed the included articles, performed data extraction, and evaluated the risk of bias via an adapted Checklist for Reporting In Vitro studies (CRIS) for in vitro studies and Reporting Randomised Clinical studies (RoB2) for clinical studies. RESULTS: Seventeen studies assessed the marginal and internal fit of onlay and inlay restorations, eight of which found that a conventional workflow demonstrated improved fit compared to digital, whilst the remaining nine studies found the contrary. Differing methods were utilised across the studies to assess fit, including: the silicone replica method, microcomputed tomography, microscopy and software-based measurements. Similar fracture strengths were reported between both conventional and digital workflows in three studies. One clinical study assessed survival rates of both pressed and CAD/CAM ceramic restorations and found the survival outcomes to be similar after seven years. No studies were found that investigated patient-reported outcomes or endocrowns. CONCLUSIONS: No consensus was reached as to whether the digital or conventional workflow is better.

The genetic basis of hypodontia in dental development.

Dental agenesis is one of the most common developmental anomalies in humans, characterised by the developmental absence of one or more teeth. It can present as an isolated condition (non-syndromic hypodontia) or associated with a syndrome (syndromic hypodontia). This paper aims to review the genetic basis of hypodontia with reference to aetiology, classification and the subsequent clinical features.Significant progress has been made to identify the developmental basis of tooth formation, though there is still a lack of knowledge within the literature of the aetiological basis of inherited tooth loss.Gene anomalies or mutations in WNT10A, MSX1, PAX9, AXIN2 and EDA appear to be most critical during tooth development, leading to various forms of tooth agenesis.

Are adjunctive therapies effective in reducing gingivitis and plaque?

Data sources PubMed, CENTRAL, Scopus and Cochrane electronic databases were used as the data sources for the systematic review. All randomised control trials that reviewed antiseptics published up to and including 26 February 2019 were included. A manual search of reference lists of the selected studies was conducted, including information from previous systematic reviews conducted by the same authors.Study selection Two trained and calibrated reviewers screened titles and abstracts that investigated the efficacy of adjuncts to mechanical plaque control, in systematically healthy patients aged 18 years or older with dental plaque biofilm-induced gingivitis, in an intact periodontium (GP) or in patients previously treated for periodontitis with gingival inflammation (PP_GI). Studies with at least one test group and a control group were included, where changes from baseline up to six months in gingival or bleeding indices was the primary outcome.Data extraction and synthesis Data was extracted by three reviewers and reported outcomes extracted at baseline, six months and the longest to follow-up visit. Meta-analysis was conducted for six-month data on antiseptics investigating gingival indices, bleeding indices and plaque indices. Studies were compared via mean treatment effect, calculated for baseline to six months, and analysed using weighted mean differences (WMD) or standardised mean differences (SMD). Statistical heterogeneity was assessed using Cochran's Q and I squared statistic. Study-specific estimates were pooled using the random-effect model and meta-regression analysis performed. Sensitivity analysis was performed to assess the contribution of each study to the evidence and Begg's rank correlation test utilised to assess publication bias.Results Following screening of 1,101 articles, 70 were included in quantitative synthesis. Adjuncts yielded statistically significant reductions in gingival index, plaque index and plaque. Meta-regression analysis showed use of mouth rinses resulted in greater reductions in plaque when compared with dentifrices, whereas antiseptic agents were similarly effective in reducing gingivitis in plaque in patients with GP and PP_GI.Conclusions Based on the present evidence, adjunctive antiseptics in mouth rinses and dentifrices demonstrate statistically significant reductions in gingival, bleeding and plaque indices, when used in adjunct to mechanical plaque control. Clinical significance must be interpreted with caution due to the heterogeneity among studies included and significant publication bias.

What are the main factors associated with root caries?

Data sources Medline, EMBASE, PubMed and Scopus databases were used as the data sources for the systematic review. Articles published between 1 January 1990 to 31 October 2018 were included with no language restrictions. A manual search of the references lists of the selected studies and review articles was conducted.Study selection Two independent researchers identified observational studies that investigated at least one risk factor of root caries in the study population. Studies were only included if they demonstrated statistical analysis of data on root caries, had a sample size of >100 and were in vivo. A third researcher was consulted to achieve consensus if there was disagreement. Methodological quality was evaluated via the modified Newcastle-Ottawa Scale for cross-sectional studies.Data extraction and synthesis Data was extracted and pooled into descriptive summary tables with study characteristics and results. Data on the presence and extent of root caries was recorded in addition to information on the relationship between the studied factors and root caries found in the unadjusted and adjusted data. Due to heterogeneity of key aspects among the included studies, meta-analysis was not conducted. Data were grouped under six categories - sociodemographic, general health behaviour, general health condition, fluoride exposure, oral health behaviour and oral health condition - and qualitatively analysed.Results Following screening of 984 articles, 62 were included in methodological quality assessment. Twenty-five were classified as moderate quality, 37 as low quality and 18 excluded. Of the 44 included articles which were qualitatively analysed, a higher association of dental caries was found in tobacco users and those with low socioeconomic status, gingival recession, poor oral hygiene and in older age groups.Conclusions Based on the present evidence, there are a number of factors associated with root caries. More high-quality observational analytical studies are needed in this field in future studies.

Investigating the appropriateness of surgical endodontic referrals to a West Sussex regional referral unit.

Aim To audit the appropriateness, after triage, of surgical endodontic referrals to Queen Victoria Hospital, a regional referral unit in West Sussex. To discuss the current referral pathway with the aim of improving general dental practitioner (GDP) understanding of indications for surgical endodontics via the referral process.Methodology A three-year retrospective review of all surgical endodontic referrals made to Queen Victoria Hospital, East Grinstead was completed. This was inclusive of all referrals made via the National Health Service (NHS) Vantage Rego e-referral system and GDP referral letters. The quality of referrals was analysed as indicated or contraindicated in accordance with the Royal College of Surgeons guidelines for surgical endodontics and periradicular surgery.Results Out of the 34 referrals included in data analysis, 50% contained one or more contraindication for surgical intervention. The most commonly recorded contraindications to treatment were poor-quality root canal treatment, periodontal disease compromising the long-term success of treatment and a poor coronal seal deeming the tooth unrestorable post-surgical intervention.Conclusions A more efficient surgical endodontic referral system will aid resource allocation within the NHS. These results are a first step to aiding necessary modification of the primary care referral pathway to achieve a more effective service for patients, with improved acceptance rate of referrals and better surgical outcomes.

Investigating the construct validity of a haptic virtual caries simulation for dental education.

Introduction: Teaching dental caries removal is limited by the material and methods available in the preclinical teaching space. Plastic teeth do not simulate the tactile feel of a lesion and natural teeth do not allow for standardised training and assessment. A novel method for simulating caries has been reported. Here, to investigate the construct validity of a caries simulation, whether haptic simulation could contribute to the understanding of caries removal, the performance of first-year dental students on the haptic simulation exercise is compared with that of experienced dentists. Method: A virtual block comprising healthy dentine, pulp, enamel and a carious lesion with significant spread along the amelodentinal junction (ADJ) was developed for the Simodont dental trainer. The case was presented to 112 first-year students and 17 clinicians following a 15 min training period on a block which contained green caries and displayed live progress throughout the exercise. All participants were given the same verbal instructions: to remove all unsupported enamel and caries along the ADJ while retaining as much healthy tissue as possible. Results: Clinicians performed better than the dental novices in precision and overall performance. Clinicians removed more material on average, except for healthy dentine, of which similar amounts were removed by both groups. Discussion: We presented a novel haptic caries exercise and investigated the construct validity of the task. The simulation may bridge the gap between preclinical and clinical dental education in caries removal. Conclusion: Clinically experienced dentists outperformed novices on a haptic caries simulation exercise. The exercise may be a useful tool for assessing conceptual understanding of caries removal.