IMPLANTS STUDY III

The feasibility of a clinical trial of pain related to temporomandibular muscle and joint disorders: The results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks

To determine the incidence of periodontal disease in a general dental practice, and to evaluate the effectiveness of treatment in preventing tooth loss over a period of 12 years. This was a single centre retrospective analysis. A general dental practice in Bournemouth. Over a 6-month period from February 1997 to August 1997 records were made of all patients attending at the practice who had presented for dental examination between September 1985 and September 1986. A database was constructed to record the number of teeth present at the beginning of the study, those which at their initial exam had probing depths of between 5 and 6 mm, and those with 7 mm and greater. If teeth were lost, the date of the extraction was recorded. All patients were treated by conventional dental therapy. Tooth loss was chosen as the end-point. 13% of the patients presenting initially had periodontal problems, and conventional treatment resulted in very few teeth being lost over the study period. Periodontal disease affected only a small number of the patients in the general dental practice. Those patients affected responded well to conventional therapy, resulting in very few teeth being lost during the period of study.

Study question What’s the ploidy status of grade “C” blastocysts and what are their implantation potential and birthweight outcomes when tested euploid? Summary answer Grade “C” blastocysts were less likely to be euploid compared to grades “A/B”. Euploid “C”s led to reduced but reasonable implantation potential with similar birthweights. What is known already In contrast to grade “A” or “B”, grade “C” blastocysts are generally considered borderline quality in most in vitro fertilization programs, with inconsistent policies between clinics. Little evidence has been reported regarding their euploidy rate, implantation potential, and birthweight outcomes. Study design, size, duration This retrospective cohort study included 426 consecutive autologous-oocyte patients undergoing PGT-A (biopsy at day 5/6) at two associated private clinics between January 2013 and August 2020. A total of 1418 resulting blastocysts (tested either euploid or aneuploid) were analysed. Implantation outcomes were assessed in a subset of 520 singly transferred euploid blastocysts. Birthweight outcomes were evaluated in 209 singleton newborns using a gestation-adjusted Z score taking into account gestational age and baby gender. Participants/materials, setting, methods Blastocysts were graded “A/B/C” according to a combination of inner cell mass and trophectoderm morphology. Endpoints included ploidy, implantation and birthweight outcomes. Multiple regression (logistic or linear) was performed to investigate relative prognosis of grade “C” blastocysts using different endpoints in reference to grade “A/B” blastocysts, expressed as either adjusted odds ratio (aOR) or coefficients (β) with 95% confidence intervals (CI). Maternal age and biopsy day (5/6) were included as potential confounders at regression analysis. Main results and the role of chance Grade “C” blastocysts (n = 466) were associated with a lower euploidy rate in reference to either grade “A” (n = 179, aOR=0.412, 95% CI: 0.278–0.611, P = 0.000) or “B” blastocysts (n = 773, aOR=0.535, 95% CI: 0.418–0.685, P = 0.000). Euploid “C” grade blastocysts (n = 128) led to significantly reduced chance to implant when compared to either grade “A” (n = 90, aOR=0.387, 95% CI: 0.215–0.696, P = 0.002) or “B” blastocysts (n = 302, aOR=0.617, 95% CI: 0.404–0.944, P = 0.026); although implantation rate was still considered at a reasonable level (44.5%) as opposed to grades “A” (66.7%) or “B” (57.6%). However, no significant difference was observed in the birthweight (g, mean ± standard deviation) following the transfer of a single euploid grade “C” blastocyst (n = 42, 3310.8±704.1) in comparison to a single euploid grade “A” (n = 48, 3367.8±519.3, P > 0.05) or “B” blastocyst (n = 119, 3284.5±535.5, P > 0.05). Taking into account maternal age, biopsy day, gestational age and baby gender; further multiple linear regression analysis also showed similar results using either birthweight itself (C vs A, β=–52.395, 95% CI: –148.83–43.893, P = 0.282; C vs B, β=–104.338, 95% CI: –272.653–63.977, P = 0.223), or the gestation-adjusted Z score as an endpoint (C vs A, β = 0.101, 95% CI: –0.001–0.164, P = 0.052; C vs B, β = 0.084, 95% CI: -–0.073 – 0.241, P = 0.290). Limitations, reasons for caution The retrospective design of this study does not allow control for unknown confounders. Inner cell mass or trophectoderm was not graded separately making it difficult to further break down the “C” grade blastocysts. Only blastocysts suitable for biopsy were included for analysis, so results may not extrapolate to untested blastocysts. Wider implications of the findings: Grade “C” blastocysts may still hold its clinical value despite reduced euploidy rate. PGT-A may be considered as a potential approach to utilize grade “C” blastocysts more effectively, without affecting birthweight outcomes. This is also potentially useful in patient counselling. Trial registration number Not applicable

The randomized case presentation (RCP) study is designed to assess the degree of diagnostic accuracy for described periodontal cases. This is to lay the basis for practitioner calibration in the Practitioners Engaged in Applied Research and Learning (PEARL) Network for future clinical studies. The RCP consisted of 10 case scenarios ranging from periodontal health to gingivitis and mild, moderate, and severe periodontitis. Respondents were asked to diagnose the described cases. Survey diagnoses were compared to two existing classifications of periodontal disease status. The RCP was administered via a proprietary electronic data capture system maintained by the PEARL Data Coordinating Center. Standard analytic techniques, including frequency counts and cross-tabulations, were used for categorical data with mean and standard deviation and median values reported for continuous data elements. Demonstrable variations in periodontal assessment for health, gingivitis, and mild, moderate, and severe periodontitis were found among the 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was for severe periodontitis (88%) and the lowest for gingivitis (55%). The highest percentage of variation was found in cases with health and gingivitis. There was variation among PEARL practitioners in periodontal diagnosis that may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis.

Introduction Antibiotic prescribing in general dental practice is common and may contribute to antimicrobial resistance. A scoping review was undertaken to map the existing literature on patterns of antibiotics prescriptions in general dental practice to gain a more focused understanding of prescribing behaviors of general dental practitioners (GDPs). Content This review was conducted in accordance with the PRISMA extension for Scoping Reviews. The review protocol was registered on the Open Science Framework. Eligibility criteria included original research studies which reported the antibiotic prescribing behaviors of GDPs and published between January 1990–February 2025. Scopus and PubMed were searched, followed by screening of the articles based on the eligibility criteria. A total of 2,076 records were retrieved following searches on PubMed and Scopus. Title and abstract screening were carried out for 215 articles, and 34 articles were considered for full text screening and finally 17 studies were included in the review. Antibiotics were prescribed for a wide range of conditions including cellulitis, abscesses, periapical infection, and periodontal conditions. Amoxicillin and amoxicillin with clavulanic acid were prescribed most commonly. Summary The results highlight a disconnect between professional guidelines and prescribing practices of dentists. Dentists appear to prescribe antibiotics for clinical situations which may be managed better with operative interventions. Outlook The review underscores the need to improve antibiotic stewardship in general dental practice settings to curb inappropriate antibiotic use and address the escalating threat of antimicrobial resistance.

This chapter will discuss factors influencing the value of health education and health promotion in general dental practice. Four key areas are reviewed, namely: the role that general dental practice could play in health education and health promotion; criticisms of the current practice of health education in general dental practice; the role of chairside health education and health education materials in general dental practice; developing an oral health promotion strategy for general dental practice.

The aim of this study was to conduct a field study to survey the performance of digital radiography and how it was used by dentists in general dental practice. 19 general dental practitioners were visited at their clinics. Ambient light (illuminance) was measured in the rooms where the monitors were placed. Different technical display parameters were noted. Test images and two phantoms--one low-contrast phantom and one line-pair resolution phantom--were used to evaluate the digital system. How the dentists used the enhancement program was investigated by noting which functions were used. Average illuminance in the operating room was 668 lux (range 190-1250 lux). On radiographs of the low-contrast phantom taken at the clinic, the ability to observe the holes decreased as illuminance increased. On average, the "light percentage" initially set on the monitor had to be decreased by 17% and contrast by 10% to optimize the display of the test images. The general dental practitioners used the enhancement programs most often to alter brightness and contrast to obtain the subjectively best image. Large differences between the clinics were noted. Knowledge of how to handle digital equipment in general dental practice should be improved. A calibrated monitor of good quality should be a given priority, as should proper ambient light conditions. There is a need to develop standardized quality controls for digital dental radiography.

Clinicians commonly consider atrophic site topography as an important determinant in deciding the augmentation technique to utilize, as well as forecasting the likelihood of success. The purpose of this retrospective study was to examine the influence of initial atrophic posterior mandible morphology on the outcome of implants placed following augmentation. A total of 52 patients contributed 71 edentulous sites, and 185 implants were placed with mean follow-up of 37.97months. The initial defect morphology was classified according to ABC classification (Journal of Oral Implantology, 37, 2013a and 361). Ridge augmentation was performed by "cortical autogenous tenting" (CAT) followed by either simultaneous or delayed implant placement after 4-6months of healing. The European Academy of Osseointegration success criteria were used to evaluate implant outcomes. The overall survival and success rates of dental implants were 98.91% and 80%, respectively. Cumulative success and survival rates in CAT group were 95% and 100% after 2years of follow-up. The highest marginal bone loss (MBL) was observed (1.26mm±0.99) around implants placed in augmented edentulous sites with initially narrow and flat alveolar crest (defect class CII). Conversely, least MBL (0.48mm±0.78) was detected around implants placed into edentulous sites with two sloped boney walls (defect class AII). Differences between MBL observed around implants placed into initial defect class C, initial defect type and class A (I, II), as well as class BII, were statistically significant (P<0.05). Among all implants, 148 were considered as successful, 26 exhibited satisfactory survival, nine with compromised survival, and two implants failed. The present data confirmed the effect of initial ridge morphology on the outcome of implants placed into augmented bone. Specifically, class A and class B atrophic ridge defects, with one and two vertical boney walls, respectively, may be considered as more favorable recipient sites than class C defects with flat morphology. This conclusion is based on least MBL around implants placed into initial defect class A and class B augmented sites, and higher MBL in implants placed into class C recipient sites. A randomized controlled trial is warranted to examine these exploratory observations.

Preparedness of dental practices to treat cardiac arrest: Availability of defibrillators

In the introductory chapter, we explore how networked learning has developed in recent years by summarising and discussing the research presented in the chapters of the book. The chapters are structured in three sections, each highlighting a particular aspect of practice. The first section focuses on the relationship between design and its influence on how networked learning practices are implemented. The second section extends this discussion by raising the notion of experiencing networked learning practices. Here the expected and unexpected effects of design and its implementation are scrutinised. The third and final section draws attention to a growing topic of interest within networked learning: that of networked learning in informal practices. In addition, we provide a reflection on the theories, methods and settings featured in the networked learning research of the chapters. We conclude the introduction by discussing four main themes that have emerged from our reading of the chapters and which we believe are important in taking forward the theory of networked learning. They are as follows: practice as epistemology; the coupling of learning contexts (the relationship and connection of learning contexts and spaces); the agency and active role of technology within networked learning; and the messy, often chaotic and always political nature of the design, experience and practice of networked learning.

Aim To determine the prevalence of restoration overhangs in a general dental practice and investigate if these are associated with an increase in the rate of alveolar bone loss locally.Methods Historical dental records were randomly and anonymously selected from the records of patients in a general dental practice. The most recent bitewing radiographs were examined and any overhangs were recorded along with location. Sequential bitewing radiographs were examined so that the restored tooth with an overhang could be compared over time with a similar but unrestored tooth which acted as a control.Results A total of 111 dental records were audited and an overhang was observed in 67 cases. The prevalence of overhangs was greatest on upper molar teeth. Bone loss was calculated from 35 historical sets of bitewing radiographs over a period of up to 25 years. The mean bone loss on the unrestored control teeth was 0.06 mm/year and on the teeth adjacent to the overhangs it was 0.16 mm/year. This difference of 0.1 mm/year was statistically significant (paired t-test, P = 0.01). There was no significant difference between males and females. The mean size of the overhang was 0.9 mm (range 0.4-2.0 mm) with the bigger overhangs being associated with greater bone loss; however, not all ledges were associated in bone loss.Conclusions Restoration overhangs can be associated with increased bone loss and larger overhangs may be most problematic, although other factors are involved as not all ledges caused bone loss.

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing concern to healthcare workers. Successful prophylaxis requires careful planning in advance. Whilst all practices should have a policy for sharps injuries, prevention of needlestick injuries remains the best policy.

This manuscript was concerned with the extent to which the definition of the networked learning is manifest in the networked learning research. To this end, it explored how the definition is utilised in the design and application of the research. Technology (mediation and/or facilitation), connections (interactions), and network (community and/or context) were the three categories I explored the networked learning research. While the definition of the networked learning is open-ended in nature, the findings show that the networked learning researchers have enough commonality in their approach to the networked learning.

To reduce the number of antibiotics inappropriately prescribed by general dental practitioners, and to increase overall prescription accuracy. A prospective clinical audit carried out between September and March of 2002-3 and 2003-4. General dental practices in Eastern England. The pre-audit antibiotic prescribing practices of 212 general dental practitioners were recorded over an initial six week period. On each occasion this included which antibiotic had been chosen, together with its dose, frequency and duration, as well as the clinical condition and reason for which the prescription had been raised. When related to prophylaxis, the patient's medical history was also noted. Following education on contemporary prescribing guidelines, presentations which illustrated the practitioners' previous errors, and the agreement of standards to be achieved, the process was repeated for another six weeks, and the results compared. In the pre-audit period, 2,951 antibiotic prescriptions were issued, and during the audit this was reduced by 43.6% to 1,665. The majority were for therapeutic reasons, with only 10.5% and 13.6% for medical prophylaxis during the pre-audit and audit periods respectively. Over both periods, amoxicillin and metronidazole were the two most commonly prescribed antimicrobials (63.4% and 21.2% respectively). In the pre-audit period, only 43% of all prescriptions were error free in dose, frequency, and/or duration of use, but this rose significantly to 78% during the audit. Equally, using contemporary published guidelines, out of all the prescriptions made in the pre-audit period, only 29.2% were deemed to be justified, as compared to 48.5% during the audit. Clinical audit, in conjunction with education, and prescribing guidelines can favourably change antibiotic prescribing patterns among general dental practitioners.

Minimal Intervention Dentistry (MID) is a modern approach to the management of caries, which emphasizes prevention and early interception of disease, underpinned by an understanding of the role of the dental plaque biofilm in disease initiation and progression, and how this is affected by lifestyle and behavioral factors. The MID approach should be the standard of care in modern restorative dentistry, as it avoids over-zealous restorative interventions as well as supervised neglect. Incorporating the principles of MID into general dental practice for the management of dental caries involves using Caries Risk Assessment (CRA), as well as a minimally invasive restorative approach utilizing conservative caries removal methods, minimal cavity designs and the use of adhesive restorative materials. A range of methods now exist for measuring the contribution of risk factors to dental caries risk, allowing the clinician to target their interventions at the factors operating in the individual patient, by applying the concepts of ecological change to modify the biofilm, and motivational interviewing to alter patient lifestyle and dietary behaviour. This review discusses how the principles of MID are used for individual patient care, and suggests methods for implementation of MID into general dental practice.