Evaluation of performance of dental providers on posterior restorations: does experience matter? A data envelopment analysis (DEA) approach

Does a new formula have an input in the clinical success of posterior composite restorations? A chat study

OBJECTIVE

To compare the clinical behavior of a universal light-curing, ultra-fine particle hybrid composite and successor of this material in class I and II cavities after 60 months.

MATERIALS AND METHODS

Forty patients (21 females, 19 males) with ages ranging between 18 and 38 years (23.15 ± 5.15) received 80 (13 Cl I and 67 Cl II) resin composite restorations (Charisma/Charisma Classic, Kulzer GmbH) in combination with an etch and rinse adhesive system (Gluma 2Bond) under rubber dam isolation. Two experienced operators performed all the restorations. Restorations were evaluated by the other two examiners according to the FDI criteria at baseline and at 6, 12, 18, 24, 36, 48 and 60 months. Surface characteristics of one restoration selected randomly were examined under a scanning electron microscope (SEM) at each recall. Data were analyzed statistically (p < 0.05).

RESULTS

After 60 months, recall rate was 90%. None of the restorations failed. Three restorations from Charisma and 4 from the Charisma Classic group showed minor surface staining. Twelve Charisma and 14 Charisma Classic restorations were scored as 2 for margin staining. Four restorations from both groups showed minor shade deviations but no significant difference was observed between the two restorative materials for any criteria evaluated after 60 months (p > 0.05). SEM evaluations were in accordance with the clinical findings.

CONCLUSIONS

Both materials exhibited clinically similar and successful performance over the 60-month observation period.

CLINICAL RELEVANCE

A new formulation of resin composite may not always perform better clinical performances.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT02888873.

Technical efficiency and its influencing factors in Malaysian hospital pharmacy services

Various pharmacy services are offered in public health facilities, ranging from distributive activities (dispensing) to patient-oriented services (pharmaceutical care). These activities are monitored through indicators established at the national level. In Malaysia, the indicators have not been transformed into a measurement of hospital pharmacy service efficiency. The main objectives of this study were to assess the relative performance of hospital pharmacy services and to investigate the factors that may affect the performance levels. Double-bootstrap data envelopment analysis was applied to measure the technical efficiency levels of 124 public hospital pharmacies in 2014. An input-oriented variable returns to scale model was adopted in the study, while bootstrap truncated regression was conducted to identify the factors that may explain the differences in the efficiency levels. The average bias-corrected technical efficiency score varies according to the hospital size (0.84, 0.78 and 0.82 in small, medium and large hospitals, respectively). The hospital size, hospital age, urban location and information technology are important determinants of the efficiency levels. The study contributes to establishing baseline technical efficiency information for public hospital pharmacy services in Malaysia. The measurement of hospital pharmacy efficiency can guide future policy making to improve performance and ensure the optimum level of available resources.

Longevity of 2- and 3-surface restorations in posterior teeth of 25- to 30-year-olds attending Public Dental Service-A 13-year observation

OBJECTIVES

The aim of this patient document-based retrospective study among 25- to 30-year-old Finnish adults was to evaluate longevity of 2- and 3-surface posterior restorations according to type of tooth, size of restoration, and restorative material used.

METHODS

Data were extracted from electronic patient files of the Helsinki City Public Dental Service (PDS), Finland. A total of 5542 2- and 3-surface posterior composite and amalgam restorations were followed indirectly from 2002 to 2015. Longevity of restorations was illustrated using Kaplan-Meier curves. Annual failure rates (AFRs) of the restorations were calculated separately by type of tooth, size, and material. Differences in longevity were statistically tested with log-rank tests.

RESULTS

Composite restorations formed the majority (93%). The longest median survival times and the smallest failure rates were found for teeth in the upper jaw, for premolars, and for 2-surface restorations. Median survival time of all restorations was 9.9 years (95% CI 9.6, 10.2) and re-intervention of restorations occurred less often in the maxilla (AFR 4.0%) than in the mandible (AFR 4.7%). Median survival time of composite restorations was greater for 2-surface than for 3-surface restorations: in premolars 12.3 vs. 9.6 years (p<0.001) and in molars, 9.2 vs. 6.3 years (p<0.001); for molar amalgams the difference (8.0 vs. 6.3 years) was non-significant (p=0.38). Median survival time of 2- and 3-surface restorations in premolars exceeded that in molars (12.0 vs. 8.7 years; p<0.001).

CONCLUSIONS

Longevity of posterior composite multisurface restoration is comparable to amalgam longevity.

CLINICAL SIGNIFICANCE

Regarding material choices for posterior multisurface restorations, composite and amalgam perform quite similarly in molars, 3-surface restoration being challenge for both materials.

Determinants of efficiency in reducing child mortality in developing countries. The role of inequality and government effectiveness

The main aim of this article was to analyze the relationship of income inequality and government effectiveness with differences in efficiency in the use of health inputs to improve the under-five survival rate (U5SR) in developing countries. Robust Data Envelopment Analysis (DEA) and regression analysis were conducted using data for 47 developing countries for the periods 2000-2004, 2005-2009, and 2010-2012. The estimations show that countries with a more equal income distribution and better government effectiveness (i.e. a more competent bureaucracy and good quality public service delivery) may need fewer health inputs to achieve a specific level of the U5SR than other countries with higher inequality and worse government effectiveness.

Survival characteristics of composite restorations in primary teeth

OBJECTIVES

This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used.

MATERIALS AND METHODS

Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis.

RESULTS

For the observation period of 8 years (mean 1.7 years), the cumulative failure rate was 17.2 % with annual failure rates of 10.0 %. In 8.8 % of the cases, fillings failed due to secondary caries. In 8.3 % technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05).

CONCLUSIONS

Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure.

CLINICAL RELEVANCE

Filling loss of composites in the primary dentition is associated with secondary caries on the long term.

A STUDY OF DENTAL 3D POINTS CLOUD MEASUREMENT SYSTEM BASED ON GRATING PROJECTION

A novel non-contact dental 3D points cloud measurement system based on grating projection is proposed in this paper. The system has the key functions of calibration, phase unwrapping and conversion of two-dimensional image to the 3D point cloud and so on, and it can provide three-dimensional graphics of the dental wax with rotations and translation to observe and measure the various parts of dental wax surface. The system can be used as a useful test and analysis tool for clinical medicine teaching and researches.

The measurement of efficiency and productivity of health care delivery

The measurement of efficiency and productivity of health service delivery has become a small industry. This is a review of 317 published papers on frontier efficiency measurement. The techniques used are mainly based on non-parametric data envelopment analysis, but there is increasing use of parametric techniques, such as stochastic frontier analysis. Applications to hospitals and other health care organizations and areas are reviewed and summarised, and some meta-type analysis undertaken. Cautious conclusions are that public provision may be potentially more efficient than private, in certain settings. The paper also considers conceptualizations of efficiency, and points to dangers and opportunities in generating such information. Finally, some criteria for assessing the use and usefulness of efficiency studies are established, with a view to helping both researchers and those assessing whether or not to act upon published results.

Using quality report cards for reshaping dentist practice patterns: a pre-play communication approach

Rationale, aims and objectives Understanding how information disclosure influences dentists' patterns of practice change is important in developing quality-improvement policies and cost containment. Thus, using quality report cards is a promising strategy for investigating whether dentists will reshape their patterns of practice because of the influence of peer comparison. Methods Based on the coordination game, a data warehouse decision support system (DWDSS) was used as a pre-play communication instrument, along with the disclosure of quality report cards, which allow dentists to search their own service rates of dental restoration and restoration replacement as well as compare those results with others. Results and conclusions The group using the DWDSS had a greater decrease in two indicators (i.e. service rates of dental restoration and restoration replacement) than the dentists who did not use it, which implies that the DWDSS is a useful facility for helping dentists filter and evaluate information for establishing the maximum utility in their practice management. The disclosure of information makes significant contributions to solving managerial problems associated with dentists' deviation of practice patterns.

The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth

BACKGROUND

Limited information is available from randomized clinical trials comparing the longevity of amalgam and resin-based compomer/composite restorations. The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New England Children's Amalgam Trial.

METHODS

The authors randomized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam (n=267) or compomer (primary teeth)/composite (permanent teeth) (n=267) restorations and followed them up semiannually. They compared the longevity of restorations placed on all posterior surfaces using random effects survival analysis.

RESULTS

The average+/-standard deviation follow-up was 2.8+/-1.4 years for primary tooth restorations and 3.4+/-1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams (P=.10), with 3.0 percent versus 0.5 percent (P=.002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams (P=.45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams (P=.02).

CONCLUSION

Although the overall difference in longevity was not statistically significant, compomer was replaced significantly more frequently owing to recurrent caries, and composite restorations required seven times as many repairs as did amalgam restorations.

CLINICAL IMPLICATIONS

Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.