Monolithic Zirconia Single Crowns Supported by Narrow or Standard Diameter Titanium-zirconium Implants in Posterior Sites: One-year Results of a Randomized Controlled Trial.

The replacement of missing teeth with implant-supported prostheses has become a standard treatment option with reliable long-term outcomes in various clinical indications.1-6 The implant-supported single crowns, in particular, presented the most favorable outcome with a survival rate of 89.5% to 96% over a 10-year period.5,6 A notable prosthetic maintenance requirement, however, was reported irrespective of the prosthetic material used for the crown construction.1,7 Metal-ceramic restorations have been considered the gold standard when replacing single or multiple missing teeth with implant-supported fixed dental prostheses.8 A systematic review of 4363 metal-ceramic implant-supported single crowns in the anterior and posterior region reported an impressive survival rate of 98.3% over five years.9 Yet, the biologic and prosthetic complications associated with these restorations were substantial with a rate of 13.5%. In the posterior region, a recent systematic review of short-term randomized controlled trials10 reported a survival rate of 99.1% for metal-ceramic implant-supported single crowns. The reported prosthetic complications, mainly ceramic chipping, were also notable with an incidence rate of 7.6%.mIn recent years, the introduction of high-strength all-ceramic materials as well as digitaldesign and manufacturing processes, has allowed faster fabrication of more esthetic and cost effective restorations.11 Zirconia-based fixed dental prostheses on teeth and implants are now increasingly used and show 5-year cumulative survival rates of 89.4 to 100%.12 These restorations are typically made up of a zirconia framework that is veneered with a layer of glass ceramic to impart translucency for enhanced esthetics.13 However, chipping of the ceramic layer has been a lingering issue, shifting the attention toward the use of full anatomic monolithic zirconia restorations.14,15 Replacement of missing teeth with dental implants in posterior ridges with limited bone width can be surgically challenging and the notion of narrow diameter implants has been suggested.16,17 These implants were thought to offer potential advantages in terms of costeffectiveness and surgical morbidity.18,19 The literature, however, remains controversial on treatment outcomes with narrow diameter implants, particularly in posterior sites.19-21 When single tooth replacement with monolithic zirconia implant-supported single crowns in posterior sites are considered, only short to medium-term outcomes are available.22-26 The survival rates and clinical performances reported in these studies were variable. Crown survival rates between 84% and 100% were demonstrated over an observation time of one to three years, while the prosthetic complications were between 0% to 14%. In three studies,22,23,25 standard diameter titanium implants were used in premolar and molar sites to support the single crowns. The remaining two studies by Mühlemann et al. (2020) and Zumstein et al. (2023) reported the one-year and three-year outcomes, respectively, of the same cohort. In these studies, narrow titanium-zirconium (TiZr) implants of 3.3 mm diameter were exclusively utilized in molar sites. The implant and crown survival rates reported at one and three years were 97.4% and 84%, respectively. The lower survival rate observed in the report of Zumstein et al. (2023) resulted from fracture of five implants and the subsequent loss of their respective crowns. Aside from these two reports, no other information on the outcomes of monolithic zirconia single crowns supported by narrow diameter TiZr implants in posterior sites are available. The validity of this treatment, therefore, needs further investigation with well-designed clinical trials. Hence, a randomized controlled trial was undertaken to assess various implant, prosthetic, and patient-reported outcomes of monolithic zirconia single crowns supported by either narrow or standard diameter titanium-zirconium (TiZr) implants in posterior sites. The present report focuses on the one-year prosthetic results.

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives.

OBJECTIVE: Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment. DESIGN: PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019). RESULTS: Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits. CONCLUSION: Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

Enamel matrix derivative for alveolar ridge preservation: A randomized controlled trial.

OBJECTIVE: The aims of this clinical trial were to evaluate the radiographic dimensional changes in alveolar ridge and patient-reported outcomes following tooth extraction and alveolar ridge preservation (ARP) using either deproteinized bovine bone mineral (DBBM) with EMD or DBBM alone. METHODS: Participants requiring at least one posterior tooth extraction and ARP were randomly allocated into two treatment groups: ARP using either DBBM with EMD or DBBM alone. Cone-beam computed tomography (CBCT) images were recorded immediately prior to extraction and at 6 months. Changes in alveolar ridge height (ARH) and alveolar ridge width (ARW) at 1, 3, and 5 mm were recorded. RESULTS: A total of 18 participants with 25 preserved sites were evaluated. ARH and ARW changed significantly from baseline to 6 months for both treatment groups but the difference between the groups was not statistically significant over the 6-month follow-up period (ARH: DBBM/EMD 1.26 ± 1.53 mm vs. DBBM 2.26 ± 1.60 mm; ARW-1 DBBM/EMD 1.98 ± 1.80 mm vs. DBBM 2.34 ± 1.89 mm). A significant difference, favoring DBBM with EMD group, was observed in percentage of sites that had less than 1 mm loss in ARH (54.5% sites in DBBM/EMD group vs. 14.3% sites in DBBM alone group). The participants' perception of bruising, bleeding, and pain in the first two postoperative days was significantly in favor of DBBM alone group. CONCLUSIONS: There were no significant differences in radiographic mean measurements of ARH and ARW following ARB with DBBM and EMD or DBBM alone.

The Shortened Dental Arch Concept: Awareness, Knowledge, and Practice of Dentists in Dubai and the Northern Emirates, United Arab Emirates.

Methods: This is a cross-sectional study utilizing an online questionnaire anonymously to investigate the awareness and views of dentists about SDA. The questionnaire was sent to all 901 dentists registered with the Emirates Medical Association (EMA). The questionnaire consists of 17 questions, which comprise demographics, awareness, and application in dental practice, preferred treatment modality, and risks and benefits associated with SDA. The data were analyzed using SPSS Statistics. Results: The response rate reported was 40.3%. Two-thirds of the respondents (65.8%) were aware of the SDA concept; however, it was not usually applied in clinical practice (n = 196, 54.7%). Specialists were more aware of the concept (p ≤ 0.001) and applied it more frequently in their clinical practice (p=0.041) than general dental practitioners (GDPs). Respondents agreed that SDA was associated with the risks of teeth migration (n = 211, 59.9%), tooth wear (n = 196, 55.8%), and/or temporomandibular disorder (TMD) (n = 163, 45.3%). The implant was the treatment of choice for many of the participants (n = 169, 46.6%) to replace missing molars, followed by the acrylic removal partial denture (RPD) (n = 129, 35.5%). Conclusions: Most dentists who responded to this survey were aware of the SDA concept and had a positive attitude about it. However, they did not apply it frequently in their clinical practice.

A Retrospective Analysis of Biological Complications of Dental Implants.

Methods: A retrospective analysis of patients aged ≥18 years and having dental implants placed at Dubai Health Authority in 2010. Relevant information related to systemic-, patient-, implant-, site-, surgical- and prosthesis-related factors were collected. The strength of association between the prevalence of peri-implant mucositis and peri-implantitis and each variable was measured by chi-square analysis. A binary logistic regression analysis was performed to identify possible risk factors. Results: A total of 162 patients with 301 implant-supported restorations were included in the study. The age of the patients ranged between 19 and 72 with a mean age of 46.4 ± 11.7 years. The prevalence of peri-implant mucositis at the patient and implant levels were 44.4% and 38.2%, respectively. For peri-implantitis, the prevalence at the patient level was 5.6%, while the prevalence at the implant level was 4.0%. The binary logistic regression identified three risk factors (smoking habits, histories of treated periodontitis and lack of peri-implant maintenance) for peri-implantitis. Conclusion: Within the limitations of this study, smoking habits, history of treated periodontitis and lack of peri-implant maintenance were significant risk factors for peri-implantitis. Early detection of these factors would ensure appropriate planning and care of patients at high risk of developing peri-implant diseases.

Self-reported adaptability among postgraduate dental learners and their instructors: Accelerated change induced by COVID-19.

It is forecasted that the skills and competencies necessary for post-pandemic success in higher education need to be founded upon adaptability, coping, and Self- Regulated Learning (SRL). It is worth investigating how stakeholders perceived their adaptability and coping with the accelerated change accompanying Coronavirus Disease of 2019 (COVID-19). Accordingly, the purpose of this study was to assess the self-reported adaptability of postgraduate dental learners and their instructors in the context of abrupt transition to distance learning induced by the pandemic. This study utilized a convergent mixed methods study design. The quantitative and qualitative data were concurrently collected from instructors and learners, using a tailor-made survey of items measured with a Likert-type scale, complemented with open-ended questions. The collected datasets were independently analyzed. Descriptive and inferential analysis were conducted using the quantitative data. Qualitatively, the researchers underwent a multi-staged thematic analysis. The generated information was then integrated using a joint model analysis. The percentage of the total average of self-reported adaptability for both groups of stakeholders was 81.15%. The instructors, with a mean of satisfaction of 17.94 (±1.76), rated their adaptability significantly higher than the learners, with a mean of satisfaction of 15.66 (±2.77) (p = 0.002). The thematic analysis resulted in two interrelated themes: Self and Environment. Within the Self theme, three subthemes surfaced: Cognitions, Emotions, and Behaviors. As for the Environment theme, it encapsulated two subthemes: Enablers and Impediments. The stakeholders perceived themselves to have adapted well to the transition, and SRL appeared as a cornerstone in the adaptation to the accelerated change accompanying COVID-19. There appeared to be an interplay between the cognitions, emotions, and behaviors on the level of the self as part of the adaptation process. Also, building upon existent models of SRL, this study uncovered that the stakeholders considered the environment to play a crucial role in their adaptation process. This highlights the importance of developing a climate that remains, despite external pressures, conducive to attaining learning and teaching goals. It is also crucial for university-level mental health promotion activities to proactively foster, among learners and instructors, adaptability, building 'academic resilience'.

Correction: Rapid transition to distance learning due to COVID-19: Perceptions of postgraduate dental learners and instructors.

[This corrects the article DOI: 10.1371/journal.pone.0246584.].

A qualitative study of trainer and trainee perceptions and experiences of clinical assessment in post-graduate dental training.

BACKGROUND: The implementation of workplace-based assessment (WBA) needs to ensure the achievement of pre-set competences but may look different across varying contexts, such as in post-graduate dental education. The purpose of this study is to explore the perception of residents, faculty members and alumni concerning their experience with clinical assessment, and what configurations they consider as optimal to maximise the entailed learning experience. METHODS: This study relied on a qualitative descriptive design using two data collection tools: focus group sessions, and semi-structured, one-to-one interviews. Data were triangulated from three sources: residents, faculty members and alumni. The data were inductively analysed based on constructivist epistemology. This was done using the Thematic Analysis approach, facilitated by NVivo software. RESULTS: The analysis revealed two mutually exclusive themes: process and people. Within process, variables related to quality, workflow and feedback surfaced. As for the people theme, the main two group of stakeholders referred to in the related analysis were the trainees and the trainers. DISCUSSION: There are many variables that need to be considered when developing an evidence-driven WBA. In addition, factoring into the design of the WBA the perception of the main stakeholders will enable contextualisation which is expected to raise the reliability of the adapted tools. CONCLUSION: This study introduced a framework that could support post-graduate universities in their journey towards developing context-specific WBA.

The Oral Health Status of Attendees and Residents in United Arab Emirates Care Homes.

OBJECTIVES: This cross-sectional study assessed the oral health status of attendees and residents in United Arab Emirates (UAE) care homes. MATERIALS AND METHODS: All care homes identified from the UAE Ministry of Health website were selected and all attendees or residents included. Medical conditions were classified according to World Health Organization (WHO) criteria. Oral and dental status was recorded on the WHO Oral Health Assessment form for adults and demographic details were recorded separately. The three examiners had training and calibration exercises before conducting the dental examinations with an overall mean inter-examiner κ of 0.67. RESULTS: A total of 107 patients participated in the study with a mean age of 67.5 years (standard deviation [SD] = 15.65 years). The mean age of men (n = 57) (69.2 years, SD = 16.3) was not significantly different to the mean age of women (65.5 years, SD = 14.8, P > 0.05). The American Society of Anaesthesiologists (ASA) classification of mild disease was present in 71 participants, whereas 27 were classified with severe systemic disease. Multiple medical problems were common (n = 28), followed by endocrine disease (n = 26) and mental health problems (n = 20). Gingivitis and/or periodontitis were present in 58 (72%) of 81 dentate participants (26 participants were edentate). Overall mean decayed, missing, filled teeth (DMFT) was 23.2 (SD = 9.0) but mean DMFT in men was significantly greater (26.5) than women at 19.8 (P < 0.001). Age had a weak positive correlation with DMFT, Spearman's rho = +0.43 (P < 0.001). Eighteen participants of 88 (20.5%) complained of pain or soreness at the time of examination. The frequency of tooth brushing/cleaning the mouth was not correlated to participants' mobility (being bed-bound). Age and gender were predictive for DMFT but not education or ASA classification. Gender and ASA classification predicted periodontal status. CONCLUSION: Oral health was generally poor with pain and discomfort present in a high number of care home residents/attendees. Carers require training in oral health as dental care is a priority for this group.

Fracture resistance of porcelain veneered zirconia crowns with exposed lingual zirconia for anterior teeth after thermal cycling: An in vitro study.

STATEMENT OF PROBLEM: In some clinical conditions minimally invasive complete crown tooth preparations are indicated. This is especially true when gross removal of tooth structure would weaken the remaining tooth or violate the vitality of the dental pulp. OBJECTIVE: The purpose of this study was to investigate the influence of (1) exposed lingual zirconia with veneered zirconia crowns, and (2) reduced lingual thickness of monolithic lithium disilicate crowns on the fracture resistance of the crowns after cyclic loading. Metal-ceramic crowns with exposed lingual metal served as controls. MATERIALS AND METHODS: Twenty-four maxillary central incisor crowns were fabricated in identical shape on metal testing dies in 3 groups: metal-ceramic crowns (MC, n = 8), veneered zirconia crowns (VZ, n = 8), and monolithic lithium disilicate crowns (MO, n = 8). A conservative preparation design with 0.75 mm lingual clearance was used for each crown system. All crowns were cemented to their corresponding crown preparations with self-adhesive resin cement (Multilink Automix). The crowns were subjected to 1000 cycles of thermal cycling, then cyclic loading of 111 N by means of a stainless steel ball, and 50,000 cycles of loading were applied for the fatigue test. Fatigue loading was followed by a continuously increasing compressive load, at a crosshead speed of 1 mm/min until failure. The compressive load (N) required to cause failure was recorded. Means were calculated and analyzed with one-way ANOVA and the Tukey HSD test (α = .05). RESULTS: There was a significant difference between MO vs. MC (P = .0001), MO vs. VZ (P = .0001), and VZ vs. MC (P = .012). CONCLUSIONS: There was a significant difference in the mean fracture resistance of MC, VZ, and MO crowns in this in vitro study. The MC group recorded the highest mean fracture strength.