Aspects Regarding Sustainability among Private Dental Practitioners from Bucharest, Romania: A Pilot Study.

Oral health professionals' knowledge of sustainability is essential for promoting environmental protection in dental healthcare. This pilot study involved an online survey addressed to 70 dental private practitioners from Bucharest, Romania, to evaluate their awareness of the concept of sustainability in dentistry. The performed statistical analysis revealed that 41.4% of the participants were well aware of sustainability in dentistry, with older participants demonstrating significantly higher levels of such awareness (p = 0.001). Sustainability awareness among participants correlates positively with their knowledge of the negative environmental impacts of dental activity (p < 0.001) and with the concern for sustainable dentistry implementation in their workplace (p = 0.037). Improper biohazardous waste disposal was identified as the primary cause of negative environmental impact of dental practices by 87.1% of participants. Installing high energy-efficient dental equipment was selected as the most important action to implement sustainability in participants' dental practices (64.3%). Overall, 51.4% of the participants reported that the COVID-19 pandemic had a medium impact on their dental activity in terms of sustainability. Our study found that participants have a moderate level of awareness regarding sustainability in dentistry, highlighting the need for education on sustainability for oral health professionals.

Modular Digital and 3D-Printed Dental Models with Applicability in Dental Education.

Background and Objectives: The ever more complex modern dental education requires permanent adaptation to expanding medical knowledge and new advancements in digital technologies as well as intensification of interdisciplinary collaboration. Our study presents a newly developed computerized method allowing virtual case simulation on modular digital dental models and 3D-printing of the obtained digital models; additionally, undergraduate dental students' opinion on the advanced method is investigated in this paper. Materials and Methods: Based on the digitalization of didactic dental models, the proposed method generates modular digital dental models that can be easily converted into different types of partial edentulism scenarios, thus allowing the development of a digital library. Three-dimensionally printed simulated dental models can subsequently be manufactured based on the previously obtained digital models. The opinion of a group of undergraduate dental students (n = 205) on the proposed method was assessed via a questionnaire, administered as a Google form, sent via email. Results: The modular digital models allow students to perform repeated virtual simulations of any possible partial edentulism cases, to project 3D virtual treatment plans and to observe the subtle differences between diverse teeth preparations; the resulting 3D-printed models could be used in students' practical training. The proposed method received positive feedback from the undergraduate students. Conclusions: The advanced method is adequate for dental students' training, enabling the gradual design of modular digital dental models with partial edentulism, from simple to complex cases, and the hands-on training on corresponding 3D-printed dental models.

Gender Differences in Oral Health: Self-Reported Attitudes, Values, Behaviours and Literacy among Romanian Adults.

A topic that has been less researched on, especially in Romania, is the identification of gender differences in oral health. The present scientific research used an online survey to assess the attitudes (dental beliefs survey-R/R-DBS), the values (oral health values scale/OHVS), the behaviours (dental neglect scale/DNS), and the literacy (oral health literacy scale/OHLS) related to oral health and to dental professional services in the case of a sample of 600 Romanian adults (Meanage = 30.84). The relation between the level of knowledge as a predictor of attitudes and values related to oral health was analysed by the means of a structural equation based on the partial least square method (PLS-SEM). The results show that women have more positive attitudes towards dental medical services, higher oral health values, better self-care behaviours, and higher oral health literacy than men. In the case of men, attitudes and behaviours related to self-care are influenced by their oral health literacy and level of education; in the case of women, the latter are influenced only by their level of oral health literacy. The impact that knowledge in oral health has on attitudes, values, and behaviours was highlighted. The differences in attitudes and values related to oral health between the two genders can be accounted for by the differences in formal and informal education (studies and oral health literacy, respectively).

Compressive and Flexural Strength of 3D-Printed and Conventional Resins Designated for Interim Fixed Dental Prostheses: An In Vitro Comparison.

A provisionalization sequence is essential for obtaining a predictable final prosthetic outcome. An assessment of the mechanical behavior of interim prosthetic materials could orient clinicians towards selecting an appropriate material for each clinical case. The aim of this study was to comparatively evaluate the mechanical behavior-with compressive and three-point flexural tests-of certain 3D-printed and conventional resins used to obtain interim fixed dental prostheses. Four interim resin materials were investigated: two 3D-printed resins and two conventional resins (an auto-polymerized resin and a pressure/heat-cured acrylic resin). Cylindrically shaped samples (25 × 25 mm/diameter × height) were obtained for the compression tests and bar-shaped samples (80 × 20 × 5 mm/length × width × thickness) were produced for the flexural tests, observing the producers' recommendations. The resulting 40 resin samples were subjected to mechanical tests using a universal testing machine. Additionally, a fractographic analysis of failed samples in bending was performed. The results showed that the additive manufactured samples exhibited higher elastic moduli (2.4 ± 0.02 GPa and 2.6 ± 0.18 GPa) than the conventional samples (1.3 ± 0.19 GPa and 1.3 ± 0.38 GPa), as well as a higher average bending strength (141 ± 17 MPa and 143 ± 15 MPa) when compared to the conventional samples (88 ± 10 MPa and 76 ± 7 MPa); the results also suggested that the materials were more homogenous when produced via additive manufacturing.

Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review.

The purpose of this study is to outline relevant elements regarding the biochemical interactions between prosthetic materials used for obtaining implant-supported restorations and the oral environment. Implant-supported prostheses have seen unprecedented development in recent years, benefiting from the emergence of both new prosthetic materials (with increased biocompatibility and very good mechanical behavior), and computerized manufacturing technologies, which offer predictability, accuracy, and reproducibility. On the other hand, the quality of conventional materials for obtaining implant-supported prostheses is acknowledged, as they have already proven their clinical performance. The properties of PMMA (poly (methyl methacrylate))-which is a representative interim material frequently used in prosthodontics-and of PEEK (polyether ether ketone)-a biomaterial which is placed on the border between interim and final prosthetic use-are highlighted in order to illustrate the complex way these materials interact with the oral environment. In regard to definitive prosthetic materials used for obtaining implant-supported prostheses, emphasis is placed on zirconia-based ceramics. Zirconia exhibits several distinctive advantages (excellent aesthetics, good mechanical behavior, biocompatibility), through which its clinical applicability has become increasingly wide. Zirconia's interaction with the oral environment (fibroblasts, osteoblasts, dental pulp cells, macrophages) is presented in a relevant synthesis, thus revealing its good biocompatibility.

Bending Fracture of Different Zirconia-Based Bioceramics for Dental Applications: A Comparative Study.

The fabrication of fixed dental prostheses using aesthetic materials has become routine in today's dentistry. In the present study, three-unit full zirconia fixed prosthetic restorations obtained by computer-aided design/computer-aided manufacturing (CAD/CAM) technology were tested by bending trials. The prostheses were intended to replace the first mandibular left molar and were manufactured from four different types of zirconia bioceramics (KatanaTM Zirconia HTML and KatanaTM Zirconia STML/Kuraray Noritake Dental Inc.; NOVAZir® Fusion float® ml/NOVADENT/Dentaltechnik; and 3D PRO Zirconia/Bloomden Bioceramics). In total, sixteen samples were manufactured-four samples per zirconia material. Additionally, the morphology, grain size area distribution, and elemental composition were analyzed in parallelepiped samples made from the selected types of zirconia in three different areas, noted as the upper, middle, and lower areas. The scanning electron microscope (SEM) analysis highlighted that the grain size area varies with respect to the researched area and the type of material. Defects such as microcracks and pores were also noted to a smaller extent. In terms of grain size area, it was observed that most of the particles in all samples were under 0.5 µm2, while the chemical composition of the investigated materials did not vary significantly. The results obtained after performing the bending tests showed that a zirconia material with fewer structural defects and an increased percentage of grain size area under 0.5 µm2, ranging from ~44% in the upper area to ~74% in the lower area, exhibited enhanced mechanical behavior. Overall, the resulting values of all investigated parameters confirm that the tested materials are suitable for clinical use.

Molecular Interactions between Saliva and Dental Composites Resins: A Way Forward.

Dentin and enamel loss related to trauma or especially caries is one of the most common pathological issues in dentistry that requires restoration of the teeth by using materials with appropriate properties. The composite resins represent dental materials with significant importance in today's dentistry, presenting important qualities, including their mechanical behavior and excellent aesthetics. This paper focuses on the saliva interactions with these materials and on their biocompatibility, which is continuously improved in the new generations of resin-based composites. Starting from the elements involved on the molecular landscape of the dental caries process, the paper presents certain strategies for obtaining more advanced new dental composite resins, as follows: suppression of oral biofilm acids formation, promotion of remineralization process, counteraction of the proteolytic attack, and avoidance of cytotoxic effects; the relation between dental composite resins and salivary oxidative stress biomarkers is also presented in this context.

Biochemical Interaction between Materials Used for Interim Prosthetic Restorations and Saliva.

The purpose of this study was to analyze the oxidative stress level and inflammatory status of saliva in the presence of certain materials used for obtaining interim prosthetic restorations. Four types of interim resin materials were investigated: a pressure/heat-cured acrylic resin (Superpont C+B, SpofaDental a.s Czech Republic, /KaVo Kerr Group), a milled resin (Telio CAD polymethyl methacrylate, Ivoclar Vivadent AG, Liechtenstein), a 3D printed resin (NextDent C&B MFH, NextDent by 3D Systems, the Netherlands), and a pressure/heat-cured micro-filled indirect composite resin (SR Chromasit, Ivoclar Vivadent AG, Liechtenstein). The disk-shaped resin samples (30 mm diameter, 2 mm high) were obtained in line with the producers' recommendations. The resulting resin specimens were incubated with saliva samples collected from twenty healthy volunteers. In order to analyze the antioxidant activity of the tested materials, certain salivary parameters were evaluated before and after incubation: uric acid, gamma glutamyl transferase (GGT), oxidative stress responsive kinase-1 (OXSR-1), and total antioxidant capacity (TAC); the salivary levels of tumor necrosis factor (TNFα) and interleukin-6 (IL-6) (inflammatory markers) were measured as well. The obtained results are overall favorable, showing that the tested materials did not cause significant changes in the salivary oxidative stress level and did not influence the inflammatory salivary status.

Survey on the Current Clinical and Technological Level of Implant Prosthesis Application and Its Complications among Romanian Prosthodontic Specialists.

Objectives: The present study aims to identify the current level of clinical and technological performance of dental prosthetic rehabilitation on implants and the possible existence of correlations between different designs and occurring complications in Romanian practice. Material and method: An online questionnaire with 36 questions, grouped into five sections, has been designed using the Google Forms application. In 2019, it was approved by the Romanian Dental and Maxillofacial Prosthetic Society, and the link to the questionnaire was distributed via email to 70 members. The answers with multiple choice option were summarized in an Excel document, coded and statistically processed in the specific software (SPSS v20.0; IBM Corp). Fisher's exact test, likelihood ratio and linearby- linear association were used, and pairs of two questions were tested considering a standard statistical significance p value=0.05. Results: The results show that screwed rehabilitations (80.5%) on platform switched (70.9%) bone level implant (76.4%) with multiunit (69.1%) abutments for fixed total prosthesis, and custom abutments (43.6%) for removable prosthesis are preferred in Romanian practice. Most common problems of fixed rehabilitation on implants are related to aesthetics (65.5%) and for overdenture to unscrewing (56.4%). Resin-polymerized material in the laboratory, acrylic teeth and milled metallic structure in both arches was the preferred design for fixed restauration in both arches. Multiple statistic significant correlations (p<0.05) were found between the design type and complications. Conclusions: Our findings outline current clinical and technological preferences in Romanian practice on prosthetic implant rehabilitations, illustrating a great need for further research and education consensus.

A Review on the Biocompatibility of PMMA-Based Dental Materials for Interim Prosthetic Restorations with a Glimpse into their Modern Manufacturing Techniques.

This paper's primary aim is to outline relevant aspects regarding the biocompatibility of PMMA (poly(methyl methacrylate))-based materials used for obtaining interim prosthetic restorations, such as the interaction with oral epithelial cells, fibroblasts or dental pulp cells, the salivary oxidative stress response, and monomer release. Additionally, the oral environment's biochemical response to modern interim dental materials containing PMMA (obtained via subtractive or additive methods) is highlighted in this review. The studies included in this paper confirmed that PMMA-based materials interact in a complex way with the oral environment, and therefore, different concerns about the possible adverse oral effects caused by these materials were analyzed. Adjacent to these aspects, the present work describes several advantages of PMMA-based dental materials. Moreover, the paper underlines that recent scientific studies ascertain that the modern techniques used for obtaining interim prosthetic materials, milled PMMA, and 3D (three-dimensional) printed resins, have distinctive advantages compared to the conventional ones. However, considering the limited number of studies focusing on the chemical composition and biocompatibility of these modern interim prosthetic materials, especially for the 3D printed ones, more aspects regarding their interaction with the oral environment need to be further investigated.

Elderly Patients' Perception of Previewing the Prosthetic Treatment Outcome.

The demographic statistics indicate that, with the industrial development and the advances in the medical field, the average life of the population has started to increase significantly; consequently, the needs of treatments in geriatric dentistry are becoming more and more significant. The purpose of this study was to evaluate patients' perception of diverse techniques used to obtain previews for final fixed prosthetic restorations: digital smile design (DSD), wax-up, indirect mock-up, temporary restorations, Computer-Aided Design (CAD). A focus group that included 11 participants, all of them geriatric patients, was formed; patients were invited to respond to a set of seven questions before and after various previsualization methods were applied. The focus-group report indicated that the indirect mock-up and the temporary restorations were considered by the geriatric patients as the best methods for obtaining good prosthetic previews. Comparing to the other tested methods, the use of indirect mock-up increased the acceptance of the prosthetic treatment plan and offered the most influential visual impact for 72.7% of participants. In addition, all tested previews allowed excellent communication with patients, the best results being obtained with the temporary prosthetic restorations (for 54.5% of participants). This approach represented a tool for better decisions regarding final dental restoration and has had a positive influence on patients' acceptance of the treatment plan as well, making the final restoration more predictable.

Key Factors Correlations in Selecting Dental Services.

The factors which influence patients in their choice of a dental care office has recently become more complex. Our objective was to assess the correlations between different key factors (demographic aspects, dentists' professionalism, factors related to dental care offices) that influence the selection of a particular dental care office by adult patients. An online questionnaire (self-administered survey) was applied to a random sample of 117 adult dental patients in private clinics in Bucharest, Romania. The survey consisted of 12 questions, and it was conducted during a 2-week period. All the collected data were subjected to statistical analysis. The obtained results revealed statistically significant correlations between studied factors, i.e., elderly patients compared to younger patients considered the use of the state-of-the-art medical devices was important for the dental office (p=0.043, R=0.187). In comparison to women, male patients were searching more often information regarding the dental offices on social media (p=0.002, R=0.284); patients that attached more importance to the dentist's professional degree were the ones that attached more importance to its reputation (p<0.001, R=0.381) and to the dental office location (p=0.022, R=0.211). The results highlighted specific patterns in patients' perception of factors related to the selection of dental offices, as also found in scientific literature. The present study offers a perspective on how to improve dental care and patients' oral health.