A Classroom Practice and Assessment Resource for Dental Clinical Treatment Planning

Introduction

Dental students' opportunities to practice clinical treatment planning prior to the clinical experience are often limited. This resource permits students to practice treatment planning in the classroom and allows the instructor to efficiently provide feedback to a large number of students.

Methods

I developed a computer-based treatment plan worksheet (Microsoft Excel, Google Sheets, or Qualtrics) consisting of four sequence steps and a list of Common Dental Terminology (CDT) codes. I implemented this educational activity in the Case Management and Treatment Planning course (second year, spring quarter). The course included 10 weekly sessions of 1 hour each. I gave students a practice case at the beginning of the course. They submitted comprehensive sequenced treatment plans as assignments using the Qualtrics treatment plan worksheet 2 days after the interdisciplinary treatment planning didactic session. In the subsequent debrief session, I discussed the case with the entire class and focused on themes observed from the students' performance on the assignments.

Results

I graded all students' submissions (n = 87) using CDT codes both with and without consideration of sequence steps and observed variations in students' performance. Many students (n = 36, 41%) opted to give feedback through an anonymous survey, with 88%-96% of them agreeing or strongly agreeing that the educational activity allowed them to practice, demonstrate their knowledge, and improve their skills in treatment planning.

Discussion

This computer-based worksheet lets students practice clinical treatment planning in the classroom and allows the instructor to effectively assess a large number of students' assignments.

Phosphoric Acid Etch Partially Restores the Initial Bond Strength of Composite to Silver Diamine Fluoride-Treated Enamel Using Universal Adhesives

BACKGROUND

Restoring bonding composite to silver diamine fluoride (SDF)-treated enamel is challenging. This study investigates if phosphoric acid etch restores composite bond strength to SDF-treated enamel using universal adhesives.

METHODS

Twenty-four recently extracted permanent teeth were randomly divided into 4 (2 experimental (SDF) and 2 control (CTR)) groups: SDF+Water: SDF (1 min) then water rinse (15 mL); CTR+Water: no treatment and water rinse (15 mL); SDF+Etch+Water: SDF (1 min), 35% phosphoric acid (40 s) then water rinse (15 mL); CTR+Etch+Water no treatment, 35% phosphoric acid (40 s) then water rinse (15 mL). The enamel surface in all the groups was bonded (All-Bond Universal) to 4-5 mm composite blocks (Z-250). Each sample was sectioned, and 6-8 beams (1 mm × 1 mm) were selected. The micro-tensile bond strength was measured by dividing the micro-tensile force peak by the adhesive surface area. Univariate ANOVA and Chi-square were used for between-group comparisons with p < 0.05.

RESULTS

SDF+Water had significantly lower tensile strength compared to all the groups (p < 0.05). Although no difference was found in the tensile strength between the SDF+Etch+Water and the CTR+Etch+Water, the SDF+Etch+Water had significantly more adhesive failures compared to the CTR+Etch+Water (p = 0.047).

CONCLUSIONS

While phosphoric acid etch seems to restore the initial composite bond strength to SDF-treated enamel, the long-term success of composite restorations bonded to SDF-treated enamel may need further investigation.

Can students develop clinical competency in treatment planning remotely through flipped collaborative case discussion?

INTRODUCTION

Effectiveness of flipped learning in clinical education is unknown. This study evaluates the effectiveness of remote case-based learning for teaching clinical treatment planning compared with traditional in-person clinical experience.

MATERIALS AND METHODS

Four cases containing medical and dental charts were discussed through flipped learning with faculty panel during the COVID-19 lockdown. Prior to each session, students worked individually or in groups to complete assignments with leading questions. After the final assignment, students completed a survey to rate the learning experience from each case, compare the remote experience with the previous in-person clinical experience and provide suggestions to improve remote clinical instruction in the future. Students' performance measured by the number of case assessments and competencies completed post-lockdown was compared with pre-lockdown and the previous year using odd ratio (OR), Chi-squared test (χ2) and significant level p < .05.

RESULTS

A total of 106 students completed the course, and 99 students completed all survey questions. Students reported positive learning experiences (overall mean = 7.84, SD = 1.11). Post-lockdown, statistically significant increase in the proportions of total passed attempts (χ2 p = .002, OR = 2.23), competencies (χ2 p = .028, OR = 2.05) and case assessments (χ2 p = .004, OR = 2.73) was observed between the current class and the previous pre-COVID-19 class (108 students). Post-lockdown, students also passed significantly more attempts (χ2 p < .0001), competencies (χ2 p < .0001) and case assessments (χ2 p = .008) compared with pre-lockdown.

CONCLUSIONS

Although a flipped classroom does not replace in-person clinical experience, teaching clinical treatment planning remotely improved students' readiness and clinical performance through collaborative learning, practice and case exposure.

Radiographic Changes to Silver Diamine Fluoride Treated Carious Lesions after a Rinsing Step

Silver diamine fluoride (SDF) is radiopaque. This in vitro study compares the changes in the radiopacity of carious lesions after SDF application, potassium iodide (PI) application, and water rinse. Ten recently extracted human teeth were sectioned and divided into two groups (n = 10 in each group): Group 1 = SDF, Group 2 = SDF + PI. Teeth in Group 1 received SDF for 1 min and rinsed with 15 mL water. Group 2 received the same protocol with the addition of PI application for 1 min after SDF application. All samples were scanned with micro-computed tomography before SDF application, after SDF application, after PI application (group 2) and after water rinse. The radiopacity of the carious lesions increased significantly after SDF application in Group 1 and 2 (p < 0.017, p < 0.008, respectively). A significant increase in radiopacity after PI application was also observed in Group 2 (p < 0.008). Water rinsing significantly decreased the radiopacity in Group 1 and 2 (p < 0.017, p < 0.008, respectively), but the radiopacity remained significantly higher than the preoperative values (Group 1 p < 0.017, Group 2 p < 0.008). The radiopacity of carious lesions increases after SDF and SDF + PI applications. Water rinsing could reduce the radiopacity of SDF and SDF + PI treated carious lesions, and might reduce the content of SDF in carious lesions.

Genotype and malocclusion in patients with osteogenesis imperfecta

OBJECTS

To investigate the relationship between genotype and severity of malocclusion in osteogenesis imperfecta (OI).

SETTING AND SAMPLE POPULATION

A total of 49 patients participated in this cross-sectional study (age range: 5-19 years; 28 females; diagnoses: OI type I, N = 7; OI type III, N = 11; OI type IV, N = 27; OI type V, N = 2; OI type VI, N = 2).

MATERIALS AND METHODS

Sequence analysis of COL1A1/COL1A2 and other OI-related genes was compared to the Peer Assessment Rating (PAR), an index reflecting the severity of malocclusion.

RESULTS

The mutation spectrum was as follows: COL1A1, N = 22; COL1A2, N = 22, IFITM5, N = 2; SERPINF1, N = 2; no mutation detected, N = 1). Compared to patients with COL1A1 mutations, patients with COL1A2 mutations had significantly higher scores for total PAR, anterior cross-bite, anterior open bite and anteroposterior buccal occlusion. Males with COL1A2 mutations had significantly higher total PAR scores than females (median 36 vs 30, P = .047, Mann-Whitney test). Exploratory correlation between age and buccal vertical occlusion was noted in patients with COL1A2 mutations (Spearman correlation: r = .46, P = .03, power = .50). Two patients with OI type V (caused by IFITM5 mutations) had total PAR scores of 44 and 21. Both patients scored high for "segment." Patients with OI type VI (due to SERPINF1 mutations) scored similar to OI type V for "centreline." Considerable difference was observed in the total PAR score between the 2 patients with OI type VI. They had total PAR of 43 and 2.

CONCLUSION

Type of disease-causing mutation affects the severity of malocclusion in individuals with OI.

Profile of bacteria colonizing the exposed bone of patients with anti-osteoclastic drug-related osteonecrosis of the jaws

Microbial etiology for anti-osteoclastic drug-related osteonecrosis of the jaw (ARONJ) was suggested. This study investigates any link between bacteria colonizing ARONJ sites and other oral cavity sites. Microbiota samples of 10 ARONJ patients were collected from the exposed bone, adjacent teeth, contralateral teeth, and tongue. DNA checkerboard hybridization was used for microbiota analysis with 43 genomic DNA probes prepared from human oral bacterial (38) and candida (5) species, using Socransky's bacterial complexes as a guide. The frequency and the mean proportion of each bacterial species were used. Eikenella corrodens, Streptococcus constellatus, and Fusobacterium nucleatum were dominant in the ARONJ sites and detected in most teeth samples. Staphylococcus aureus was also dominant in the ARONJ sites and tongue. Significant correlations were found between the mean proportions of bacterial species colonizing adjacent teeth, contralateral teeth, and tongue (p < 0.001, R(2) > 0.69). No significant correlation (p > 0.05, R(2) < 0.025) was found between bacteria colonizing ARONJ sites and other evaluated sites. Within the study limitations, it was concluded that the primary sources of microorganisms colonizing ARONJ sites could be other sites such as teeth and tongue. The microbial profile of the necrotic bone is predominantly colonized with bacteria from Socransky's green and orange complexes, as well as with species associated with bone infections.