Effect of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes on bacterial contamination during dental implant surgery: A randomized controlled clinical trial

Background

Although the role of chlorhexidine and other mouthwashes in periodontal therapy has been elucidated, little information is available on their use as routine preoperative mouth rinses before surgery, especially in periodontal procedures such as dental implant surgery.

Objective

This study aimed to compare the efficacy of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes in reducing bacterial contamination at the time of implant placement.

Materials and Methods

Eligible patients who underwent dental implant surgery were randomly divided into four groups based on the mouthwash used: (1) 0.12 % chlorhexidine, (2) essential oil, (3) cetylpyridinium chloride, and (4) saline (served as the control group). All the patients of each group rinsed preoperatively with 15 mL of the respective mouthwash for 60 s. Saliva samples before (pre) and immediately after rinsing with the mouthwash (post) and after suturing the flap (end) were collected on the day of the implant placement. Real-time quantitative polymerase chain reaction (qPCR) was performed to analyze the samples and quantify the targeted periodontal pathogens using a propidium monoazide (PMA) dye.

Results

Forty patients were included in the study. Real-time qPCR demonstrated a significant reduction in the number of pathogens in the saliva samples of the mouthwash groups compared to that of the control group. A statistically significant difference was observed between the groups for the pre-post and pre-end samples (p < 0.001) but not for the post-end samples (p = 0.203). A statistically significant difference was observed between the chlorhexidine, essential oil, and cetylpyridinium chloride mouthwash groups and the saline group (P < 0.001). The bacterial counts significantly differed with and without the use of the PMA dye.

Conclusions

Preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes can reduce the bacterial load at the time of implant placement, thereby reducing the incidence of implant-related complications.

Evaluation of marginal and internal adaptation of veneers generated by the guided prosthetic tooth preparation system

OBJECTIVE

This in vitro study aimed to assess and contrast the marginal and internal adaptation of all-ceramic prefabricated veneers manufactured via the FirstFit guided tooth preparation system against all-ceramic veneers produced using the chairside Computer-Aided Design/Computer Aided Manufacture (CAD/CAM) system following identical guided preparation protocols.

MATERIALS AND METHODS

Two main groups were included, with 16 lithium disilicate veneers per group. Four typodonts were used for the test (FirstFit) and control CAD/CAM groups. Intraoral scans created master casts and preparation guides. Guides performed preparations on typodont teeth (two central incisors and two lateral incisors). Prepared teeth were scanned (CEREC Omnicam) to design and mill CAD/CAM veneers. Marginal gap thickness and cement space thickness were measured using light microscopy at four locations: marginal, cervical internal, middle internal, and incisal internal.

RESULTS

No significant difference existed between groups for marginal adaptation (p = 0.058) or incisal internal adaptation (p = 0.076). The control group had significantly lower values for middle internal adaptation (p = 0.023) and cervical internal adaptation (p = 0.019).

CONCLUSIONS

Guided preparation evaluation showed no significant differences in marginal or incisal internal adaptation. The CAD/CAM group had significantly lower middle and cervical internal adaptation values.

Attention-deficit hyperactivity disorder and psychostimulant use in patients seeking dental care-Associations with common orofacial pain complaints

BACKGROUND

Dental medicine should expand its scope to properly assess medical and psychosocial factors that might have an impact on patients' oral health. Based on previous literature and clinical experience, attention-deficit/hyperactivity disorder and psychostimulant medications might represent factors associated with orofacial pain symptoms.

OBJECTIVE

The aim of the study was to assess whether common orofacial pain complaints such as jaw pain, jaw clicking, teeth clenching and headaches are more prevalent in dental patients who have an ADHD diagnosis and/or use psychostimulant medications.

METHODS

Orofacial pain symptoms prevalence was compared among four groups from a sample of new patients seeking dental care at Tufts University School of Dental Medicine (n = 11 699) based on ADHD diagnosis and psychostimulants intake: G1: no ADHD, no stimulants; G2: yes ADHD, yes stimulants; G3: yes ADHD, no stimulants; G4: no ADHD, yes stimulants.

RESULTS

In multivariable logistic regression models adjusting for age, gender, tobacco use, and alcohol consumption, significant differences were found for clenching (p < .0001), jaw pain (p < .0001), and headache (p < .0001). Compared to G1, two groups (G2 and G4) exhibited significantly higher odds of clenching and headaches, whereas only G2 exhibited significantly higher odds of jaw pain.

CONCLUSIONS

In comparison with patients without ADHD and not taking psychostimulants medications, dental patients using psychostimulants with and without ADHD diagnosis report headaches and teeth clenching more frequently, while jaw pain is reported more frequently only by those taking psychostimulants with an ADHD diagnosis. Further research is necessary to assess the nature of these associations and their clinical relevance.

Attitudes and opinions of telehealth in the dental school environment: A survey study

PURPOSE

The objective of this study was to assess provider attitudes and opinions regarding telehealth in the dental school environment.

METHOD

A survey was developed and validated and was sent to 849 predoctoral students, postdoctoral students (residents), and faculty at a single dental school. It consisted of 13 questions regarding the participants' professional backgrounds, opinions, and attitudes toward telehealth. The survey opened on November 16, 2021, and remained open for 6 weeks.

RESULTS

Of 849 survey recipients, 163 (19%) responded. Among 161 usable surveys, 90 (56%) were predoctoral students, 42 (26%) were postdoctoral students, and 29 (18%) were faculty. Fifty-four percent reported having completed at least one telehealth visit. Among this subset, 80% strongly agreed or agreed that telehealth is a good adjunct in providing care; 74% strongly agreed or agreed that telehealth has improved communication with patients.

CONCLUSION

Most dental providers reported positive opinions and attitudes regarding telehealth's ability to improve communication and serve as an adjunct to providing care.

PRACTICAL IMPLICATIONS

In the right circumstances, telehealth offers an alternative to traditional oral healthcare delivery methods. Based on the perceptions of dental providers, the use of telehealth may also be beneficial in combination with traditional approaches in the dental school environment.

Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact

Objective

This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities.

Methods

A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives.

Results

Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight.

Conclusion

The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.

The relationship between sleep and salivary and serum inflammatory biomarkers in adolescents

Objectives

Poor sleep behavior can trigger an inflammatory response and contribute to the development of inflammatory diseases. Cytokines can act as indicators of inflammation and may precede the onset of inflammatory diseases. This study aimed to determine the association between sleep timing parameters (bedtime, sleep duration, sleep debt, and social jetlag) and the levels of nine serum and salivary inflammatory and metabolic biomarkers.

Methods

Data were collected from 352 adolescents aged 16-19 years enrolled in Kuwait's public high schools. The levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), adiponectin, leptin, and insulin were measured from saliva and serum samples. We conducted mixed-effect multiple linear regression modeling to account for the school variable as a random effect to assess the relationship between the sleep variables and salivary and serum biomarkers. Mediation analysis was conducted to check if BMI was a mediator between bedtime and the biomarkers.

Results

There was a statistically significant elevation in serum IL-6 level associated with later bedtime (0.05 pg./mL, p = 0.01). Adolescents with severe sleep debt of ≥2 h had an increase in salivary IL-6 biomarker levels (0.38 pg./mL, p = 0.01) compared to those who had sleep debt of <1 h. Adolescents with sleep debt of ≥2 h had significantly higher levels of serum CRP (0.61 μg/mL, p = 0.02) than those without sleep debt. Additionally, we found that the inflammatory biomarkers (CRP, IL-6, IL-8, IL-10, VEGF, and MCP-1) and metabolic biomarkers (adiponectin, leptin, and insulin) had more statistically significant associations with the bedtime variables than with sleep duration variables. CRP, IL-6, and IL-8 were associated with sleep debt, and IL-6, VEGF, adiponectin, and leptin levels were associated with social jetlag. BMIz was a full mediator in the relationship between late bedtime and increased serum levels of CRP, IL-6, and insulin.

Conclusion

Adolescents who go to bed at or later than midnight had dysregulated levels of salivary and serum inflammatory biomarkers, suggesting that disrupted circadian rhythm can trigger higher levels of systemic inflammation and potentially exacerbate chronic inflammation and the risk of metabolic diseases.

Accuracy of static computer-aided implant surgery (S-CAIS) using CAD-CAM surgical templates fabricated from different additive manufacturing technologies

STATEMENT OF PROBLEM

Different 3D printers are available for guided implant surgery, but studies that evaluate their source of errors and their cost-effectiveness are lacking.

PURPOSE

The purpose of this in vitro study was to compare the accuracy of different 3-dimensional (3D) printed surgical templates made using different additive manufacturing technologies and to evaluate the effect of implant location on the accuracy of fully guided implant placement.

MATERIAL AND METHODS

Fifty partially edentulous maxillary typodonts with edentulous sites in the right second premolar (SP), right lateral incisor (LI), left central incisor (CI), and left first molar (FM) locations were scanned and printed from the standard tessellation language (STL) datasets. The study compared 5 groups for the fabrication of implant surgical templates: Varseo S-Bego (Bego), Polyjet-Stratasys (Poly), Low Force Stereolithography-FormLabs (LFS), P30+-Straumann (P30), and M2-Carbon (M2). After fully guided implant placement, the typodont was scanned, and the 3D implant positions were compared with the master model by superimposing the STL files. Descriptive statistics were calculated for groups and subgroups, and comparisons among the groups and subgroups were conducted via 2-way mixed analysis of variance, Tukey honest significant difference, and post hoc Bonferroni tests (α=.05).

RESULTS

The results were site specific and not consistent within each group. For angle deviation, the within-group analysis for P30 demonstrated significantly lower values for implants positioned at site SP (1.4 ±0.8 degrees) than for sites LI (2.3 ±0.7 degrees; P=.001) and CI (2.3 ±0.8 degrees; P=.007). For 3D offset at base for implant CI, LFS was significantly higher than Bego (P=.002), Poly (P=.035), or M2 (P=.001); P30 was also significantly higher than Bego (P=.014) and M2 (P=.006). LFS had a significantly higher 3D offset at the tip than Bego (P=.001) and M2 (P=.022) for implant CI.

CONCLUSIONS

The choice of 3D printer seemed to influence fully guided implant surgery in terms of the final implant position compared with initial implant planning. However, although statistically significant differences were present across groups, all additive manufacturing technologies were within clinically acceptable values.

Retention of Zirconia Crowns Compared to Stainless Steel Crowns: An Ex-Vivo Study

PURPOSE

The purpose of this study was to compare the retention of 3M stainless steel crowns^™ (SSCs), Kinder Krowns^® zirconia crowns (ZCs), and EZCrowns ZCs on extracted primary mandibular second molars ex-vivo.

METHODS

A total of 45 extracted primary mandibular second molars were allocated randomly to either of the three groups. All teeth were mounted in Dentsply acrylic molds and then prepared for crown cementation. Crowns were cemented with glass ionomer cement (GIC). Retention testing was performed using Instron 5566A. Differences in retention between the groups were tested via Welch's analysis of variance (ANOVA), and post hoc comparisons were performed with the Games-Howell test.

RESULTS

Welch's ANOVA resulted in statistically significant differences between the three groups (P<0.001). The mean±SD force in Newtons (N) for the SSC group, Kinder Krowns^® group, and EZCrowns group were 337.0±137.1 N, 89.4±53.6 N, and 106.5±77.7 N, respectively. Post hoc comparisons with the Games-Howell test presented that the SSC group had significantly higher retention than both the ZC groups (P<0.001). There was no significant difference between the ZC groups (P=0.76).

CONCLUSIONS

Within the limitations of this ex-vivo study results, due to their statistically significant higher retention, stainless steel crowns should be selected over zirconia crowns when in need of a full coverage restoration. But if esthetics are a concern, dentists can choose freely between either of the ZCs tested in this study.

Effect of supramucosal height of a scan body and implant angulation on the accuracy of intraoral scanning: An in vitro study

STATEMENT OF PROBLEM

Intraoral scanners (IOSs) provide a digital alternative to conventional implant impression techniques. However, the effect of the supramucosal height of the scan body and implant angulation on the accuracy of IOSs remains unclear.

PURPOSE

The purpose of this in vitro study was to measure the impact of the supramucosal height of the scan body and implant angulation on the accuracy (trueness and precision) of intraoral digital implant scans in partially edentulous models.

MATERIAL AND METHODS

Two maxillary partially edentulous casts with 4 implant analogs were fabricated, 1 with 4 parallel implants (P-groups) and 1 with 2 implants distally inclined 18 degrees (A-groups). An implant scan body was positioned on each implant analog (CARES RC Mono Scanbody). For each cast, 3 subgroups were determined based on the soft tissue moulage fabricated for each reference cast exposing 3 mm (P-3 and A-3 subgroups), 5 mm (P-5 and A-5 subgroups), and 7 mm (P-7 and A-7 subgroups) of the implant scan bodies. The 2 reference casts were registered by using a coordinate measurement machine and desktop scanner (7 Series Dental Wings) and then scanned using an IOS (TRIOS 4) (n=15). Linear and angular discrepancy values and root mean square (RMS) error values between the implant scan bodies measured on the reference and experimental scans were computed with an inspection software program (Geomagic). Mann-Whitney U tests with Bonferroni correction were applied for planned comparisons (α=.05/9 ≈ .006).

RESULTS

For linear discrepancies, statistically significant differences were found between groups P-3 and A-3 (P=.004) and between P-7 and A-7 (P=.005). For angular discrepancies, statistically significant differences were found between groups A-3 and A-5 (P=.002) and between P-7 and A-7 (P=.003). The RMS error analysis found no statistically significant differences among the groups.

CONCLUSIONS

Implant angulation of 18 degrees did not significantly affect the accuracy of the intraoral scans in terms of 6 of the 9 planned comparisons, although the angled groups had lower mean values. Also, the supramucosal height of the scan body did not significantly affect the accuracy of the intraoral scans in terms of 17 of the 18 planned comparisons. Results may vary with different implant scan body designs.

A comparison of the caries risk between patients who use vapes or electronic cigarettes and those who do not: A cross-sectional study

BACKGROUND

Evidence on the potential oral health effects of vaping is scarce and there are limited data on possible links to both caries and periodontal disease. The authors assessed the association between electronic cigarette (e-cigarette) or vape use and caries risk level. The Caries Management by Risk Assessment tool was used.

METHODS

A cross-sectional study of patient records was conducted; 13,098 patients who attended the dental school clinics from January 1, 2019, through January 1, 2022, were included in the study. Mann-Whitney U test and multivariable ordinal logistic regression were used to assess the relationship between use of e-cigarettes or vapes and caries risk level.

RESULTS

Data from 13,216 patients were included in the data set initially; 13,080 responded "no" when asked whether they used e-cigarettes or vapes (99.3%), and 136 responded "yes" (0.69%). There was a statistically significant difference (P < .001) in caries risk levels between the e-cigarette or vape group and the control group; 14.5%, 25.9%, and 59.6% of the control group were in the low, moderate, and high caries risk categories, respectively, and 6.6%, 14.3%, and 79.1% of the e-cigarette or vape group were in the low, moderate, and high caries risk categories, respectively.

CONCLUSIONS

In this study population, there was an association between use of e-cigarettes or vapes and caries risk level of patients; vaping patients had a higher risk of developing caries.

PRACTICAL IMPLICATIONS

Within the study limitations, it was recommended that use of e-cigarettes or vapes should not only be included in the routine dental-medical history questionnaire, but also among the risk factors that increase a patient's caries risk level.

Evaluation of mindfulness practice in mitigating impostor feelings in dental students

OBJECTIVES

This study examined (i) the prevalence of impostor feelings in first-year dental students, (ii) student perceptions of a mindfulness practice as a tool to cope with impostor feelings, and (iii) students' ability to identify their level of impostor feelings.

METHODS

Two hundred three D1 students at a single institution participated in a mandatory Mind-Body Wellness Course that included the presentation "Understanding Imposter Phenomenon" (lecture #1) and a second presentation "Impostor Phenomenon and Mindfulness: Tools for Success" (lecture #2) 6 months later. Before lecture #2, all students predicted the level to which they suffer from imposter feelings and then took the Clance Impostor Phenomenon Scale (CIPS) to determine the actual level. After lecture #2, 155 of the students completed a survey on whether the mindfulness practices in the lecture impact their perceptions on coping with impostor feelings.

RESULTS

Fifty-two percent of students were classified as frequent or intense impostors by the CIPS. Fifty-one percent predicted their CIPS classification correctly; 43% underestimated their impostor classification. After lecture #2, 86% reported feeling confident they could recognize their impostor feelings, and 93% reported feeling more aware of how impostor feelings influence their thoughts, behaviors, and actions. Eighty-six percent reported feeling the mindfulness exercise was a helpful tool to build habits to cope with impostor feelings; 83% reported feeling confident they could utilize mindfulness practices to mitigate these feelings when they arise.

CONCLUSIONS

Frequent or intense impostor feelings may be common in first-year dental students. Mindfulness practice has potential to mitigate such impostor feelings.

Shear Bond Strength of Different Restorative Materials to Primary Tooth Dentin Treated with Silver Diamine Fluoride

Purpose: To investigate shear bond strength (SBS) of three restorative materials on primary dentin after silver diamine fluoride (SDF) application.<br/>Methods: Thirty primary teeth were randomized into three groups of 10 teeth. Each tooth was split mesiodistally and randomized into experimental (artificial caries plus SDF) and control (sound dentine without SDF) groups. Glass ionomer cement (GIC), resin-modified bioactive resin (ACTIVA), and composite resin (CR) restorations were tested for SBS and mode of failure (MF).<br/> Results: All SDF groups exhibited significantly lower SBS compared to the control (CR: P =0.001; ACTIVA: P =0.001; GIC: P =0.004). For the SDF group, the compa- rison of materials was statistically significant (P =0.006); posthoc tests showed significance only between CR and ACTIVA (P =0.009) and between ACTIVA and GIC (P =0.020). The lowest mean value was obtained for ACTIVA (1.4 MPa) and the highest mean value was obtained for CR (3.3 MPa). For the control group, Welch's F test was statistically significant (P =0.044), but all posthoc tests were not. For MF, SDF exhibited a significantly greater percentage of adhesive failures with ACTIVA and CR than with GIC. In the control group, a mixed MF was more dominant with no significant differences.<br/>Conclusion : The SDF group had significantly lower SBS.

Digital VS Conventional Full-Arch Implant Impressions: A Retrospective Analysis of 36 Edentulous Jaws

PURPOSE

There is a paucity of comparative clinical studies assessing the accuracy of full-arch digital versus conventional implant impressions. The aim of this retrospective study was to compare the three-dimensional (3D) deviations between full-arch digital and conventional implant impressions for edentulous maxillae and mandibles.

MATERIALS AND METHODS

Twenty-seven patients (36 edentulous jaws) were treated with one-piece, screw-retained implant-supported fixed complete dental prostheses (IFCDPs). Twenty-one jaws were maxillary, and 15 were mandibular. Full-arch conventional impressions and intraoral digital scans with scan bodies and an intraoral scanner had been taken during the impression phase. Following verification of the conventional stone casts, the casts were digitized. The generated standard tessellation language (STL) files from both impression techniques were merged and analyzed with reverse engineering software. The primary aim was to evaluate the accuracy between conventional and digital full-arch scans, while the effect of the edentulous jaw in 3D accuracy was the secondary aim.

RESULTS

The cumulative 3D (mean ±SD) deviations between virtual casts from intraoral full-arch digital scans and digitized stone casts generated from conventional implant impressions were found to be 88 ±24 μm. In the maxillary group, the mean ±SD 3D deviation was 85 ±25 μm, compared to 92 ±23 μm for the mandibular group (P = .444).

CONCLUSION

The 3D implant deviations found between the full-arch digital and conventional impressions lie within the clinically acceptable threshold. No statistically significant difference was identified between maxillary and mandibular jaws in terms of 3D deviations. This article is protected by copyright. All rights reserved.

An esthetic evaluation of different abutment materials in the anterior Maxilla: A randomized controlled clinical trial using a crossover design

PURPOSE

To assess the effect of implant abutment material and soft tissue thickness on the peri-implant soft tissue color using spectrophotometry and to evaluate gingival esthetics and patient satisfaction with three different abutments.

MATERIALS AND METHODS

Twenty-five patients with a missing maxillary tooth in the esthetic area received an endosseous implant using a two-stage protocol. Grey titanium, pink anodized titanium, and hybrid zirconia custom abutments were fabricated for each participant and inserted for one week with a cross-over design in a randomized manner. Color measurements were made using a spectrophotometer comparing midfacial peri-implant soft tissue and marginal gingiva of the contralateral tooth. CIE Lab color scale was employed following the formula: ΔE = [(∆L)² +(∆a)² +(∆b)² ] ^½ . PES scores were recorded, and patient satisfaction questionnaires were completed at each abutment change visit and at 1-year follow-up. Statistical analysis was performed using Friedman's test and the Wilcoxon signed-rank test with Bonferroni correction as well as the Mann-Whitney U test (α = 0.05).

RESULTS

Abutment material type significantly affected the ΔΕ values of the peri-implant mucosa when compared to the contralateral teeth. At baseline, the highest ΔΕ means ± standard deviation (SD) values were obtained with grey titanium (11.25 ±2.98), followed by pink anodized titanium (9.90 ±2.51), and zirconia abutments (6.46 ±1.43). Differences were statistically significant irrespective of soft tissue thickness. The highest PES values were obtained with zirconia abutments (10.88 ±0.88), followed by pink anodized titanium (10.12 ±1.13) and the lowest with grey titanium (9.68 ±1.41). PES differences were significant only for the thin soft tissue group. Regarding patient satisfaction, VAS scores for the pink anodized and zirconia hybrid abutment groups were higher than the grey titanium group for each question.

CONCLUSION

The color difference between soft tissues around teeth and implants was significant in all groups regardless of tissue thickness. The hybrid zirconia abutments resulted in the least color difference, followed by pink anodized and grey titanium. Significantly different PES values were recorded only for the thin tissue group. There was no significant difference in patient satisfaction between zirconia and pink anodized abutments at the 1-year follow up. Pink anodized abutments represent a good esthetic alternative to zirconia hybrid abutments especially in mechanically challenging situations. This article is protected by copyright. All rights reserved.

Accuracy of Different Surgical Guide Designs for Static Computer-Assisted Implant Surgery: An in vitro Study

The aims of this study were to evaluate the effect of (i) the different surgical guide designs and (ii) implant placement location on the accuracy of fully guided implant placement in single edentulous sites using an in vitro study model. Forty-five partially edentulous models were scanned and divided into three groups: group 1, tooth-supported full-arch surgical guide; group 2, three different tooth-supported shortened surgical guides (SSGs); and group 3, tooth-supported full-arch surgical guide with a crossbar. All surgical guides were printed and used for fully guided implant placement. A total of 180 implants (60 per group) were placed, and scanbodies were positioned on all models, and postoperative surface scan files (STL) files were obtained. Superimposition of preoperative and postoperative STL files was performed, and the accuracy of implant position was evaluated. The interaction between group and implant location was statistically significant for angle, 3D offset at the base, and at the tip (p<0.001). The post-hoc tests showed a statistically significantly higher deviation for group 2 compared to group 3 for all outcomes for implants #4 (p<0.05) and #7 (p<0.05). There was also a statistically significant difference in all outcomes between groups 1 and 3 for implant #7 (p<0.05). All surgical guide designs presented satisfactory performance with clinically acceptable levels of deviation. However, SSGs presented higher accuracy for guided implant placement in a single-edentulous site, whereas a full-arch surgical guide with a crossbar presented superior outcomes when two or more guided implants were placed simultaneously.

Efficacy of an Er:YAG laser in the decontamination of dental implant surfaces: An in vitro study

BACKGROUND

Emergence of peri-implant diseases led to the development of various methods for implant surface decontamination. This study was designed to compare the efficacy of biofilm removal from implant-like titanium surfaces by an erbium-doped yttrium-aluminum-garnet (Er:YAG) laser, titanium brush, and carbon fiber curet.

METHODS

Eight study subjects were recruited. A custom mouth appliance that held eight sandblasted and acid-etched titanium discs was fabricated for each subject. Subjects were asked to wear this appliance for 72 hours to allow for biofilm development. After retrieval, discs were removed and randomized to one of four treatment groups. The discs were stained with a two-component nucleic acid dye kit, and the residual biofilm was visualized under fluorescence microscopy. Quantification of residual biofilm was performed using an image analysis software and expressed as the percentage surface area.

RESULTS

Fifty-nine titanium discs were randomized to the four treatment groups. The percentage of titanium disc area covered by residual biofilm was 74.0% ± 21.6%, 32.8% ± 24.0%, 11.8% ± 10.3%, and 20.1% ± 19.2% in the control, Er:YAG, titanium brush and carbon fiber curet groups, respectively (mean ± SD). The biofilm-covered area significantly decreased in each of the three treatment groups compared with control (P < 0.008). Comparisons between treatment groups did not reveal statistical significance.

CONCLUSIONS

Er:YAG laser treatment is an effective method for reducing the bacterial biofilm on titanium discs. However, on a threadless titanium surface, Er:YAG laser does not exhibit a significantly greater efficacy in biofilm removal than commonly used titanium brushes or carbon fiber curets.

A comparative retrospective study of different surgical guide designs for static computer-assisted implant surgery in posterior single edentulous sites

AIM

The aim of this retrospective clinical study was to compare the accuracy of static Computer-assisted implant surgery (sCAIS) in posterior single edentulous patients using different surgical guide designs.

MATERIALS AND METHODS

Thirty-seven partially edentulous patients with a total of 54 implants were included in the study. Seventeen implants were included in Group 1-Unbounded Tooth-Mucosa Supported; 18 implants in Group 2-Unbounded Tooth Supported; and 19 implants in Group 3 (Control)-Bounded Tooth Supported. All partially edentulous patients were treated with fully guided implant surgery using the corresponding surgical guide. Discrepancies between the pre-planned and post-operative implant position were evaluated.

RESULTS

The mean angular deviation ± standard deviation (SD) was 2.91 ± 1.56°, 3.33 ± 1.72° and 2.25 ± 1.13° for Groups 1, 2, and 3, respectively. The mean ± SD 3D offset at base was 0.66 ± 0.29 mm, 0.77 ± 0.24 mm, and 0.49 ± 0.22 mm; and 3D offset at tip was 0.84 ± 0.45 mm, 1.07 ± 0.38 mm, and 0.75 ± 0.25 mm for Groups 1, 2, and 3, respectively. No statistically significant differences between groups were found for angular deviation. There were statistically significant differences between Groups 2 and 3 for 3D offset at base (p = .002) and 3D offset at tip (p = .010).

CONCLUSIONS

Different surgical guide designs for posterior single edentulous areas appear to be associated with the accuracy level of sCAIS. In unbounded sites, having additional posterior attached soft tissue support is preferable.

Factors affecting dental students' postgraduate plans: A multi-site study

PURPOSE

This multi-site study examined dental students' postgraduate plans and factors affecting them, perceptions of pathways with the best future, and whether those postgraduate plans changed during dental school.

METHODS

An online survey was made available to all four dental classes (2018, 2019, 2020, and 2021) and advanced standing/international dental students at eight US dental schools. The survey questionnaire consisted of two parts: (1) 14 questions pertaining to demographic information and (2) 11 questions pertaining to career path choices and possible influencing factors.

RESULTS

Overall response rate was approximately 38.4% (1459/3800). For those responding 34.0% planned to enroll in a general dentistry residency, followed by associate dentist in a private practice (31.4%), and specialty residency (17.6%). Quality of life, to increase knowledge/clinical skills, and intellectual satisfaction were most often rated extremely important factors; Influence of family members in dentistry and prestigious specialty received the most responses of not important. General dentistry was perceived to have the best future in terms of overall impact on the profession, potential for positive impact on patient's quality of life, and personal quality of life; oral and maxillofacial surgery was believed to have the best future in terms of salary. Students changed their postgraduate plan during dental school 43.0% of the time, with race (p = 0.006) and year of progress toward degree (p < 0.001) being significant associations.

CONCLUSIONS

General dentistry remains the most popular pathway. Many dental students change their plans during dental school; a better understanding of these trends and contributing factors may aid development of practice readiness curricula.

Biaxial flexural strength of various CAD-CAM glass-ceramic materials

PURPOSE

To evaluate and compare the flexural strength of three CAD-CAM glass-ceramic materials and to investigate the effect of various surface treatments on their flexural strength.

METHODS

120 rectangular specimens were fabricated from three different types of CAD-CAM ceramic blocks and were divided into three groups: zirconia-reinforced lithium silicate (Celtra Duo, Group 1), leucite-reinforced glass-ceramic (IPS Empress CAD, Group 2), and lithium disilicate ceramic (IPS e.max CAD, Group 3). Dimensions of the specimens were standardized to 14.5x12.5 mm and 1.5 mm thickness. Specimens in each group were randomized into four subgroups. The first subgroup (NS) did not undergo any surface treatment; the second subgroup (P) underwent polishing only; the third subgroup (G) underwent glazing only; and the fourth subgroup (PG) underwent both polishing and glazing surface treatments. Biaxial flexural strength (FS) testing was performed until fracture occurred; FS was calculated in MPa. All analyses were performed using SPSS version 24.

RESULTS

Group NS2 showed the lowest FS (89.34 ± 25.30 MPa). Group PG3 showed a significantly higher FS (365.38 ± 52.52 MPa) than Group P3 (268.15 ± 48.34). There was a statistically significant difference among the material groups for each surface treatment: IPS e.max CAD showed the highest FS, which was significantly greater than that of both Celtra Duo and IPS Empress CAD. The combination of polishing and glazing surface treatment resulted in significantly higher flexural strength than polishing alone for all three materials tested. For each material, no significant difference was found between the following surface treatments: control and polishing-only surface treatments; glazing-alone and the combination of polishing and glazing surface treatments. For each surface treatment, Celtra Duo showed significantly lower flexural strength than IPS e.max CAD. However, it displayed higher flexural strength than IPS Empress CAD, although the difference was only significant for glazing and the combination of polishing and glazing.

CLINICAL SIGNIFICANCE

This study provides the clinician with an estimate of the flexural strength of glass-ceramic materials and shows how various surface treatments affect their strength.

Influence of zirconia crown artifacts on cone beam computed tomography scans and image superimposition of tomographic image and tooth surface scan: An in vitro study

STATEMENT OF PROBLEM

Zirconia restorations create significant artifacts on 3D cone beam computed tomography (CBCT) imaging. Static computer-assisted implant surgery (s-CAIS) relies on the accuracy of superimposition between an intraoral surface scan and CBCT imaging. However, how the artifacts from zirconia on the tomographic image might affect the predictability of s-CAIS is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of zirconia crown restorations on the superimposition process for s-CAIS.

MATERIAL AND METHODS

Four stone casts generated 4 groups: a control group (CG) with no crowns and 3 experimental groups with 4 (TG4), 7 (TG7), and 13 (TG13) zirconia crowns. A total of 40 CBCT scans were made for the 4 groups (n=10). All CBCTs were imported into a computer planning software program, and the casts from all 4 groups were scanned by using a high-resolution laboratory scanner. The standard tessellation language (STL) files were imported, segmented, and the 3 files superimposed for all groups. The accuracy of the superimposition was assessed, in millimeters, in 3 planes corresponding to anterior-posterior, horizontal, and vertical, as well as the overall measurement, and the results were analyzed statistically (α=.05).

RESULTS

The overall analysis demonstrated statistically significant differences between all groups (P<.001), except between CG and TG4. The anterior-posterior dimension demonstrated significant differences between CG and TG7 (P<.001), CG and TG13 (P<.001), TG4 and TG7 (P=.004), and TG4 and TG13 (P=.001). For the vertical dimension analysis, significant differences were found between CG and TG7 (P=.001), CG and TG13 (P<.001), and TG4 and TG13 (P<.001). For the horizontal variable, statistically significant differences were found between CG and TG7 (P=.049), CG and TG13 (P<.001), TG4 and TG13 (P<.001), and TG7 and TG13 (P=.003).

CONCLUSIONS

The accuracy of the superimposition of the images was influenced by the number of zirconia crowns, with an increased number reducing the superimposition accuracy.

Accuracy of 3D Printed Implant Casts Versus Stone Casts: A Comparative Study in the Anterior Maxilla

PURPOSE

To conduct an in vitro comparison of the amount of three-dimensional (3D) deviation of 3D printed casts generated from digital implant impressions with an intraoral scanner (IOS) to stone casts made of conventional impressions.

MATERIAL AND METHODS

A maxillary master cast with partially edentulous anterior area was fabricated with two internal connection implants (Regular CrossFit, Straumann). Stone casts (n = 10) that served as a control were fabricated with the splinted open-tray impression technique. Twenty digital impressions were made using a white light IOS (TRIOS, 3shape) and the Standard Tesselation Language (STL) files obtained were saved. Based on the STL files, a digital light processing (DLP) and a stereolithographic (SLA) 3D printer (Varseo S and Form 2) were used to print casts (n = 10 from each 3D printer). The master cast and all casts generated from each group were digitized using the same IOS. The STL files obtained were superimposed on the master cast STL file (reference) to evaluate the amount of 3D deviation with inspection software using the root mean square value (RMS). The independent-samples Kruskal-Wallis test and Dunn's test with Bonferroni correction (for post hoc comparisons) were used for statistical analyses.

RESULTS

The Varseo S group had the lowest median RMS value [77.5 µm (IQR = 91.4-135.4)], followed closely by the Conventional group [77.7 µm (IQR = 61.5-93.4)]. The Form 2 had the highest mean value [98.8 µm (IQR = 57.6-87.9)]. The independent-samples Kruskal-Wallis test revealed a significant difference between the groups (p = 0.018). Post hoc testing revealed a significant difference between Varseo S and Form 2 (p = 0.009).

CONCLUSION

The casts generated from the Varseo S 3D printer had better 3D accuracy than did those from the Form 2 3D printer. Both the Varseo S group and the conventional stone casts groups had similar 3D accuracy.

Oral health conditions and correlates: a National Oral Health Survey of Rwanda

Background: Dental diseases are chronic, lifelong and preventable yet affect over half the world's population. Personal oral hygiene practices and socio-economic factors contribute to oral health outcomes affecting oral health quality of life. Integrating basic oral care within community level health systems increases accessibility and availability of oral health resources.Objective: National Oral Health Survey of Rwanda (NOHSR) data were investigated for associations of socio-demographic characteristics, personal oral hygiene practices, oral health outcomes, and oral health quality of life indicators.Methods: Data were analyzed and descriptive statistics calculated. Multivariable logistic regression models were developed to assess associations between untreated caries, calculus, and pain with various independent variables (demographics and personal oral hygiene practices). Additional logistic regression models examined associations between quality of life indicators and the aforementioned independent variables as well as untreated caries and pain.Results: Those who did not use a toothbrush (62.7%), or toothpaste (70.0%), and cleaned their teeth less than once per day (55.3%) had a higher prevalence of untreated caries. Approximately one-third of those in rural areas cleaned their teeth once per day or more compared to two-thirds of those in urban areas (35.4% vs. 71.2%). Those cleaning their teeth less than once daily were estimated to have 56.0% higher odds of caries than those who cleaned their teeth once a day or more (OR = 1.56, [95% CI 1.25-1.95]). Those with secondary education or higher and those with skilled jobs demonstrated more frequent teeth cleaning and higher toothbrush and toothpaste use. Quality-of-life indicators varied significantly with untreated caries and pain.Conclusion: Socio-economic, individual, and workforce characteristics are important considerations when assessing oral health outcomes. This study investigated social demographic disparities in relation to oral health related behaviors and outcomes. This information can help guide oral health care programming in Rwanda.

Comparative analysis of dimensional alterations following extraction of maxillary molars using three-dimensional images' superimposition: a CBCT study

The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12 months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76 mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23 mm²) and 65.10% (8.33 ± 4.51 mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.

Volumetric Changes Following Lateral Guided Bone Regeneration

Resorbable membranes are well described and employed for horizontal guided bone regeneration (GBR). However, the currently available literature does not provide information on the bone volumetric changes during the healing that follows GBR procedures and dental implant placement. Therefore, the aim of this pilot study was to initially analyze the volumetric bone changes after treating pristine edentulous mandibular defects with lateral GBR using freeze-dried bone allograft (FDBA) and collagen resorbable membrane. Six patients were selected for the analysis. Clinical changes in bone volume before and after GBR were measured. In addition, digital volumetric analysis of the augmented ridges was performed preoperatively, as well as 4 and 6 months after the GBR procedure. At the time of dental implant placement, bone cores were collected during the osteotomy for histologic analysis. Data on volume changes showed a mean of 297.5 ± 134 mm³ augmented bone volume at 4 months with 5% ± 3.78% resorption from 4 to ≥ 6 months. Histologic bone core analysis showed 44.9% plusmn; 5.1% mineralization in the area of augmentation. Within the limitations of this pilot study, resorbable membranes exhibited reliability for GBR in intercalated mandibular defects, providing sufficient bone volume gain at ≥ 6 months for implant stabilization and limited resorption during graft healing.

Relationships Between Opioid Dosing, Pain Severity, and Disability in a Community-Based Chronic Pain Population: An Exploratory Retrospective Analysis

OBJECTIVE

To determine the relationship between opioid dose change, pain severity, and function in patients with chronic pain.

DESIGN

Retrospective cohort study.

SETTING

Community interdisciplinary pain management practice.

SUBJECTS

A total of 778 patients with chronic pain prescribed opioids for three or more consecutive months between April 1, 2013, and March 1, 2015.

METHODS

Changes in opioid dose, pain severity rating, modified Roland Morris Disability Questionnaire score, and opioid risk data were extracted from medical records and analyzed for associations.

RESULTS

Two hundred forty-three subjects (31.2%) had an overall dose decrease, 223 (28.7%) had a dose increase, and 312 (40.1%) had no significant change in dose (<20% change). There was a weak negative correlation between change in opioid dose and change in pain severity (r = -0.08, P = 0.04) but no association between change in disability scores and dose change (N = 526, P = 0.13). There was a weak positive correlation between change in pain severity rating and change in disability scores (r = 0.16, P < 0.001).

CONCLUSIONS

The results suggest that escalating opioid doses may not necessarily result in clinically significant improvement of pain or disability. Similarly, significant opioid dose reductions may not necessarily result in worsened pain or disability. This exploratory investigation raised questions of possible subgroups of patients who might demonstrate improvement of pain and disability with opioid dose adjustments, and further research should prospectively explore this potential, given the limitations inherent in retrospective analyses. Prescribers should still consider reduction of opioid doses as recommended by current guidelines, in an effort to mitigate the potential risks associated with high-dose treatment.

Direct-acting oral anti-coagulants in dental practice: A Retrospective Observational Study (Part 1)

OBJECTIVES

The objective of this retrospective observational study was to determine the incidence of direct-acting oral anti-coagulant (DOA) use in patients receiving invasive dental procedures. The secondary objective was to investigate the precautionary measures implemented and the post/intraoperative complications associated with DOA use.

METHODS

Electronic record database, Axium, was retrospectively reviewed, and patients using NGOA and treated between 2010 and 2017 were identified. Charts of patients who underwent invasive dental procedures were further reviewed to investigate the preoperative/intraoperative precautionary measures taken and identify any intraoperative/postoperative complications.

RESULTS

A total of 130 patients were identified, with their annual number steadily rising from 12 in 2011 to 52 in 2016. Among those, 64 patients (49.23%) underwent invasive dental procedures. Pretreatment medical consults were obtained in all patients undergoing invasive procedures; however, only 7 (10.94%) were instructed to discontinue their DOA. Preoperative laboratory testing was obtained for two patients. Intraoperatively, 34 (53.13%) cases of excessive bleeding were reported, all were locally controlled with hemostatic agents. Only 4 instances of postoperative complications were documented.

CONCLUSIONS

Despite the rise in the use of DOA, there is no consistent pattern for preoperative laboratory testing and DOA discontinuations. Expert consensus may be of great importance to develop practice guidelines.

Digital workflow: In vitro accuracy of 3D printed casts generated from complete-arch digital implant scans

STATEMENT OF PROBLEM

Data on the accuracy of printed casts from complete-arch digital implant scans are lacking.

PURPOSE

The purpose of this in vitro study was to compare the 3D accuracy of printed casts from a complete-arch digital implant intraoral scan with stone casts from conventional impressions.

MATERIAL AND METHODS

An edentulous mandibular cast with 4 multiunit abutments with adequate anteroposterior spread was used as the master cast. Digital scans (n=25) were made by using a white light intraoral scanner (IOS). The generated standard tessellation language (STL) data sets were imported into a computer-assisted design (CAD) software program to generate complete-arch implant casts through 3D printing technology. The 25 printed casts and the mandibular master cast were further digitized by using a laboratory reference scanner (Activity 880; Smart Optics). These STL data sets were superimposed on the digitized master cast in a metrology software program (Geomagic Control X) for virtual analysis. The root mean square (RMS) error and the average offset were measured.

RESULTS

When compared with the master cast, the printed casts had a mean ±standard deviation RMS error of 59 ±16 μm (95% CI: 53, 66). The maximum RMS error reached 98 μm. The average offsets were all negative, with a significant difference compared with zero (P<.001).

CONCLUSIONS

The implant 3D deviations of the printed casts from complete-arch digital scans had statistically significant differences compared with those of the master cast but may still be within the acceptable range for clinical application.

Effect of acidic pH on surface roughness of esthetic dental materials

STATEMENT OF PROBLEM

Exposure to gastric acid in patients with bulimia nervosa and gastroesophageal reflux disease (GERD) causes demineralization of hard tooth structures. This chemical attack also causes the degradation of dental ceramics, which results in increased surface roughness and reduced strength. However, studies comparing the effect of acidic pH on resin matrix ceramic with other computer-aided design and computer-aided manufacturing (CAD-CAM) esthetic materials are lacking.

PURPOSE

The purpose of this in vitro study was to compare the surface roughness changes of different CAD-CAM restorative dental materials after exposure to acidic pH by using a 3D optical interferometer.

MATERIAL AND METHODS

Five esthetic CAD-CAM block materials, a leucite glass-ceramic (IPS Empress CAD), a zirconia (BruxZir Solid Zirconia), a resin matrix ceramic (VITA Enamic), a lithium disilicate glass-ceramic (IPS e.max CAD), and a feldspathic porcelain (VITABLOCS Mark II CAD) were tested. Eighteen specimens were sectioned from CAD-CAM blocks into 2-mm-thick rectangular plates and immersed in 10 mL of 5% hydrochloric acid (HCl) with (pH=2) at 37 °C for 45 and 91 hours. The surface roughness average (Ra) of the specimens was measured by using a 3D optical interferometer before the storage period (baseline), after 45 hours, and after 91 hours of exposure to HCl. Statistical analyses were performed with the Kruskal-Wallis test and the post hoc Dunn test with Bonferroni correction (α=.05).

RESULTS

Regarding the comparison of surface roughness changes at different periods of evaluation (baseline, 45 hours, 91 hours), there were no statistically significant differences for lithium disilicate (P=.063) or zirconia (P=.513). Leucite glass-ceramic, feldspathic porcelain, and the resin matrix ceramic demonstrated statistically significant differences (P<.001). For all tests that were statistically significant, greater surface roughness was found at the time point with the longer HCl exposure. Regarding the comparison of materials in terms of change in surface roughness between baseline to 45 hours and baseline to 91 hours, the Kruskal-Wallis test indicated a statistically significant difference among the materials in both cases (P<.001). Lithium disilicate and zirconia exhibited the least change in surface roughness among the 5 materials.

CONCLUSIONS

Leucite glass-ceramic, feldspathic porcelain, and resin matrix ceramic showed statistically significant increases in surface roughness when they were exposed to simulated gastric acid for 45 and 91 hours. Lithium disilicate and zirconia showed no statistically significant change in surface roughness after exposure to HCl for 45 and 91 hours.

The Association Between Cannabis Use and Aberrant Behaviors During Chronic Opioid Therapy for Chronic Pain

Objective

Health care providers are likely to see an increase in the concomitant use of cannabis and opioids, particularly with the increased liberalization and ongoing research into the possible role of medical marijuana for chronic pain. Recent literature reports a prevalence of concurrent use ranging from 8.9% to 31.8%. The primary aim of this study was to determine the relationship between cannabis use and aberrant drug behaviors in noncancer pain patients receiving chronic opioid therapy.

Design

Retrospective chart review.

Setting

Community-based, interdisciplinary pain management center.

Subjects

Data from 209 patients who were evaluated for a medication management program between October 1, 2011, and January 1, 2014, and met inclusion criteria. Forty-four were positive for cannabis in their initial random urine drug toxicology.

Methods

Data from electronic health records, including demographics, urine drug toxicology, disability, opioid dose, opioid risk assessment data, and pain severity were analyzed to examine differences among cannabis users and noncannabis users.

Results

Subjects with cannabis in their initial urine drug toxicology were more likely to have a future occurrence of an opioid-related aberrancy (P < 0.001), be male (P = 0.047), have a history of substance abuse (P = 0.013), and be enrolled into a higher level of clinical monitoring of opioid medication use (P = 0.008). No other associations with demographic and clinical variables reached statistical significance.

Conclusions

Concurrent use of cannabis and opioids by patients with chronic pain appears to indicate higher risk for opioid misuse. Closer monitoring for opioid-related aberrancy is indicated for this group of patients.

Bottle-Weaning Recommendations Among Pediatricians and Pediatric Dentists

Purpose: The purpose of this study was to determine how pediatricians (MDs) and pediatric dentists (PDs) interpret professional associations' guidelines for weaning of bottle-fed infants and assess ensuing provider recommendations. Methods: A survey was sent to 11,479 MDs and PDs. Results: 721 MDs and 1,005 PDs responded, yielding an overall response of 1,726 (15 percent). MDs (88 percent) and PDs (87 percent) responded that weaning is a transitional time period with both a start and a finish. Most MDs (76 percent) and PDs (62 percent) selected 12 and 15 months, respectively, for finishing weaning. Both MDs (91 percent) and PDs (89 percent) answered that complete bottle unavailability represented weaning cessation. MDs (71 percent) and PDs (84 percent) strongly agreed on importance for a pediatrician's weaning recommendations, with MDs more frequently giving recommendations (two to three visits) than PDs (one to two visits). Conclusions: Guidelines relating to bottle-fed infants are not uniformly understood by MDs and PDs. Bottle-weaning recommendations of MDs and PDs vary. There are well-documented risks of prolonged bottle use. Thus, development of clear, preventive guidelines that address the timely and complete removal of a bottle are warranted.

The World Health Organization Disability Assessment Schedule-2.0 (WHODAS 2.0) in a chronic pain population being considered for chronic opioid therapy

Purpose

To examine the validity of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of function in a community-based sample of patients with chronic pain conditions undergoing evaluation for chronic opioid therapy.

Patients and methods

One hundred nine of 124 patients were evaluated for a chronic opioid therapy program between December 1, 2014 and April 10, 2015, inclusive, at one community-based interdisciplinary pain management practice. Measures included: demographic data; the WHODAS 2.0; a modified version of the Roland Morris Disability Questionnaire (RMDQ-m); the Patient Health Questionnaire-9 item (PHQ-9); the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R); the Current Opioid Misuse Measure (COMM), the Opioid Risk Tool (ORT); opioid dose. These data were collected as part of routine care, and this retrospective chart review study examined the data from this convenience sample, comparing the results of each assessment tool to the results of the WHODAS 2.0.

Results

Median score on the WHODAS 2.0 was 25.69 (IQR=16.01 to 35.28). WHODAS 2.0 score was significantly correlated with the RMDQ-m (r_s=0.69, p<0.001), the PHQ-9 (r_s=0.68, p<0.001), the COMM (r_s=0.52, p<0.001) and the SOAPP-R (r_s=0.51, p<0.001). There was no significant correlation between the WHODAS 2.0 and the ORT (r_s=0.14, p=0.12) or opioid dose (r_s=0.07, p=0.47).

Conclusions

The WHODAS 2.0 was significantly positively correlated with other measures, including measures of disability, risk of opioid misuse, and depression among patients being evaluated for chronic opioid therapy. The WHODAS 2.0 may be a useful measure of disability across a number of important domains when discussing expectations of both patients and providers at initiation of opioid therapy for chronic pain management. This assessment and discussion is crucial, particularly given the focus on function, rather than analgesia alone, when evaluating the effectiveness of opioid treatment.

Prescription of potentially inappropriate medications in geriatric patients: data from a single dental institution

OBJECTIVES

The Beers criteria and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) are consensus-driven lists of potentially inappropriate medications (PIMs) in geriatric patients. The primary objective was to determine the frequency of PIMs prescribed to geriatric patients at Tufts University School of Dental Medicine. The secondary aim was to determine the American Society of Anesthesiologists (ASA) status of these patients and suggest that Beers/STOPP guidelines should be implied with consideration to the patient's ASA status.

STUDY DESIGN

Beers/STOPP criteria were studied and PIMs thus identified. A retrospective electronic chart review of patients at TUSDM aged 65 and older was performed for calendar years 2013, 2014, and 2015. Search queries were generated for ASA status, along with PIMs prescribed.

RESULTS

Out of 15,569 geriatric patients, more than half of patients between 65-74 years were classified as ASA I. Over a 3-year period, 895 (5.75%) and 840 (5.4%) received new prescriptions for opioids or nonsteroidal anti-inflammatory drugs, respectively. New prescriptions for muscle relaxants, benzodiazepines, and tricyclic antidepressants were given to 65 (0.42%), 44 (0.28%), and 38 (0.24%) patients, respectively.

CONCLUSIONS

PIMs are prescribed at low percentages to geriatric patients. However, prescription of opioids, benzodiazepines, and nonsteroidal anti-inflammatory drugs across undergraduate and postgraduate clinics is not uncommon. The majority of Tufts University School of Dental Medicine geriatric patients fall within the category of ASA I-II. ASA classification must be taken into consideration when PIMs are prescribed to geriatric patients rather than relying solely on chronologic age.

Salivary alkaline phosphatase activity and chronological age as indicators for skeletal maturity

OBJECTIVES

To investigate the relationship between salivary alkaline phosphatase activity (ALP), protein concentration, and chronological age with cervical vertebral maturation stages (CVMS) as noninvasive biomarkers for skeletal maturity assessment.

MATERIALS AND METHODS

This cross-sectional study included 79 subjects (48 females, 31 males; 7 to 23 years old) categorized into five CVMS based on lateral cephalographs evaluated by three examiners. ALP activity and protein concentration in unstimulated whole saliva were compared among five CVMS. The association between age and CVMS was assessed and five multinomial logistic regression models were utilized to predict CVMS based on salivary ALP activity, protein concentration, and chronological age.

RESULTS

Salivary ALP reached the peak at early pubertal stage and then declined with a significant difference between CVMS I and CVMS II (P < .001) and between CVMS I and CVMS V (P = .004). A significant positive correlation between age and CVMS was found (r_s = 0.763, P < .001). The models' overall correct classification rates for predicting CVMS were 32.9% using protein concentration, 35.4% using ALP activity, and 53.2% using both ALP activity and age.

CONCLUSIONS

The combination of salivary ALP activity and chronological age may provide the best CVMS prediction.

10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility

Objective

To evaluate clinical outcomes and health care utilization at 12 months post spinal cord stimulator (SCS) implantation compared with baseline and a matched sample of patients receiving conventional medical management (CMM) for the treatment of low back and lower extremity pain.

Patients

A retrospective study of patients with at least 24 months of active treatment at an interdisciplinary community pain center between December 1, 2014 and December 31, 2017. Thirty-two patients receiving implantation of a high-frequency (10 kHz) SCS and 64 patients receiving CMM were identified through propensity matching at a ratio of 2:1.

Methods

Data were extracted from medical records, including pain severity, prescribed opioid dose in morphine milligram equivalents, patient perception of disability, and volume of interventional pain procedures and total office visits to the pain center.

Results

Reductions in opioid dose were significantly greater for the SCS group than the CMM group. The 26.2 mg morphine equivalent dose reduction represents a 28% reduction from baseline, with 71.4% of those prescribed opioids in the SCS group reducing their dose at 12 months post-implant. Among those with SCS, there were significant within-group reductions in numerical pain score for low back and lower extremity pain, reducing by 46.2% and 50.9% from baseline, respectively. Change in functional pain score was not significant for either SCS group or CMM. Both groups had significant within-group reduction in disability. Reduction of interventional procedure volume was significant for both groups with a greater reduction observed in the SCS group. Office visit volume reduction was significant for the CMM group, but this was not a significant difference from the SCS group.

Conclusions

Results support the efficacy of 10 kHz SCS for analgesia, reduction of opioid utilization, reduction of interventional pain procedures, and patient perception of disability.

Building oral health research infrastructure: the first national oral health survey of Rwanda

Background: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions.

Objective: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies.

Methods: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument.

Results: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively.

Conclusion: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

Does Pre-Emptive Administration of Intravenous Ibuprofen (Caldolor) or Intravenous Acetaminophen (Ofirmev) Reduce Postoperative Pain and Subsequent Narcotic Consumption After Third Molar Surgery?

PURPOSE

Pre-emptive analgesia is known to reduce postoperative pain after third molar removal. The purpose of this study was to compare postoperative pain in patients receiving either preoperative intravenous (IV) ibuprofen or preoperative IV acetaminophen for third molar surgery.

PATIENTS AND METHODS

This study was a randomized, single-blinded clinical study conducted in patients undergoing surgical extraction of 2 or more impacted third molars under deep sedation. This study compared 2 interventions: 800 mg of IV ibuprofen (Caldolor; Cumberland Pharmaceuticals, Nashville, TN) and 1,000 mg of IV acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom). The primary outcome variable was postoperative pain measured on a visual analog scale at different time points. The secondary outcome variable was the amount of postoperative analgesic (narcotic and over-the-counter) medication taken in both groups. The Mann-Whitney U test was used to compare groups in terms of outcomes, the χ² test was used to assess associations between nominal variables, and Spearman correlations were used to assess associations between continuous variables. Significance was set at P < .05.

RESULTS

The study sample consisted of 58 patients (39 female and 19 male patients). A total of 41 patients (IV ibuprofen, n = 19; IV acetaminophen, n = 22) completed the study. Equal distributions of age, gender, and number of impacted teeth were noted between the groups. At 4 hours postoperatively, the pain level in the ibuprofen group was significantly lower than that in the acetaminophen group (P = .004). This trend continued at 24 hours (P = .019) and 48 hours (P = .017). The average amount of narcotic medication taken in the ibuprofen group (2.68 ± 2.26 doses) was lower than that in the acetaminophen group (7.32 ± 6.68 doses), and the result was statistically significant (P = .005).

CONCLUSIONS

Pre-emptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.

Effectiveness of an oral health education seminar for paediatric and family medicine residents

AIM

To assess the immediate effect of a 60-minute oral health educational seminar for paediatric and family medicine residents in improving their knowledge, attitude, likelihoodtowards incorporating oral health preventive practice in their current practices to well-child visits, and confidence in identifying and referring patients with dental trauma.

MATERIALS AND METHODS

Baseline pre- and post-test design was used to evaluate the immediate effect of a 60-minute PowerPoint oral health educational seminar given to the paediatric and family medicine residents.

STATISTICS

Multiple-choice items were used and the pre- and post-test data were analysed with McNemar and Wilcoxon signed-rank tests. A p-value <0.05 was considered statistically significant.

RESULTS

Sixty-eight residents participated in the oral health educational seminar and completed the questionnaire. The mean age of participants was 29.9 years old (SD ±4.8 yrs.). Immediately following a 60-minute oral health educational seminar, there was an overall significant increase in participants' knowledge, attitudes and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits (p<0.05). More confidence in identifying and referring patients with dental trauma was reported by 100% of participants.

CONCLUSIONS

A 60-minute oral health educational seminar was effective in improving paediatric and family medicine residents' immediate knowledge, attitude, and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits. Significantly more residents felt more confident in identifying and referring patients with dental trauma. Key messages: an oral health educational seminar can be effective in improving paediatric and family medicine residents' immediate knowledge, attitude, and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits.

Radiographic Effectiveness of Resin Infiltration in Arresting Incipient Proximal Enamel Lesions in Primary Molars

PURPOSE

The purpose of this split-mouth, randomized, prospective clinical trial was to evaluate radiographically the effectiveness of resin infiltration, as an adjunct to standard-of-care preventive measures compared to standard-of-care preventive measures alone, in arresting the progression of non-adjacent, incipient, proximal enamel lesions in primary molars 24 months after treatment.

METHODS

The study included a total of 45 healthy five- to eight-year-olds who had been diagnosed radiographically with at least two non-adjacent, incipient, proximal enamel lesions in primary molars (90 lesions). Test group lesions were treated using resin infiltration followed by five percent topical sodium fluoride (NaF) application versus five percent NaF alone in the control group. The alpha level was set at 0.05.

RESULTS

The children were examined after six, 12, 18, and 24 months. Twenty-five subjects were examined at the 24-month follow-up visit, At which time 10 of the 25 test lesions (40 percent) showed caries progression while 18 of the 25 control lesions (72 percent) showed caries progression (P=0.04).

CONCLUSION

Resin infiltration as an adjunct to standard-of-care preventive measures is significantly more effective radiographically in reducing the progression of non-adjacent, incipient, proximal enamel lesions in primary molars compared with standard-of-care preventive measures alone after 24 months.

Effect of instruction, light curing unit, and location in the mouth on the energy delivered to simulated restorations

PURPOSE

To determine the amount of energy (Joules/cm²) delivered by students to simulated restorations in a patient simulator based on the restoration location, the curing light unit used, and before vs. after instruction on how to improve their light curing technique.

METHODS

30 dental students "light cured" two simulated restorations (that were 1-mm deep anterior and 4-mm deep posterior) using three light-curing units (LCUs) : VALO, Bluephase G2, and Optilux 401. A MARC Patient Simulator was used to measure the irradiance (mW/cm²) received by the restorations in real-time to calculate the radiant exposure (J/cm²) delivered during a 20-second exposure. At first, students were asked to use the light curing technique that they had been previously taught. They were then given 5 minutes of additional verbal instructions and a practical demonstration on proper curing technique using the patient simulator. They then light cured the restorations again. Based on a literature review, 16 J/cm² was considered the minimum acceptable radiant exposure.

RESULTS

Before receiving instruction using the simulator, some students delivered as little as 4 J/cm² to the restoration. A mixed model test determined that the radiant exposure delivered to the anterior restoration was significantly greater than that delivered to the posterior restoration (Plt; 0.001). Additionally, when the locations were compared for each LCU individually, a paired t-test determined that before the students received the additional instruction, the anterior restoration received a significantly greater radiant exposure than the posterior restoration, for all three LCUs. Further paired t-tests and Wilcoxon signed-rank tests determined that after instruction, the radiant exposure improved significantly at both the anterior and posterior locations, for all three LCUs. The Bluephase G2 and the VALO each individually delivered 45% more radiant exposure than the Optilux 401 (P< 0.001 for both). The Bluephase G2 and VALO lights delivered similar mean radiant exposures (25.4 J/cm² and 25.7 J/cm², respectively). This difference was not significant. Depending on the light unit used, at the posterior location, there was a 24 to a 52% increase in the mean radiant exposure that was delivered after instruction compared to before instruction.

CLINICAL SIGNIFICANCE

Prior to using the patient simulator, students and their instructors thought that the students were delivering an adequate amount of energy when light curing. This was not always the case. The location of the restoration, the curing light output, its size and shape and how it is used all affected the amount of energy delivered to a restoration. Dental professionals and educators should be aware that appropriate training can improve the amount of energy delivered, and that restorations in posterior teeth will require longer exposure times than those in anterior teeth.