Contemporary Educational Interventions for General Practitioners (GPs) in Primary Care Settings in Australia: A Systematic Literature Review.

Background: The primary purpose of educational interventions is to optimize the clinical management of patients. General practitioners (GPs) play a major role in the detection and management of diseases. This systematic literature review will describe the type and outcomes of educational interventions designed for general practitioners (GPs) in the Australian context. Methods: PubMed, CINHAL, and Scopus databases were systematically searched for studies on educational interventions conducted for GPs in Australia during 1st January 2008 to 11th June 2018. Data collected on the methodology of the interventions, GPs satisfaction regarding the educational intervention, changes in knowledge, confidence, skills and clinical behavior of the GPs. We also assessed whether the acquired clinical competencies had an impact on organizational change and on patient health. Results: Thirteen publications were included in this review. The methods with which educational interventions were developed and implemented varied substantially and rigorous evaluation was generally lacking particularly in detailing the outcomes. The reported GP response rate varied between 2 and 96% across studies, depending upon the method of recruitment, the type of intervention and the study setting (rural vs. urban). The most effective recruitment strategy was a combination of initial contact coupled with a visit to GP practices. Nine of the studies reviewed reported improvement in at least one outcome measure: gaining knowledge, improving skills or change in clinical behavior which was translated into clinical practice. In the 3 pre- and post-intervention analysis studies, 90-100% of the participating GPs reported improvement in their knowledge and attitudes. Conclusion: Education interventions for GPs in Australia had low response (recruitment) and retention (GPs that participated in follow-ups) rates, even when financial benefits or CPD points were used as incentives. Higher GP response rates were achieved through multiple recruitment strategies. Multifaceted interventions were more likely to achieve the primary outcome by improving knowledge, skills or changing practice, but the effect was often modest. Inconsistent results were reported in studies involving the use of multiple contact methods within an intervention and conducting online interventions.

A digital approach to dynamic jaw tracking using a target tracking system and a structured-light three-dimensional scanner.

PURPOSE: This technical procedure describes a method for tracking mandibular movement using a three-dimensional (3D) optical scanner and target tracking system to digitally portray the motion of the mandible and temporomandibular joints by merging cone beam computed tomography (CBCT) data. METHODS: Four nonreflective targets were attached to the labial surface of the incisors in a noncolinear arrangement. Mandibular movement was tracked directly using a 3D facial scanner and target tracking software after merging facial scanning data, digital data obtained from a diagnostic cast, and CBCT scan data based on several landmarks of the anterior teeth. The moving path of the subjects' mandible was converted to CBCT-based data to confirm the actual movement of the mandible and temporomandibular joints. CONCLUSIONS: The digital implementation of mandibular movement using a 3D optical scanner and target tracking system is not prone to the same restrictions and limitations inherent in mechanical equipment; therefore, it is possible to reconstruct more realistic movement(s). This technique can be used in a wide variety of dental applications involving movement of the mandibular jaw, such as fabrication of dental prostheses, or for the diagnosis and treatment of temporomandibular joint disease.

Recording the trajectory of mouth opening and closing for the fabrication of an occlusal splint.

Various attempts have been made to transfer the transverse hinge axis and mandibular movement pattern to the mechanical articulator and to fabricate dental prostheses with the fewest errors. However, the occlusal adjustment of a dental prosthesis is always necessary to ensure a precise intraoral fit even when the facebow transfer technique is used in the cast mounting procedure. This is because the true hinge axis is not obtained when the facebow is applied to a patient who exhibits a variable mandible movement pattern rather than a single rotational axis. This technique merges facial scanning data and digital data obtained from a diagnostic cast based on measurements of several landmarks of the anterior teeth and makes it possible to design a dental prosthesis while considering the mandibular opening and closing movements of the patient. This technique could be used to design prosthetic restorations, occlusal splints, and intermediate splints for orthognathic surgery and for complete mouth rehabilitation when changes in vertical dimensions are needed.

Accuracy of implant impressions without impression copings: a three-dimensional analysis.

STATEMENT OF PROBLEM: Implant impressions without impression copings can be used for cement-retained implant restorations. A comparison of the accuracy of implant impressions with and without impression copings is needed. PURPOSE: The purpose of this study was to evaluate and compare the dimensional accuracy of implant definitive casts that are fabricated by implant impressions with and without impression copings. MATERIAL AND METHODS: An acrylic resin maxillary model was fabricated, and 3 implant replicas were secured in the right second premolar, first, and second molars. Two impression techniques were used to fabricate definitive casts (n=10). For the coping group (Group C), open tray impression copings were used for the final impressions. For the no-coping group (Group NC), cementable abutments were connected to the implant replicas, and final impressions were made assuming the abutments were prepared teeth. Computerized calculation of the centroids and long axes of the implant or stone abutment replicas was performed. The Mann-Whitney U test analyzed the amount of linear and rotational distortion between groups (α =.05). RESULTS: At the first molar site, Group NC showed significantly greater linear distortion along the Y-axis, with a small difference between the groups (Group C, 7.8 ± 7.4 µm; Group NC, 19.5 ± 12.2). At the second molar site, increased distortion was noted in Group NC for every linear and rotational variable, except for linear distortion along the Z-axis. CONCLUSIONS: Implant impression with open tray impression copings produced more accurate definitive casts than those fabricated without impression copings, especially those with greater inter-abutment distance.

The microtomographic evaluation of marginal bone resorption of immediately loaded scalloped design implant with various microthread configurations in canine mandible: pilot study.

This study was undertaken to evaluate the effect of microthread geometry of scalloped design implant on marginal bone resorption. Four types of scalloped design titanium implant specimens were prepared. The type 1 implant had a machined scalloped collar, type 2 had a sandblasted and acid-etched scalloped collar, type 3 had horizontal microthreads, and type 4 had parabolic microthreads, which are parallel with the scalloped conical margin. Two implants of a type were randomly installed immediately after extraction in the mandible of a beagle dog. Definitive prostheses were delivered immediately after surgery. After 12 weeks of healing, the dog was sacrificed and microtomography was performed. Type 4 specimens showed a marginal bone loss pattern definitively analogous to the scalloped margin. In this preliminary study, microthread geometry affected the marginal bone resorption pattern of scalloped design implants. However, additional specimens and more controlled conditions should be applied in future studies to confirm these results.

Influence of transmucosal designs of three one-piece implant systems on early tissue responses: a histometric study in beagle dogs.

PURPOSE: The purpose of this study was to investigate the early tissue response around three one-piece implant systems with different transmucosal designs. MATERIALS AND METHODS: Three one-piece dental implant systems with different profiles and surface roughnesses on the transmucosal portion were examined in the current study. The transmucosal portions were flared and machined (FM), concave and machined with microgrooves (CMG), or straight and anodic oxidized (SA). A total of 30 implants (10 of each type) were placed in computer-generated randomized order in the mandibular residual ridges of five beagle dogs. Six months later, all animals were sacrificed and histologic sections were prepared to measure epithelial tissue height, connective tissue contact, and the amount of bone resorption. One-way analysis of variance and the Bonferroni post hoc test were used for statistical evaluation (alpha = 95%). RESULTS: After a 6-month nonfunctional loading period, all 30 implants were clinically immobile. Slight swelling and redness of the peri-implant soft tissue were noticed around most of the implant abutments. Histometric analysis showed that the FM implants had a longer epithelial tissue height than the CMG implants. The CMG implants showed the greatest amount of connective tissue attachment among the three groups and the least amount of marginal bone resorption. The CMG and SA implants showed bone growth above the initial reference point at 10 and 7 measurement sites, respectively, whereas no bone overgrowth was noted around the FM implants. CONCLUSION: Based on this study conducted in five beagle dogs, a concave transmucosal profile with a microgrooved surface was associated with longer connective tissue attachments and less bone resorption versus implants that were flared with a machined surface or straight with an anodic oxidized surface in the early healing phase. Int J Oral Maxillofac Implants 2010;25:309-314.

The change of rotational freedom following different insertion torques in three implant systems with implant driver.

STATEMENT OF PROBLEM: Implant drivers are getting popular in clinical dentistry. Unlike to implant systems with external hex connection, implant drivers directly engage the implant/abutment interface. The deformation of the implant/abutment interface can be introduced while placing an implant with its implant driver in clinical situations. PURPOSE: This study evaluated the change of rotational freedom between an implant and its abutment after application of different insertion torques. MATERIAL AND METHODS: Three kinds of internal connection implants were utilized for the current study (4.5 × 12 mm Xive, 4.3 × 11.5 mm Inplant Magicgrip, 4.3 × 12 mm Implantium MF). An EstheticBase, a 2-piece top, a Dual abutment was used for its corresponding implant system. The rotational freedom between an implant and its abutment were measured before and after applying 45, 100 Ncm insertion torque. Repeated measures ANOVA was used for statistical analysis. RESULTS: Under 45 Ncm insertion torque, the rotational freedom between an implant and its abutment was significantly increased in Xive (P = .003). However, no significant change was noted in Inplant Magicgrip and Implantium MF. Under 100 Ncm torque, both in Xive (P = .0005) and Implatium MF (P = .03) resulted in significantly increased rotational freedom between the implant and its abutment. DISCUSSION: The design of the implant/implant driver interface effectively prevented the deformation of implant/abutment interface. Little change was noted in the rotational freedom between an implant and its abutment, even though the insertion torque was far beyond clinical application. CONCLUSIONS: The implant/abutment joint of internally connecting implants were quite stable under insertion torque in clinical situation.