Recommendations for remaining agile in the face of a dental faculty workforce shortage

PURPOSE

Dental education is facing a faculty workforce shortage. Lack of preparation risks faculty, student, and staff morale and is an impediment to institutional growth and innovation. Administrators and faculty must consider strategies to better prepare for, and be successful within, a faculty shortage environment.

METHODS

We review strategies utilized by health professional institutions that have confronted faculty workforce shortages.

RESULTS

These strategies were grouped into four domains reflecting the organizational units that typically direct and initiate change within dental education institutions: budget and finance, human resources, organizational structure, and curricular structure. Recommendations using a four-pronged approach based on these domains have been developed for remaining agile in the face of a faculty workforce shortage.

CONCLUSIONS

Local needs assessments and strategic planning are the first steps in highlighting institutional strengths and identifying gaps within each of the domains. Faculty development and retention efforts, as well as increasing curricular efficiencies, are essential for success across all domains.

Comparison of Dehydrated Human Amnion-Chorion and Type 1 Bovine Collagen Membranes in Alveolar Ridge Preservation: A Clinical and Histological Study

Alveolar ridge preservation maintains ridge dimensions and bone quality for implant placement. The aim of this randomized controlled clinical study is to compare the use of a human amnion-chorion membrane to a collagen membrane in an exposed-barrier ridge preservation technique.  Furthermore, this study will determine if intentional membrane exposure compromises ridge dimensions and bone vitality.Forty-three patients requiring extraction and delayed implant placement were randomly assigned into either the experimental or control group. Twenty-one participants received human amnion-chorion membrane (test) during ridge preservation while twenty-two participants received the collagen membrane (control). In both groups, demineralized freeze-dried bone allografts were used to graft the socket and primary closure was not achieved.The patients underwent implant placement after an average healing period of 19.5 weeks, and 2.7 X 8-mm core bone specimens were obtained for histomorphometric analyses. The clinical ridge dimensions were measured after extraction and at the time of delayed implant placement. No significant difference was observed in the mean vital bone formation between the experimental (51.72 ± 8.46%) and control (49.96 ± 8.31%; P > 0.05) groups. The bone height and width did not differ, as determined by clinical measurements (P > 0.05). Using either a human amnion-chorion membrane or type 1 bovine collagen as the open barrier did not change healing, compromise ridge dimensions, or affect bone vitality between the two groups.

Orthodontic treatment of patient with maxillofacial fibrous dysplasia: A case report

Fibrous dysplasia is a benign skeletal disorder in which the normal bone and marrow are replaced by fibrous tissue and haphazardly distributed woven bone. The aim of this case report is to discuss the orthodontic treatment of a 13-year-old patient with fibrous dysplasia in the left maxilla. The patient had rotated maxillary second premolars, moderate crowding in both maxillary and mandibular arches with low maxillary frenal attachment. Orthodontic treatment was done with full fixed appliance and extraction of maxillary and mandibular third molars. Maxillary frenectomy and free gingival graft in mandibular anterior region were performed by a periodontist. The oral and maxillofacial surgery team monitored fibrous dysplasia in the left maxilla on a yearly interval. There is very limited information about orthodontic management of patients with craniofacial fibrous dysplasia. This case report discusses the orthodontic treatment and the importance of interdisciplinary approach in the management of patient with maxillofacial fibrous dysplasia.

Key words:Orthodontic treatment, fibrous dysplasia, maxillofacial fibrous dysplasia, case report.

Helping Dental Students Make Informed Decisions About Private Practice Employment Options in a Changing Landscape

According to the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors, 45.3% of new graduates planned to enter private practice immediately after graduation; of those, while 65% planned to become an associate dentist in a private practice, 28.3% intended to enter a corporate group practice-the only category that saw an increase over the previous year. Current trends indicate that the number of new graduates choosing to enter some form of private practice without further education will continue to remain high, due in large part to the need to repay educational debt. In light of these trends, the question that must be asked is whether dental schools are optimally preparing students to make informed decisions regarding future employment options in the changing dental practice landscape. This article argues that dental schools should review their curricula to ensure graduates are being prepared for this changing environment and the increased business pressures associated with dental practice. Important considerations in preparing dental students to be successful in the process of selecting a practice model are identified.

The large zinc finger protein ZAS3 is a critical modulator of osteoclastogenesis

Background

Mice deficient in the large zinc finger protein, ZAS3, show postnatal increase in bone mass suggesting that ZAS3 is critical in the regulation of bone homeostasis. Although ZAS3 has been shown to inhibit osteoblast differentiation, its role on osteoclastogenesis has not been determined. In this report we demonstrated the role of ZAS3 in bone resorption by examining the signaling mechanisms involved in osteoclastogenesis.

Methodology/Principal Findings

Comparison of adult wild-type and ZAS3 knockout (ZAS3−/−) mice showed that ZAS3 deficiency led to thicker bones that are more resistant to mechanical fracture. Additionally, ZAS3−/− bones showed fewer osteoclasts and inefficient M-CSF/sRANKL-mediated osteoclastogenesis ex vivo. Utilizing RAW 264.7 pre-osteoclasts, we demonstrated that overexpression of ZAS3 promoted osteoclastogenesis and the expression of crucial osteoclastic molecules, including phospho-p38, c-Jun, NFATc1, TRAP and CTSK. Contrarily, ZAS3 silencing by siRNA inhibited osteoclastogenesis. Co-immunoprecipitation experiments demonstrated that ZAS3 associated with TRAF6, the major receptor associated molecule in RANK signaling. Furthermore, EMSA suggested that nuclear ZAS3 could regulate transcription by binding to gene regulatory elements.

Conclusion/Significance

Collectively, the data suggested a novel role of ZAS3 as a positive regulator of osteoclast differentiation. ZAS3 deficiency caused increased bone mass, at least in part due to decreased osteoclast formation and bone resorption. These functions of ZAS3 were mediated via activation of multiple intracellular targets. In the cytoplasmic compartment, ZAS3 associated with TRAF6 to control NF-kB and MAP kinase signaling cascades. Nuclear ZAS3 acted as a transcriptional regulator for osteoclast-associated genes. Additionally, ZAS3 activated NFATc1 required for the integration of RANK signaling in the terminal differentiation of osteoclasts. Thus, ZAS3 was a crucial molecule in osteoclast differentiation, which might potentially serve as a target in the design of therapeutic interventions for the treatment of bone diseases related to increased osteoclast activity such as postmenopausal osteoporosis, Paget's disease, and rheumatoid arthritis.

Impact energy absorption of three mouthguard materials in three environments

The objective of this study was to compare the impact energy absorption of three mouthguard materials in three environments. Thirty specimens with 12.7 cm x 12.7 cm x 4 mm dimensions were prepared for each material: ethylene vinyl acetate (EVA, T&S Dental and Plastics), Pro-form (Dental Resources Inc), and PolyShok (Sportsguard Laboratories). Ten specimens of each material were conditioned for 1 h at 37 degrees C in three environments: dry (ambient) condition, deionized water and artificial saliva. Specimens were impacted at 20 mph by a 0.5-inch diameter indenter containing a force transducer (Dynatup Model 9250 HV, Instron Corp), based upon ASTM Standard D3763. Energy absorption was determined from the area under the force-time curve during impact (approximately 5 or 7 ms depending on the material). Groups were compared using anova and the Tukey test. Energy absorption values, normalized to specimen thickness (mean +/- SD in J mm(-1)), were: (i) Dry: EVA 4.73 +/- 0.27, Pro-form 3.55 +/- 0.25, PolyShok 6.32 +/- 0.24; (ii) DI water: EVA 4.82 +/- 0.40, Pro-form 3.78 +/- 0.33, PolyShok 5.87 +/- 0.38; (iii) Artificial saliva: EVA 5.63 +/- 0.49, Pro-form 4.01 +/- 0.54, PolyShok 6.37 +/- 0.55. PolyShok was the most energy-absorbent material in all three environments. EVA was significantly more impact resistant than Pro-form in all three environments. EVA and Pro-form performed significantly better after saliva conditioning than dry or water conditioned, but PolyShok did not show any difference in energy absorption when conditioned in any of the three environments. Characteristic deformation patterns from impact loading were observed with an SEM for each material. The superior energy absorption for PolyShok is attributed to the polyurethane additive.