Esthetic Rehabilitation with No-Preparation Veneers Applying BOPT: A Case Report with a 12-Month Follow-Up.

A 45-year-old female patient was referred to the Department of Cosmetic Dentistry, Damascus University, seeking to improve dental aesthetics. The clinical examination showed a low smile line and microdontia in the maxillary arch. The treatment plan consisted of applying no-prep veneers with gingival modification, which is described in the biologically oriented preparation technique (BOPT) as a gingitage technique. The gingitage of the sulcus was performed using a yellow ring diamond flame with an inclination of 45 degrees, which causes it to bleed and creates a space between the internal wall of the sulcus and the axial wall of the tooth. After a 12-month follow-up, the gingiva was free of inflammation, recession, and plaque, and there was no increase in probing depth, according to the modified gingival index (MGI), gingival recession index (GRI), Silness-Loe plaque index (PI), and the community periodontal index of treatment needs (CPITN), respectively. The porcelain veneers were intact, with no chippings, cracks, and marginal discoloration. The patient was satisfied with her new smile.

Evaluating the efficiency of two different over-the-counter tooth whitening systems: a randomised controlled clinical trial.

OBJECTIVES: To compare whitening efficiency and tooth sensitivity (TS) of two different over the counter (OTC) whitening systems in comparison to conventional at-home bleaching using 20% carbamide peroxide. MATERIALS AND METHODS: A randomised controlled clinical trial was conducted with three parallel groups (n = 13): (A) at-home whitening using 20% carbamide peroxide (20% CP), (B) OTC ready-to-use gel trays and (C) OTC-paint on gel. Clinical colour change values (ΔE) were measured using spectrophotometry at T0: baseline, T1: 7-day and T2: 14-day from whitening start, T3: 2 weeks and T4: 6 months after whitening end. TS was recorded using a visual analogue scale (VAS). ΔE and TS values were statistically analysed. The level of significance for all tests was 5%. RESULTS: Significant differences in ∆E values were recorded between the experimental groups. ∆E values were significantly higher in the 20% CP conventional at-home whitening group. TS measurements were significantly higher in the 20% CP whitening group (p < 0.05). CONCLUSION: Conventional at-home whitening revealed significantly improved colour change when compared to the OTC-paint on gel and OTC ready-to-use gel tray whitening systems. There was a significant colour relapse in OTC systems. CLINICAL RELEVANCE: The use of tested OTC systems is not recommended as they are not effective in a clear and prolonged improved shade change. Conventional at-home whitening using 20% CP showed higher whitening efficiency and colour stability. This trial was registered with a International Standard Randomised Controlled Trial Number (ISRCTN23096480), Registration date: 12/04/2023.

Scaffolding Self-Regulated Learning in Operative Dentistry Through Self-Assessment Training.

OBJECTIVES: This study aimed to investigate how effective self-assessment training is in improving the self-regulated learning (SRL) ability of operative dentistry students. The secondary aim was to explore students' attitudes towards self-assessment in clinical settings. INTRODUCTION: Self-assessment has been the focus of dental education research for decades and has been claimed to be cornerstone in the SRL process. METHODS: This is quasi-experimental study conducted at Damascus University Faculty of Dental Medicine, Syria. A modified direct observation of procedural skills (DOPS) assessment protocol with a self-assessment component was applied to a convenience sample of students across five clinical encounters in 2022. Data were collected during clinical training on the DOPS form and at the end of the experiment using a structured questionnaire with a single open-ended question. The qualitative part of the study followed a deductive theory-informed content analysis approach, relying on Zimmerman SRL theory. RESULTS: A total number of 32 students participated in the study, eight of whom were male. During the experiment assessment, participants showed overwhelming positive attitudes towards the utility of self-assessment (m ≥ 3.5; max:4) and the overall assessment method (3.3 ≥ m ≥ 3.5; max:4). Cronbach's alpha for the post-experiment questionnaire was 0.888. A total of 84.4% of the participants strongly agreed that self-assessment is useful in clinical training. Data collected (qualitative and quantitative) from participants revealed the positive effects of self-assessment on all three phases of SRL, especially the reflection phase. CONCLUSION: Self-assessment practice and training showed positive results in terms of improving SRL and performance in a clinical context; SRL appeared to be affected by self-assessment in all phases (forethought, performance, and reflection). Participants' perceptions of self-assessment were generally very positive. These findings imply the potential benefits of applying self-assessment training interventions to foster the SRL ability of learners within the clinical context.

Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment.

BACKGROUND: Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees' self-assessment of operative procedures. METHODS: A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%. RESULTS: Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants' self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants' attitudes towards the assessment method were positive. CONCLUSIONS: The findings suggest that the self DOPS method was effective in developing participants' ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.

Effect of bioactive glass paste on efficacy and post-operative sensitivity associated with at-home bleaching using 20% carbamide peroxide: a randomized controlled clinical trial.

BACKGROUND: The aim of this study was to evaluate the effect of bioactive glass (BAG) 45S5 paste on colour change and tooth sensitivity (TS) when used in combination with 20% carbamide peroxide (CP) during at-home vital tooth bleaching. METHODS: Twenty-four patients were selected and assigned into two experimental groups (n = 12) in a double-blind study design. Each patient received 20% CP followed by the application of either BAG paste or non-active placebo paste. The shade evaluation was performed using a digital spectrophotometer based on the CIE L*a*b* colour space system at different time points and the overall colour changes ΔE were calculated. TS was evaluated using visual analogue scale (VAS). The values of ΔE and TS were statistically analysed using paired t-test. The level of statistical significance was established at p = 0.05. RESULTS: The overall colour changes (ΔE) between baseline and each time point showed no significant differences between BAG and placebo groups (p > 0.05). The use of BAG paste significantly decreased TS reported by the participants. CONCLUSIONS: The association of BAG paste with at-home bleaching treatment presents a promising method as it decreased TS and did not deteriorate bleaching efficacy. Trial registration This study was approved and registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under Registration number: ACTRN12621001334897.

Peer-assessment ability of trainees in clinical restorative dentistry: can it be fostered?

OBJECTIVES: The study was conducted to investigate whether peer-assessment among dental students at the clinical stage can be fostered and become closer to that of experienced faculty assessors. METHODS: A prospective pilot study was conducted in 2021 at the Faculty of Dentistry, Damascus University. Sixteen 5th year clinical students volunteered to participate in the study. A modified version of the validated Peer Direct Observation of Procedural Skills (Peer-DOPS) assessment form was used together with a grading rubric. Participants undertook peer-assessment on their colleagues across three encounters. The difference between peers and faculty assessment was the main variable. RESULTS: The mean difference between peers and faculty assessment decreased after each encounter with a significant difference and a medium effect size between the first and third encounters (p = 0.016, d = 0.67). Peer-assessment was significantly higher than faculty, however, the overestimation declined with each encounter reducing the difference between peer- and faculty assessment. Peers' perception of the educational benefit of conducting assessment was overwhelmingly positive, reporting improvements in their own performance. CONCLUSION: This pilot study provides preliminary evidence that dental students assessment ability of their peers can be fostered and become closer to that of experienced faculty assessment with practice and assessment-specific instruction.

Bridging the gap between self-assessment and faculty assessment of clinical performance in restorative dentistry: A prospective pilot study.

PURPOSE/OBJECTIVES: The current study was undertaken to investigate whether self-assessment of clinical skills of undergraduate dental students could be bridged with faculty assessment by deliberate training over an extended period. A secondary aim was to explore students' perception of self-assessment and its effect on their learning and motivation. MATERIAL AND METHODS: A prospective pilot study was conducted at the Department of Restorative Dentistry at Damascus University. Sixteen students participated in the study, ranging in age between 22 and 23 years. A modified Direct Observation of Procedural Skills form with a grading rubric was used to register and guide students' self-assessment; both were pretested on four students before the study. In total, four clinical encounters were completed by each student. Students were trained on how to conduct proper self-assessment before and after each clinical encounter. A postcourse questionnaire was used to investigate students' perception of self-assessment. RESULTS: Bias in self-assessment decreased consistently after each encounter, and the difference in bias between the first (bias = 0.77) and the last encounter (bias = 0.21) was significant with a medium effect size (p = .022, d = 0.64). The percentage of disconfirming performance dimensions decreased from 39.7% to 26.9%. Students' ability to exactly pinpoint strengths improved consistently and significantly. However, their ability to pinpoint areas of improvement was volatile and showed no significant difference. Bland-Altman graph plots showed higher levels of agreement between self-assessment and faculty assessment. Moreover, students' perception of self-assessment was very positive overall. CONCLUSIONS: These findings suggest the possibility that the gap between self-assessment and faculty assessment could be bridged through deliberate training. Future longitudinal research using a larger sample size is still required to further explore whether self-assessment can be actively bridged with faculty assessment by deliberate training.

Management of a Rare Case of Geminated and Fused Central Incisors in the Same Maxillary Dental Arch.

A 27-year-old man presented with developmental disorders in the maxillary incisors and asymmetric smile. Differential diagnosis between geminated and fused maxillary central incisors was conducted using cone-beam computed tomography (CBCT). The complexities of root canal system was handled using suitable shaping instruments and ultrasonic activation tips. Root apexes were sealed with mineral trioxide aggregate plugs. The anterior maxillary gingiva was surgically recontoured, and CAD/CAM Zirconia crowns were placed after the gingival healing phase. The combination of the 3D radiological examination, the clinical screening, and the use of a diagnostic wax-up presented a successful approach to manage this rare clinical case.

Effect of CPP-ACP on efficacy and postoperative sensitivity associated with at-home vital tooth bleaching using 20% carbamide peroxide.

OBJECTIVES: To evaluate CPP-ACP effect on colour change and tooth sensitivity (TS) associated with at-home vital tooth bleaching using 20% carbamide peroxide (CP). METHODS: A randomised double-blind placebo-controlled clinical trial was conducted to measure the TS and tooth colour change of 24 patients at 3-day, 7-day, 14-day and 30-day periods. The participants were instructed to apply 20% CP (7 days-04 h each) followed by the application of either CPP-ACP or non-active placebo paste, delivered by the bleaching custom tray (7 days-30 min each). Lightness (L*), redness (a*) and yellowness (b*) were measured using a digital spectrophotometer and the overall colour changes ∆E were calculated. ∆E and TS values were statistically analysed. The level of statistical significance was established at p = 0.05. RESULTS: No significant differences were detected between CPP-ACP and placebo groups regarding the ∆E. The ∆E measurements presented significant differences within CPP-ACP groups between 3-day vs. 14-day and 30-day measurements. The CPP-ACP application reduced significantly the TS reported by the participants at 3-day when compared with the placebo group. CONCLUSION: The application of CPP-ACP paste during at-home tooth bleaching with 20% CP was beneficial since its use reduced the TS and presented no deteriorating effect on the colour change. CLINICAL RELEVANCE: The current findings are of importance for clinicians to manage TS reported by patients when a high CP bleaching agent is used.

Effect of Er:YAG laser-activated irrigation on dentine debris removal from different parts of the root canal system: An in vitro study.

BACKGROUND: There is insufficient information available in the literature about the efficacy of laser-activated irrigation (LAI) in removing dentine debris at different coronal-apical levels of the root canal system (RCS). OBJECTIVES: To evaluate the efficacy of erbium (LAI) in removing dentine debris from different coronal-apical levels of the RCS when compared to passive ultrasonic irrigation (PUI) and conventional irrigation (CI). MATERIAL AND METHODS: Forty-five single-rooted human teeth were split longitudinally into halves. In each sample, a standardized groove was cut 2-6 mm from the apex along the canal wall of the 1st half, and another standardized groove was cut 10-14 mm from the apex along the canal wall of the 2nd half. Each groove was filled with dentine debris mixed with sodium hypochlorite (NaOCl) 5.25%. The samples were assigned to 3 experimental groups according to the irrigant activation techniques (n = 15); (a) CI group, (b) PUI group and (c) LAI group. The amount of the remaining dentine debris was identified and scored using a stereomicroscope. RESULTS: Laser-activated irrigation removed significantly more debris than PUI and CI systems. The efficacy of dentine debris removal was not affected by the root canal third within all groups. CONCLUSIONS: Erbium LAI enhances dentine debris removal from the artificial irregularities in the RCS.

Evaluating the Clinical Use of Light-emitting Diode vs Halogen Photocuring Units.

PURPOSE: To clinically examine the effect of the type of ight-curing unit on the light intensity output and to assess different operator variables which affect light curing of photo-initiated restorative dental materials, in Damascus, Syria. MATERIALS AND METHODS: A total of 185 private dental practices in the Damascus area were visited to invite the clinicians to participate in this study. The intensity of 163 light-curing units (LCUs) was assessed by radiometry in a standard protocol. The age of the curing unit, light tip direction, distance from restoration surface, time of exposure and the presence of adherent composite remnants on the tip of the light pipe were assessed. Independent samples t-tests and ANOVA with Bonferroni post-hoc tests were conducted (p = 0.05). RESULTS: The light intensity was affected significantly by the type of the LCU (p < 0.001). The increased age of light-curing units significantly reduced the emitted light intensity in LED and QTH units (p < 0.05). The presence of adherent resin composite remnants on the pipe tip of the curing unit was monitored in 74 cases out of 163 (45%). The disinfection wipe was the most common method used to ensure infection control of the curing units. CONCLUSION: LED units exhibited a significantly better light intensity output at the tip when compared to the QTH units. It is important for dentists to consider all practical aspects which can influence the efficacy of LCUs in daily practice.

Surface pre-conditioning with bioactive glass air-abrasion can enhance enamel white spot lesion remineralization.

OBJECTIVE: To evaluate the effect of pre-conditioning enamel white spot lesion (WSL) surfaces using bioactive glass (BAG) air-abrasion prior to remineralization therapy. METHODS: Ninety human enamel samples with artificial WSLs were assigned to three WSL surface pre-conditioning groups (n=30): (a) air-abrasion with BAG-polyacrylic acid (PAA-BAG) powder, (b) acid-etching using 37% phosphoric acid gel (positive control) and (c) unconditioned (negative control). Each group was further divided into three subgroups according to the following remineralization therapy (n=10): (I) BAG paste (36 wt.% BAG), (II) BAG slurry (100 wt.% BAG) and (III) de-ionized water (negative control). The average surface roughness and the lesion step height compared to intra-specimen sound enamel reference points were analyzed using non-contact profilometry. Optical changes within the lesion subsurface compared to baseline scans were assessed using optical coherence tomography (OCT). Knoop microhardness evaluated the WSLs' mechanical properties. Raman micro-spectroscopy measured the v-(CO3)(2-)/v1-(PO4)(3-) ratio. Structural changes in the lesion were observed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX). All comparisons were considered statistically significant if p<0.05. RESULTS: PAA-BAG air-abrasion removed 5.1 ± 0.6 µm from the lesion surface, increasing the WSL surface roughness. Pre-conditioning WSL surfaces with PAA-BAG air-abrasion reduced subsurface light scattering, increased the Knoop microhardness and the mineral content of the remineralized lesions (p<0.05). SEM-EDX revealed mineral depositions covering the lesion surface. BAG slurry resulted in a superior remineralization outcome, when compared to BAG paste. SIGNIFICANCE: Pre-conditioning WSL surfaces with PAA-BAG air-abrasion modified the lesion surface physically and enhanced remineralization using BAG 45S5 therapy.

Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders.

OBJECTIVE: To evaluate the potential of bio-active glass (BAG) powder and BAG containing polyacrylic acid (PAA-BAG) to remineralise enamel white spot lesions (WSL). METHODS: 32 human enamel samples with artificial WSLs were assigned to 4 experimental groups (n=8); (a) BAG slurry, (b) PAA-BAG slurry, (c) "standardised" remineralisation solution (positive control) and (d) de-ionised water (negative control). Mechanical properties of enamel were assessed using surface and cross-section Knoop microhardness. Micro-Raman spectroscopy in StreamLine™ scan mode was used to scan lesion cross-sections. The intensity of the Raman phosphate peak at 959 cm(-1) was fitted and measured producing depth profiles analysed using a double-step fitting function. A further 20 samples (n=5) were used to obtain 3D images of surfaces using non-contact white light profilometry permitting measurement of lesion step height in relation to the sound enamel reference level, and to scan the lesion surface using scanning electron microscopy (SEM). Data were analysed statistically using one-way ANOVA with Tukey's HSD post-hoc tests. RESULTS: BAG, PAA-BAG and the remineralisation solution exhibited statistically significantly higher surface and cross-section Knoop microhardness compared to the negative control. Micro-Raman spectroscopy detected significantly higher phosphate content within the treated groups compared to the negative control group. Lesions' depth was not significantly reduced. SEM images revealed mineral depositions, with different sizes and shapes, within BAG, PAA-BAG and the positive control groups. CONCLUSION: BAG and PAA-BAG surface treatments enhance enamel WSL remineralisation, assessed by the resultant improved mechanical properties, higher phosphate content and morphological changes within the artificial lesions.