Digital prosthetic workflow during COVID-19 pandemic to limit infection risk in dental practice

Knowledge, attitude, and practice of dental health professionals toward dental impression disinfection protocol during the COVID-19 pandemic in Saudi Arabia- a cross-sectional study

BACKGROUND

Despite the updated guidelines on dental impression disinfection protocols during the COVID-19 pandemic, adherence to such procedures has not been studied among dental health professionals in Saudi Arabia. Understanding DHPs' knowledge, attitudes, and practices regarding COVID-19 is crucial in assessing a willingness to adhere to the recommendations provided by health authorities in mitigating the spread of COVID-19 via dental impressions impacting patient safety and infection control measures. Hence, this study aimed to assess dental health professionals' (DHPs) knowledge, attitudes, and practices (KAP) toward dental impression disinfection protocol during the COVID-19 pandemic in Saudi Arabia.

METHODS

A cross-sectional study using an online survey was conducted from 14 December 2022 to 21 March 2023 among practicing dentists, dental assistants (DA), dental laboratory technicians (DT), and dental hygienists in Saudi Arabia. A validated and reliable questionnaire that consisted of 38 items along with demographic variables was prepared to collect the data. Using Google Forms, a questionnaire link was prepared and shared on the social media platforms of DHPs in Saudi Arabia. A descriptive analysis was conducted to report the percentages and frequencies. The mean knowledge, attitude, and practice scores were analyzed using an Independent t-test, ANOVA, and Pearson's correlation tests.

RESULTS

A total of 718 DHPs voluntarily participated in the survey. Most of the DHPs exhibited average knowledge 392 (54.6%), neutral attitudes 393(54.7%), and adequate 549 (76.5%) practice towards dental impression disinfection protocol. The mean knowledge score differed significantly across nationality (p = 0.013), type of DHPs (p < 0.001), qualification (p = 0.045), and experience (p = 0.028) of the study participants. Significant differences in attitude towards impression disinfection were observed in different age groups (p = 0.002), qualifications (p = 0.015), and experiences (p = 0.024) of the DHPs. Similarly, practice varied across different age groups (p = 0.010), nationality (p = 0.013), type of DHPs (p = 0.019), qualification (p = 0.044), experience (p = 0.041), and COVID-19 Infection (p = 0.006). Moreover, a significant positive correlation between knowledge-attitude (r = 0.258, p < 0.01), knowledge-practice (r = 0.283, p < 0.01), and attitude-practice (r = 0.196, p < 0.01) was observed.

CONCLUSION

DHPs considered in this study demonstrated average knowledge and attitudes toward impression disinfection, requiring improvement through continuous dental education and training. However, they displayed acceptable dental impression disinfection practices during the COVID-19 pandemic. It is highly recommended that continuing education programs should mainly reinforce the knowledge of sodium hypochlorite, iodophor, and phenolics and their concentrations to be used as an impression disinfectant. Additionally, it should focus on techniques of disinfecting elastomeric, hydrocolloid, zinc oxide and eugenol, and impression compound materials to mitigate the spread of COVID-19 based on Saudi ministry of health guidelines.

Evaluation of Intraoral Full-Arch Scan versus Conventional Preliminary Impression

An accurate impression is vital during prosthodontic rehabilitation. Digital scanning has become an alternative to conventional impressions. This study compares conventional preliminary impression techniques with digital scanning, evaluating the efficiency, treatment comfort, and trueness. Impressions of 28 patients were taken using conventional and digital techniques. The efficiency of both impression techniques was evaluated by measuring the mean working time. A visual analog scale questionnaire (1-10) was used to appreciate the participants' perceptions of discomfort. Morphometric measurements, which were carried out to determine the differences between the casts, were made on the buccolingual cross sections of teeth 11 and 31 and the distolingual and mesiobuccal cusp tips of each first molar. The total treatment time was 75.5 min for conventional and 12 min for digital impressions. The patients scored a mean discomfort assessment of 6.66 for conventional and 9.03 for digital scanning. No significant differences existed between the examined areas (p < 0.05, Wilcoxon and Mann-Whitney tests) of the digital casts obtained by both techniques. The intraoral scan can be considered as an alternative to conventional preliminary impressions for performing study model analysis during orthodontic treatment planning. The digital impression is more comfortable and accepted by the patients than the conventional impression and has a shorter working time.

Comparative Verification of the Accuracy of Implant Models Made of PLA, Resin, and Silicone

Polylactic acid (PLA) has gained considerable attention as an alternative to petroleum-based materials due to environmental concerns. We fabricated implant models with fused filament fabrication (FFF) 3D printers using PLA, and the accuracies of these PLA models were compared with those of plaster models made from silicone impressions and resin models made with digital light processing (DLP). A base model was obtained from an impact-training model. The scan body was mounted on the plaster, resin, and PLA models obtained from the base model, and the obtained information was converted to stereolithography (STL) data by the 3D scanner. The base model was then used as a reference, and its data were superimposed onto the STL data of each model using Geomagic control. The horizontal and vertical accuracies of PLA models, as calculated using the Tukey-Kramer method, were 97.2 ± 48.4 and 115.5 ± 15.1 μm, respectively, which suggests that the PLA model is the least accurate among the three models. In both cases, significant differences were found between PLA and gypsum and between the PLA and resin models. However, considering that the misfit of screw-retained implant frames should be ≤150 µm, PLA can be effectively used for fabricating implant models.

Accuracy of Dental Models Fabricated Using Recycled Poly-Lactic Acid

Based on the hypothesis that the fabrication of dental models using fused deposition modeling and poly-lactic acid (PLA), followed by recycling and reusing, would reduce industrial waste, we aimed to compare the accuracies of virgin and recycled PLA models. The PLA models were recycled using a crusher and a filament-manufacturing machine. Virgin PLA was labeled R, and the first, second, and third recycles were labeled R1, R2, and R3, respectively. To determine the accuracies of the virgin and reused PLA models, identical provisional crowns were fitted, and marginal fits were obtained using micro-computed tomography. A marginal fit of 120 µm was deemed acceptable based on previous literature. The mesial, distal, buccal, and palatal centers were set at M, D, B, and P, respectively. The mean value of each measurement point was considered as the result. When comparing the accuracies of R and R1, R2, and R3, significant differences were noted between R and R3 at B, R and R2, R3 at P, and R and R3 at D (p < 0.05). No significant difference was observed at M. This study demonstrates that PLA can be recycled only once owing to accuracy limitations.

A new proposal for improving the accuracy of intraoral scanning for partially edentulous residual ridge

PURPOSE

This study investigated the usefulness of a newly proposed intraoral scanning method, using markers that can be used directly in the oral cavity, in order to improve the accuracy of impression taking of the residual ridge for fabrication of removable partial dentures.

METHODS

An intraoral scanner was used to scan a dental model of a partially edentulous mandibular arch (Kennedy Class I). As markers, pieces of dried pasta were used. The scanning operation was performed under three conditions. In Condition 1, scanning was performed on the remaining teeth and the residual ridge without markers. In Condition 2, scanning of the remaining teeth and residual ridge was performed with markers. In Condition 3, the markers were removed from the model used in Condition 2, and the residual ridge was scanned again. The scanning data of each condition was superimposed on the control data, and the shape error was calculated and compared among the conditions.

RESULTS

There was a significant difference in trueness of the residual ridge before and after marker application. The application of markers improved the trueness, while maintaining precision. Re-scanning after removing the marker did not affect trueness between before and after re-scanning and the re-scanned region showed shape continuity with the surrounding region.

CONCLUSION

The present method using markers that can be used in the oral cavity was effective in improving the accuracy of impression taking at the residual ridge.

Comparison of Malaysia's Bachelor of Dental Technology curriculum with three other countries: Proposing a basic curriculum framework

INTRODUCTION

A dental technologist is one of the most essential allied dental health professionals and the dental technology curriculum should be comprehensively reviewed on a regular basis. This study aims to compare the only existing Bachelor of Dental Technology (BDT) curriculum in Malaysia with BDT programmes offered by other well-established universities, and map out the similarities and differences, as well as to explore future recommendations and propose a new curriculum framework.

MATERIALS AND METHODS

A descriptive analysis was carried out using Laurie Brady's four-stage strategy. First, available curriculum materials were collected from four different institutions' electronic webpage: AIMST (Malaysia), GU (Australia), UO (New Zealand) and CMU (United Kingdom), and then compared based on three key domains: curriculum contents, teaching and learning strategies and assessments. Following that, the similarities and differences between various curricula were identified. Future recommendations and a curriculum framework were then proposed.

RESULTS

The core BDT curriculum content is concurred upon by all four universities, with an emphasis on basic sciences, laboratory materials, practical sessions and research projects. However, the credit weightage for each course or module varied across the four institutions, with some offering unique subjects and implementing different teaching methods and assessments. A simple BDT curriculum framework with a proposed syllabus was designed based on the three key domains and future recommendations for curriculum improvement were explored.

CONCLUSION

The present study identified several areas for Malaysian BDT curriculum development and improvement. The proposed framework can be a guide for Malaysian dental schools in designing a comprehensive dental technology programme.

Pandemic Preparedness and Response: A Foldable Tent to Safely Remove Contaminated Dental Aerosols—Clinical Study and Patient Experience

The D-DART (Droplet and Aerosol Reducing Tent) is a foldable design that can be attached to the dental chair to prevent the spread of contaminated dental aerosols. The objective of this study was to evaluate the ability of the D-DART to reduce spread of aerosols generated during dental treatment. Thirty-two patients (sixteen per group) undergoing deep ultrasonic scaling were recruited and randomly allocated to groups D-DART or Control (no D-DART). After 20 min from the start of the treatment, the clinician’s face shield and dental chair light were swabbed and the viable microbial load was quantified (ATP bioluminescence analysis, blinded operator). Statistical analyses were performed with Tukey’s Honest Test with a level of significance pre-set at 5%. There were significant increases in ATP values obtained from the operator’s face shield and dental chair light for the Control compared with baseline (31.3 ± 8.5 and fold increase). There was no significant change in microbial load when the D-DART was used compared with baseline (1.5 ± 0.4 fold increase). The D-DART contained and prevented the spread of aerosols generated during deep scaling procedures.

Pros and Cons of CAD/CAM Technology for Infection Prevention in Dental Settings during COVID-19 Outbreak

The purpose of this commentary is to update the evidence reported in our previous review on the advantages and limitations of computer-aided design/computer-aided manufacturing technology in the promotion of dental business, as well as to guarantee patient and occupational safety. The COVID-19 pandemic led to an unprecedented focus on infection prevention; however, waves of COVID-19 follow one another, asymptomatic cases are nearly impossible to identify by triage in a dental setting, and the effectiveness of long-lasting immune protection through vaccination remains largely unknown. Different national laws and international guidelines (mainly USA-CDC, ECDC) have often brought about dissimilar awareness and operational choices, and in general, there has been very limited attention to this technology. Here, we discuss its advantages and limitations in light of: (a) presence of SARS-CoV-2 in the oral cavity, saliva, and dental biofilm and activation of dormant microbial infections; (b) the prevention of SARS-CoV-2 transmission by aerosol and fomite contamination; (c) the detection of various oral manifestations of COVID-19; (d) specific information for the reprocessing of the scanner tip and the ward from the manufacturers.

Intraoral scanning reduces procedure time and improves patient comfort in fixed prosthodontics and implant dentistry: a systematic review

OBJECTIVES

The primary aim of this systematic review was to evaluate whether intraoral scanning (IOS) is able to reduce working time and improve patient-reported outcome measures (PROMs) compared to conventional impression (CI) techniques, taking into account the size of the scanned area. The secondary aim was to verify the effectiveness of IOS procedures based on available prosthodontic outcomes.

MATERIALS AND METHODS

Electronic and manual literature searches were performed to collect evidence concerning the outcomes of IOS and CI performed during the treatment of partially and complete edentulous patients for tooth- or implant-supported restorations. Qualitative analysis was conducted to evaluate the time efficiency and PROMs produced by the two different techniques. Clinical prosthodontic outcomes were analyzed among the included studies when available.

RESULTS

Seventeen studies (9 randomized controlled trials and 8 prospective clinical studies) were selected for qualitative synthesis. The 17 included studies provided data from 430 IOS and 370 CI performed in 437 patients. A total of 7 different IOS systems and their various updated versions were used for digital impressions. The results demonstrated that IOS was overall faster than CI independent of whether quadrant or complete-arch scanning was utilized, regardless of the nature of the restoration (tooth or implant supported). IOS was generally preferred over CI regardless of the size of the scanned area and nature of the restoration (tooth- or implant-supported). Similar prosthodontic outcomes were reported for workflows implementing CI and IOS.

CONCLUSIONS

Within the limitations of this systematic review, IOS is faster than CI, independent of whether a quadrant or complete arch scan is conducted. IOS can improve the patient experience measured by overall preference and comfort and is able to provide reliable prosthodontic outcomes.

CLINICAL RELEVANCE

Reduced procedure working time associated with the use of IOS can improve clinical efficiency and the patient experience during impression procedures. Patient-reported outcome measures (PROMs) are an essential component of evidence-based dental practice as they allow the evaluation of therapeutic modalities from the perspective of the patient. IOS is generally preferred by patients over conventional impressions.

Remote Management of Prosthodontic Emergencies in the Geriatric Population During the Pandemic Outbreak of COVID-19

The global pandemic outbreak of coronavirus disease 2019 (COVID-19) has put the world in a panic situation. It has been evident that the geriatric population is more susceptible to acquire this infection. Thus, due to this ongoing crisis, geriatric individuals cannot visit a dental operatory, and there is the possibility of their dental needs and emergencies to remain unattended. Partial or complete edentulism is very prevalent among the geriatric population, and prosthodontic management of these patients is essential for their well-being. However, the prosthesis can lead to various emergencies of the oral and its supporting structures. There are currently no available recommendations to address these prosthodontic emergencies in geriatric individuals during this pandemic period. Hence, the aims of this minireview were to discuss the common prosthodontic emergencies in the geriatric population and provide recommendations to manage these issues during the COVID-19 pandemic outbreak.

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (<4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m³ vs. 50.52 ± 0.23 μg/m³). Moreover, higher levels of PM (53.95 ± 2.29 μg/m³ vs. 27.85 ± 0.14 μg/m³) were produced when the dental unit's windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation-both window and door opened-during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

Dental Workload Reduction during First SARS-CoV-2/COVID-19 Lockdown in Germany: A Cross-Sectional Survey

An observational cross-sectional survey was planned to analyze the weekly workload reduction of German dentists during lockdown due to the global COVID-19 pandemic. Participants were predominantly members of the Free Association of German Dentists and filled in an online questionnaire. The questionnaire was sent to a total of 9416 dentists, with a response rate of 27.98% (n = 2635). Respondents were divided into seven macro areas by gross domestic product. Nearly two-thirds of dentists (65.16%) reported a reduction in their practice workload of more than 50% compared to the pre-pandemic period with statistically significant differences between German macro areas (p < 0.01). Weekly workload was reduced during the lockdown in 93.00% of study participants, while 55.33% dental care centers with multiple employed dentists under the direction of a non-dentist general manager had only a 40% reduction in weekly workload compared to a solo practice or a practice of a dentist with an employed dentist (30.24% and 28.39%, respectively). Dentists in Germany drastically reduced their practice activity during the first wave of the COVID-19 lockdown, both in rural and urban areas. Short, medium, and long-term effects of the pandemic on dental practices, dental staff as well as patient care need to be further investigated.

COVID-19 and its impact in the dental setting: A scoping review

INTRODUCTION

The scoping review examined the evidence related to infection control and transmission measures of the SARS-CoV-2 virus in a dental setting during this pandemic. Dental practitioners are normally guided in practice by set ethical principles, thus the researchers wanted to determine how these rules are managed during this pandemic.

METHODS

A protocol specific for the objectives of this study was developed according to the criteria for a scoping review. Relevant databases (Pubmed, Scopus, Elsevier, Science Direct, Wiley), including online access to health/ dental organizations (World Health Organization/ American Dental Association), were searched to identify evidence which was restricted to the English language for the period 2015-2020. Predetermined eligibility criteria were applied, evidence was assessed and data extracted for each included article. Relevant outcomes assessed were: infection control measures, transmission of the SARS-CoV-2 virus, such as modes and sources of transmission and the ethical principles related to the dental setting with a focus on the COVID-19 pandemic.

RESULTS

Searches yielded a total of 402 articles: 387 from electronic databases and 15 from other sources. Of these, 231 were unrelated to the objectives of the current scoping review. The full text of 69 studies was assessed for eligibility, of which 26 were finalized for inclusion following the objectives and inclusion criteria set for the scoping review. Most of the included articles were reviews, recommendations and guidelines for dentists. A narrative explanation of the pre-specified outcomes is reported for the 3 areas covered for this review. There is no clinical evidence available that can support the recommendations by individuals, dental organizations or health authorities related to the objectives of this review, but these may be considered as the much needed guidelines during the unprecedented COVID-19 pandemic. A different ethical framework is required during a pandemic and these must be informed by evidence.

Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review

A high level of unmet oral health needs is very common among elderly people. In a society that is getting older and that has been hit so hard by the coronavirus pandemic, the development of new strategies aimed at enhancing general and oral health status should be crucial in order to promote healthy aging. The aim of this systematic review is to assess the feasibility of Teledentistry in communities or in a domiciliary setting where elderly people live. A structured and systematic research was performed on the major electronic databases for studies published in English until 30 June 2020: the PubMed, Cochrane Library, Web of Science, Scopus, and CINAHL databases. A total of 13 articles were identified through database searching using combinations of keywords. Out of 13 papers, eight abstracts were reviewed to assess if they were coherent with the aim of the study, and full texts were retrieved. After abstract reviews, seven articles were selected for closer inspection. Of these, six were assessed for eligibility. Four papers were aimed at assessing patients and health practitioners experiences about Teledentistry, three studies reported a cost analysis and cost description of Teledentistry in residential aged care facilities, and two studies investigated the feasibility and accuracy of Teledentistry for diagnosis dental pathology. The implementation of Teledentistry in residential aged care facilities and in home-assistance programs could be a viable tool for the management of oral care in people who cannot access dental care.

COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil

A nationwide survey of dentists was carried out in Brazil, a new pandemic epicenter, to analyze how dental care coverage has been affected in public versus private networks, changes in routine and burdens, and how local prevalence of COVID-19 affects dental professionals. Dentists were recruited via email and Instagram®. Responses to a pre-tested questionnaire were collected May 15-24, 2020. COVID-19 case/death counts in the state where respondents work was used to test associations between contextual status and decreases in weekly appointments, fear of contracting COVID-19 at work, and current work status (α = 0.05). Over 10 days, 3,122 responses were received (response rate ~2.1%) from all Brazilian states. Work status was affected for 94%, with less developed regions being more impacted. The pandemic impact on clinical routine was high/very high for 84%, leading to varied changes to clinic infrastructure, personal protective equipment use, and patient screening, as well as increased costs. COVID-19 patients had been seen by 5.3% of respondents; 90% reported fearing contracting COVID-19 at work. Multilevel models showed that greater case and death rates (counted as 1000 cases and 100 deaths per million inhabitants) in one's state increased the odds of being fearful of contracting the disease (18% and 25%). For each additional 1000 cases/100 deaths, the odds of currently not working or treating only emergencies increased by 36% and 58%. The reduction in patients seen weekly was significantly greater in public (38.7±18.6) than in private clinics (22.5±17.8). This study provides early evidence of three major impacts of the pandemic on dentistry: increasing inequalities due to coverage differences between public and private networks; the adoption of new clinical routines, which are associated with an economic burden for dentists; and associations of regional COVID-19 incidence/mortality with fear of contracting the disease at work.

Comprehensive review of guidelines to practice prosthodontic and implant procedures during COVID-19 pandemic

OBJECTIVES

To present a comprehensive review of current literature available on Corona virus disease and dentistry, modifications required in dental and laboratory settings; and recommended disinfection protocols in current scenario. Special emphasis has been given to discuss guidelines for handling different prosthodontic procedures and implications of this pandemic on prosthodontic practice, education and research.

MATERIALS AND METHODS

Relevant literature pertaining to COVID-19 and dentistry was scrutinized on electronic search engines including PubMed, EMBASE and Cochrane. Guidelines given by various organizations, institutions, national and international regulatory bodies and Indian Prosthodontic Society were also consulted to gather information pertaining to the objectives of our review.

RESULTS

and observations: A total of 160 articles including cross-sectional studies, in vitro study, narrative reviews, letters to the editor and opinions were found to be relevant in accordance with our search strategy. Documented literature revealed that Covid-19 pandemic has culminated in serious clinical, financial and psychological implications in the field of dentistry. Certain steps such as adoption of teledentistry, judicious use of protective equipment, use of rubber dams, pre-procedural rinses have been suggested unanimously. However, there is a dearth of evidence-based recommendations in literature. Data regarding consequences of delaying prosthodontic procedures and patients' perspectives is also sparse.

CONCLUSION

The COVID-19 necessitates the need to adopt a balanced approach while treating patients and safeguarding the dental professionals at the same time. Risk-benefit ratio has to be assessed along with stringent following of guidelines and disinfection protocols to combat this unprecedented situation.