A study of operating positions in conservative dentistry.
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Dental Equipment↗
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Issues regarding practical validity and gender bias of the Perceptual Abilities Test (PAT).
A brief history of the Dental Admission Test is provided, with emphasis on the development and utilization of the Perceptual Abilities Test (PAT). Concerns regarding the predictive utility of the PAT are discussed, and alternative approaches to assessing perceptual and motor skills are examined. To assess the predictive validity of the PAT, scores were collected for 492 students who graduated from the University of Oklahoma College of Dentistry over a ten-year period. Scores were compared to Preclinical Operative Dentistry practical exam scores for each subject. Correlational analysis indicated the PAT maintains a statistically significant capacity for predicting technical performance in dental school, but the practical significance of the predictive capacity is limited. The results also indicate a gender bias favoring male applicants. Implications regarding continued reliance by admissions committees on the Perceptual Abilities Test are discussed and recommendations are provided, including modification of the PAT, use of the PAT only as a gross screening tool, and discontinuing the use of the PAT in making dental school admission decisions.
Aptitude Tests↗
[Bonded bridge: its place in current dentistry].
Prevention and Adhesion are the two pillars in which the present Dentistry rests. Great changes are observed in the daily professional practice, fundamentally visible in Operative Dentistry. It does seem, however, that these changes may happen in Prosthodontics, fixed or removable. Careful attention and suitable study are not given to adhesion in connection with Prosthodontics. The Adhesive Prosthetics, practised since 1970, has improved a lot during the 1980 decade. Cast structures to be bonded to enamel surface are being treated in different ways with abrasions or retentions of high relief. Microscopic retentions got through electrolytic bonding, oxidizations, metallizations or simply sand blastings are obtained these seem to affect not only nickel chrome alloys but also to noble alloys, similar to those of type IV. New and modern designs, in which the classical anchorages for inlays are combined with those used in this type of prosthetics, give determined conditions of permanency and longevity. The development of adhesive cements to metallic structures adds new benefits with regard to th e practice of this type of prosthesis, impossible to forget in this time of considerable scientific and technical improvement.
Cementation↗
[Bonded amalgams. An important change in operatory dentistry].
The incorporation of new adhesives which are able to bond amalgam to the dental structure means a hopeful and encouraging advance in Operative Dentistry. The present study has been done from the point of view of the general practitioner, and lets us check the efficacy of the bonded amalgam and compare it with the techniques and materials traditionally used.
Acid Etching, Dental↗
Cultivating critical thinking in the clinical learning environment.
The dental education knowledge base suggests a lack of understanding and research about how to teach critical thinking skills in the clinical learning environment. The acquisition of critical thinking skills is essential to the development of future practitioners, yet difficult to measure quantitatively. This study used qualitative research methods to assess the frequency and nature of teaching critical thinking skills in the University of Florida College of Dentistry predoctoral student clinics. Thirteen faculty and forty-four students in six clinics (oral diagnosis/treatment planning, endodontics, periodontology, operative dentistry, prosthodontics, and emergency care/oral surgery) were observed by an independent evaluator. Critical thinking skills were infrequently taught, and teacher-dominated instruction predominated. The findings underscore the need for thoughtful curriculum planning prior to predoctoral clinical instruction and periodic appraisal of clinical instruction. Suggestions for improving critical thinking in the clinical learning environment are presented.
Clinical Competence↗
Air abrasion: its uses and abuses.
Air abrasion, a pseudo-mechanical, non-rotary method of cutting and removing dental hard tissue, was originally conceived in 1945. After promising early clinical developments, the advent of the air turbine handpiece and burs resulted in the loss of this early technology to mainstream dentistry. However, recent advances in adhesive dentistry have called for changes to concepts in cavity design and preparation, and air abrasion has once again come to the forefront of clinical operative dentistry. This review explains the mode of action of the current units and discusses some of the clinical uses of this technique as well as potential pitfalls.
Acid Etching, Dental↗
Secondary caries.
This paper reviews secondary caries which is the major reason for failure of restorations and therefore worthy of attention if operative dentistry is to be cost effective. The basic premise of the review is that the secondary caries process is difficult to diagnose and cannot be permanently treated away by operative management. Preventive therapy, dependent on the patients' self-care, is essential. However, the quality of the restorative material and the skill with which it is handled are also relevant to the prevention of further failure.
Dental Caries↗
Effect of operators' skills on increase in cavity volume of restorations.
OBJECTIVE: The purpose of this in vitro study was to evaluate the change in cavity volume after removal of amalgam and resin composite restorations, based on the dental skills of the operators. METHOD AND MATERIALS: A high-speed turbine and diamond burs were used to prepare Class II cavities in 60 acrylic resin mandibular first molar teeth. After the teeth were weighed with precision scales, the cavities were restored with amalgam or posterior resin composite. The restored teeth were then stored in distilled water at room temperature for 48 hours. Three undergraduate students with 2 years' practical experience on patients, and three postgraduate students with an additional 4 years' practical experience in the Department of Operative Dentistry, removed the restorations from the cavities with a high-speed turbine, and the teeth were all weighed again. After cavities were rerestored with the same materials, each restoration was removed once more by the same operator. The weighing procedure was repeated before and after the removal of the restorations. The data were subjected to paired and unpaired t tests. RESULTS: Every time a restoration was removed from a tooth, the cavity preparation became significantly larger, but the postgraduate students caused significantly smaller increases in cavity volume. CONCLUSION: Increases in cavity volume are not based on the nature of t he restorative material; however, the individual experience levelsand dental skills of the operators lead to significant differences in the cavity volume increase.
Clinical Competence↗
Balancing dental service requirements and supplies: epidemiologic and demographic evidence.
As a counterpoint to negative interpretations of recent trends, this article presents a positive picture of dentistry in the 1990s and 21st century. Reported trends show large increases in older dentate adults who are retaining more of their natural dentition, new diagnosis and treatment technologies, increased incidence of dental caries in older adults, increased awareness of periodontal diseases, greater interest in esthetic dentistry, and generally higher expectations for health and fitness in our society. All of these factors point to a greater need for adult dental services. Therefore, in the next 30 years, the dental profession should be prepared to provide increased amounts of diagnostic, preventive, adult operative, fixed prosthodontic, and endodontic and orthodontic services. Declines in need should be expected in children's operative dentistry, extractions, and complete dentures.
Aging↗
A pilot study comparing the effectiveness of conventional training and virtual reality simulation in the skills acquisition of junior dental students.
The use of virtual reality (VR) in the training of operative dentistry is a recent innovation and little research has been published on its efficacy compared to conventional training methods. To evaluate possible benefits, junior undergraduate dental students were randomly assigned to one of three groups: group 1 as taught by conventional means only; group 2 as trained by conventional means combined with VR repetition and reinforcement (with access to a human instructor for operative advice); and group 3 as trained by conventional means combined with VR repetition and reinforcement, but without instructor evaluation/advice, which was only supplied via the VR-associated software. At the end of the research period, all groups executed two class 1 preparations that were evaluated blindly by 'expert' trainers, under traditional criteria (outline, retention, smoothness, depth, wall angulation and cavity margin index). Analyses of resulting scores indicated a lack of significant differences between the three groups except for scores for the category of 'outline form', for group 2, which produced significantly lower (i.e. better) scores than the conventionally trained group. A statistical comparison between scores from two 'expert' examiners indicated lack of agreement, despite identical written and visual criteria being used for evaluation by both. Both examiners, however, generally showed similar trends in evaluation. An anonymous questionnaire suggested that students recognized the benefits of VR training (e.g. ready access to assessment, error identification and how they can be corrected), but the majority felt that it would not replace conventional training methods (95%), although participants recognized the potential for development of VR systems in dentistry. The most common reasons cited for the preference of conventional training were excessive critical feedback (55%), lack of personal contact (50%) and technical hardware difficulties (20%) associated with VR-based training.
Competency-Based Education↗
An investigation of potential applications of intensifying screens in intraoral radiography.
In medicine, the somewhat degraded image from the screen/film system is accepted for most diagnostic purposes in the interest of radiation thrift. In dentistry, however, the superb image resolution and sharpness of the radiation-intensive, direct-exposure film is the standard for intraoral radiography. There may be occasions in dental practice where such quality is not necessary, thus making the high level of exposure difficult to justify. In a laboratory study, screen-type radiographs were effectively substituted for ultraspeed film in the monitoring stages of endodontic therapy and as posttreatment films in operative dentistry. Even with a slow system, the radiation exposure was one sixteenth of the usual periapical dose. If clinical trials support these conclusions, only the lack of a practical periapical cassette limits the application of this significant method of radiation reduction to dental practice.
Dental Restoration, Permanent↗
[The fight over dentistry 1919-1924].
In the history of many professions there are periods of more or less pronounced borderline fights against other professions and/or charlatans. This article is about such an example from the profession of dentistry in Sweden. From the middle of the second decade of this century, there was an increasing discrepancy between the need for dental care and the too low number of dentists. Furthermore: the majority of the Swedish people could not afford dental care at all. In the public debate the concept "dental misery" was created. In 1919 a famous Swedish paediatric professor, Isak Jundell, presented a debate article in "Allmänna Svenska Läkartidningen" (Journal of the Swedish Medical Association), with a proposal for building up a corps of dental assistants with shorter training than dentists, but still with competence for tooth cleaning, extraction and some operative dentistry. The aim of the proposal was to give people easier available and cheaper dental care. The dental profession had been questioned and threatened and the reaction from the advocates of the dentists was immediate and intense. Now followed an almost five year long struggle, with the Swedish Dental Association on one side and parts of the medical profession, dental technicians, even some dentists and a number of politicians on the other. The controversy ended up in the Swedish Parliament in 1924 where many members in both the chambers had signed motions concerning authorisation of dental technicians. The dentists won the fight thanks to the resolution in the Parliament not to authorise the technicians. But still more important, from a social political point of view, was a statement from the Parliament with a commission to the Government to analyse the prerequisites for building up a Public Dental Health Service organisation in Sweden. After a series of committees this was finally a reality fourteen years later, in 1938, when the Parliament in a resolution initiated "folktandvården".
Dental Assistants↗
A new classification and techniques for simple restorative dentistry.
It is nearly one hundred years since G. V. Black proposed a simple, five-stage classification for carious lesions based upon the site of the lesion and the type of restorative material likely to be used for restoration. In the absence of both effective preventive measures and a knowledge of remineralization his approach was essentially surgical: having identified a lesion remove it surgically, as well as all surrounding susceptible tooth structure, to prevent recurrence. Surgery is no longer regarded as the primary choice for treatment of a disease and there are many factors which suggest that this system is out of date. Preservation of natural tooth structure should be the principal aim and this is best achieved through remineralization. Remaining cavitated areas can then be restored more conservatively, thus assisting in maintaining aesthetics as well as strength in the tooth crown. If the profession is to adopt a new approach to operative dentistry it is suggested that the psychology of introducing a new classification for carious lesions is a desirable move.
Dental Cavity Preparation↗
Comparison of vertical with lateral condensation technique in obturation of root canal system.
OBJECTIVE: To compare vertical condensation with laterally condensed gutta-percha technique in obturation of root canal system. DESIGN: A comparative study. PLACE AND DURATION OF STUDY: The Armed Forces Institute of Dentistry (Operative Deptt), Rawalpindi. SUBJECTS AND METHODS: Fifty six human permanent extracted teeth were collected from central incisor to second molar from the both arches and in vitro root canal procedure was carried out. RESULTS: Warm vertical technique resulted in a uniform smooth surface and least observable space between gutta percha and canal wall, especially in middle and apical region. CONCLUSION: Root canal obturation by warm vertical condensation is better than cold lateral condensation.
Humans↗
A survey of the correspondence between abrasions and tooth brushing habits in Erzurum, Turkey.
AIM: To determine whether there is a correlation between dental abrasions and the frequency and technique of tooth brushing, as well as to examine the prevalence of dental abrasion according to age and gender. MATERIALS AND METHODS: This study was carried out on 428 adults (242 female, 186 male) 20 years of age and older, who attended the Department of Operative Dentistry, Department of Oral Diagnosis and Oral Radiology Faculty of Dentistry, Atatürk University. RESULTS: The study revealed a statistically significant relationship between abrasive lesions and age groups as well as between abrasive lesions and gender. A statistically significant difference was determined between abrasions and tooth brushing frequency, while there was no statistically significant relation between abrasions and tooth brushing technique (p>0.05). CONCLUSION: The prevalence of tooth brushing abrasions increases with age, and lesions are seen more frequently in males than in females. Also, tooth brushing technique is not important to the presence of abrasions, but increased tooth brushing frequency results in an increase in the number of abrasions.
Adult↗
Subcutaneous facial emphysema complicating dental anaesthesia.
A 20 year-old female developed swelling and protrusions of the tongue and marked facial swelling while under general anaesthesia for dental restoration and gigivectomy. The initial diagnosis was angioedema; however x-rays showed marked subcutaneous emphysema more extensive in the perimandibular area with a minimal amount in the neck. There was no evidence of pneumomediastinum or pneumothorax. The iatrogenic subcutaneous emphysema was felt to be due to air-driven dental equipment. Tracheal intubation was maintained for 21 hours to prevent airway obstruction. The patient was treated with oxygen and antibiotics. Subcutaneous emphysema may occur following root canal therapy, tooth extraction, periodontal surgery and operative dentistry, due to the use of air-driven dental equipment. It has the potential to cause obstruction.
Adult↗
Interdisciplinary cooperation exemplified by two complex cases of enamel erosion.
OBJECTIVE: Students of the Frankfurt am Main University Hospital participate in an interdisciplinary instructional unit in which they are presented with complex interdisciplinary findings and previous diagnostic records that are discussed in the patient's presence. We have recently observed a growing number of patients presenting defects of dental hard tissue in the form of erosions, defined as a loss of dental hard tissue due to the frequent and direct effect of acids not involving micro-organisms. These patients also presented marked malocclusions. For the most part, the diagnoses involve operative dentistry, dental prosthetics, orthodontics, oral, maxillofacial and plastic surgery. The clinicians discuss causes and therapeutic alternatives, at which point the therapeutic course is determined in consultation with the patient. CASE HISTORIES: We present herein two exemplary cases complex in etiology, as well as in treatment planning and realization. The case descriptions illustrate the importance of interdisciplinary agreement and cooperation in difficult courses of therapy, illustrating that, in the interest of the patient, it makes sense to establish interdisciplinary networks.
Adolescent↗
Effect of carticaine on the sarcoplasmic reticulum Ca2+-adenosine triphosphatase. II. Cations dependence.
Ca2+-ATPase is a major intrinsic protein in the sarcoplasmic reticulum (SR) from skeletal muscles. It actively transports Ca2+ from the cytoplasm to the SR lumen, reducing cytoplasmic [Ca2+] to promote muscle relaxation. Carticaine is a local anesthetic widely used in operative dentistry. We previously showed that carticaine inhibits SR Ca2+-ATPase activity and the coupled Ca(2+) uptake by isolated SR vesicles, and increases the rate of Ca2+ efflux from preloaded vesicles. We also found that these effects were antagonized by divalent cations, and concluded that they were mainly due to the direct interaction of carticaine with the Ca2+-ATPase protein. Here we present additional results on the modulation of the above effects of carticaine by Ca2+ and Mg2+. The activating effect of Ca2+ on the ATPase activity is competitively inhibited by carticaine, indicating a decreased Ca2+ binding to the high affinity Ca2+ transport sites. The activating effect of Mg2+ on the phosphorylation of Ca2+-ATPase by orthophosphate is also inhibited by carticaine. The anesthetic does not affect the reaction mechanism of the cations acting as cofactors of ATP in the catalytic site. On the basis of the present and our previous results, we propose a model that describes the effect of carticaine on the Ca2+-ATPase cycle.
Anesthetics, Local↗