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PubMed1996

A qualitative investigation of factors governing dentists' treatment philosophies.

The day to day decisions made by general dental practitioners have a significant influence on the oral health of the population, and yet are often poorly understood. This paper describes a qualitative study which sought to identify issues, other than the extent of pathology, which impinge upon dentists' restorative treatment decision making. It also aimed to develop a classification of these issues. Content analysis of in-depth interviews with 20 randomly selected general dental practitioners delineated 10 broad areas of concern. While each of these topics may influence a treatment decision to a greater or lesser degree, the issues relating to treatment planning can be divided into a classification which involves patient, profession and practitioner characteristics. This study indicates that an understanding of disease processes and of available treatment options is an insufficient basis for treatment decision making, as many considerations outside these straightforward concepts of health are brought to bear on decisions made within the dental surgery.

Clinical Competence↗
PubMed1999

Longevity of new hybrid restorative materials in class III cavities.

The aim of this study was to evaluate the durability of two new tooth-colored restorative materials, a polyacid-modified resin composite (compomer) and a resin-modified glass ionomer cement. In an intra-individual comparison with a resin composite, the materials were studied during a 5-yr period. In 50 patients, 154 large class III restorations were placed. Most patients received one of each of the three materials. The restorations were evaluated by modified United States Public Health Service (USPHS) criteria. Of the 144 restorations evaluated, 15 were found unacceptable. No significant differences were seen between the materials concerning recurrent caries incidence. The resin composite showed a significantly better color match. No difference was found between resin composite fillings in enamel- or total-etched cavities. Significantly higher surface roughness was found in the aged resin-modified glass ionomer cement restorations. Fracture of the incisal enamel corner was observed adjacent to 10 restorations. None of the three total-etch techniques resulted in postoperative sensitivity or loss of vitality. All the restorative techniques showed a low failure rate during the 5-yr follow-up.

Acid Etching, Dental↗
PubMed1998

Long-term strength of aesthetic restoratives.

Glass-ionomer cements have established an important role in clinical dentistry since their introduction over 20 years ago. More recently, in an attempt to enhance the strength of the material, resin additions have been made to conventional glass-ionomer cements. This study established the long term flexural strength of two hybrid glass-ionomer cements, by use of a bi-axial flexural strength test (Shell test), and compared the values with those obtained for a light curing composite resin and a conventional glass-ionomer cement. The results demonstrated that those materials with a high resin component relying on polymerization as the main method of setting had a greater initial flexural strength than those with little or no resin addition. Those materials where the glass-ionomer acid-base reaction provided a substantial contribution to the setting reaction showed an increase in strength as they matured, whereas a decline in strength with time was observed for those materials where the resin setting reaction predominated.

Acrylic Resins↗
PubMed2002

The effects of mouthrinses on microhardness and colour stability of aesthetic restorative materials.

Detrimental effects exerted on oral and dental tissues by frequent mouthrinse use are observed, but studies about their effects on aesthetic restorative materials are limited. In this study, the purpose was to examine the effects of three proprietary mouthrinses on three different aesthetic restorative materials. Mouthrinses were used as treatment groups, while distilled water served as the control. From a total of 72 specimens, each experimental group consisting of 24 samples were prepared from each restorative test material by using metal moulds. The samples were stored in 20 mL of one of the mouthrinses for 12 h, which was reported as the equivalent time to 1 year of 2-min daily mouthrinse use. Changes between baseline and after treatment measurements of surface microhardness and colour of the test materials were established by using Vickers microhardness tester and spectrophotometer. Statistical analyses were performed by analysis of variance (anova), with Bonferroni correction. The level of significance was set as 0.05 in all tests. There were no significant interactions between the test solutions and the test materials with regard to microhardness (P > 0.05), and colour changes of the materials (P > 0.05). Effects of mouthrinses on restorative materials may differ depending on many in vivo factors that could not be replicated in vitro. Therefore, routine assessment of the effects of mouthrinses on aesthetic restorative materials is recommended.

Analysis of Variance↗
PubMed1998

Reducing variability in treatment decision-making: effectiveness of educating clinicians about uncertainty.

The objective of this study was to investigate whether or not education about the concept of uncertainty reduced variability in treatment decision-making. Three small groups of dentists in North York, Canada were asked to make restorative treatment decisions about simulated bitewing radiographs. They subsequently took part in a seminar about variations in perception and judgement and were given explanations of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. A repeat reading of the radiographs was then performed by both test and control groups. Results indicated that the intervention increased the accuracy, and decreased the variability of dentists' restorative treatment decisions. Kappa statistics were 0.33, 0.34 and 0.31 before the seminar, and 0.40, 0.43 and 0.41 after the seminar. Standard errors for kappas were 0.06, 0.05 and 0.05 before the seminar, and 0.02, 0.02 and 0.05 after the seminar. The area under the ROC curve was 0.7136 before the seminar and 0.7835 after the seminar. The data demonstrate that the dentists' decisions were less variable and more accurate following the educative intervention. This study suggests that there is potential for improving consistency and accuracy in clinical decision-making through education in probabilistic reasoning.

Adult↗
PubMed2001

From amalgam to composite: selection of restorative materials and restoration longevity in Finland.

The aim of this study was to obtain information on restorative dental care in Finland and to analyze the changes in treatment over a 5-year period. A random sample of dentists was drawn from the registers of the health authorities and the dental association in Finland, and in the spring of 1997 a questionnaire was sent requesting the dentists to record information for each restoration placed during a given period. A total of 1,229 dentists were contacted, and 659 responded. The dentists treated 5,305 adults during the study period and placed 6,322 restorations. The most common restorative material was composite resin, which was used in 74.9% of the restorations, whereas amalgam was used in 4.8% and glass ionomers in 9.4% of the restorations. The median ages of failed restorations were nearly 12 years for amalgam, slightly less than 5 years for composite, and slightly more than 4 years for glass ionomer. The results indicate that clinical dentistry in Finland has made a definite step towards the post-amalgam era. However, the functional periods of the failed tooth-colored restorations were disappointingly short and warrant some serious consideration.

Adolescent↗
PubMed2004

Dental treatment needs of children in a rural subcounty of Uganda.

OBJECTIVES: To describe normative dental treatment needs of 5-7 and 12-year-olds in a rural sub county of Uganda and devise a strategy to improve oral health. DESIGN: Clinical survey. SETTING: Primary schools in the subcounty. SAMPLE AND METHODS: School-based random cluster sample of 236 5-7-year-olds and 202 12-year-olds. Dental status and treatment need data were collected according to WHO Oral Health Surveys Basic Methods. Additional data for 12-year-olds included dental fluorosis using the Thylstrup and Fejerskov index (TFI), oral hygiene procedures and experience of oral pain in the previous month. RESULTS: In the 5-7-year-olds, mean dmft was 1.47 (50.8% dmft = 0). A total of 52.5% needed fillings and almost one third needed a tooth extracted. Among the 12-year-olds, mean DMFT was 0.64 (65.8% DMFT = 0), 28.5% had dental fluorosis and 6.7% had TFI > 2. Toothache in the previous four weeks was reported by 36.5%, 30.2% needed a filling and 6.4% needed one or more teeth extracted. CONCLUSIONS: Dental disease is a significant public health problem in this population. An efficient way to meet the needs of the children would be to increase the availability of fluoride toothpaste and to develop a service to provide treatment using Atraumatic Restorative Technique.

Adolescent↗
PubMed1990

Diagnosis of caries and treatment decisions in approximal surfaces of posterior teeth in vitro.

The diagnosis of caries and treatment planning decisions have been reported to vary widely between individual dentists. However, opinions differ as to whether, in general, this results in too much or too little treatment. Eighty-six dentists, mainly attending post-graduate meetings, participated in this study. They were asked to make diagnostic and treatment planning decisions on a selection of extracted teeth set in realistic contact with each other. These decisions were compared with the appearance of the proximal surfaces before setting the teeth in contact, and the histological appearance of the teeth that were sectioned after the dentists had made their decisions. Opinions as to whether caries was present and whether it required treatment showed a wide distribution. However, had the decisions been acted upon, between 1-6% of the sound surfaces would have been filled, but 20-68% of teeth with clearly cavitated surfaces or histological evidence of dentine involvement would not have been filled.

Bicuspid↗
PubMed2004

The influence of some different factors on the accuracy of shade selection.

The purpose of this study was to elucidate some of the factors on which accurate shade taking depends. Custom shade tabs (0.5, 1.0 and 1.5 mm porcelain thickness) were fabricated from selected Vita and Shofu porcelains. Four main factors were investigated, namely, the difference between the two types of porcelain used, the effect of light quality, the effect of porcelain thickness and the experience of the observer. The chi-square test for independence at a probability level of P <0.05 was used to analyse the results. The results indicated that in ideal light there was no difference between the two porcelains (P=0.58). The experienced observers proved better than the novice observers in ideal light conditions (P=0.003). Thickness was also significant in the overall results (P=0.0001), in that thicker samples gave more accurate results. The results indicate that in adverse light, there was an overall difference between the two porcelains (P=0.046), but no difference between the experienced and novice observers. The thickness made no difference to the experienced or the novice observer in adverse light. These results indicate that the most influential factor on shade taking was the light quality (P <0.0001); better results were obtained overall for the ideal light situation. In ideal light thicker samples gave better results (P=0.0001).

Clinical Competence↗
PubMed1988

Replacement of amalgams with crowns: a cost-effectiveness analysis.

No formal analyses comparing the treatment alternatives of replacing a failed amalgam with either another amalgam or crown have been done to determine the optimum treatment strategy based on lifetime costs to the patient. Using decision analysis, a computer model was developed of the lifetime restorative needs of an adult's posterior tooth. A cost-effectiveness analysis of large amalgams vs crowns was then done to determine the optimum strategy. According to the analyses, the optimum treatment decision is to attempt to replace the failed first amalgam with another amalgam, instead of with a crown. When this amalgam restoration fails, then the subsequent replacement may be with a crown. Potential lifetime cost savings were between 11% and 24% if the first replacement was an amalgam. This study concludes that the technique of decision analysis provides the dental community with an effective evaluation tool for the study of clinical decision-making, taking into account all levels of clinical uncertainty.

Adult↗
PubMed1991

Objective and subjective need for cosmetic dentistry in the Dutch adult population.

In order to assess the objective and subjective need for cosmetic dentistry in the Dutch adult population in 1986 a stratified sample of 2784 dentate persons, aged 15-74 yr, participated in the study. The aesthetics of anterior teeth and first premolars in the maxillary mandibular arch were determined by dental examiners as well as by the examinees. According to the dental examiners 16-63% of the people in the age range from 15 to 74 yr were in need of cosmetic dental care. Based on the patient's opinion (subjective need) these percentages varied between 18 and 40% in the different age groups. The discrepancy between the objective and subjective assessment in the percentage of people in need of cosmetic dental care increased with age.

Adolescent↗
PubMed2004

Combined technique with polyethylene fibers and composite resins in restoration of traumatized anterior teeth.

Traumatized anterior teeth need quick esthetic and functional repair. Esthetic requirements of anterior teeth require the use of composite materials which, in the most complex cases, can be used in association with fibers so as to improve their mechanical resistance. Many kinds of fibers are available. The authors considered parameters such as physical properties, water absorption, ease of cutting and of laying. Polyethylene fibers appear to have the best properties in elasticity, translucency, adaptability, tenaciousness, resistance to traction and to impact. Fifteen children, between 7 and 13 years old, with crown fractures of the anterior sector were treated. In the case of a simple crown fracture, the missing part was restored by polyethylene fibers and composite resins. In the case of a complex crown fracture needing endodontic treatment, the fibers were used as a central core stump in order to restore the dental morphology. At control examinations, the teeth restored by this technique were acceptable, both in function and in aesthetics. Thus, the authors recommend this combined technique for predictable restoration of traumatized anterior teeth.

Adolescent↗
PubMedDate not supplied

The invisible Class IV restoration.

Advances in bonding technology have allowed the dentist to create truly esthetic restorations. However, some clinical situations still present difficult esthetic challenges. A common area of difficulty is the maxillary Class IV, where the interface between restorative material and tooth structure is frequently visible. Using a combination of composite resins, the authors present a technique for solving this problem to create esthetic, natural-looking Class IV restorations.

Adult↗