The link between social anxiety and intimate loneliness is stronger for older adults than for younger adults.

OBJECTIVES: The current study focuses on the association between social anxiety (e.g. fear of social interactions or negative judgment by others) and intimate loneliness (lacking meaningful relationships, i.e. having low quantity/quality of intimate companionship) in older and younger adults. We assessed whether social anxiety, a factor which hampers intimacy, may be associated with intimate loneliness to a greater extent in older adults versus younger adults. METHOD: Measures of loneliness (Revised UCLA loneliness scale) and social anxiety (Leibowitz social anxiety scale) were obtained from 342 participants (220 younger adults, age = 19-40, and 122 older adults, age = 61-89). RESULTS: Age differences were evident for non-intimate types of loneliness but not for intimate loneliness. Further, older adults were less socially anxious. Critically, the strength of the social anxiety-intimate loneliness link was more robust among older adults. Effects remained significant after controlling for demographic and computer/social media variables. CONCLUSIONS: Older adults with high levels of social anxiety displayed greater intimate loneliness relative to younger adults. On a theoretical level, the results reveal that the pruning mechanism of investing more in closer and more rewarding relationships among older adults may be challenged under high social anxiety. The results suggest that older adults with higher intimate loneliness may benefit from interventions aimed at decreasing their social anxiety.

But is it publishable? Mastering the MMed message.

The research requirement for South African specialist registration offers opportunities and challenges. For some clinicians it may spark a lifelong interest in clinical investigation, while for many others it may provide a potential publication opportunity. Integrating the specific requirements of an MMed mini-dissertation with those of standard medical publications can be difficult for first-time authors and their supervisors; published guidance caters to full-length laboratory Master's or doctoral research. We suggest that research is more likely to be publishable if it is locally relevant, has a clear clinical message and is coherently presented.

Publication rate of 309 MMed dissertations submitted between 1996 and 2017: Can registrars fulfil HPCSA Form 57 MED amendments?

BACKGROUND: The recent amendment to the Health Professions Council of South Africa (HPCSA) Form 57 MED allows specialist registration on publication of the compulsory MMed research assignment in an accredited journal. No data exist on the conversion rate of MMed dissertations to publication. OBJECTIVES: To establish conversion rates of MMed dissertations to accredited publications. Associated variables arising from the publishing exercise were also investigated. METHODS: A total of 309 MMed dissertations, submitted between 1996 and 2017, were downloaded from the public domain. Each dissertation was recorded as to format, submission year, awarding university and clinical discipline. Electronic searches determined publication outcomes. Journal title, accreditation status, year of publication, registrar position on author ranking and publication type were extracted for each output. Descriptive analysis was undertaken and, where appropriate, Fisher's exact test at p>0.05 was used to establish statistical significance. RESULTS: A total of 116 dissertations were published at an overall conversion rate of 37.5%, culminating in 136 outputs. Publication-ready dissertations had a significantly higher conversion rate (60.3%) than monographs (30.5%) (p>0.0001). All but 6 of the 80 publishing journals were accredited. SAMJ was the journal of choice for 13% of papers. The registrar was the first author in the majority of publications. In the case of monographs, 66% were published after dissertation submission compared with 50% of publication-ready formats. CONCLUSIONS: Conversion of the South African MMed dissertation into a journal-accredited scientific article was achieved in 60.3% of publication-ready-format submissions, suggesting that the HPCSA amendment facilitating specialist registration is attainable. Retrospective reviews of dissertations provide valuable insights to improve understanding of the contentious issue of the registrar research requirement that permits specialist registration.

Content analysis of the South African MMed mini-dissertation

Background. There is no baseline information on the South African (SA) MMed mini-dissertation, which became a compulsory (and controversial) research component for specialist registration in 2011.Objective. To obtain evidence-based information regarding the current composition of the research output of the MMed mini-dissertation.Methods. SA MMed mini-dissertations (N=307) were downloaded from electronic theses and dissertation websites and 8 university repositories that provide specialist training. Fourteen variables were noted for each mini-dissertation, the data were entered into an Excel (2016) (Microsoft, USA) spreadsheet and analysed using descriptive statistics.Results. The 307 mini-dissertations, representing 24 of the Colleges of Medicine of SA, were submitted from 1996 to 2018, mainly in monograph format (76%) and almost equally divided between prospective and retrospective studies. Observational studies predominated, with meta-analyses, systematic reviews and randomised controlled trials comprising 5% of the sample. Although quantitative investigations dominated (82%), just less than half of these used statistics to test variables. Confirmed ethical compliance improved from 41% in pre-2011 dissertations to 83% for dissertations submitted during 2015 - 2018.Conclusions. This study provides descriptive data on the SA MMed mini-dissertation. Comparisons indicate that the MMed research component compares favourably with the content and research approach of similar international specialist trainee research outputs

How long does it take a registrar to complete the compulsory research project enabling specialist registration?

BACKGROUND: The 2011 Health Professions Council of South Africa mandate requires a research component in the form of an MMed degree to permit specialist registration. Registrars consider that the time required to complete an MMed interferes with clinical training, service delivery obligations, and study and exam time. Net research time to completion is difficult to establish because MMed research activity is often intermittent, starting and finishing anywhere within the 4-year clinical training period. Conversely, gross dissertation completion time (DCT) is easily calculated by subtracting the ethics approval date from the dissertation submission date. OBJECTIVES: To use gross DCT as a proxy to assess the time needed by registrars to finish the required research project. Additionally, the effect of four variables, namely dissertation format, clinical discipline, university research resources and the introduction of the 2011 ruling on gross DCT, was determined. METHODS: The sample was 213 MMed dissertations, downloaded from the public domain. The dissertation submission date was subtracted from the ethics approval date to give the gross DCT in months. Descriptive analysis and χ2 testing were used to determine the effects of the four variables on gross DCT, with significance set at p<0.05. A 12-month proposal preparation time was added to the gross DCT to fully reflect the MMed research timeline. RESULTS: Sampled dissertations were from 2005 to 2017 and all eight MMed training universities were represented, as were 23 clinical disciplines. The mean (standard deviation) gross DCT was 31.0 (19.6) months, with a wide completion range of 0.2 - 109 months. When 12 months' proposal preparation time was added, gross mean research completion time rose to 43 months (31 + 12 = 43). A mere 41% of dissertations were sufficiently concluded to free up the final year for exam preparation. Gross DCT was not significantly affected by the 2011 requirement, university resources or clinical discipline. Dissertation format (publication ready v. monograph) significantly decreased gross DCT (p=0.01). CONCLUSIONS: Large standard deviations and a wide range of finishing times detract from the positive findings that most dissertations were completed within the 4-year clinical training time period. Publication-ready dissertations significantly shortened MMed completion time. Unique study and work commitments and lack of research experience challenge speedy MMed completion. Existing research and supervisory supportive structures should be remodelled to better suit the research needs of the andragogic specialist registrar.

Things may not be as Expected: Surprising Findings when Updating Work Load at the Wits Human Research Ethics Committee (Medical)

Objectives. To compare numbers of applications to the University of the Witwatersrand Human Research Ethics Committee (Medical) for clearance by the full committee during 2011 - 2013; to see the proportion of clinical Master's applications in 2013 and to look for the influence of eight variables in applications reviewed from January to June 2013.Methods. A retrospective extraction of data from committee minutes (2011-2013) and application forms (January - June 2013) was done. Statistical analysis was completed using SAS for Windows (version 9.4). Variables examined were committee decision; choice of research method; supervision or not; supervisors' research degree; supervisors' publication group; university administrative entity; registered degree and month of approval after first review.Results. Total numbers were 685 (2011); 845 (2012; a 23.4% increase from 2011) and 769 (2013; a 9.0% decrease on the previous year). In 2013; 22% of applications were for clinical Master's degrees required by the Health Professions Council of South Africa (HPCSA) for specialist registration. A number of cross-tabulations of variables are presented. Logistic regression analysis (Proc Catmod) showed that three variables significantly influenced the committee's initial review decision; namely school (p=0.03); applicants' registered degree (p=0.01) and the research method chosen (p=0.03). The month of committee approval was also significantly affected by school (p=0.002). Preferred research methodologies for supervised and independent research applications differed within and between schools.Conclusion. A predicted continuous increase in number of applications from 2011 to 2013 did not happen for unknown reasons. Research method; school; and registered degree significantly influenced the committee's decision at the initial review of applications. For clinical Masters; and other Masters; a supervisor's degree had no effect on the committee's decision at the initial review of applications; however undergraduate and honours applicants having supervisors without a research degree had more than double the approval rate at first review than when supervisors had either a Doctorate or a Master's (p=0.008). Supervisors' possession of a research degree did not increase approval rate of applications nor did a supervisor's publication grouping

Visual and digital comparative tooth colour assessment methods and atomic force microscopy surface roughness.

This study compared digital and visual colour tooth colour assessment methods in a sample of 99 teeth consisting of incisors, canines and pre-molars. The teeth were equally divided between Control, Ozicure Oxygen Activator bleach and Opalescence Quick bleach and subjected to three treatments. Colour readings were recorded at nine intervals by two assessment methods, VITA Easyshade and VITAPAN 3D MASTER TOOTH GUIDE, giving a total of 1782 colour readings. Descriptive and statistical analysis was undertaken using a GLM test for Analysis of Variance for a Fractional Design set at a significance of P < 0.05. Atomic force micros copy was used to examine treated ename surfaces and establish surface roughness. Visual tooth colour assessment showed significance for the independent variables of treatment, number of treatments, tooth type and the combination tooth type and treatment. Digital colour assessment indicated treatment and tooth type to be of significance in tooth colour change. Poor agreement was found between visual and digital colour assessment methods for Control and Ozicure Oxygen Activator treatments. Surface roughness values increased two-fold for Opalescence Quick specimens over the two other treatments, implying that increased light scattering improved digital colour reading. Both digital and visual colour matching methods should be used in tooth bleaching studies to complement each other and to compensate for deficiencies.

Tooth colour change with Ozicure Oxygen Activator: a comparative in vitro tooth bleaching study.

INTRODUCTION: This in vitro study compared a new tooth bleaching product, Ozicure Oxygen Activator (O3, RSA) with Opalescence Quick (Ultradent, USA) using a randomised block design to assess tooth colour change. AIM: Colour change, stability and relapse in canine, incisor and premolar teeth was assessed following three bleach treatments and subsequent tooth colour assessment. METHODS: Ninety nine teeth (canines, incisors and premolars), which were caries free, had no surface defects and were within the colour range 1M2 and 5M3 were selected. Teeth were randomly divided into the three experimental groups: Opalescence Quick, Ozicure Oxygen Activator and control. The three experimental groups received three treatments of one hour each over three consecutive days. Tooth colour was assessed using the Vitapan 3D Master Tooth Guide (VITA, Germany). A General Linear Models test for analysis of variance for a fractional design with significance set at P < 0.05 was used to test for significance. RESULTS: Both bleaching methods significantly lightened the teeth (P < 0.0001). Tooth colour change was mainly after the first hour of tooth bleaching. The tooth type was significant in tooth colour change (P = 0.0416). Tooth colour relapse and resistance to colour change were observed. CONCLUSIONS: Ozicure Oxygen Activator bleached teeth in a manner and to an extent similar to Opalescence Quick.

Participation of dental researchers at annual SA IADR Conferences (1967-2004): drivers and passengers.

A descriptive study of SA IADR Conference participation 1967-2004 showed that both membership numbers and conference presentations have declined by half over the past 20 years. Of the total of 3 259 presentations, from mainly the six Schools of Oral Health Sciences (SOHS), the majority were from SOHS 1, followed by the SOHS 2, 3, 5, 4 and 6. Productivity of individual SOHS has changed over the years. Number of annual presentations per school has varied according to the organising school and the distance of the school from the conference venue. Research prizes are well supported. Research active "drivers" have high personal research productivity but do not significantly influence (P > 0.05) the number of conference presentations of their respective schools.

What becomes of dental research trainees once they leave the Dental Research Institute? An analysis over 53 years.

The careers of 131 dental research trainees were followed (1954-2007) to establish whether and how they utilised their research training in keeping with clinical research workforce needs. The Dental Research Institute database was used to obtain trainee demographic, teaching and research outputs which were examined according to degree types: PhD (18); MSc (55); MDent (42) and dropout (16). Current careers show that 48% are in exclusive private practice and 15% in exclusive academia with further 15% practitioners having academic links via sessional teaching or research at a dental school. Most (63%) have remained in South Africa but emigration is high amongst the PhD and MSc groups. Forty-one per cent of the cohort is of age

Waviness of atraumatic restorative treatment (ART) prepared surfaces.

INTRODUCTION: The wave (W) element offers a surface topography assessment method with the potential to yield unique data. AIMS AND OBJECTIVES: This study uses glass ionomer cement specimens prepared with six Atraumatic Restorative Treatment (ART) surface treatments to explore arc- and line-modified waviness of these surfaces to determine if they gave similar results. METHODS: Six specimens (5 x 1.5mm) were prepared for each of the six surface treatments: (1) surface compressed with a Vaseline lubricated finger (Va); (2) Va followed by carving with an excavator(Ca); (3) Ca burnished with a ball burnisher (Bu); (4) surface compressed with the gloved finger lubricated with poly-acrylic acid (Aa); (5) surface cured against a Mylar strip (My); (6) My polished with a white rubber sulcus wheel (Po). After storage in distilled water for seven days at 37 degrees C W(a), W(v), W(p), W(t) was analysed using arc- and line-modifications of the raw profile. The data were analysed using a General Linear Models analysis and Tukey's Studentised range test with P < 0.05. RESULTS: Ca and Bu; Va and Aa; and My and Po formed three groups with descending ranking order for W whether arc- or line-modified. Arc-modified tracing data was unable to statistically distinguish between surface treatments whereas line-modification showed significant differences between treatments for all parameters measured (W(a), W(v0, W(p), W(t)). CONCLUSIONS: Line-modified waviness data was better able to distinguish between surface treatments than arc-modification. Wave offers unique surface topography data having potential value to dental materials researchers.

DRI productivity and participation at the SA IADR (1967-2004).

This analysis describes the scientific research productivity and participation of the Dental Research Institute (DRI) in the South African Division of the International Association for Dental Research (1967-2004). A total of 438 presentations were delivered by the 257 individuals conducting research under the auspices of the DRI. Presenters were mainly DRI staff (45%); from the associated Dental School 26% and private practitioners 22%. Most the presentations were produced by a minority of researchers. Postgraduates had 150 presentations linked to research for their higher degrees. While the numbers of DRI presentations has declined with time, staff presentation productivity has increased. There has been a slight change in abstract descriptors with a recent falling away of animal studies. Sixty eight percent of oral presentations were ultimately published with between 1 to 4 oral presentations contributing towards a journal publication. Most of the current presenters have reached retirement age and their SA IADR activity will cease.

Measurement of dental restorative material topography.

INTRODUCTION: The tracing of peaks and valleys produced during surface profiling of dental materials are read against a mean line which can be modified in the form of a line or arc. Roughness (R) is commonly used to measure the topography of restorative materials, but the profile (P) value is also generated during the tracing and includes both roughness and waviness of the surface. AIMS AND OBJECTIVES: The purpose of this study was to determine if line and arc modified tracings and R and P surface topography measurements give similar results. METHODS: Thirty six cavities (5 x 1.5mm) were prepared in Perspex discs, restored with Fuji IX, a high strength glass ionomer cement, following the Atraumatic Restorative Treatment (ART) technique and the surface of six cavities were each treated as follows: press finger with vaseline (Va); press finger with polyacrylic acid (Aa); carving (Ca); burnishing (Bu); Mylar strip (My); polishing (Po). Topography was assessed using a profilometer which ran three equidistant tracings (3.6mm) on each surface giving a total of 18 readings for each treatment (n=6). The results of Ra, Rv, Rp, R, and Pa, Pv, Pp, P, for all 6 surface treatments were compared and analysed using ANOVA and Tukey's studentised range test with significance set at P<0.05. RESULTS: Within R + line, R + arc, P + line and P + arc, significant differences were apparent between treatments. Pairwise comparisons showed fewer instances of significant differences between surface treatments when R + line (1 instance of significant difference) was compared to R + arc (2). P + line showed 12 instances of significant differences between surface treatments while P + arc showed no difference. CONCLUSION: Both line and arc tracings gave similar results for R and either may be used in assessing surface roughness. The total deviation of the profile P showed more significant differences between treatments with line than with arc and may be a more sensitive tool when dealing with small sample numbers or subtle differences between surface treatments.

Does mechanical pressure force bacteria into the dentinal tubules of carious and non-carious teeth--an exploratory study.

BACKGROUND: Although many researchers have confirmed bacterial migration within dentine, no evidence was found to show whether bacteria can be easily forced into dentine during caries treatment. OBJECTIVES: This exploratory study was to see if bacteria could be easily forced into dentinal tubules of carious and non-carious teeth using hand excavation and air pressure. METHODS: Two (2) carious and ten (10) non-carious teeth were used. Class I (Black's Classification) cavities were created using rotary instruments in the non-carious teeth, while the carious teeth were excavated using hand instruments to remove the caries. The cavity of one carious tooth was etched and in the other tooth was not. Five (5) of the non-carious tooth cavities were etched, of which, one tooth was also disinfected. The remaining five non-carious teeth were not etched and included one tooth that was disinfected. Bacterial cultures of S. mutans, E. coli and Veilonella were placed in the prepared cavities and hand excavators and air pressure were used in an attempt to force bacteria down into the dentinal tubules. Thereafter, the teeth were fixed, decalcified and prepared for electron or light microscopy. RESULTS: One etched, and one etched and disinfected non-carious tooth showed bacteria in the dentinal tubules. One carious tooth (etched) showed bacterial presence in the dentinal tubules. CONCLUSION: This study shows that it is difficult to force bacteria into dentinal tubules using hand excavation (as in the Atraumatic Restorative Treatment technique) so a definitive study is not indicated.

Scientific surface roughness values for resin based materials.

INTRODUCTION: Surface roughness of dental restorative materials is most often established with the Ra value obtained using profilometry or by assessing surface topography with the scanning electron microscope (SEM). Both methods should validate each other in confirming surface roughness. AIMS AND OBJECTIVES: The purpose of this study was to compare surface roughness values obtained with a profilometer to the SEM appearance of 6 resin-based restorative materials and assess whether Ra was appropriate as a sole surface roughness measure. Methods Six 5mm diameter specimen discs of Prodigy (Pr); Z100 (Z); Compoglass F (C); Hytac Aplitip (H); Photac-Fil (Pf) and Vitremer (V) were prepared against Mylar strips and stored in distilled water for 14 days. One side of each disc was sequentially polished with Soflex discs to super fine state, the other side remained unpolished. Three surface roughness measurements were made on each surface (n=18) recording Ra, Rv, Rp and Rt values, this data was subjected to a four way ANOVA and Tukey's Studentised Range Test (p=0.05). Two unpolished and two polished discs per material were prepared for SEM, evaluated and visually grouped for surface roughness. RESULTS: Approximate ascending order of roughness was Z, Pr, H, C, V, Pf for Ra, Rv, Rp and Rt and un/polished treatment. Polishing increases surimens into a "bland" (Pr, H, Z, C) and "textured" group (Pf and V). The polished specimens gave four groups: (Pr), (Z and C), (H) and (V and Pf) of increasing surface complexity. Polishing caused surface scratching, removed the matrix, reduced or removed filler particles and exposed voids within the material. CONCLUSIONS: This study emphasises the importance of using more than one technique to assess surface roughness. Rv and Rp values should be utilised to better understand polish induced surface feature changes. Rv maximum is a better measure to identify surface defects which could affect restoration longevity.

Spreadability of two glass ionomer cements used in atraumatic restorative treatment (ART).

'Press finger' in atraumatic restorative treatment (ART) is used to spread a glass ionomer cement (GIC) to seal the restoration margin and adjacent pits and fissures. This study compared the spreadability of Fuji IX and Ketac-Molar to establish which was best suited for this purpose. Twenty equally spaced cavities (35 mm apart) were machine-cut in each of two Perspex slabs 200 x 100 x 20 mm. Each cavity was 3 mm deep with a 4 mm diameter. Two V-shaped grooves 1 mm deep were cut to traverse the cavities: one 0.5 mm wide, the other 0.25 mm wide. Equal amounts (0.25 ml) of GIC were dispensed, 20 cavities for Fuji IX and 20 for Ketac-Molar and condensed under light finger pressure using a 20 mm diameter cork thinly coated with petroleum jelly. This allowed the GIC to be condensed into the cavity and spread into the differently sized grooves. The samples were stored in deionised water for 24 hours whereafter the length to which the GIC had spread along each groove from the cavity edge was measured to the closest 0.01 mm. The data were analysed using ANOVA and the unpaired Student's t-test (P < 0.05). There was a statistically significant difference between the length of spread of the two GICs (t = 2.534; P = 0.013) which was confined to the 0.25 mm width groove (t = 2.83; P = 0.007) with Fuji IX spreading much further along the groove (10.25 +/- 1.17 mm) than Ketac-Molar (7.66 +/- 4.21 mm). Fuji IX appears to be the better sealant material when selecting for spreadability in ART.

Marginal adaptation of mineral trioxide aggregate (MTA) compared with amalgam as a root-end filling material: a low-vacuum (LV) versus high-vacuum (HV) SEM study.

AIM: To compare the marginal adaptation of mineral trioxide aggregate (MTA) or amalgam root-end fillings in extracted teeth under low-vacuum (LV) versus high-vacuum (HV) scanning electron microscope (SEM) viewing conditions. METHODOLOGY: Root-end fillings were placed in 20 extracted single-rooted maxillary teeth. Ten root ends were filled with MTA and the other 10 root ends were filled with amalgam. Two 1 mm thick transverse sections of each root-end filling were cut 0.50 mm (top) and 1.50 mm (bottom) from the apex. Gap size was recorded at eight fixed points along the dentine-filling material interface on each section when uncoated wet (LV wet (LVW)) and dry under LV (0.3 Torr) in a JEOL JSM-5800 SEM and backscatter emission (LV dry uncoated (LVDU)). The sections were then air-dried, gold-coated and gap size was recorded once again at the fixed points under HV (10(-6) Torr; HV dry coated (HVDC)). Specimen cracking, and the size and extent of the crack were noted. RESULTS: Gap sizes at fixed points were smallest under LVW and largest under HVDC SEM conditions. Gaps were smallest in MTA root-end fillings. A General Linear Models Analysis, with gap size as the dependent variable, showed significant effects for extent of crack in dentine, material and viewing condition (P = 0.0001). CONCLUSIONS: This study showed that MTA produced a superior marginal adaptation to amalgam, and that LVW conditions showed the lowest gap size. Gap size was influenced by the method of SEM viewing. If only HV SEM viewing conditions are used for MTA and amalgam root-end fillings, a correction factor of 3.5 and 2.2, respectively, may be used to enable relative comparisons of gap size to LVW conditions.

How well do fourth year Wits dental students place resin composite restorations?

OBJECTIVES: To evaluate, by means of a scanning electron microscope (SEM) the quality of resin composite restorations, placed as a first attempt by fourth-year dental students. METHODS: Ten Class IV direct composite restorations, placed in plaster-mounted extracted incisor teeth as part of pre-clinical course requirements, were selected. Specimens were evaluated and graded on a two-point scale by a staff member according to departmental clinical evaluation criteria. Five restored teeth were prepared for surface evaluation of marginal integrity, surface roughness and contour using SEM. The remaining specimens were embedded in resin and ground down transversely, parallel to the incisal edge until a dentine core was apparent. The ground surfaces were polished, prepared for SEM and assessed for etched layer, placement of bonding agent, composite adaptation and overall consistency. RESULTS: Clinical assessment and SEM surface evaluation correlated favourably for all criteria, except contour, indicating that students were reasonably competent in finishing techniques. Ground samples revealed acceptable etched enamel layers and marginal adaptation. Bonding agent thickness varied between 0 and 200 microns casting doubt on procedural accuracy. Porosities and voids were apparent within the resin composite. Internal features were the main reason for unsatisfactory grades. CONCLUSIONS: Students placed restoration satisfactorily. They would benefit if able to examine sectioned restorations to understand critical placement techniques which would contribute to resin composite restoration success. A research component can be introduced into the dental undergraduate curriculum by way of similar projects linked to didactic course-work.

Microscope observations of ART excavated cavities and restorations.

This in vitro light and scanning electron microscope study examined 39 extracted tooth specimens, hand excavated and restored according to atraumatic restorative treatment (ART), using 'press finger', by 'skilled' and 'novice' operators. Surface features of five excavated cavities, 12 restoration surfaces and the tooth restoration relationships of 22 bisected restored tooth crowns were examined to better understand the clinical effect of the technique. Hand-excavated cavity surfaces were rough with a complex surface arrangement of grooves, crevices, ridges, furrows and overhangs. Enamel and dentine were covered with debris except where surface fractures exposed enamel prisms and occluded dentinal tubules. Ten of the 22 bisected restored specimens had large voids (1-3 mm in length) within the glass-ionomer cement (GIC) restoration or at the tooth-restoration interface. Smaller bubbles (< 50 microns) and irregular shaped inclusions were common in all restorations. Adaptation of the GIC to the cavity margin was extremely variable and easily distinguished from the effects of dehydration shrinkage. It is thought that cavity surface irregularities could cause placement problems making it difficult to adapt the GIC to cavity peripheries. While 'press finger' enabled excellent penetration of GIC into fissures, the technique left restoration surfaces rough. At low magnification, surfaces were irregular; at magnifications higher than X500 scratches, pits, porosities, chipping and voids were evident. However, the 'press finger' technique was able to merge the GIC to a fine edge on the occlusal surface so that the restoration margin was not obvious. No apparent difference was found between the restorations placed by the 'skilled' and 'novice' operators. Tooth-restoration relationships in the ART approach are entirely different to those of traditional restorative techniques. The ART approach requires skill, diligence and comprehension to be undertaken correctly.

Accurate diagnosis of occlusal carious lesions--a stereo microscope evaluation of clinical diagnosis.

This study was undertaken to validate the caries status of 214 teeth by serial sectioning and microscopy after caries diagnosis using four methods. Two hundred and fourteen extracted human teeth with varying degrees of caries were mounted in the jaws of nine training manikins. All tooth surfaces were examined and recorded for caries by four dentists using bitewing radiographs, fibre-optic transillumination (FOTI), mirror alone and a mirror and sharp probe on two separate occasions. Thereafter the teeth were serially sectioned and assessed microscopically for depth of caries lesion on a graded score of 0-7. This report assessed the diagnostic outcome of 2,183 observations for occlusal surfaces. Sound diagnoses predominated over unsound until caries was present in the inner half of dentine. Specificity was between 90% and 95% and sensitivity 26% and 50% depending on which diagnostic method was used and where the sound/unsound threshold was set. Negative and positive predictive values were similarly influenced and varied between 53% and 80% and 73% and 90%, respectively. Probit analysis showed no significant differences (P < 0.05) between examiners and diagnostic methods. Diagnosis of occlusal caries undertaken in an in vitro simulated clinical situation is inaccurate until the caries lesion extends deep into the dentine no matter which of the four methods was used.