Journal of Dental Sciences最新文献

The shift towards virtual assessment in dental education represents a significant advancement over traditional evaluation methods, offering new opportunities for assessing both theoretical knowledge and practical skills. This review examines the use of virtual assessment tools within the context of dental education. A narrative literature review was conducted, analyzing studies published between 2000 and 2024, sourced from PubMed, the Cochrane Library, and Embase. From the initial search, 13 studies were selected for qualitative synthesis. The results indicate that virtual assessments, facilitated by technologies such as computer-based simulations and remote objective structured clinical examinations (OSCEs), have enhanced the accuracy and comprehensiveness of dental student evaluations. These methods allow for more consistent and objective assessments of competencies, addressing some limitations of traditional practical exams. However, the integration of virtual assessments presents challenges, including the need for significant investment in technology, infrastructure, and training for faculty and students. Despite these challenges, the review concludes that virtual assessment has the potential to become a cornerstone of modern dental education, offering a scalable and adaptable solution for evaluating dental competencies in diverse learning environments.

Background/purpose: This study aimed to evaluate the initial implementation of competency-based medical education (CBME) through entrustable professional activities (EPAs) in Taiwan dental education, focusing on tooth extraction EPAs across undergraduate year (UGY), postgraduate year (PGY), and oral and maxillofacial surgery-residency (OS-R) levels.

Materials and methods: Using the Delphi method, an advisory team developed and validated three levels of trial EPAs, which were implemented through the Emyway platform. A structured questionnaire was used to evaluate teachers' and students' experiences and satisfaction with Emyway and the EPAs. Data were collected from the participants at two university-affiliated hospitals in Taiwan. Statistical analyses comparing teachers' and students' experiences and satisfaction were conducted.

Results: The EQual rubric scores for the EPAs were high across all levels (UGY: 4.80, PGY: 4.78, R: 4.79) with no significant differences. The demographic characteristics and Emyway experiences were similar among 7 teachers and 17 students. No significant difference was observed in terms of satisfaction with EPA design and usage between the teachers and students. For the teachers and students, the overall Emyway satisfaction scores were 3.86 and 3.76 and the EPA content satisfaction scores were 4.00 and 3.71, respectively, with no significant differences.

Conclusion: The study successfully introduced EPAs into Taiwan dental education, demonstrating high EQual rubric scores and moderate satisfaction. Emyway is a convenient and effective platform for EPA implementation. Future efforts should focus on the expansion of EPAs to other dental specialties and integration of CBME into Taiwan dental education to align with international standards.

Background/purpose: Computer-assisted implant surgery (CAIS) is increasingly performed to reduce deviations in implant position. Dynamic CAIS or navigation systems provide instant display of implant drilling instruments and patient positions directly on the computer monitor. Augmented reality (AR) technology allows operators to visualize real-time information projected onto the lenses of AR glasses. Although AR is being used in medical applications, there are few clinical studies on applying AR glasses to dental implants. The purpose of this randomized clinical study was to compare the accuracy of implant position using the dynamic CAIS with and without AR glasses.

Materials and methods: Twenty patients who needed a single dental implant were randomly divided into two groups: combined dynamic CAIS with AR glasses (AR glasses group, n = 10) and dynamic CAIS without AR glasses (non-AR glasses group, n = 10). Three-dimensional (3D) deviations of implant platform, apex and angular deviations were measured and analyzed using independent t-tests (P < 0.05).

Results: The 3D angular deviations in the AR glasses and non-AR glasses groups were 1.47 ± 1.01° and 2.42 ± 0.76°, respectively. Mean 3D entry point and apical deviations were 0.75 ± 0.45 mm and 0.87 ± 0.45 mm in the AR glasses group, whereas the non-AR glasses group were 1.11 ± 0.44 mm and 1.18 ± 0.50 mm, respectively. There was no statistically significant difference between the two groups.

Conclusion: Implant position accuracy using dynamic CAIS with AR glasses was similar to dynamic CAIS without AR glasses during a single implant placement.

Oral and maxillofacial surgery (OMS) is a field that straddles knowledge and clinical experience from both medical and dental specialties. In the small island nation of Singapore, the rapidly and constantly changing needs of its diverse and aging population, as well as changes in the mindsets of both students and educators have led to many developments in the local OMS program. Tied to the only dental school in the country, the curriculum of the training program has kept up with the changes in the demographics and attitudes of the local patient pool, which comprises a multicultural population with both traditional and modern mindsets. Since its inception, the training program has also shifted away from the traditional apprenticeship model of surgical specialties to include more integrated and modular learning with a heavy emphasis on evidence-based medicine, simulation training workshops, and more focus on digital planning and other technological advancements. This review explores the current scope of training and practice in the Singapore landscape, and how it has evolved and been tailored to meet the needs of its patients and future clinicians.

Background/purpose: Spacing between teeth is a common trait across different stages of dentition. With the tide of the digital impression, the scanning trueness of the intraoral scanner (IOS) is a hot subject. This study aimed to determine the correlation between the level of the spaced dentition and trueness of the intraoral scanning.

Materials and methods: Four arch lengths of deciduous tooth models (spacing Model 1, Model 2, Model 3, Model 4 = 0, 1, 2, 3 mm; maxillary arch length = 73.268, 81.922, 90.776, 97.698 mm; mandibular arch length = 69.092, 76.160, 86.228, 94.344 mm) were designed to measure trueness via an IOS. Statistical analysis included one-way analysis of variance followed by post hoc Tukey tests for comparisons of the data.

Results: The trueness varied across different levels of spacing, with the highest deviation observed between intraoral and desktop scans in Model 3, followed by Model 4, Model 2, and Model 1 in the maxillary arch. In the mandibular arch, the sequence of deviation from highest to lowest was Model 4, Model 3, Model 1, and Model 2. Significant differences were observed among these models in both the maxilla and mandible (P < 0.001).

Conclusion: In both the maxilla (2 mm spacing, arch length ≥81.922 mm) and mandible (3 mm spacing, arch length ≥86.228 mm), scanning accuracy decreases with longer arch lengths. This indicates that as arch length increases, so does the deviation in scanning accuracy. Therefore, the clinician should notice the deviation when using IOSs for the spaced cases.

Background/purpose: Titanium (Ti) is extensively used in dental and orthopedic implants due to its excellent mechanical properties. However, its smooth and biologically inert surface does not support the ingrowth of new bone, and Ti ions may have adverse biological effects. The purpose is to improve the corrosion resistance of titanium and create a 3D structured coating to enhance osseointegration through a very simple and fast surface treatment.

Materials and methods: This study investigated the use of sandblasting, acid etching, and NaOH leaching to produce porous Ti implants with enhanced biological activity and corrosion resistance.

Results: These surface modifications generated a mixed oxide layer resembling the extracellular matrix (ECM), consisting of a dense amorphous TiO2 inner layer (50-100 nm thick) and a TiO2 outer layer with interconnected pores (pore size 50-500 nm; 150-200 nm thick). The inner layer significantly improved corrosion resistance, while the hydrophilic outer layer, with its porous structure, facilitated protein albumin adsorption and promoted the attachment, proliferation, and mineralization of human bone marrow mesenchymal stem cells.

Conclusion: The combined surface treatment approach of sandblasting, acid etching, and NaOH leaching offers a comprehensive solution to the challenges associated with titanium implants' biological inertness and corrosion susceptibility. By enhancing both the biological activity and corrosion resistance of Ti surfaces, this protocol holds significant promise for improving dental and orthopedic implants' success rates and longevity. Future studies should focus on in vivo assessments and long-term clinical trials to further validate these findings and explore the potential for widespread clinical adoption.

Background/purpose: Daily flushing of dental unit waterlines is important for infection control. However, the effect of flushing on water quality management in portable dental units (PDUs) for mobile dental treatments remains unclear. In this study, we aimed to investigate the factors affecting the effectiveness of PDU flushing.

Materials and methods: Free residual chlorine concentration (FRCC) and heterotrophic plate counts (HPCs) in handpiece discharge water were evaluated as water quality indicators to determine the effectiveness of flushing PDUs, considering flushing duration, periods of PDU use, FRCC in the water used, pre-water drainage in water tanks and waterlines, and season. The effect of flushing on heterotrophic bacterial flora was analyzed by 16S rRNA gene sequencing.

Results: PDUs with longer usage periods required a longer flushing duration for FRCC recovery. FRCC reached the standard level for water quality in Japan after at least 20 s of flushing. Flushing changed heterotrophic bacterial flora close to that of fresh tap water by reducing Sphingomonas. Flushing with purified water or stagnant tap water with insufficient FRCC did not allow the HPCs to reach the target level. Without pre-water drainage of the water tanks and waterlines in the summer, the HPCs did not always reach the target level, even with flushing.

Conclusion: Periods of PDU use, pre-water drainage, water temperature, and FRCC substantially affect the effectiveness of PDU flushing. Flushing for at least 20 s with water containing appropriate free residual chlorine effectively restores the water quality of PDUs.

Background/purpose: Dysbiosis of oral microbiota has been reported in late stage of chronic hepatitis B (CHB) infection with cirrhosis. CHB is characterized by the constant virus-induced liver injury which may lead to liver cirrhosis and hepatocellular carcinoma (HCC). However, some patients show normal liver function without antiviral treatment, associating with favourable prognosis. The oral microbiota composition and oral health status in these patients is unidentified.

Materials and methods: The study focuses on the composition of oral microbiota and oral health status in individuals with CHB and HBV vaccinees as controls. The CHB patients were hepatitis B 'e' antigen (HBeAg)-negative, with or without elevated liver enzyme increase at time of sampling, The 16S rRNA high-throughput sequencing and bioinformatic analysis were applied to investigate oral bacterial diversity, and oral examination including decay-missing-filled teeth (DMFT) index, probing depth (PD) and mucosal status was performed, along with oral health questionnaire, to assess the oral health status in CHB patients and healthy controls.

Results: Our results indicate that their oral microbiome compositions are not significantly different though some have increased ALT/AST liver enzyme levels at the time of sampling, compared to the healthy control participants who are vaccinated e.g. protected from this viral disease. CHB patients here bore a good oral health status and life-style habits as comparing to healthy controls.

Conclusion: These findings suggest that a health-associated salivary microflora is present in CHB without severe liver injury. Continued regular dental health and lifestyle support in liver disease patients is therefore justified.

Background: /purposeSince 1995, Taiwan's National Health Insurance (NHI) has offered a comprehensive dental coverage to over 99 % of the population. This study mainly analyzed the dental service utilization and expenditure trends by the gender, age, and service type and evaluated the resource allocation across different demographics from 2000 to 2020.

Materials and methods: Nationwide NHI administrative data were used to assess the dental visit rates, average visits per user, and per capita expenditure by the gender, age, and 11 service categories for the years 2000, 2005, 2010, 2015, and 2020. The analysis accounted for the fluctuations in the point value within the global budget system and calculated the dental expenditure across the demographic groups and service types.

Results: The dental visit rates increased across all demographics, with the most substantial growth in the 0-14 age group (37.0 % in 2000 to 66.9 % in 2020). However, the visit rates for the older adults remained low at 39.5 % in 2020. Although the per capita expenditure rose significantly, the disparities persisted, with lower spending for the 65+ age group (58.5 USD) compared to the children (64.6 USD) in 2020. Operative dentistry and endodontic treatment expenditures showed declines in spending share, while preventive care and periodontal treatment expenditures increased.

Conclusion: While Taiwan has made progress in increasing the dental utilization, especially for the children, challenges remain in improving access for the older adults. Policy adjustments are needed to enhance the dental care according to the diverse oral health needs of the different age groups.

Background/purpose: The postgraduate year training program for dentists (PGYD) provides the comprehensive clinical training to bridge the gap between the academic education and the hands-on clinical practice. This study mainly explored the influence of training institutions on the future dental practice choices (in clinics or hospitals) after the completion of the PGYD program in Taiwan.

Materials and methods: A nationwide, register-based cohort analysis was conducted on all 3,966 PGYD trainees from July 2010 to April 2023. Data on the training time, institution type, and demographic characteristics were extracted from the PGYD and dentist registration systems. Chi-square tests and t-tests were used to assess the differences in the future dental practice choices and the PGYD training variables.

Results: For the PGYD training institutions, the dental clinics increased substantially, while the medical centers and teaching hospitals declined. The trainees who spent more time in the dental clinics were more likely to practice in the dental clinics, while those trained in the hospitals were more likely to choose the hospital-based practice (P < 0.001). The male dentists were more likely to practice in the dental clinics and the female dentists were prone to practice in the hospitals (P < 0.001).

Conclusion: The type and duration of the PGYD training significantly influence the future dental practice choices, with trainees who undergo more clinic-based training tending to choose dental clinic practice. However, the hospital-level training remains crucial for the specialty development, and further policy efforts are needed to improve the imbalance in the dentist distribution.