Abstract
Motivations and experiences among dentists in rural private practice: A qualitative study
Prouty Z, Reynolds JC, Askelson N. J Public Health Dent. 2023;83(3):265-274. doi: 10.1111/jphd.12575. Epub 2023 Jun 18.
Objectives
Despite the critical importance of access to dental care for rural residents and concerns about a shrinking rural dentist workforce, few studies have examined rural dentist motivations to practice in rural areas. The aim of this study was to explore practicing rural dentists’ motivations and experiences qualitatively through semi-structured interviews to help inform and guide recruitment and retention efforts in rural areas.
Methods
Dentists were included in the sample frame if they were general dentists in private practice and had a primary practice located in a rural Iowa county. Rural dentists with publicly available email addresses were contacted by email to participate. Semi-structured interviews were administered to 16 private practice general dentists. All interviews were audio recorded, transcribed, and coded using pre-set and emergent codes.
Results
Participants were most commonly male (75%), under age 35 (44%), white (88%), and practiced in a partnership arrangement (44%). The main codes regarding dentists’ experiences and motivations to practice in a rural area included familiarity with a rural area, community, financial factors, and clinical care delivery. Having been raised in a rural area was a major influence in most dentists’ decisions about where to locate.
Conclusions
The importance of rural upbringing in this study underscores the need to consider rural upbringing in dental student admissions. Additional findings, such as financial benefits of a rural practice and other practice-related factors can be used to inform recruitment efforts.
Copyright © 2023 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals LLC on behalf of American Association of Public Health Dentistry. Reproduced with permission.
Factors associated with the outcome of root canal treatment–A cohort study conducted in a private practice
Juricˇ R, Vidmar G, Blagus R, Jan J. Int Endod J. 2024 Jan 20. doi: 10.1111/iej.14022. Online ahead of print.
Aim
To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome.
Methodology
In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1–4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ⩽2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations.
Results
1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7–82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01–0.24]), root PAI (OR = 0.29[0.20–0.42], 0.21[0.13–0.34] and 0.22[0.12–0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21–0.43] and 0.24[0.16–0.37] for diameters of 1–5 mm and ⩾6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27–0.97] and OR = 0.45[0.24–0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43–0.94]) and two canals per root (OR = 0.67[0.54–0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08–0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26–0.75] and 0.62[0.40–0.97] respectively), resin sealer (OR = 0.58[0.39–0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21–0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21–0.56]).
Conclusion
The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.
Copyright © 2024 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society. Reproduced with permission.
Present status and future directions: The restoration of root filled teeth
Bhuva B, Austin R, Ferrari P, et al. Int Endod J. 2022;55(Suppl 4):1059-1084. doi: 10.1111/iej.13796. Epub 2022 Jul 19.
This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long-term survival. To obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic-restorative procedures on restoration and tooth longevity. Furthermore, the currently available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has. Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence. However, conceptually, minimally invasive endodontic-restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness of the preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well-designed prospective clinical studies.
Copyright © 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society. This is an open access article distributed under the terms of the Creative Commons CC BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0.
Treatment of cracked teeth: A comprehensive narrative review
Whitworth J, Gavriil D, Kakka A. Clin Exp Dent Res. 2022;8(5):1218-1248. doi: 10.1002/cre2.617. Epub 2022 Jul 9.
Objectives
The term “cracked tooth” is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up-to-date comprehensive overview regarding the treatment of cracked teeth.
Materials and methods
An electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several “Grey literature” sources up to February 22nd 2022 using a combination of pre-specified ‘free-text’ terms (keywords) and “subject headings.” The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow-up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full-text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers.
Results
In total, 64 articles were selected for inclusion in this narrative review.
Conclusions
Cracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non-cracked root filled teeth.
Copyright © 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons CC BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0.
Considerations for predictable outcomes in static computer-aided implant surgery in the esthetic zone
Markovic J, Peña-Cardelles JF, Pedrinaci I, et al. J Esthet Restor Dent. 2024;36(1):207-219. doi: 10.1111/jerd.13171. Epub 2023 Nov 29.
Objective
To provide technical and clinical recommendations for implementing a digital workflow in Static Computer-Aided Implant Surgery in the anterior maxilla.
Clinical considerations
An optimal 3D implant position is crucial for achieving satisfying results in implant rehabilitation in the esthetic area. Due to its complexity, implant placement in the esthetic zone should be executed with precision and predictability. Static Computer-Aided Implant Surgery requires thorough planning and detailed attention to every step of the digital workflow protocol.
Conclusions
Implant positioning in the esthetic zone using Static Computer-Aided Implant Surgery is a technique-sensitive procedure that requires precise execution of each step. This approach ensures accurate prosthetically driven 3D implant placement and prevents potential errors that could lead to inaccurate positioning.
Clinical significance
The proper implementation of Static Computer-Aided Implant Surgery may increase the level of agreement between the planned and definitive implant 3D positions in the esthetic zone, thus enhancing the esthetic outcomes of implant rehabilitation.
Copyright © 2023 Wiley Periodicals LLC. Reproduced with permission.
Accuracy of computer-aided design trial restorations fabricated with different digital workflows
Taha D, Allam S, Morsi T. J Prosthet Dent. 2023:S0022-3913(23)00650-9. doi: 10.1016/j.prosdent.2023.09.034. Online ahead of print.
Statement of problem
Trial restorations are a versatile tool for visualizing the esthetic treatment plan and should be an accurate replica of the planned smile design. The accuracy of conventionally fabricated trial restorations has been investigated; however, studies on the accuracy of different digital workflows for trial restoration fabrication are lacking.
Purpose
The purpose of this in vitro study was to evaluate the accuracy of computer-aided design (CAD) trial restorations fabricated with different digital workflows.
Materials and methods
A patient in need of additive esthetic treatment was examined, and intraoral and extraoral photographs and intraoral digital scans were made, followed by 3D digital smile design using the exocad software program. The reference virtual design was converted into trial restorations (N=40) by using different digital workflows: subtractive manufacturing, additive manufacturing, additive manufacturing of 3D designed index, and silicone index on an additively manufactured cast. Fabricated trial restorations of all groups were scanned with a desktop scanner, providing a standard tessellation language (STL) file serving as the test data for each trial restoration. All the STL files of the test and reference data were imported into a reverse engineering software program to evaluate the 3D trueness of each workflow. Also, analog and digital 2D linear measurements (maxillary left central incisor height, maxillary left central incisor width, and intercanine width) were made to assess any dimensional alterations between the fabricated trial restorations and the reference digital smile design. A 1-way analysis of variance (ANOVA) was used to analyze the data followed by the Tukey post hoc test (α=.05).
Results
For 3D trueness measurements, root mean square (RMS) values representing the deviations between the fabricated trial restorations and the reference digital smile design varied significantly among the different groups (P<.001), with the highest mean deviation found in the group of additive manufacturing of 3D designed index (0.21 ±0.01 mm), while the lowest mean value of deviation was found in the group of subtractive manufacturing (0.11 ±0.02 mm). For both the digital and analog 2D linear measurements, post hoc pairwise comparisons showed the group of additive manufacturing of 3D designed index to have significantly higher values of deviation than the other groups in all assigned measurements (P<.001).
Conclusions
The accuracy of CAD trial restorations was affected by the fabrication technique, and implementing conventional steps in the digital workflows of trial restoration fabrication may result in discrepancies that affect accuracy when compared with the reference design.
Copyright © 2023 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved. Reproduced with permission.