Survey Study among Dentist in Bulgaria to Develop a Model for Risk Management in Dental Practice.

Background: Quality control and risk management in the field of dental services is an important part of improving patient safety as well as that of the dentists. The introduction of a risk management model would simplify and facilitate this process. Aim: The aim of the study is to gather information about the structurе and organization of work processes in Bulgarian dental practices, which will serve as a basis for building a risk management model. Material and Methods. A survey was conducted among randomly selected dental associations in Bulgaria-Plovdiv, Sofia, Varna, and Burgas through an anonymized questionnaire, containing 30 questions. The respondents meet the main criteria, namely, to be dentists and to practice in Bulgaria. The study includes demographic data, information on the attitude of Bulgarian dentists towards issues related to quality management, and safety and risk in respect to dental practice. The results have been processed and analyzed through descriptive and graphical analysis using the statistical program SPSS 20.0. Results: A total of 103 Bulgarian dentists took part in the study, out of which 25.24% ± 4.28% have acquired a specialty. Women are 52.43% ± 4.92%, and men -47.57% ± 4.92%. The largest is the relative share of the respondents in the age range of 25-35 years -63.10% ± 4.75% and with work experience of 6-15 years -52.43% ± 4.92%. Most of the respondents do not define in writing the main tasks and activities -52.43% ± 4.92%, and do not use checklists in their practice -54.73%. The majority of the respondents do not hold regular meetings with their teams -50.49% ± 4.93%, as well as they do not conduct surveys among their patients -68.93% ± 4.56%. The majority of the respondents -41.75% ± 4.86% are guided by their personal judgment in respect to whether the written information provided to patients is comprehensible and accessible. The majority of dentists -45.63% ± 4.91% take informed consent only for expensive procedures in written and oral form -53.40% ± 4.92%. Out of all the respondents, 75.73% ± 4.22% have not analyzed the risk of slipping in their practices for the last two years. Conclusion: There is a lack of written definition of the main tasks and processes, as well as no use of checklists in the practices of most of the interviewed dentists. Meetings with teams are held irregularly. There is a lack of surveys among patients, as well as no objective feedback from patients regarding the comprehensibility of the information materials provided. Informed consent is obtained from patients mainly in written and oral form and only for costly manipulations. In the practices of most of the interviewed dentists, there has been no assessment of the risk of slipping and falling for the last 2 years.

T-Scan Novus System in the Management of Splints-Pilot Study.

The purpose of this pilot study was to demonstrate the capabilities of the T-Scan Novus system in bruxism treatment by splints. Bruxism patients underwent treatment with a splint made by additive manufacturing. Intraoral scanning was performed using Trios Color (3Shape), and digital design was performed using 3Shape Dental system design - splint studio. The biocompatible material Dental LT Clear Resin was printed using a Formlabs Form 2 printer. The T-Scan Novus system with a software attached to it, version 9.1, was used for digital examination of the occlusion. A splint with an occlusal thickness of 2.5 mm was developed and software adapted with relief to antagonists. The digitally set occlusion with even contacts turned out to be clinically unbalanced. After adjusting with T-Scan Novus, a balanced occlusion was achieved in the right and left halves. The treatment of bruxism with splint therapy continues to be the main method. Its combination with digital technologies allows more precise constructions and more accurate balancing of occlusal relationships.

Occlusal Indicators Used in Dental Practice: A Survey Study.

INTRODUCTION: The function of the masticatory apparatus is complete when the dentition is intact with contact between the individual teeth and proper occlusion with the antagonists. For years, occlusal contacts have been studied to determine their exact location and describing various materials and methods for their registration such as paper foil, silk, and Shimstock foil. For years, occlusal contacts have been studied to determine their exact location and describe various materials and methods for their registration such as paper foil, silk, shim stock foil, the T-Scan system, and more recently the OccluSense system. The primary aim of the study was at evaluating which of the occlusal indicators is the most commonly used in practice, and the secondary aim was whether dentists are willing to use digital methods to examine occlusion. MATERIALS AND METHODS: The main primary information of the survey was collected by sending electronically anonymous questionnaires to 2014 dentists, randomly selected from all regions of the country. 228 questionnaires were filled in and returned. To achieve the goal of the study, the self-developed questionnaire was created and tested to survey the opinion about the use of occlusal indicators in dental practice. Each questionnaire contains questions about the sociodemographic and professional status of the people in the group and their opinion about the positives and negatives and the effectiveness of occlusal indicators. RESULTS: The obtained results confirm the statement that the most frequently used occlusal indicator in dental practice is the articulation paper. Articulation foil and silk are used less frequently than articulation paper. Of the listed quality indicators, Shimstock foil is rarely used in practice. Of the indicated quantitative indicators, the T-Scan system is more used than the OccluSense system. In the era of rapid technology development, the opinion and desire of dentists to increasingly want to introduce in their clinical practice quantitative methods are the digital diagnosis of occlusion. CONCLUSION: In any dental practice, if technically possible, digital methods would be used, giving more accurate and reliable data on the registered occlusal contacts.

Comparative Study Qualitative and Quantitative Techniques in the Study of Occlusion.

INTRODUCTION: The wide variety of methods for recording occlusal contacts and the contradictory data on the interpretation of the obtained markings provoked us to make a comparative laboratory study between different occlusal indicators. PURPOSE: Evaluation of a qualitative and quantitative method for registration of occlusal contacts in static occlusion in laboratory conditions. MATERIALS AND METHODS: In completion of the objective, we designed an apparatus for registration of the occlusal contacts (AROC) in static occlusion which is used, corresponding to the MIP in clinical conditions. The occlusal indicators that were included in the study were articulating paper 100 µ, articulating foil 12 µ, and T-Scan Novus system with a sensor thickness of 100 µ. The collected primary statistical information was entered and processed with the statistical package SPSS Statistics 19.0, and the graphs were prepared using Microsoft Office 2019. We performed descriptive statistical analysis in this study. Comparisons were performed using one-way analysis of variance (ANOVA), Student's t-test, and Pearson coefficient method. For a significance level, p < 0.05 was chosen. Result and Discussion. With quality occlusal indicators, it is possible only to visually determine the size, number, and intensity of the marked contacts. After the statistical processing of the obtained data on the number of registered contacts, a significant difference is found in the number of contacts of certain teeth (18, 24, 25, 28, 38, 35, 34, 33, 44, 45, and 48) registered with articulating paper and articulating foil. The maximum force that is reported during the study with the T-Scan system is 93.72% and the forces in the right half of the dentition are 51.7% and in the left 48.9%. To visualize the location of the registered occlusal contacts with the system, it is intraoral to use a quality indicator and we recommend the use of articulating foil. CONCLUSION: Based on findings from the current in vitro simulation, we can conclude that the type of occlusal indicator influences the registration of contacts, and therefore, we propose as a method of choice to achieve a balanced occlusion in clinical practice to combine the use of one conventional and one quantitative method.

Occlusion and disocclusion time analysis in young patients affected by bruxism.

INTRODUCTION: Bruxism is an involuntary parafunctional habit performed unconsciously during sleep by the jaw muscles in which the tooth rows are pressed against each other and move horizontally. The symptoms in the oral cavity are slightly elusive which makes it difficult to diagnose. AIM: The aim of this study was to analyze the occlusion and disocclusion times in young adults affected by bruxism compared with healthy subjects. MATERIALS AND METHODS: Thirty-four patients (15 men and 19 women) aged between 20-25 years were included in the study. They were allocated into two groups: group 1 - controls (n=13), and group 2 - patients who reported clenching or grinding their teeth (n=21). The study was conducted using a T-Scan Novus occlusion diagnostic device. The results obtained for the occlusion and disocclusion times were analyzed using the latest version of the T-Scan system software (ver. 9.1). The values for occlusion and disocclusion times of all subjects were recorded in the T-Scan. RESULTS: The occlusion times in the control group were found to be longer than those in the bruxism group. The disocclusion times of the subjects in group 1 were found to be shorter than those in group 2. CONCLUSIONS: The T-Scan system makes it possible to quantify the occlusion and disocclusion times, which helps to diagnose an initial form of bruxism in individuals at a young age.

Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism.

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape, 2014), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

Comparative Study of Occlusal Contact Marking Indicators.

BACKGROUND: A variety of indicators to register occlusal contacts are used in the daily dental practice. One of the most frequently used qualitative occlusal indicators is the articulating paper. Its reliability is often disputed because this indicator could produce false positive results or fail to register any occlusal contacts. AIM: To compare the number and size of the recorded contacts on a tooth surface obtained with articulating paper and foil. MATERIALS AND METHODS: Typodonts of upper and lower jaw with intact dental arches Frasaco A-3Z were fixed in a Girbach arcon articulator. Articulating contacts were marked with 12-micron Bausch articulating foil and 200-micron Bausch articulating paper under the same load. For each study a new sheet of the occlusal indicators was used, and 10 repetitions were made for each one. After every marking, the lower jaw was dismounted from the articulator and the distribution of the markings was videographed using a camera. The number of occlusal contacts was entered in a table. We analysed the markings on the first maxillary and first mandibular molars. RESULTS: We found that fewer and bigger contacts were recorded using the 200-micron articulating paper in comparison with the contacts obtained using the foil. CONCLUSIONS: The type of occlusal contact indicator has an effect on the number and the size of the occlusal contact markings.

The T-SCAN System in Evaluating Occlusal Contacts.

BACKGROUND: Normal occlusal and articulation relations between the jaws ensure equal distribution of occlusal forces during mastication. A T-SCAN system allows these relations to be measured dynamically during the articulation cycle. AIM: To evaluate the T-SCAN III system in measuring and assessing the forces of occlusal contacts and their digital presentation. PATIENTS AND METHODS: Thirty students aged 19 - 22 years were examined. Of these only one matched the study criteria: - intact dentition; - without or with class I fillings in teeth 36 or 46; - Angle's class I jaw relation We used a computerized occlusal analysis system T-SCAN in the study. It comes with a registering sensor for the occlusal contacts, a module for transmitting the signals to a computer, and conversion software to generate images on a computer screen. RESULTS: We evaluated the system's capabilities in registering the occlusal contacts during mastication on an occlusion film and the occlusal forces using a digital display. CONCLUSION: The T-SCAN system provides the only accurate way to determine and evaluate the time sequence and force of occlusal contacts by converting the qualitative data into quantitative and displaying them digitally.