Teaching of posterior composites for the restoration of permanent teeth in undergraduate dental training programmes: Systematic review and meta-analysis.

OBJECTIVES: To systematically assess aspects of teaching of posterior composite restorations (PCRs) in permanent teeth in dental schools. STUDY SELECTION: Quantitative studies reporting on dental schools' teaching regarding the placement of PCRs in permanent teeth. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed based on the Medical Education Research Study Quality Instrument (MERSQI). SOURCES: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in January 2023. DATA: Forty sources reporting on 34 studies having surveyed 1,286 dental schools were included. Overall, 92.7% (95%-CI: 88.2-95.5) of dental schools reported to teach PCRs. PCRs in three-surface Class II cavities are taught by 82.0% (95%-CI: 70.4-89.7). The mandatory use of liners in deep cavities is taught by 78.3% (95%-CI: 68.9-85.5), and 44.0% (95%-CI: 34.3-54.2) reported to teach bulk-fill composites. While most posterior restorations placed by students were composites (56.1%; 95%-CI: 46.0-65.8), 94.7% (95%-CI: 86.6-98.0) of dental schools (still) teach posterior amalgam restorations. The proportion of dental schools teaching PCRs in three-surface Class II cavities increased and the mean proportion of PCRs among all posterior restorations increased over time (padj.≤0.003). CONCLUSIONS: The teaching of PCRs in dental schools around the world reflects the increased use of resin composite in clinical practice, with students in countries where dental amalgam continues to be used, placing more posterior composites than restorations of dental amalgam. The teaching of PCRs, which is anticipated to increase, will continue to be refined with further developments in adhesive materials, devices, instrumentation, and techniques. CLINICAL SIGNIFICANCE: Graduating dentists can be expected to be familiar with the use of resin composites for the restoration of posterior teeth.

Teaching of composite restoration repair in Brazilian dental schools.

OBJECTIVES: The aim was to investigate aspects of the teaching of restoration repair as a minimally invasive alternative to replacing defective direct composite restorations in undergraduate curricula teaching programs in Brazilian dental schools. METHODS: A 14-item validated survey questionnaire was mailed to directors/coordinators of operative/restorative dentistry teachers of Brazilian Dental Schools. Data were collected on demographic characteristics of the teachers and institutions, together with questions on the teaching of the repair of defective resin-based composite restorations as part of the school curriculum; the rationale behind the teaching; the nature of the teaching (preclinical and/or clinical); how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability and expected longevity of completed repairs. RESULTS: Two hundred and twenty-two (94%) directors/ coordinators of dental curricula in Brazil were contacted. One hundred and thirty-one directors/coordinators (59%) replied, providing the e-mail address from the teacher responsible for the operative/restorative dentistry program in their school. Of these, 104 responded to the questionnaire (79% response rate). Ninety-three (89%) of the participating schools reported teaching composite repairs as an alternative to replacing restorations. Of the theoretical content, 43% was taught at preclinical and clinical levels, whereas most practical experience (53%) was acquired at clinical levels. Eighty-eight schools (95%) reported tooth substance preservation being the main reason for teaching repair techniques. All schools that taught repairs reported high patient acceptability. CONCLUSIONS: The teaching of composite restoration repair as an alternative to restoration replacement is established in undergraduate programs in most of the Brazilian dental schools surveyed. CLINICAL SIGNIFICANCE: The reasons for teaching restoration repair in Brazil were found to be quite unanimous among teachers, especially regarding the preservation of tooth structure. Variations were found in the clinical indications for repair, suggesting the need for further investigations. Monitoring repaired restorations should be encouraged and could contribute to future studies.

Current and future trends in the teaching of removable partial dentures in dental schools in Malaysia: A cross sectional study.

AIMS: To investigate, using a validated questionnaire, the teaching of removable partial dentures (RPDs) in dental schools of Malaysia. MATERIALS AND METHODS: A validated questionnaire to investigating trends in the teaching of RPDs in dental schools in Oceania was emailed (in English version form) to Heads of Restorative/Prosthodontics/course coordinators in the 13 dental schools in Malaysia. Follow-up reminders were sent and participants were given six weeks to complete and return the questionnaire. Data was entered into an Excel spreadsheet and results compiled and analyzed. RESULTS: Completed questionnaires were received from 13 dental school - a 100% response rate. All schools (n = 13) provided a preclinical technical course in RPD design. In most schools (n = 9, 69.2%), course work was supervised by senior lecturers while rest of the institutions made use of associate professor/professors. There were significant differences (p<0.05) between dental schools in terms of the contact hours dedicated to preclinical teaching. Students received an average of 62 h of instruction. Didactic instruction was the primary focus with practical (78 h) and didactic teaching (32 h). All dental schools (n = 13) provided practical surveyor design teaching (8 h). The staff student ratio for formal lectures (1:61), tutorials (1:29) and lab demonstrations (1:12) were recorded. Majority of the schools (n = 11, 84.6%) employed paired teaching in clinical sessions. All schools (n = 13, 100%) emphasized on increased teaching of RPD design and prescription writing in future clinical RPD courses. CONCLUSION: Teaching of RPDs in Malaysia may be considered sufficient and comparable to the teaching in other parts of the world. CLINICAL SIGNIFICANCE: Whilst the teaching of partial dentures at Dental Schools in Malaysia provides the core competencies involved in partial denture design and construction based on sound fundamental, scientific principles they should address the challenges of teaching partial dentures and other areas of dental education including improving working conditions for dental professionals.

European Federation of Periodontology Survey of Postgraduate and Specialist Training in Europe in 2020.

AIMS: The survey's aim was to establish which universities and other educational organisations deliver postgraduate and specialist training in Periodontology in the 31 countries who are members of the European Federation of Periodontology (EFP) and to obtain details of how these programmes are organised, funded, regulated and evaluated. METHODS: A questionnaire and covering letter were emailed to all national periodontal societies. The questions were on the name of country, official recognition, training programmes, entry to specialist training, specialist training assessment and recognition after completion of training. RESULTS: Twenty-nine (93%) of national periodontal societies responded. Key findings included the following: Periodontology was reported as being recognised at a national level in 17 countries, there was a three-year full-time programme in 12 countries, no fees were charged for specialist training in 10 countries, in 14 countries trainees received annual salaries, end of training (summative) assessments varied from country to country, 12 countries reported that they had a requirement for specialists in Periodontology to complete continuing education to maintain registration as specialists. CONCLUSIONS: This survey has established which universities and other educational organisations deliver postgraduate and specialist training in Periodontology and how these programmes are organised, funded, regulated and evaluated. To provide uniformly high-quality periodontal care for patients in all European countries, further harmonisation of postgraduate and specialty training in Periodontology would be advantageous.

Influence of dental college funding and time established on the satisfaction of dental graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: With the emergence of graduates from all government and private-funded dental colleges in Saudi Arabia (SA), it is pressing to explore the graduates' satisfaction with the dental undergraduate education and training they received. The aim of the present study was to investigate the graduates' satisfaction with their education and training according to college funding arrangements (government vs private-funded) and time since establishment (established- >15 years vs new-<15 years). METHODS: A piloted, electronic questionnaire was emailed to all the members of the Saudi Dental Society who had graduated from government and and private dental colleges in SA (2,185 registrants). RESULTS: The response rate was 36.4%, with 580 government-funded college graduates (72.9%) and 216 private college graduates (27.1%) having completed and returned the questionnaire. The distribution of participants between established and new colleges was 'established' 396 (49.8%) and 'new' 400 (50.2%). Levels of dissatisfaction were recorded for graduates from established and new, government-funded and private colleges. The levels of dissatisfaction were greater amongst the graduates of established and government-funded colleges. CONCLUSION: The findings of the present study indicate concerning levels of dissatisfaction with important aspects of dental education in SA. It is suggested that there is a pressing need for more integration of basic and clinical sciences and an emphasis on hands-on training. National coordination of arrangements for dental curricula could make a major contribution to addressing the problems identified.

Teaching of the repair of defective composite restorations in Middle Eastern and North African Dental Schools.

OBJECTIVES: To evaluate the status of teaching of repair of defective resin-based composite restorations in dental schools in the Middle Eastern and North African (MENA) countries. METHODS: A validated 14-item questionnaire was mailed to the directors of the operative/restorative dentistry department in 40 MENA dental schools. Data were collected on teaching, including whether the repair of resin-based composite restorations was part of the dental school curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability and expected longevity of the repair procedure. RESULTS: Thirty-two schools responded to the survey (response rate of 80%). Twenty-two (69%) schools reported the teaching of resin-based composite repairs as an alternative to the replacement of restorations. Of the schools not teaching repairs, 80% indicated that they plan to include this topic in the curriculum within the next five years. Most schools taught theoretical and practical aspects of repair at a clinical level only. Two-thirds of schools reported tooth substance preservation being the main reason for teaching repair techniques. The main indications for repair treatment were marginal defects (59%), followed by partial loss of restoration (56%). Most schools that performed repairs reported high patient acceptability. Considerable variation was noted in relation to expected longevity of resin- based composite repairs. CONCLUSIONS: The repair of defective resin-based composite restorations is actively taught within most of the surveyed schools. Advantages of repair, compared to replacement include minimum intervention, preservation of tooth structure, and savings of time and cost. CLINICAL SIGNIFICANCE: The decision between replacing or repairing a defective resin-based composite restoration in the MENA region tends to be based on clinicians' subjective experience and judgement. However, to further enhance the teaching of resin-based composite repair standardised guidelines need to be developed based on existing evidence.

A nationwide survey assessing the satisfaction of dental colleges graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: To date, there are no publications on the Saudi graduates' perceived value of their dental curriculum. The aim of this nation-wide survey was to investigate graduates' satisfaction with specific disciplines of their dental education and training. The first part of this study addressed findings according to the respondents' gender and the number of years of postgraduate experience (Graduate-related factors). METHODS: An electronic questionnaire was emailed to registrants of the Saudi Dental Society, specifically dental interns, general dentists, and specialized dentists who graduated from private and governmental dental colleges in Saudi Arabia (n = 2185). RESULTS: The response rate was 36.4 %. The number of male respondents was (n = 352, 44.2 %), the remainder being female (n = 444, 55.8 %). The number of recent dentists (≤ 5 years since graduation) was (n = 428, 53.8 %) and experienced dentists (n = 368, 46.2 %). There were statistically significant gender variations in satisfaction levels, and among dentists with different post-graduation experiences. Although male and female dental students are taught similar curriculums and have similar graduation requirements, there were statistically significant differences in various subjects covered. Similarly, recent and experienced dentists reported statistically significant differences in satisfaction in various subjects. CONCLUSION: This study provides graduates' perspectives on the strengths and weaknesses of their dental education in Saudi Arabia. The findings help in curriculum reform and collaborations between the dental colleges nationally. Ultimately this can lead to formulating a national dental accreditation and assessment body. CLINICAL SIGNIFICANCE: The findings of this study provide graduates' perspective on the dental education received in Saudi Arabia. This will help stimulate discussion and collaboration within and amongst the colleges on improving their curriculum in this fast-paced, evolving field of dentistry.

Current and future trends in the teaching of direct posterior resin composites in Malaysian dental schools: a cross-sectional study.

OBJECTIVE: To investigate the current and future teaching of posterior composite restorations in undergraduate curricula in Malaysian dental schools. METHODS: A 24-item validated questionnaire including closed and open questions on the teaching of posterior composites was emailed to faculty members in all 13 Dental Schools in Malaysia. Responses were compiled on Excel and analysed. RESULTS: All 13 dental schools responded to the survey yielding a 100 % response. All schools indicated the use of posterior composites for 2- and 3-surface cavities in premolars and molars. The didactic teaching time devoted to composites was greater than for amalgam (38 h vs 29 h). Clinically, most posterior restorations placed by students were composites (average 74.1 %, range 10 %-100 %); the remaining 25.9 % were amalgams (range, 0 %-50 %). Slot-type cavities were the preparation techniques most commonly taught (n = 11,84.6 %). The use of rubber dam for moisture control was mandatory in most schools (n = 11, 84.6 %). History of adverse reaction to composites was found to be the most common contraindication to composite placement. The phase down of teaching and use of amalgam in Malaysia is expected to occur within the next six years. CONCLUSION: The trend to increase the teaching of posterior composites reported for other countries is confirmed by the findings from Malaysian dental schools. Notwithstanding this trend, the use of amalgam is still taught, and future studies are required to investigate the implications of the phase down of amalgam in favour of posterior composites. CLINICAL SIGNIFICANCE: Notwithstanding the increase in the teaching of posterior composites there is a pressing need to update and refine clinical guidelines for the teaching of posterior composites globally.

Effects of toothbrushing on surface characteristics of microhybrid and nanofilled resin composites following different finishing and polishing procedures.

OBJECTIVES: To evaluate the effects of simulated tooth brushing (STB) on the surface roughness of microhybrid and nanofilled resin composites following different finishing and polishing procedures. MATERIALS AND METHODS: Ninety cylindrical-shaped specimens of Filtek Supreme XT (a universal nano resin composite) and Filtek Z250 (a universal microhybrid resin composite) were prepared. The specimens were allocated at random into 9 paired groups each of 10 specimens. The finishing and polishing systems included were Tungsten Carbide bur (TC); Diamond bur (Db); Sof-Lex discs (S); PoGo discs (PG); TC + S; Db + S; TC + PG; Db + PG. Polymerisation against a Mylar strip without finishing and polishing acted as the control. Surface roughness was measured using a 3D non-contact optical profilometer and surface morphology was examined by scanning electron microscopy. Specimens were subjected to the equivalent of four years STB and surface roughness was measured again. RESULTS: Mylar formed surfaces were the smoothest for both composites before and after STB. Finishing with the diamond finishing bur caused significantly greater surface irregularity (p < 0.0001) before and after STB compared to the tungsten carbide bur. The surface treatment with Db + PG resulted in significantly greater surface roughness following STB than all other regimes of finishing and polishing (p < 0.01). CONCLUSION: Where indicated clinically, finishing is better conducted using a tungsten carbide bur rather than a diamond finishing bur. The combination of tungsten carbide bur/Enhance PoGo and tungsten carbide bur/Sof-Lex surface protocols produced a similarly smooth finish for both composites. The composite surfaces in all groups increased in surface irregularity following STB. CLINICAL SIGNIfiCANCE: Whilst finishing using a tungsten carbide finishing bur followed by either the Sof-Lex or PoGo polishing system may be found to result in a smooth surface finish, all the surfaces investigated increased in surface roughness following toothbrushing.

Contemporary teaching of posterior composites at dental schools in Austria, Germany, and Switzerland.

OBJECTIVE: To investigate current teaching and operative techniques for posterior composite resin restorations in dental schools in Austria, Germany, and Switzerland. METHODS: Data on teaching, including operative techniques applied in the placement of posterior composites, were collected by means of a 25-item validated questionnaire sent to the Heads of Department of Operative/Restorative Dentistry at all 38 dental schools in Austria, Germany, and Switzerland. Responses were compiled in Excel and analysed. RESULTS: Thirty-three schools responded to the survey, resulting in a response rate of 87 %. All dental schools indicated teaching of 2- and 3-surface posterior composite restorations. About one third only of the preclinical teaching is assigned to teaching posterior composite restorations, while the vast majority of posterior restorations placed by students in their clinical instruction are composite (89.6 ±â€¯9.3 %). Most dental schools teach few contraindications to posterior composites, except for adverse reactions such as allergies. All dental schools consider moisture control to be important, while approaches to the management of exposed dentine differ. CONCLUSIONS: The teaching of the placement of posterior composite restorations is common to all the dental schools in Austria, Germany, and Switzerland which participated in the present study. Most aspects of the teaching were found to be consistent amongst the schools. However, marked variations were observed in respect of operative techniques for the placement of posterior composites. CLINICAL SIGNIFICANCE: Graduates from dental schools in Austria, Germany, and Switzerland may be found to have received theoretical, preclinical, and clinical instruction in posterior composites, but do show some variation in approach to the management of exposed dentine.

The teaching of removable partial dentures in dental schools in Oceania.

OBJECTIVES: To examine the current arrangements and trends in the teaching of removable partial dentures (RPDs) in dental schools in Oceania. METHODS: A validated and trialled 30-item electronic survey was sent via e-mail to 12 dental schools in Oceania that offered undergraduate dentistry. The survey explored various aspects of the teaching of RPDs in preclinical and clinical courses including: educational content and process, staff members involved, facilities and techniques utilized, clinical requirements, coursework evaluation and perceived challenges to RPD teaching. RESULTS: The response rate of the survey was 75 % (n = 9). All respondent schools taught a preclinical course in RPD design and production, with the majority (67 %) starting the clinical provision of RPD patients in Year 3. The mean duration of the course was 63 h for hands-on activities and 23 h for didactic teaching. The courses were mainly taught by senior lecturers. On average, students made four units of acrylic RPD and two cobalt-chromium RPDs during the course. All respondent schools taught prescription writing for RPD. The majority of schools (n = 8) stated that they had an adequate patient pool for students to treat. Lack of adequately trained staff for teaching and pressure on teaching time from other sources were the most commonly reported challenges. CONCLUSION: The structure and content of RPD courses in dental schools of Oceania provide an adequate level of competence on the subject, and is broadly similar to other parts of the world. Plans should be in place to maintain and improve the quality of educational programmes to keep pace with growing student numbers and the rapidly evolving profession. CLINICAL SIGNIFICANCE: With increasing numbers of patients presenting to general dental practitioners requiring complex RPDs, it is paramount that undergraduate training programs produce graduates with the competencies necessary to care for such patients to a high standard.

Performance of zirconia implants.

Design A prospective, controlled clinical study, conducted at least in part in practice, to compare approximal plaque index (API), sulcus bleeding index (SBI), periodontal probing depth (PPD), probing attachment level (PAL), creeping or recession of the mucosa/gingiva (CR/REC) and pink esthetic (PE) scores between Z-look 3 Implant System dental implants (Z-Systems, Oensingen, Switzerland) and adjacent natural teeth as controls over a mean follow-up period of 7.8 years (range: 6.1-9.7 years). The peri-implant marginal bone levels (MBL) at implant placement and follow-up visits were determined by panoramic radiography and recorded for comparison.Microbial contamination of the implants and control teeth was investigated using Paro Check 20 (Greiner Bio-one, Frickenhausen, Germany; Institute for Mikro-ecology, Herborn-Horbach, Germany). A validated questionnaire to assess patient satisfaction provided data to complement the clinical findings. The study, which lacks a clearly stated hypothesis, was approved by the ethics committee of the University Hospital in Frankfurt, Germany (No. 118/08).Sample selection Thirty-eight 'healthy' adult, partially edentulous patients (15 females, 13 males) with a mean age of 63.5 years (range: 39-80 years of age) were included in the study. A total of 106 zirconia implants were placed in these patients. No details of power calculations or inclusion/exclusion criteria are provided other than 'healthy' and partially edentulous.Data analysis SPSS for Windows statistical software was used for data analysis. The Gaussian distribution was analysed using the Kolmogorov-Smirnov test. As most of the data was 'non-normally' distributed, non-parametric tests were applied. The level of significance was set at 0.05. The Wilcoxon signed-ranks test was used for comparison of the API, SBI, PPD, PAL, CR/REC and microbial data. The analyses could be considered appropriate for the intended purpose.Results The findings presented pertain to 83 implants (38 maxillary and 45 mandibular) and 570 control teeth in 28 patients who remained in the study. The 26% attrition in patients and 22% attrition in implants available for investigation was attributed to 'decease and relocation'. Such attrition was presumably anticipated and factored into power calculations given the mean age of the patients being 63.5 years at the beginning of the study. A survival rate of 100% is reported with 'no major complications' despite 'biological impairment' having been observed in one patient, resulting in increased bone resorption, PPDs and recession/attachment loss affecting both implants and control teeth. The zirconia implants had a statistically significant lower plaque accumulation (P <0.01) compared to control teeth, whereas peri-implant PPDs were significantly higher around the implants (P <0.01). It is reported that the data presented 'underlines the tissue-friendly properties of zirconia implants'. The mean peri-implant bone resorption (1.2 mm) associated with the implants was interpreted as moderate 'without indication for a growing peri-implantitis'. The microbial analysis 'revealed no statistically significance difference in the total number of bacteria within the peri-implant sulcus when compared to corresponding regions of the CT' (control teeth)'. Several bacteria in the 'red complex', considered to play a vital role in the development of periodontitis, were detected in significantly higher numbers around zirconia implants when compared to control teeth. The results presented are difficult to put into context not knowing how the zirconia implants were restored and loaded in function, and in the absence of information on the maintenance regimes followed by the patients. It would certainly appear that the patients had good oral health both at the outset and throughout the duration of the study.Conclusion Given the limitations of the study and its reporting, it is suggested in the conclusion that 'the superiority of zirconia implants regarding plaque affinity and soft-tissue compatibility could be proven' is not fully supported. Similarly, the conclusion that 'the findings of the present prospective study could prove the ability of zirconia implants to replace missing teeth with maintenance of peri-implant hard- and soft-tissue health' is not considered to be fully supported. That said, the study does demonstrate that in selected patients, assumed to have and to maintain good oral health, zirconia implants of the type investigated may be found to have good clinical performance, assuming the implants investigated were all restored at an appropriate time following placement and were in function throughout the duration of the study.

Leadership in dental education.

Dental school education continues to evolve at a significant pace. The challenge for those in leadership positions in dental education is to deliver a curriculum which is contemporary, evidence-based, and at the same time meeting the expectations of regulators and the established dental workforce - the latter being professional colleagues, including employers of future graduates. An important change in recent years is the acceptance that dental education itself is no longer a 'start-stop process', beginning at entry to dental school and concluding at graduation. Rather, dental education should be viewed as a continuous and life-long continuum. Perhaps one of the greatest attributes we can develop in our students is the desire and ability to seek to update, refresh and develop their knowledge and skills in the ever-advancing world of dental practice.