Correlation Between Student Performances on Case-Based Constructed-Response Formative Assessment and Summative Assessment.

OBJECTIVES: This study aimed to evaluate the impact of formative assessment with case-based constructed-response question (CRQ) formats on student performance on the final summative assessment in the second-year periodontics course. METHODS: Classroom quizzes with case-based CRQs were implemented as the formative assessment during the course. Each student received feedback on their responses from the course director. After all students (N = 128) took the second-year final examination, the Friedman test was conducted to compare student performances in each assessment over time. The multiple linear regression (MLR) model was used to evaluate the association between the second-year final examination score and plausible predictors-student gender, the second-year formative and midterm examination scores, and time spent on the final examination. RESULTS: The mean % scores in the formative assessment (51) and midterm (84) examination were significantly lower than that of the final (87) examination (P < .01). The number of students who failed the final (6) examination was significantly lower than the midterm (16) examination (P = .03). The midterm (P < .0001) and the formative assessment (P = .0009) scores significantly affected the second-year final examination score while student gender (P = .59) and time spending (P = .83) showed no correlations. CONCLUSION: Within the limitations of the study, student performance on case-based CRQs was correlated with student performance on the summative assessment.

Evaluation of student readiness for clinical dental education at the end of preclinical education.

OBJECTIVES: This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE. METHODS: The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1 = 134) and B (class of 2025; n2 = 129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores. RESULTS: Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p = 0.035) and the practical examination score (p = 0.03) while not associated with gender (p = 0.53) and the written examination score (p = 0.11). CONCLUSION: Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

Survival analysis of root-resected molars from 1 to 13.4 years: A retrospective cohort study.

STATEMENT OF PROBLEM: While root resective therapy may extend the longevity of a molar, data on patient selection and outcomes of root resection are scarce. PURPOSE: The purpose of this retrospective cohort study was to analyze the survival of root-resected molars and investigate factors affecting the decision and outcomes of the therapy. MATERIAL AND METHODS: Patient- and tooth-related data from participants who had received root resection between 1999 and 2022 were collected. Cox regression was used to build predictive models for time-to-tooth loss based on predictors-initial diagnoses (carious, endodontic, periodontal, or endodontic-periodontal lesions), the presence of a complete-coverage crown, and the location of the tooth in the arch (P<.001). RESULTS: Of 60 teeth, all from different participants, 31 molars were resected because of endodontic lesions. The failure rate was 35% with 21 teeth extracted. At 5 years, the survival probability was 0.58, considering all predictors. The survival of molars resected because of carious or endodontic lesions was significantly lower than those because of periodontal or endodontic-periodontal lesions (P<.05). The hazard ratio for tooth loss in the resected teeth was 15.6, 95% confidence interval (CI) (3.7 to 83.2) without complete-coverage crowns and 8.6, 95% CI (2.2 to 43.2) at the most posterior location. CONCLUSIONS: Root resection provided to manage a localized periodontal lesion had the highest prognosis. The absence of a crown and the location as the most posterior tooth in the arch were associated with poor survival following resection.

Effectiveness of distance learning for preclinical periodontal education.

INTRODUCTION: This study aimed to investigate the effectiveness of distance learning (DL) for the second-year periodontics course compared to classroom learning (CL). MATERIALS AND METHODS: DL for Class A (n1 = 126) and CL for Class B (n2 = 133) were implemented. The same instructors recorded or delivered the same lectures in the two learning modules during the second-year periodontics course. Classes A and B took the same final examinations (a total % score of 200). General linear model (GLM) and ordinal logistic regression (OLR) analyses were conducted after considering individual first-year final % scores as a covariate to test if the second-year final % scores and the distributions of letter grades were significantly different between Class A and B. RESULTS: The mean second-year final % score of the DL group (166.4) was significantly higher than that of the CL group (160.8) (independent t-test, p = .019). However, in GLM, the first-year final % scores significantly affected the second-year scores (p = .016); the second-year final % scores between the two groups were not significantly different (p = .268) after considering the individual first-year scores. In OLR, there was no difference in the likelihood of getting lower grades in the second-year course between the two groups (odds ratio = 1.6; 95% confidence interval = [0.95, 2.72], p = .078) after considering the first-year final % scores. CONCLUSION: Within the limitations of the study, the DL for preclinical periodontics resulted in comparable student learning outcomes when compared to the traditional CL.

Management of a prosthetic complication on an implant restoration placed when the patient was 10 years old: A case report.

The use of dental implants in pediatric patients may create unique complications. A 38-year-old patient presented with a mobile, cement-retained implant crown due to an abutment screw loosening. The maxillary right central incisor implant was placed when the patient was 10 years old. Pus discharge from the peri-implant sulcus was observed. The mucosal margin of the implant was at the level of the mucogingival junction of neighboring teeth. Radiographically, the platform of the implant appeared to be at the level of the apical third of the adjacent roots. After removing the existing implant-retained crown, the inflamed peri-implant tissue covering the implant platform was removed and the stability of the implant was confirmed. A new screw-retained implant crown was made using an angulated screw channel to correct the labiopalatal angulation of the implant and allow for retrievability. Pink porcelain was used to match the mucosal margin of the implant crown to that of the maxillary left central incisor. This case report highlights the risk of implant placement in pediatric patients and agrees with previous reports that implants should be delayed until growth is complete.

New approach to expedite the delivery of the final crowns for teeth requiring crown lengthening surgery: a pilot study.

BACKGROUND: The healing period from crown lengthening procedures (CLPs) often delays the final crown delivery. This study aimed to explore the feasibility of a new approach expediting the delivery of the final crowns for teeth requiring CLPs. METHODS: Teeth requiring CLPs and single-crown restorations between the canine and the second molar were included. After the initial tooth preparation, a CLP was performed. In the experimental group, the final tooth preparation and final impression were made during the CLP; the final crown was then delivered at the suture-removal appointment. In the control group, the final impression was made 8 weeks after the CLP. The level of gingival margin (GM), pocket depth (PD), and crestal bone levels (CBLs) were compared between the two groups before CLPs (T0), at delivery of the crowns (T1), and at 12 months in function (T2). RESULTS: Twenty-one lithium-disilicate crowns were delivered to 20 subjects and followed up. The mean interval between the CLPs and the delivery of crowns was 2.5 weeks for the experimental group and 12 weeks for the control group. No significant differences were observed between the two groups in the level of GM, PD, and CBLs at each time point. No significant treatment difference in crestal bone loss was observed between the two groups at T2 (Experimental = -0.11 mm, Control = -0.03 mm; p = 0.67). CONCLUSION: Making the final tooth preparation and the final impression at the CLP significantly reduced the time between the CLP and the delivery of the final crown and showed comparable clinical outcomes.

Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners.

This study aimed to access the knowledge in diagnosing dental infections and the practice in treatment planning for the affected teeth among dental practitioners (DPs) and senior (final-year) students. A survey questionnaire containing two cases (Case A; periodontal abscess and Case B; periapical abscess) with four questions per case was delivered to potential participants. Fifty-nine DPs voluntarily participated in the survey. For senior students, the case study was a part of their course requirements; one of the two cases (either Case A or B) was randomly assigned to the 126 seniors. The distribution of responses was significantly different between the DP and senior groups except for the diagnosis of Case B (Fisher's exact test; p = 0.05). Only 31% of the participants diagnosed Case A as periodontal abscess; most of them selected periodontal surgery as the first treatment option. Despite a high agreement in diagnosing Case B, the choice of treatment was significantly different; the most frequent treatment option was extraction (51%) from the DP group and root canal retreatment (57%) from the senior group. The study revealed that the diagnosis of periodontal abscess was more challenging than that of periapical abscess among dental professionals.

Early crestal bone loss around implants placed at previously failed sites compared with initially integrated implants: A retrospective cohort study.

BACKGROUND: There is minimal information on early crestal bone loss (CBL) associated with implants placed at failed sites. PURPOSE: This retrospective cohort study aimed to evaluate CBL of surviving and restored implants placed at previously failed sites (replaced implants [RIs]) compared to that of implants initially integrated and restored (pristine implants [PIs]), within the same subjects from implant placement to 17 months post-delivery of restoration. METHODS: Subjects who had both PI(s) and RI(s) were recruited. The following data were retrieved: patient demographics, implant locations, types of implant failure, use of bone graft procedure(s), and intraoral radiographs at implant placement (T0), restoration delivery (T1), and the post-restoration follow-up (T2). A blinded evaluator measured crestal bone levels at T0, T1, and T2. RESULTS: Forty-four implants (22 in the RI and 22 in the PI group) from the 22 subjects were reviewed. The 22 implants in the RI group were placed either at early failure (17) or late failure (5) sites. There was a 4.6 times higher likelihood of bone graft procedures performed in association with RIs compared to PIs when using a generalized linear mixed model. Differences in crestal bone levels were compared between the two groups at each time point. There were no significant differences in the mesial and mean crestal bone levels between the PI and RI groups. The RI group exhibited lower crestal bone levels on the distal side compared to the PI group at all time points. However, this difference was due to crestal bone level at T0 (p = 0.039) not due to implant replacement (p = 0.413) or bone graft procedure (p = 0.302) when using mixed regression modeling. CONCLUSION: The effect of replacements of implants at failed sites on CBL was not significant. RIs, once integrated, exhibited the same pattern of CBL as pristine implants.

Effectiveness of remote simulation-based learning for periodontal instrumentation: A non-inferiority study.

OBJECTIVES: While numerous virtual/remote simulation-based learning (SBL) modules were implemented due to the COVID-19 pandemic, limited data on their effectiveness are available. This study aimed to investigate the effectiveness of a remote SBL module for periodontal instrumentation compared to traditional onsite SBL modules. METHODS: Calibrated faculty members have instructed in all modules. Synchronous remote SBL activities using a secure videoconferencing application, which replaced onsite practices, were conducted in a small group setting in the remote SBL module for the class of 2023. After the class took the onsite second-year practical examination, a set of multiple and logistic regression analyses (N = 389) were conducted to test if the second-year practical examination scores and the passing rates were significantly different between the remote SBL (class of 2023) and onsite SBL I and II (class of 2019 and 2022) groups. RESULTS: Both mean practical examination score and passing rate from the remote SBL group (class of 2023) were significantly higher than those from the onsite SBL II group (class of 2022) when their first-year practical examination scores were not considered (p < 0.05). Once the first-year practical examination scores were considered, the remote SBL group was not significantly different from the onsite SBL I and II groups with respect to the mean second-year practical examination score and the passing rate. CONCLUSION: The proposed remote SBL module achieved the comparable student learning outcomes compared to the onsite SBL modules while it utilized less staff, time, and material expenditure.

Use of transcortical miniscrews for alveolar ridge preservation following tooth extraction: A pilot study.

OBJECTIVES: The purpose of this split-mouth pilot study was to investigate the effects of a transcortical miniscrew placed over the buccal plate of an extraction socket for alveolar ridge preservation in humans. METHODS: One week after the extraction of bilateral maxillary premolars, cone-beam computed tomography (CBCT) and intraoral digital imaging were performed (T0). A transcortical miniscrew was placed over the buccal plate of the extraction socket on one side (experiment), and the extraction socket on the contralateral side was left untreated (control). Follow-up CBCT and intraoral digital imaging were performed at 8 months immediately after miniscrew removal (T8). Changes in the width of the alveolar bone and ridge were measure by superimposing T0 and T8 of CBCTs and intraoral digital scans. RESULTS: Six participants completed the study protocol. Overall, the experimental side with the miniscrew demonstrated less bone loss and less alveolar ridge reduction than the control side. Bone loss on the experimental side (0.7 ± 0.2 mm) was significantly less than that on the control side (1.3 ± 0.7 mm) at the apical level of the socket on axial CBCT imaging (Wilcoxon signed rank test, p = .031). The experimental side (-18 ± 8%) exhibited less reduction in the alveolar ridge width than the control side (-21 ± 12%) at the crestal level on coronal superimposition of the intraoral digital scans. CONCLUSIONS: Transcortical miniscrew placement over the buccal plate of the extraction socket resulted in less resorption of the alveolar ridge and bone 8 months after tooth extraction. CLINICAL TRIAL REGISTRATION: NCT03205800: Temporary Anchorage Devices for Ridge Preservation (TAD).

Senior dental students' perceptions of evidence-based dentistry.

INTRODUCTION: This study aimed to assess senior dental students' knowledge and attitudes regarding evidence-based dentistry (EBD), their use of the current literature and considerations for patient preferences. MATERIALS AND METHODS: A modified Knowledge, Attitudes, Access, and Confidence Evaluation (KACE) survey was administered to collect data from senior dental students at the University of Maryland School of Dentistry (UMSOD). The chi-squared test was used to compare the correct response rates of each question in the knowledge of scientific evidence domain. Spearman's rank correlation coefficient was conducted to examine correlations between students' knowledge of scientific evidence and their confidence in appraising the study qualities. RESULTS: 61 seniors (out of 130) answered all survey questions. Participants displayed an intermediate level of knowledge of EBD. Only 15% of participants correctly answered to the most appropriate design; the distribution of responses appeared significantly different amongst the questions in the basic knowledge section (chi-squared test, p < .0001). There was no or very weak correlation between students' knowledge of scientific evidence and their confidence in appraising study qualities (Spearman's ρ = 0-0.18). The participants highly valued the use of the current literature and patient preferences. However, their preferred sources of scientific evidence were the Internet excluding Cochrane reviews (60%) and colleagues (56%). Forty per cent of participants rarely or never used textbooks. CONCLUSION: Whilst seniors felt confident in evaluating study qualities and implementing EBD in routine practice, their understanding of the study design was poor. Seniors' preferred sources of scientific evidence were non-peer-reviewed Internet sources and colleagues.

Acute and Chronic Pain from Facial Skin and Oral Mucosa: Unique Neurobiology and Challenging Treatment.

The oral cavity is a portal into the digestive system, which exhibits unique sensory properties. Like facial skin, the oral mucosa needs to be exquisitely sensitive and selective, in order to detect harmful toxins versus edible food. Chemosensation and somatosensation by multiple receptors, including transient receptor potential channels, are well-developed to meet these needs. In contrast to facial skin, however, the oral mucosa rarely exhibits itch responses. Like the gut, the oral cavity performs mechanical and chemical digestion. Therefore, the oral mucosa needs to be insensitive, to some degree, in order to endure noxious irritation. Persistent pain from the oral mucosa is often due to ulcers, involving both tissue injury and infection. Trigeminal nerve injury and trigeminal neuralgia produce intractable pain in the orofacial skin and the oral mucosa, through mechanisms distinct from those seen in the spinal area, which is particularly difficult to predict or treat. The diagnosis and treatment of idiopathic chronic pain, such as atypical odontalgia (idiopathic painful trigeminal neuropathy or post-traumatic trigeminal neuropathy) and burning mouth syndrome, remain especially challenging. The central integration of gustatory inputs might modulate chronic oral and facial pain. A lack of pain in chronic inflammation inside the oral cavity, such as chronic periodontitis, involves the specialized functioning of oral bacteria. A more detailed understanding of the unique neurobiology of pain from the orofacial skin and the oral mucosa should help us develop novel methods for better treating persistent orofacial pain.

Discrepancies in periodontitis classification among dental practitioners with different educational backgrounds.

BACKGROUND: The 2018 classification of periodontal disease characterizes the disease with a multidimensional staging and grading system. The purpose of this multicenter study was to examine variations in periodontitis classification among dental practitioners with different postgraduate educational backgrounds at the University of Maryland School of Dentistry and the Loma Linda University School of Dentistry using the 2018 classification. METHODS: This cross-sectional observational study included two cohorts: dental practitioners with periodontal backgrounds (n1 = 31) and those with other educational backgrounds (n2 = 33). The survey instrument contained three periodontitis cases presented with the guideline of the 2018 classification and a questionnaire including closed and open-ended questions. The participants were asked to review each case and to fill out the questionnaire independently. Fisher's exact test was conducted to examine the differences in responses between the two cohorts. Polychoric correlations were calculated to examine the relation between the level of familiarity with the 2018 classification and the accuracy of the classification. RESULTS: The distribution of item responses was significantly different between the two cohorts regarding only one item, grading for Case 1 (p = 0.01). No significant differences in accuracy between the two cohorts were observed except for two items, grading in Case 1 (p = 0.03) and staging in Case 3 (p = 0.04). There were no significant differences in risk factor identification for each case among the two cohorts (p = 1.00, Case 1; p = 0.22, Case 2). Staging in Case 3 ([Formula: see text] = 0.52) and risk factor identification in Case 2 ([Formula: see text]= 0.32) were significantly correlated with familiarity with the 2018 classification. CONCLUSION: A fair level of agreement in periodontitis classification was observed among dental practitioners with different educational backgrounds when the 2018 classification was used. The periodontal cohort showed better agreement levels and partially better accuracy. Risk factor identification for periodontal disease was difficult regardless of the educational background.

Free gingival grafts for implants exhibiting a lack of keratinized mucosa: Extended follow-up of a randomized controlled trial.

INTRODUCTION: This study is an extended follow-up of a randomized controlled trial that evaluated 18-month outcomes following free gingival grafts (FGGs) around implants with <2 mm keratinized mucosa (KM) compared to implants without KM augmentation. MATERIALS AND METHODS: Follow-up data were obtained over 48 months from 18 implants in the FGG group (11 subjects) and 8 implants in the no-surgery group (7 subjects) within the control group. FGGs were performed after 18 months for 8 implants in the control group; these 8 implants constituted a delayed FGG group (5 subjects). The width of KM, mucosal recession (MR) and crestal bone level (CBL) were obtained. RESULTS: The increased width of KM and the reduced MR following FGGs were maintained for 48 months in the FGG group, which exhibited less MR than the no-surgery group. The amount of crestal bone loss (0.4 ± 0.4 mm) in the no-surgery group was significantly greater than that in the FGG group (0 ± 0.4 mm) at 48 months. In the delayed FGG group, reduced MR and no significant differences in CBL were observed compared with the pre-graft measurements. CONCLUSIONS: FGGs can be a practical treatment option to maintain CBL around implants with limited KM.

Creeping attachment following free gingival grafts around dental implants exhibiting mucosal recession with a lack of keratinised mucosa: A case series.

Purpose: Few case reports have been published on creeping attachment around dental implants. This study aimed to assess changes in the level of the mucosal margin following placement of free gingival grafts around single implants exhibiting mucosal recession with < 2 mm keratinised mucosa compared to that of implants with ≥ 2 mm keratinised mucosa. Materials and methods: A total of 12 subjects with one or more implants were included. Nineteen implants displaying implant thread and/or prosthetic abutment exposure with < 2 mm keratinised mucosa were treated using free gingival grafts (FGG group), and 11 implants exhibiting ≥ 2 mm keratinised mucosa did not receive free gingival grafts (control group). The width of keratinised mucosa and the amount of mucosal recession were measured by a blind evaluator (MC). Results: A continual reduction in mucosal recession was observed at the 6- and 12-month followups in all except two of the FGG group implants, while no change in the level of the mucosal margin was observed in the control group. This postoperative coronal migration of the mucosal margin resulted in a 0.7-mm mean reduction in mucosal recession after 12 months in the FGG group. Conclusion: The level of the mucosal margin around implants exhibiting mucosal recession along with a lack of keratinised mucosa migrated coronally following free gingival grafts, and creeping attachment was observed in a number of patients.

Survival of dental implants at sites after implant failure: A systematic review.

STATEMENT OF PROBLEM: Despite an overall high survival rate for dental implants, the effectiveness of implant retreatment remains unclear. PURPOSE: The purpose of this systematic review was to examine the survival rate of implants placed at sites which had an implant failure and to investigate factors that might affect outcomes after retreatment. MATERIAL AND METHODS: A search of electronic databases limited to English language articles was conducted using the following MeSH terms: "dental implants," "dental implantation," or "dental restoration failure," combined with "retreatment," "replacement," or "reoperation." A hand search of selected journals was also performed. Of the retrieved 668 publications, 8 retrospective clinical studies met the inclusion criteria, providing the survival outcome for 673 implants in 557 patients after retreatment. Implant- and patient-related characteristics related to implant failures were assessed. RESULTS: The weighted mean survival rate for implants after retreatment was 86.3%, with follow-up ranging from less than 1 year to over 5 years. The survival rates of smooth-surfaced and rough-surfaced implants were compared in 217 retreated implants, revealing a significantly higher survival rate for rough-surfaced implants than for smooth-surfaced implants (90% versus 68.7%). Insufficient data were available to evaluate the effect of patient- or treatment-related characteristics on the survival of implants after retreatment. CONCLUSIONS: The survival rate of retreated implants is lower than that generally reported after initial implant placement. Higher survival rates were reported with rough-surfaced implants than with smooth-surfaced implants in retreatment. An overall implant survival rate of 86.3% after retreatment suggests that most initial implant failures are likely attributable to modifiable risk factors, such as implant architecture, anatomic site, infection, and occlusal overload.