Restorative intervention thresholds and treatment decisions of general dental practitioners in London

Current trends in placing posterior composite restorations: Perspectives from Palestinian general dentists: A questionnair study

Aim

The success of composite restorations relies on material selection and practitioner-related factors that shape the overall outcome. This study explores the practices of Palestinian general dental practitioners in placing posterior composites, examining the impact of work sector, experience, and gender on their choices.

Materials and Methods

The study was conducted as an online cross-sectional questionnaire and involved 351 participants, with a response rate of 69.8%. The survey comprised 18 closed-ended questions covering demographics, material selection, and composite placement in special cases, techniques, and factors influencing the choices. Statistical analyses included descriptive statistics, chi-squared tests, and Fisher's exact tests.

Results

Composite was the predominant choice for small-size (83.7%) and large-size posterior cavities (60.4%). Practitioners commonly opted for composite restorations in cases involving occlusal parafunctional activity (60%), poor oral hygiene (78%), and subgingival cavities (72.2%). Only 19.6% and 5.3% reported occlusal and gingival beveling, respectively. Rubber dams for isolation stood at 30%, one-step self-etch adhesives at 44.9%, and the oblique layering technique at 51%. Light-emitting diode curing units were popular (97.55%), but monitoring output with a radiometer was infrequent (93.5%). Tofflemire metal matrix usage was 46.1%, whereas a sectional matrix system was employed by 29.8%. A 2 mm layer exposure to light curing for 20 s was reported by 62%, and 27.75% utilized additional light-curing postmatrix band removal.

Conclusion

The study highlights the need for Palestinian dental professionals to update their clinical approaches in placing composite restorations in posterior teeth. Gender, work sector, and experience influence practitioners' choices, emphasizing the importance of tailored continuing education programs for improving clinical practices.

EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.

A Comprehensive Evaluation of Zirconia-Reinforced Glass Ionomer Cement's Effectiveness in Dental Caries: A Systematic Review and Network Meta-Analysis

Dental cements are in a constant state of evolution, adapting to better align with the intricacies of tooth structure and the dynamic movements within the oral cavity. This study aims to evaluate the efficacy of zirconia-reinforced glass ionomer cement-an innovative variant of modified glass ionomer cements-in terms of its ability to withstand compressive forces and prevent microleakage during dental caries reconstruction. An extensive search was conducted across various databases, encompassing PubMed-MEDLINE, Scopus, Embase, Google Scholar, prominent journals, unpublished studies, conference proceedings, and cross-referenced sources. The selected studies underwent meticulous scrutiny according to predetermined criteria, followed by the assessment of quality and the determination of evidence levels. In total, 16 studies were incorporated into this systematic review and network meta-analysis (NMA). The findings suggest that both compomer and giomer cements exhibit greater compressive strength and reduced microleakage values than zirconia-reinforced glass ionomer cement. In contrast, resin-modified glass ionomer cement (RMGIC) and high-viscosity glass ionomer cement (GIC) demonstrate less favorable performance in these regards when compared with zirconia-reinforced glass ionomer cement.

Clinical Extension of Proximal Carious Lesions Compared to Bitewing Radiographs using Photostimulable Phosphor Plates (PSP): Clinical vs. Radiographic Interproximal Carious Extension

OBJECTIVES

The aim of this study was to evaluate the use of digital bitewing radiographs using photostimulable phosphor (PSP) plates in the estimation of the true extension of proximal carious lesions.

METHODS

The sample size was calculated to be 70 teeth. Adult patients with a minimum of one posterior tooth with primary proximal caries lesions were included. A preoperative bitewing radiograph was taken and the extension of the carious lesion was measured from the most prominent point on the adjacent sound tooth to the deepest axial point of the lesion. An experienced general dentist provided the restorative treatment and made a polyvinyl siloxane impression of the cavity preparation. Clinical caries extension was measured from the most prominent point of the adjacent tooth until the deepest boundary of the axial wall of the preparation on the impression. Postoperative radiographs were taken at the completion of restorative care. The bitewing radiographs were done using PSP plates and caries extension measurements were performed using measuring tools of the digital radiography software. Pairwise comparisons were made between preoperative and postoperative radiographs, and the true clinical depth measurements using paired t-tests.

RESULTS

A significant difference of 0.82 mm was found between preoperative radiographs and clinical measurements (p<0.001). Similarly, comparisons between preoperative and postoperative radiographic measurements showed significant differences of 0.99 mm (p<0.001).

CONCLUSIONS

The study found that the true clinical extension of proximal caries after non-selective caries removal was significantly deeper than the preoperative radiographic extension assessment. This was not influenced by the tooth type, the location of the tooth, or the affected tooth surfaces.

CLINICAL SIGNIFICANCE

When a non-selective caries removal strategy is adopted, clinicians should be aware that PSP bitewing radiographs underestimate the true clinical extension of proximal caries lesions. This will have an impact on clinicians' practice and restorative treatment decisions.

Restorative thresholds for primary and permanent molars in children: French dentist decisions

BACKGROUND

Worldwide, numerous surveys have investigated practices and knowledge about caries management in adults, but few are available for children.

AIM

The present cross-sectional survey aimed to assess the restorative thresholds (RTs) in primary and permanent molars in children used by a population of dentists treating children and practicing in France.

DESIGN

The study population consisted of French dentists treating children (Fr-DTCs) who were registered in the French Society of Pediatric Dentistry (n = 250). A specific questionnaire was developed. Descriptive and statistical analyses were performed.

RESULTS

Response rate was 80.4% (n = 201). Considering that an appropriate RT is at the stage of a moderate lesion (occlusal: International Caries Detection and Assessment System 4; approximal: lesion involving the external third of dentine), more than 50% of respondents showed a tendency for iatrogenic treatment, except for occlusal carious lesions in primary molars. Inappropriate invasive strategies were more often reported for occlusal lesions in permanent than primary molars. Moreover, for both molar types, these inappropriate RTs were more often chosen for approximal than occlusal lesions.

CONCLUSIONS

The present survey suggested that Fr-DTCs tend to overtreat in terms of caries management in both primary and permanent molars.

General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

General dental practice in the United Kingdom has been in a state of unrest for over two decades, with practitioners having been confronted by two contract changes. The latest contract change of 2006 resulted in much disquiet, and services continue to be piloted in order to develop a contract that satisfies the needs of both government and the profession. Within this context, this paper explores the issues surrounding the present situation. To date, the profession has expanded service provision into the private market which has resulted in an exaggerated inverse care provision. This could be perceived as a move towards a retail philosophy and away from healthcare. In order to restore an equitable balance of care provision, the authors present possible solutions that could satisfy both parties.