Evidence based dentistry

An ideal all-ceramic restoration that conforms well and demonstrates enhanced biocompatibility, strength, fit, and esthetics has always been desirable in clinical dentistry. However, the inherent brittleness, low flexural strength, and fracture toughness of conventional glass and alumina ceramics have been the main obstacles for extensive use. The recent introduction of zirconia-based ceramics as a restorative dental material has generated considerable interest in the dental community, which has been expressed with extensive industrial, clinical, and research activity. Contemporary zirconia powder technology contributes to the fabrication of new biocompatible all-ceramic restorations with improved physical properties for a wide range of promising clinical applications. Especially with the development of computer-aided design (CAD)/computer-aided manufacturing (CAM) systems, high-strength zirconia frameworks can be viable for the fabrication of full and partial coverage crowns, fixed partial dentures, veneers, posts and/or cores, primary double crowns, implant abutments, and implants. Data from laboratory and clinical studies are promising regarding their performance and survival. However, clinical data are considered insufficient and the identified premature complications should guide future research. In addition, different zirconia-based dental auxiliary components (i.e., cutting burs and surgical drills, extra-coronal attachments and orthodontic brackets) can also be technologically feasible. This review aims to present and discuss zirconia manufacturing methods and their potential for successful clinical application in dentistry.

The objective of this manuscript is to provide an overview of currently accepted, evidence-based and/or expert opinion recommendations for the prevention and management of dental caries in dental practice. Discussions are centered on current concepts for caries lesion detection (e.g., cavitated and non-cavitated lesions) and diagnosis (e.g., active vs. arrested lesions), including thresholds for non-surgical (e.g., fluorides, sealant) and surgical (i.e., restorative) interventions, risk assessment, and a review of caries management interventions for caries disease management. The goal is to prevent and manage the caries disease process using patient-centered, risk-based interventions supported by the best available evidence, taking into account the dentist's clinical expertise and the patient's treatment needs and preferences, in order to maintain or re-establish health and preserve tooth structure.

Jan. 7 through 9, 2011, the California Dental Association Foundation hosted a symposium on caries management by risk assessment in which a diverse range of stakeholders from across the nation gathered to discuss current and future status of CAMBRA. The consensus of the group was to develop a national strategic plan for CAMBRA implementation which will chart the course to improve the standard in caries disease management within the next decade. This paper represents the initial start of this living document.

An ideal all-ceramic restoration that conforms well and demonstrates enhanced biocompatibility, strength, fit, and esthetics has always been desirable in clinical dentistry. However, the inherent brittleness, low flexural strength, and fracture toughness of conventional glass and alumina ceramics have been the main obstacles for extensive use. The recent introduction of zirconia-based ceramics as a restorative dental material has generated considerable interest in the dental community, which has been expressed with extensive industrial, clinical, and research activity. Contemporary zirconia powder technology contributes to the fabrication of new biocompatible all-ceramic restorations with improved physical properties for a wide range of promising clinical applications. Especially with the development of computer-aided design (CAD)/computer-aided manufacturing (CAM) systems, high-strength zirconia frameworks can be viable for the fabrication of full and partial coverage crowns, fixed...

To summarize the potential benefits and risks of maxillofacial cone beam computed tomography (CBCT) use in orthodontic diagnosis, treatment and outcomes and to provide clinical guidance to dental practitioners. This statement was developed by consensus agreement of a panel convened by the American Academy of Oral and Maxillofacial Radiology (AAOMR). The literature on the clinical efficacy of and radiation dose concepts associated with CBCT in all aspects of orthodontic practice was reviewed. The panel concluded that the use of CBCT in orthodontic treatment should be justified on an individual basis, based on clinical presentation. This statement provides general recommendations, specific use selection recommendations, optimization protocols, and radiation-dose, risk-assessment strategies for CBCT imaging in orthodontic diagnosis, treatment and outcomes. The AAOMR supports the safe use of CBCT in dentistry. This position statement is periodically revised to reflect new evidence and, ...

Previously in this series, I have given an overview of the main types of study design and the techniques used to minimise the likelihood of obtaining biased results. In this article I describe more fully randomised controlled trials, their uses, advantages and limitations.

This Point/Counterpoint article discusses the pros and cons of deploying one aspect of instructional technology in dental education: the use of laptops in the classroom. Two opposing viewpoints, written by different authors, evaluate the arguments. Viewpoint 1 argues that laptops in classrooms can be a catalyst for rapid curricular advancement and prepare dental graduates for the digital age of dentistry. As dental education is not limited to textual information, but includes skill development in spatial relationships and hands-on training, technology can play a transformative role in students' learning. Carefully implemented instructional technology can enhance student motivation when it transforms students from being the objects of teaching to the subjects of learning. Ubiquitous access to educational material allows for just-in-time learning and can overcome organizational barriers when, for instance, introducing interprofessional education. Viewpoint 2 argues that, in spite ...

Data sourcesThe Cochrane Central Register of Controlled Trials (CENTRAL) and Medline were searched. Manufacturers of dental floss were also contacted to identify any trials.Study selectionOnly clinical trials and field studies of two years or longer were included.Data extraction and synthesisThe studies were analysed to determine the retention rates of the various materials studied (UV-light-, light- and auto-polymerising resin-based sealants, fluoride-releasing materials, compomers, flowable composites and glass-ionomer-cement-based sealants). A meta-analysis was conducted using a random effects model for longitudinal logistic regression and Bayesian statistics.ResultsNinety-eight clinical reports and 12 field trial reports were identified; 49 trials used random allocation. Auto-polymerising sealants had the observation time of up to 20 years. % year retention rates are shown in the table. Retention rates for UV-light-polymerising materials, compomers and glass-ionomer-cement-based sealants (5-year retention rates were <19.3%) were poor, while retention rates for UV-light-polymerising materials, compomers and glass ionomer cement-based sealants were classified as inferior.ConclusionsThis meta-analysis suggested that resin-based sealants can be recommended for clinical use. The faster and less error-prone clinical application of light-polymerising materials, however, makes them the preferred choice for daily dental practice.

In the United States, early childhood caries (ECC) is a major unmet health care need adversely affecting the overall health of young children from diverse ethnic populations. Nurses who work in the newborn nursery, pediatrics, public, and community health centers have a unique opportunity to positively influence a change in this epidemic of ECC. Guided by Leininger's theory of cultural care, these authors describe ways to implement a comprehensive culturally sensitive oral health education program for parents of newborns and infants. Interventions based on the best available evidence for oral health education, a culturally sensitive caries risk assessment, recommendations for fluoride varnish treatments, and ways for parents to establish a dental home for the infant by 12 months old are presented.

To perform a systematic review in which the clinical research question for primary teeth with irreversible pulpal pathosis was "how pulpectomies with zinc oxide eugenol (ZOE) paste performed compared to other materials in their clinical and radiographic outcomes after twelve months or more follow-up period. A literature survey of the electronic database (1950-2010) used the Medical Subject Headings and free text terms. Forty three references were retrieved and inclusion criteria were applied; 15 articles remained for full-text evaluation. From these, two were selected for data extraction regarding quality characteristics and results. Selected studies showed moderate or high risk of bias. The overall success of pulpectomy was 80.0% (Calcicur), 60.0% (Sealapex) and varied from 85.0% to 100.0% (ZOE) and 89.0% to 100.0% (Vitapex). Solely Calcicur presented success rate significantly lower when compared to ZOE and Vitapex. These pastes lead to overfilled canals and particles of extr...

Objective: To design a proposal that allow first-year students of dentistry from Central University of Venezuela, an approach to research activities through the development of a literature review based on analysis of evidence, within the framework of the program's objectives of the subject "Biochemistry" for the school period 2008-2009. Methods: Feasible project in which are defined strategies for the incorporation to the teaching/learning process of the subject "Biochemistry", knowledge about search, valuation and use of evidence, and in addition has settled the methodological guidelines for conducting of a documentary research work by students studying this subject. Results: The proposal was made by defining of the objectives, the approach of the justification, the analysis of the feasibility in terms of human and technological resources available, and the description of the stages of the project implementation with their execution schedule. Conclusions: There are many initiatives across the globe attempting to give a new approach to dental education, for adapt the professional practice to the needs of the contemporary society. The pillars of this reform of the curricula are the research and the Evidence-Based Dentistry. The first will contribute to the development of core competencies such as critical thinking, teamwork, ethics and social responsibility. The second will allow the integration of these competencies to the decision making at various levels of the institutions providing dental services and general health

La educación odontológica debería estar orientada a desarrollar competencias en las nuevas generaciones de profesionales que les permitan dar respuesta oportuna y efectiva a los problemas de salud bucal de la población, sustentándose este modelo de educación en la incorporación de actividades de investigación en pregrado vinculadas a la valoración o generación de evidencia, y en tal sentido, diversas experiencias han demostrado la eficacia de este enfoque de enseñanza-aprendizaje. Sin embargo, el éxito de la implementación de este modelo depende de su aceptación por parte de la comunidad estudiantil, aunque la calidad del proceso de enseñanza-aprendizaje en este contexto va mucho más allá de tal aceptación, por lo que el grado de satisfacción de los estudiantes como resultado de dicho proceso se constituye en un valioso indicador de la calidad del mismo. Objetivo: Determinar el grado de satisfacción obtenida por los estudiantes del primer año de la Facultad de Odontología de la Universidad Central de Venezuela como resultado de la integración de la investigación al proceso de enseñanza-aprendizaje en la asignatura "Bioquímica" en el período lectivo 2008-2009. Métodos: Para la realización de este estudio transversal se encuestó a un grupo de estudiantes seleccionados aleatoriamente (40% del total de cursantes de la asignatura en el mencionado período lectivo). En la selección se excluyeron a aquellos alumnos que no realizaron el trabajo de investigación asignado. Resultados: 81,9% de los encuestados (77 estudiantes) señalaron estar "Muy Satisfechos" con la experiencia, luego de valorar cualitativamente los aspectos positivos y negativos que de acuerdo a ellos se desprendieron del enfoque dado a la materia. Conclusiones: De acuerdo al presente estudio existe un alto grado de satisfacción en los estudiantes derivado de los conocimientos adquiridos a partir de la incorporación de la investigación al proceso de enseñanza-aprendizaje en la asignatura. Trabajos como el aquí descrito son una importante fuente de retroalimentación para el docente y su institución al permitir identificar fortalezas y debilidades en dicho proceso, así como oportunidades para enriquecerlo. Este debe ser el enfoque de una educación odontológica que responda a los retos que impone la creciente demanda por profesionales que aporten soluciones creativas a los problemas de salud oral que surgen en el marco de un sistema sanitario con recursos cada vez más escasos