Is a Wiggling-Motion Modified Two-Step Impression Technique as Accurate as Conventional Techniques in Restorative Dentistry?

BACKGROUND

The purpose of this study was to evaluate dental impression accuracy of one-step and two-step techniques compared to a modified two-step technique.

METHODS

Four impression techniques were compared: (1) a one-step double mix (DM) technique, (2) a cut-out (CO) technique, in which space relief was created using a blade and a laboratory bur, (3) a membrane (ME) technique, in which space relief was created by placing a PVC membrane on top of the putty material during the primary impression, and (4) a wiggling motion (WI) technique, in which PVC membrane was placed and additional wiggling movements were performed during the first 20 s when the primary impression was seated upon the master model (MM). Impressions were poured with type IV stone. Casts were scanned with a laboratory scanner and measurements were made for each cast using three-dimensional analysis software.

RESULTS

All groups presented differences compared to MM group, in at least one intra-abutment distance. Groups DM and ME presented the most significant differences, in three and two distances, respectively, whereas CO and WI presented one significant different distance compared to MM. There were no differences between MM and the four techniques for inter-abutment distances.

CONCLUSIONS

WI yielded similar results with CO technique. Both performed better than the other groups.

Does Sterilization Affect the Performance of Single-Step Resin Composite Polishers?

(1) Background: Single-step polishers are used extensively for resin-composite polishing. The purpose of this study was to evaluate the effect of sterilization on their performance. (2) Methods: Optrapol Next Generation/Ivoclar-Vivadent, Jazz Supreme/SS White, Optishine Brush/Kerr and Jiffy Polishing Brush/Ultradent were used for polishing a nanohybrid resin composite (IPS Empress Direct/Ivoclar-Vivadent). Polishers (n = 40) were microscopically inspected before use. After polishing, surface roughness (Sa, Sz, Sdr, Sci) and gloss were determined. Polishers were subsequently sterilized and microscopically re-examined. The process was repeated four times on new samples (n = 200). Data were analyzed using the Friedman test and Wilcoxon post hoc test, at α = 0.05. (3) Results: Optrapol's performance improved after the first sterilization for Sa and gloss, whereas it declined after the fourth sterilization for Sa. Jazz's, improved after the second sterilization for Sa and gloss and after the third sterilization for Sdr. An improvement trend was observed for Optishine after the first sterilization, but not statistically significant. Sa, Sz, and gloss declined after the fourth sterilization. Jiffy's performance was inconsistent, with a trend of performance loss after the fourth sterilization. (4) Conclusions: Performance of all polishing systems improved after the initial sterilization, but deteriorated after the fourth sterilization cycle. However, their performance can be considered clinically acceptable for a longer period of use.

[Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey]

BACKGROUND

Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems.

METHODS

As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis.

RESULTS

When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality.

CONCLUSIONS

The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM.

Outcome-Based Quality Control by a Dental Reference Profile of a Population-Based Study (SHIP-0)

Objectives. The aim was to develop an instrument for quality control in dental practices. We compared the number of teeth of subjects of the Study of Health in Pomerania (SHIP-0) with those from patients of dental practices. Methods. Patients from seven dental practices (n = 1,497) were randomly sampled by age strata and gender for a period of two years. Dental status derived from patient files was transformed into practice profiles using age-specific number of teeth as a parameter. Practice profiles were compared with a nomogram, which was based on the age-specific number of teeth of 3,990 SHIP-0 participants regularly visiting the dentist. Further, negative binomial regression models were evaluated to model associations between the number of teeth with age and dental practices, including interactions. Results. The practice profiles ranged between the 45th and 95th quantile curves of the reference population SHIP-0. The rate ratios (RR) for the number of missing teeth ranged from 0.37 to 0.67 (p < 0.001) between the different dental practices, indicating lower risk for higher numbers of missing teeth in comparison to SHIP-0. Conclusions. This study showed considerable differences between dental practices and the reference population of SHIP-0 regarding the pattern of tooth loss and confirms the value of nomograms to compare age-specific numbers of teeth between patients of dental practices and a population-based-study as a tool for quality control. For further analyses, the socioeconomic status of patients and relevant risk factors will be used to adjust for structural differences in order to improve the validity of the comparisons.