Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN

Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study

PURPOSE

 There are unfavorable opinions connected with rubber dam isolation amongst dental students during adhesive restorative treatments. The aim of this study was to investigate the various barriers to practicing rubber dam isolation during dental procedures and provide necessary insight towards implementation of rubber dam among undergraduate dental students in Jazan.

MATERIALS AND METHODS

 A pre-validated questionnaire in English entitled Rubber Dam Isolation Survey (E-RDIS) based on the Capability Opportunity Motivation-Behaviour (COM-B) model of behavioral change wheel was responded by 226 university dental students.

RESULTS

 The satisfaction of training was highest among sixth year students (Mean=3.57, p<0.001). Fourth year dental students scored higher in the capability (Mean=3.18) and were more highly motivated to use rubber dams (Mean=4.21). Third year students were more likely to use rubber dams in anterior teeth (Mean=3.52) whereas fourth year students use rubber dam in posterior teeth (Mean=3.74). Lack of motivation was found to be the significant barrier influencing rubber dam usage (odds ratio (OR)=12.1; 3.74, p<0.05).

CONCLUSION

 The satisfaction with training differed among the students of different years. The rubber dam technique might be used more frequently if it were made clear to students that mastering it would be necessary for them to receive good grades.

Evaluation of Anxiety Levels in Children While Using Rubber Dam and OptraDam Isolation Techniques

Aim

The aim of the study was to evaluate the anxiety levels in children while using rubber dam and OptraDam isolation techniques.

Materials and methods

This study was a crossover trial conducted on 27 selected 6-12-year-old children. The procedure of placement of either of the isolation techniques was told and demonstrated using audiovisual aid. The sequence of the proceedings on each child (rubber dam or OptraDam) was determined randomly using toss of coin. Second demonstration was carried out 7 days after the first demonstration. The anxiety experienced was recorded using Venham's anxiety scale at two time points-after verbal explanation and after the audiovisual demonstration. The study also objectively assessed the anxiety by measuring the salivary malondialdehyde (MDA) levels of two patients.

Results

When mean values of Venham's anxiety scores after verbal explanation and after audiovisual demonstration were compared for each of the two techniques using paired Student's t test, there was statistically significant decrease in the anxiety score following audiovisual demonstration in both the techniques. When the scores between two groups after verbal explanation and after audiovisual demonstration were compared using repeated measures of analysis of variance (ANOVA), the reported anxiety scores were significantly lesser for the OptraDam technique (p = 0.000).

Conclusion

Audiovisual demonstration reduced the anxiety of children when compared to verbal explanation for both isolation techniques. OptraDam isolation was found to be less anxiety generating in children compared to rubber dam isolation.

Clinical significance

When using modern adhesive techniques, a good isolation of the working field is an important requirement for better prognosis. OptraDam being the latest addition to the rubber dam family, if found to be more children friendly can solve majority of the problems related to isolation in pediatric dentistry.

How to cite this article

S Mahima, YM Karuna, Shenoy R, et al. Evaluation of Anxiety Levels in Children while using Rubber Dam and OptraDam Isolation Techniques. Int J Clin Pediatr Dent 2023;16(2):287-291.

Evidence-based fact checking for selective procedures in restorative dentistry

OBJECTIVES

Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence.

MATERIALS AND METHODS

A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included.

RESULTS

Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs.

CONCLUSIONS

A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence.

CLINICAL RELEVANCE

This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes.

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Objective

The aim of this study was to evaluate the current clinical practice of general dentists in Saudi Arabia in restoring class II cavities using direct resin composites and to set evidence-based practice recommendations of concern.

Methods

An online survey formed of 20 questions and classified into four domains was developed. 500 dentists in 5 Saudi provinces were invited to join the survey anonymously and voluntarily using poster announcements and e-mail invitations. Descriptive statistics were used to analyze participants' responses.

Results

343 responses were received. Dentists in Saudi Arabia vary in their clinical practices and techniques of insertion of resin composite in class II cavities. 67% of participants use cotton rolls for isolating the field while 32% use rubber dam isolation. 33% and 28% of respondents use circumferential matrix (Tofflemire) and AutoMatrix, respectively. Fracture, followed by recurrent caries and open proximal contacts, was the received main reason of failure of class II direct resin composite restorations.

Conclusion

Diversity of class II resin composite practices exists among dentists in Saudi Arabia. For ensuring optimum quality outcomes and high standards of restorative dentistry healthcare, several dentists in Saudi Arabia need to reconsider their clinical practice and modify their clinical procedures of direct class II resin composites. Several evidence-based practice guidelines are recommended to dentists in this article to improve their practice and enhance the clinical reliability and longevity of class II direct resin composite restorations.

The use of latex and non-latex gloves and dental equipment in UK and Irish dental hospitals

Aim To identify glove usage within UK and Ireland dental hospitals as well as the use of latex- and non-latex-containing dental equipment.Method A self-completed questionnaire was disseminated to 16 dental hospitals in the summer of 2017. The survey concerned their current use of latex and non-latex gloves and dental equipment. In addition, information was sought regarding any problems associated with non-latex and latex gloves.Results The questionnaire response rate was 13/16 (81%), of which 100% reported the use of non-latex examination gloves. The majority were using nitrile gloves. Twelve of the 13 dental hospitals would use examination gloves for simple extractions and 11 would use sterile gloves for minor oral surgery. In ten hospitals (77%), the sterile gloves were always non-latex, and again, the majority were nitrile. Latex-containing dental equipment including orthodontic bands, prophylactic polishing cups and dental dam was still being used within some dental hospitals, but to a much lesser extent than non-latex.Conclusion All dental hospitals were using latex-free examination gloves and were showing a move towards latex-free dental equipment. This usage is comparable to what has been seen in general dental practice and follows the trend towards latex-free dentistry.

Attitude of Dental Students towards the Rubber Dam Use in Operative Dentistry

Aim:

Operative dentistry and endodontics are the two major areas where rubber dam is used extensively with special emphasis to train students on its application during dental curriculum. The purpose of the present study was to evaluate the attitude of dental students toward the use of rubber dam in operative dentistry clinics along with emphasis on evaluation of its prospective application after graduation.

Materials and Methods:

A structured questionnaire-based analysis was performed among internship students of a dentistry program, Batterjee Medical College, Jeddah, Saudi Arabia. The questions were based on training, latex allergy, and selection of jaws for application of rubber dam and prospective use of rubber dam during practice.

Results:

A completed questionnaire by all participants (n = 110) was analyzed and subjected to statistical analysis. Around 80.9% of the students agreed that adequate and satisfactory training for rubber dam placement was imparted while 59.1% agreed that they enquire about latex allergy before placement of rubber dam. Further, 85.5% of the students planned to use rubber dam for all procedures after graduation.

Conclusion:

A promising response was exhibited by this group of future dentists toward the application of rubber dam during restorative procedures.

An internet-mediated investigation into the reported clinical use of rubber dam isolation by GDPs in the UK - part 1: factors influencing rubber dam use

Aims To investigate the reported use of rubber dam isolation by UK general dental practitioners (GDPs), utilising an internet-mediated (SurveyMonkey) questionnaire reporting the demographic profile of respondents and the attitudes and factors influencing rubber dam use.Methods A piloted questionnaire was distributed to a random sample of GDPs in a private Facebook group, investigating respondent demographics, clinical applications, and attitudes towards and factors influencing rubber dam use. The data were analysed using descriptive statistics along with chi-squared and pairwise Mann-Whitney U tests.Results The response rate was 61%, with 403 valid completed questionnaires. Of these, 218 (54%) were female and 185 (46%) were male, with an age range of 23-72 years. Most of them (248; 62%) worked in mixed practices. The majority agreed that rubber dam aids placement of posterior restorations (311; 78%), provides clearer access (308; 76%), enables a higher clinical standard (355; 89%) and increases restoration longevity (257; 65%). Most agreed that proper isolation for root canal/operative procedures cannot be achieved without rubber dam use (329; 82%). Respondents disagreed with the following statements: root canal therapy completed without rubber dam isolation is as successful as those completed using rubber dam (338; 85%), rubber dam is difficult to apply (292; 73%) and rubber dam is disliked by patients (257; 64%). Respondents agreed that rubber dam use is influenced by clinical setting (259; 64%), procedure (390; 97%), choice of material being placed (382; 95%) and ease of application (337; 84%). Furthermore, 218 (54%) of the respondents expressed an interest in further training in rubber dam use.Conclusions This study provides greater insight into the attitudes and factors influencing rubber dam use, while demonstrating an interest in further training.

Treatment of Tooth Wear Associated with Reduced Occlusal Vertical Dimension Using Direct Composite Restorations and a Removable Prosthesis

Tooth wear is increasing in prevalence within the United Kingdom. Treatment of tooth surface loss can be daunting for both the clinician and patient. However, use of additive resin composite restorations is a minimally invasive treatment modality. This case illustrates the treatment of tooth surface loss in both the maxillary and mandibular arches with direct composites restorations using putty indices generated from a diagnostic wax-up recorded in centric relation. The tooth surface loss had resulted in reduced restorative space on the right hand side. The restorative treatment involved increasing the anterior vertical dimension, enabling the provision of a cobalt-chrome partial denture. This case shows the restoration of form, function and aesthetics using a reorganised occlusal approach.

Bisphenol A in human saliva and urine before and after treatment with dental polymer-based restorative materials

The aim of this study was to quantify bisphenol A (BPA) concentrations in saliva and urine before and after treatment with dental polymer-based restorative materials to assess if placement of this material is associated with increased BPA levels in saliva and urine. Twenty individuals in need of at least one dental restoration with polymer-based restorative material were included in this study. The participants were instructed to abstain from eating, drinking, and brushing their teeth for at least 10 h prior to sampling. Saliva and urine were collected before and 10 min (saliva only), 1 h, 24 h, and 1 wk after treatment. Samples were stored at -80°C before analyses. BPA in saliva and urine was determined with liquid chromatography/mass spectrometry. Linear mixed effects regression models were used for statistical analyses. There was a statistically significant increase of salivary BPA concentration directly after placement of the dental polymer-based restorations. Following placement, the concentration of BPA decreased exponentially with time. One week after treatment the BPA level in saliva was only marginally higher than before treatment. In urine, no statistically significant change of the BPA concentration was detected after treatment.

Dental dam utilization by dentists in an intramural faculty practice

Objectives

From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage.

Material and Methods

A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they completed: isolation methods, tooth location and involved surfaces, and dental restorative material.

Results

Overall, dental dam was utilized for 30% of all restorative procedures and was used less than 20% of the time for placement of class II and class III composite resins. Dental dam utilization rate by general dentists was 37% and 17.6% for prosthodontists. Those general dentists with prior history of military dental practice had a utilization rate of 78.6% and nonmilitary dentists only 7.6%. Eight faculty members responded to the questionnaire for a 42% return rate. Those who practiced dentistry in the military strongly agreed that the dental dam is the standard of care, improves their quality of restorative work, and should be documented in the dental record.

Conclusions

There were significantly different dental dam utilization rates between general dentists and prosthodontists and between dentists with prior military experience and those without.

Direct Restorations, Endodontics, and Bleaching: Materials and Techniques Used by General Dentists of New Zealand

Background

To investigate the selection and use of direct restorative materials, endodontic techniques adopted, and approaches to bleaching by general dentists in New Zealand.

Methods

A questionnaire comprising 19 sections and 125 questions was distributed via mail to 351 general dentists in New Zealand who were selected, at random, from the Dental Council of New Zealand's 2016 register.

Results

A total of 204 questionnaires were returned, of which 188 were usable. Direct resin composite was the most commonly used material for occlusoproximal cavity restorations in premolars (93.7%) and permanent molars (85.2%). Resin-modified glass ionomer cements (34%) and resin composite materials (31.4%) were more commonly used in the restoration of deciduous molars. Home-based vital bleaching was provided by a significant number of dentists (86%), while only 18% provided practice-based bleaching. Cold lateral condensation was the most commonly used obturation technique (55.8%), and 83% of respondents reported using rubber dam for treatments.

Conclusions

The findings from this study indicate that dentists in New Zealand are adapting to new materials and technologies to provide high quality care to their patients. Aesthetic treatments such as bleaching have become an integral part of general dental practice.

Frequency and Influencing Factors of Rubber Dam Usage in Tianjin: A Questionnaire Survey

Objective. To investigate the frequency and influencing factors of rubber dam usage for endodontic procedures among general dentistry practitioners and specialized practitioners (endodontist) in Tianjin. Methods. Three hundred questionnaires were distributed among practitioners from 3 different types of medical institutions in Tianjin. Data were collected and analysed using Chi-square tests. Results. There were 63.3% of respondents who have used rubber dam (response rate 82.7%, valid response rate 76.3%). However, only 0.4% and 3.1% of them recognized using rubber dam “every time” during caries direct restoration and root canal therapy, respectively. There was no significant difference in rubber dam usage between male and female practitioners. Among the respondents, practitioners with working experience between 5 and 10 years showed the highest usage rate (76.3%), while practitioners working more than 20 years showed the lowest (53.2%). The endodontists gained the highest and the most frequent usage rate and the best rubber dam technique mastering skills. Practitioners working in those stomatological departments of general hospitals showed the lowest rubber dam usage rate. Conclusions. The prevalence of rubber dam usage in Tianjin city is still low. The practitioner's gender, years of professional experience, general or specialized field, and the type of dental setting they work for are the factors that need to be considered during making policy and executing training.

Why dentists don't use rubber dam during endodontics and how to promote its usage?

Background

This survey study aimed at investigating the frequency of rubber dam use during root canal treatment, identifying influencing factors for not using it by Saudi general dental practitioners (GDPs) and endodontists. It also aimed at identifying measures that increase rubber dam usage.

Methods

After obtaining an ethical approval, two pilot studies were conducted on staff members at Taibah University College of Dentistry and a group of GDPs. A final online survey was constructed comprising 17 close-ended questions divided into six categories: demographics, endodontic practice, rubber dam use, alternative isolation methods, reasons for not using rubber dam, and measures and policies that increase its usage. The survey was emailed to 375 GDPs randomly selected from the dental register and all endodontists (n = 53) working in the western province, Saudi Arabia. Data were analyzed using the Chi-square and Linear-by-Linear association tests at p ≤ 0.05.

Results

The proportion of endodontists who used rubber dam (84.8 %) was significantly greater than that of GDPs (21.6 %) (p < 0.001). Significantly the highest proportion (40.5 %) did not use rubber dam because of unavailability at working place. Most rubber dam none-users (69.25 %) used a combination of other isolation means. The highest proportion of those who used rubber dam were working in the governmental sector (54.3 %). Among rubber dam users, the greatest proportion graduated from Saudi Arabia (57.8 %) compared to those graduated from Egypt (34.3 %) and Syria (22.4 %). There was a significant correlation between the patterns of rubber dam use during undergraduate training and its usage after graduation (p = 0.001). The highest proportion of participants (48.1 %) reported better undergraduate education as the most important factor that would increase rubber dam use in dental practice.

Conclusions

Using of rubber dam was not common in Saudi general dental practice. Dentists must follow the recommended standards of care. Place of work and patterns of using rubber dam during undergraduate study were the most influencing factors. Better undergraduate education was the most important proposed measure to increase its usage. The combination of cotton rolls and saliva high-volume ejector or gauze was the most common alternative to rubber dam isolation.

Do clinical experience time and postgraduate training influence the choice of materials for posterior restorations? Results of a survey with Brazilian general dentists

The aims of this study were to evaluate the materials available for posterior restorations and to assess whether clinical experience time and post-graduate training influence dentists' choices. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil. Information was collected regarding sociodemographic variables, level of specialization, time since graduation and working place. In addition, options regarding posterior restorations including the first choice of material, type of composite resin (if used) and use of rubber dam were also collected data. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher's exact tests (α=0.05). The response rate was 68% (187). Direct composite resin was broadly indicated (73.2%) as the first-choice for posterior restorations. Most professionals used microhybrid composite (74.5%) and 42.6% of the participants used rubber dam for placement of posterior composite restorations. Dentists with more time of clinical practice used less composite (p=0.014). Specialists used more frequently rubber dam to restore posterior teeth than did non-specialists (p=0.006). The results of this survey revealed that direct composite was the first choice of dentists for posterior restorations; microhybrid was the preferred type of composite and the use of rubber dam for composite resin placement in posterior teeth was not frequent; time since graduation and level of specialization affected dentists' choices.

Influence of Isolation Method of the Operative Field on Gingival Damage, Patients' Preference, and Restoration Retention in Noncarious Cervical Lesions

OBJECTIVES

To evaluate the retention rates, gingival damage, and patients' preferences for adhesive restorations in noncarious cervical lesions (NCCL) associated with the use of rubber dam vs cotton rolls/retraction cord isolation.

METHODS

Thirty patients having one pair of similar NCCL on opposing sides of the same arch were enrolled in this study. A total of 60 restorations were placed. In each patient one restoration was placed under rubber dam isolation (RD) using dental retainers, and the other one was placed using cotton rolls/retraction cord (CR/RC) isolation. Dental residents with more than 10 years of clinical experience restored all NCCL using the same adhesive (GO!, SDI Limited, Bayswater, Australia) and composite resin (Ice, SDI). The patients' preferences were recorded. The gingival condition (bleeding, gingival laceration, and gingival insertion level) was evaluated immediately after the restorative procedure and after one week. Gingival sensitivity was also assessed one week after the end of the restorative procedures. The clinical time required to perform each restoration was recorded. The performance of the restorations was assessed using the FDI criteria at baseline and six, 12, and 18 months after clinical service. All criteria evaluated were submitted to appropriate statistical analysis (α=0.05).

RESULTS

The retention rates of the restorations at each recall time were not affected by the isolation method (p>0.05). No significant difference between isolation methods was found in regard to patients' preferences (p=0.86), gingival bleeding (p=0.57), laceration (p=0.64), insertion (p>0.52), gingival sensitivity (p=0.52), or chairside time (p=0.77).

CONCLUSIONS

The use of CR/RC was shown to be similar to the use of RD in terms of retention rates, patient's preference, gingival damage, and chairside time for adhesive restorations in NCCL.

The Changes in Dentists' Perception and Patient's Acceptance on Amalgam Restoration in Kurdistan-Iraq: A Questionnaire-based Cross-Sectional Study

BACKGROUND

There has been considerable controversy concerning the health risks and benefits of utilizing mercury-containing amalgam. Across the developing countries, a reduction in the use of dental amalgam in oral health care provision is expected.

PURPOSE

Assessment of dentists' and patient's attitude of dental amalgam regarding attractiveness, perceived health, and treatment preferences in Kurdistan, Iraq.

MATERIALS AND METHODS

A 4-page questionnaire comprised two parts, specific for dentist and patient were structured and delivered to each dentist oneself. Both open-ended and close-ended questions about the treatment needs of patients, uses of amalgam and its alternative, the properties and usefulness of different materials. Patient's acceptance was assessed by means of structured questionnaire prepared based on commonly asked questions from routinely daily practice. Questions on the type of filling material in their mouth, previous knowledge of mercury in dental amalgam and disappointment due to mercury hazard and toxicity. They were to indicate their acceptance with filling their cavities by dental amalgam with or without prior information about its mercury content. This part was also accomplished by the dentists participated in this survey.

RESULTS

Out of 185 dentists shared, only 39 (21.1%) indicated that amalgam presents no harm for the dentists and patients. While majority of dentists 85 (45.9%) were uncertain about this issue. Amalgam was selected most often 107 (57.8%) as the material of choice for restoring posterior teeth. About 94(50.8%) and 85(45.9%) of the practitioners primarily used glass ionomer/resin-reinforced glass ionomer and composite, respectively. Among 1850 patients received treatment, only 450 (24.32%) claimed to have heard about adverse reactions to dental amalgams. Those who believed it to be safe were 200 (10.82%).Acceptance towards amalgam was 62%.

CONCLUSION

While amalgam was the most common material used for posterior restorations, direct tooth-coloured restorative materials were also popular among dentists participated in this study. Awareness of toxicity of mercury in dental amalgam was slightly low among the respondents studied. This may be suggested to be a reflection of devoid of planetary amalgam controversy in Kurdistan. The level of acceptance toward amalgam appears to be related to economics, dental education, and aesthetic orientation of the residents.

Attitude and awareness of dentist towards resin bonded bridges in Saudi Arabia

STATEMENT OF THE PROBLEM

Resin bonded bridges (RBBs) offer a conservative approach to tooth replacement. However, the use of this treatment option has been limited. Therefore, the aim of this study was to assess the knowledge and attitude of dentists in Saudi Arabia, including general dental practitioners (GDPs) and prosthodontic and restorative specialists (SPs), toward RBBs.

METHODS

In this cross-sectional study, questionnaires designed to survey knowledge of RBB performance factors were distributed to GDPs and SPs (n = 400). Specifically, opinions of GDPs and SPs regarding clinical, mechanical, technique- and patient-dependent performance factors of RBBs were obtained. Average significance and Chi-square tests were used to identify the frequency, pattern, and significance of the response variables identified.

RESULTS

A majority (65.3%) of the subjects reported using RBBs in less than 10% of their prosthodontic cases. The most common reason for the limited clinical application of RBBs was perceived poor retention (23.45%). In addition, SPs regarded the influence of enamel structure, number of pontics, cement type, RBB design, and surface treatment as "very significant" factors with respect to RBB survival. Overall, a statistically significant difference was observed between the responses of GDPs and SPs regarding their knowledge of performance factors for RBBs.

CONCLUSION

In comparison to SPs, GDPs reported greater disagreement with current standards for RBB success factors. Moreover, 60% of SPs and 71% of GDPs used RBBs for less than 10% of their prosthodontic cases. Therefore, continuing education opportunities are needed for practicing dentists, and undergraduate students need to receive greater exposure to the clinical application of RBBs.

Prevalence of Rubber Dam Usage during Endodontic Procedure: A Questionnaire Survey

AIM

To determine the prevalence and frequency of rubber dam usage for endodontic procedures among general practitioners, specialized practitioners, undergraduate final year students and Endodontists in the state of Odisha, India.

METHODOLOGY

A pre-piloted questionnaire was distributed among 737 subjects. Dentists and final year students were surveyed in relation to their prevalence of rubber dam usage.

STATISTICAL ANALYSIS USED

Chi-square/ Fisher Exact tests have been used to find the significance of study parameters on categorical scale between two or more groups.

RESULTS

Overall response rate was 71%. While about 94% of the subjects knew the use of rubber dam, 30% have used it for root canal cases and 23% use them for all cases of root canal treatment. Use of rubber dam was 15.4% in paediatric patients and 34.4% in adult patients. 68% of subjects received knowledge about rubber dam usage in undergraduate school. 75% felt that rubber dam should be compulsory before endodontic treatment & 90% were willing to gain knowledge through training and continuing dental education programs.

CONCLUSION

Whilst rubber dam is used frequently for root canal treatment than operative treatment, in the present survey there is a low prevalence of its usage during endodontic therapy. This presents quality issues, as well as medico-legal and safety concerns for the professional and patients alike. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry at dental school and through continuing dental education for practitioners to update their knowledge.

Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners

Objectives

The aim of this study was to assess technical preferences of general dental practitioners when restoring anterior composite restorations. How the level of clinical experience or post-graduate training infuenced their options was also tested.

Material and Methods

A cross-sectional study was performed using a questionnaire with general dental practitioners (GDPs) (n=276) in Southern Brazil. Information regarding post graduation training (specialization, master's or PhD degree) and linical experience (years since completing graduation) were gathered. The options regarding anterior composite restorations (type of composite, adhesive system, light curing unit, polishing procedures and rubber dam use) were collected. Data were submitted to descriptive analysis and associations were tested.

Results

Response rate was 68% (187). GDPs selected microhybrid composite (52%) and 2-step total etch adhesive system (77%). LED was the preferred method of activation for 72.8%. Immediate polishing was preferred by 75%, using a combination of techniques. Most of the respondents (74.3%) did not use rubber dam. More experienced clinicians used more halogen lights (p<0.022), performed more light monitoring (p<0.001) and were resistant to use rubber dam (p<0.012). Dentists with post-graduation training used 3-etch-and-rinse system more frequently (p<0.04), usually monitored light intensity (p<0.014) and placed rubber dam more frequently (p<0.044).

Conclusions

Hybrid composite, simplifed adhesives, LED units and immediate polishing were preferred by Southern Brazilian dentists for anterior composite restorations. Few dentists used rubber dam to perform composite restorations in anterior teeth. Clinical experience and post-graduation training infuenced the dentists' choices.

Evaluation of senior dental students' general attitude towards the use of rubber dam: a survey among two dental schools

The purpose of this study was to evaluate the general attitude of senior dental students towards rubber dam use, specifically focusing on endodontic practices prior to starting to serve community. Questionnaires were distributed to senior year students of a private school and a state school in Istanbul. Questions were asked about areas where the students used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The private school students rated isolation whereas those of the state school selected prevention of aspiration which the top advantage rubber dam provides. Students of the state school agreed with the opinion that isolation cannot be achieved without rubber dam and it extended the procedure with a significantly higher ratio compared to the private school. Within the limitations of the present study, it can be concluded that the perceptions of dental students on rubber dam needs to be improved and strategies should be developed so that this valuable adjunct will comprise one of the indispensable elements of dental care.

Direct anterior composites: a practical guide

For more than 40 years dentists worldwide have been using directly placed resin-bonded composite to restore damaged anterior teeth. While such techniques are invariably more conservative of tooth tissue than indirect procedures, operative techniques using direct composite can be challenging and are considered technique sensitive. Clinicians require both technical and artistic skill to provide composite restorations that restore function and aesthetics to blend seamlessly with the residual dentition. This paper provides an update on the aesthetic considerations involved in the restoration of anterior teeth with directly placed composite and outlines the contemporary materials, equipment and techniques that are available to optimize every clinical stage.

CLINICAL RELEVANCE

Successful restoration of anterior teeth with direct composite is an integral component of contemporary clinical practice.

Cost-effectiveness of One- and Two-step Incomplete and Complete Excavations

The treatment of deep caries lesions carries significant risks for the integrity of the pulp and often initiates a cascade of re-interventions. Incomplete caries removal may reduce these risks and avoid or delay re-treatment. The present study analyzed the cost-effectiveness of one- and two-step incomplete as well as complete excavations. We used Markov models to simulate treatment of a molar tooth with a deep caries lesion in a 15-year-old patient. Retention of the tooth and its vitality as effectiveness measures as well as accruing costs were analyzed over the patient’s lifetime. The model adopted a public-private-payer perspective within German health care. Transition probabilities were calculated based on literature reviews. Monte-Carlo microsimulations were performed with 6-month cycles. One-step incomplete excavation resulted in lower long-term costs and in longer-retained teeth and their vitality (means: 53.5 and 41.0 yrs) compared with two-step incomplete (52.5 and 37.5 yrs) and complete excavations (49.5 and 31.0 yrs), and dominated the other strategies in 70% to 100% of simulations. Regardless of the assumed willingness-to-pay ceiling value, one-step incomplete excavation had the highest probability of being cost-effective. Despite limited evidence levels of input data, we expect one-step incomplete excavation to reduce costs while retaining deeply carious teeth and their vitality for longer.

A simplified clinical technique for a routine indirect restoration impression on a challenging patient using a dry field illuminator

Detailed and accurate impressions are made when the oral environment is dry during the impression process. Maintaining a dry field on medically, physically, or emotionally compromised patients can be very challenging. If not achieved, it may compromise dental care and accurate outcomes. This article describes a technique that can be used to make a final impression for an indirect restoration in a protected, isolated, and dry environment, using a dry field illuminator.

Contemporary dental practice in the UK in 2008: aspects of direct restorations, endodontics and bleaching

OBJECTIVE

To investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004.

METHODS

A questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed.

RESULTS

A total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised.

CONCLUSION

It is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness.