CODA standard 2-24 h-"replacement of teeth" dilemma: Unintended consequences and proposed solutions.

BACKGROUND: The Commission on Dental Accreditation (CODA) was established in 1975 with the goal of serving the public and the dental profession by developing and implementing standards that guide and maintain the quality of dental educational programs. These standards are defined broadly around competencies reflective of an evidence-based definition of general dentistry and that should be met by the new graduates to function as an entry level provider. Consequently, CODA "expects each school to develop specific competency definitions and assessment methods in the context of the broad scope of general dental practice". CODA Standard 2-24 h was implemented a decade ago to address concerns that dental schools are not sufficiently proactive in incorporating implant-related curricula and clinical competencies. When the standard was implemented, most patients already preferred dental implants over FPDs. This market trend, together with the prescriptive format of the standard, had the unintended consequence of creating pressure on programs that struggled to find enough patients who will chose FPDs as a treatment option. DISCUSSION: As a short term solution, we suggest a tooth replacement competency construct that has the potential to alleviate this burden. This solution incorporates principles of ethical decision making, patient-centered care, and evidence-based dentistry, without compromising educational aspects and competency development. For the longer term, we suggested to revise and rephrase the standard so that it will be clinically-centered rather than focused on technical tools that may evolve, change, or disappear as a result of technological progress and other market trends. This, in turn, will be conducive to fulfill the intent of Standard 2-24 to allow the schools to identify "competencies that will be included in the curriculum based on the school's goals, resources, accepted general practitioner responsibilities and other influencing factors."

Should dental schools adopt teledentistry in their curricula? Two viewpoints.

INTRODUCTION: Teledentistry is a cutting edge technology that could be used to improve access to care to underserved populations and those in remote areas. OBJECTIVES: To discuss the advantages and disadvantages of adopting teledentistry into the predoctoral dental curriculum. METHODS: Two teams of dentists reviewed the pros and cons of introducing teledentistry into the predoctoral dental curriculum. RESULTS: Viewpoint 1 produced evidence that teledentistry is a cutting-edge technology that can improve access to care for underserved populations in a practical, cost-effective manner. Viewpoint 2 showed evidence that teledentistry is too new to have an evidence base to support its widespread use, legal and regulatory requirements have not been established and there is no precedent for third party payers to reimburse for this service. CONCLUSION: The authors feel that a national teledentistry policy should be developed starting at the state level with stakeholders from the dental profession, dental education, government, patient advocates, and third party payers working together to determine the best way forward.

Locator retention: does variation in number and configuration matter?

This pilot study was designed to collect initial data on overdenture attachment retention in varying configurations of attachment location in an implant-retained mandibular overdenture. A clear acrylic model of a mandible with 6 numbered implants and Locator resilient abutments was used to simulate implant placement in a patient. A clear acrylic denture was fabricated with 6 Locator housings to match the implants in the model. Attachments were tested in 4 different configurations: 2 implants, 2 and 5 (T25); 4 implants, 2-5 (T2345); 4 implants, 1, 3, 4, and 6 (T1346); and 6 implants, 1-6 (T1-6). Clear nylon male inserts were used for each test. The mean overall retentive strength across all 20 pulls was 576.0 N for configuration T1-6, 354.9 N for configuration T1346, 350.7 N for configuration T2345, and 189.9 N for configuration T25. Mean retentive strength also stabilized after the 7th pull for all 4 configurations, resulting in nonsignificant declines in retentive strength within each specific configuration after 7 pulls. Configuration T1-6 exhibited the greatest retentive strength relative to all other configurations both initially and after repeated application of force. Configurations T1346 and T2345 had similar retentive strengths, and both had greater retentive strength than T25. However, despite these differences, all 4 configurations exhibited similar losses in retentive strength from the repeated application of force during the first 7 pulls until stabilization occurred shortly thereafter.

Shear bond strength comparison of implant-retained overdenture attachment pickup materials.

This study evaluated the shear bond strength (SBS) of 4 different retentive materials for the chairside pickup of dental implant attachments. Shear force was applied to determine the SBS of each material to denture acrylic resin. The difference between SBSs of polymethyl methacrylate and UBAR (claimed to bond to metal) to metal housings was also evaluated. There were no statistically significant differences among the SBSs of Jet Denture Repair Acrylic, EZ PickUp, and UBAR, but Quick Up had an SBS that was significantly lower than that of the other 3 materials. In addition, UBAR had a higher SBS to metal housings than did processed polymethyl methacrylate.

Evaluation of the Marginal Fit of CAD/CAM Crowns Fabricated Using Two Different Chairside CAD/CAM Systems on Preparations of Varying Quality.

PURPOSE: This study evaluated the marginal gap of crowns fabricated using two new chairside computer-aided design/computer-aided manufacturing systems on preparations completed by clinicians with varying levels of expertise to identify whether common preparation errors affect marginal fit. The null hypothesis is that there is no difference in the mean marginal gaps of restorations of varying qualities and no difference in the mean marginal gap size between restorations fabricated using the PlanScan (D4D, Richardson, TX, USA) and the CEREC Omnicam (Sirona, Bensheim, Germany). MATERIAL AND METHODS: The fit of 80 lithium disilicate crowns fabricated with the E4D PlanScan or CEREC Omnicam systems on preparations of varying quality were examined for marginal fit by using the replica technique. These same preparations were then visually examined against common criteria for anterior all-ceramic restorations and placed in one of four categories: excellent, good, fair, and poor. Linear mixed modeling was used to evaluate associations between marginal gap, tooth preparation rating, and fabrication machine. RESULTS: The fit was not significantly different between both systems across all qualities of preparation. The average fit was 104 µm for poor-quality preparations, 87.6 µm for fair preparations, 67.2 µm for good preparations, and 36.6 µm for excellent preparations. CONCLUSION: The null hypothesis is rejected. It can be concluded that preparation quality has a significant impact on marginal gap regardless of which system is used. However, no significant difference was found when comparing the systems to each other. CLINICAL SIGNIFICANCE: Within the limitations of this in vitro study, it can be concluded that crown preparation quality has a significant effect on marginal gap of the restoration when the clinician uses either CEREC Omnicam or E4D PlansScan.

Sleep Disorders in Aboriginal and Torres Strait Islander People and Residents of Regional and Remote Australia.

STUDY OBJECTIVES: To compare the use of sleep diagnostic tests, the risks, and cofactors, and outcomes of the care of Indigenous and non-indigenous Australian adults in regional and remote Australia in whom sleep related breathing disorders have been diagnosed. METHODS: A retrospective cohort study of 200 adults; 100 Aboriginal and Torres Strait Islander and 100 non-indigenous adults with a confirmed sleep related breathing disorder diagnosed prior to September 2011 at Alice Springs Hospital and Cairns Hospital, Australia. RESULTS: Results showed overall Indigenous Australians were 1.8 times more likely to have a positive diagnostic sleep study performed compared with non-indigenous patients, 1.6 times less likely in central Australia and 3.4 times more likely in far north Queensland. All regional and remote residents accessed diagnostic sleep studies at a rate less than Australia overall (31/100,000/y (95% confidence interval, 21-44) compared with 575/100,000/y). CONCLUSION: The barriers to diagnosis and ongoing care are likely to relate to remote residence, lower health self-efficacy, the complex nature of the treatment tool, and environmental factors such as electricity and sleeping area. Indigeneity, remote residence, environmental factors, and low awareness of sleep health are likely to affect service accessibility and rate of use and capacity to enhance patient and family education and support following a diagnosis. A greater understanding of enablers and barriers to care and evaluation of interventions to address these are required. COMMENTARY: A commentary on this article appears in this issue on page 1255.

Utilizing self-assessment software to evaluate student wax-ups in dental morphology.

Traditionally, evaluating student work in preclinical courses has relied on the judgment of experienced clinicians utilizing visual inspection. However, research has shown significant disagreement between different evaluators (interrater reliability) and between results from the same evaluator at different times (intrarater reliability). This study evaluated a new experimental software (E4D Compare) to compare 66 student-produced tooth wax-ups at one U.S. dental school to an ideal standard after both had been digitally scanned. Using 3D surface-mapping technology, a numerical evaluation was generated by calculating the surface area of the student's work that was within a set range of the ideal. The aims of the study were to compare the reliability of faculty and software grades and to determine the ideal tolerance value for the software. The investigators hypothesized that the software would provide more consistent feedback than visual grading and that a tolerance value could be determined that closely correlated with the faculty grade. The results showed that a tolerance level of 450 µm provided 96% agreement of grades compared with only 53% agreement for faculty. The results suggest that this software could be used by faculty members as a mechanism to evaluate student work and for students to use as a self-assessment tool.