Melbourne Dental School - Research Publications
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ItemNo Preview AvailableUtilising surface-level data to explore surface, tooth, individual and family influence on the aetiology of hypomineralised second primary molars(ELSEVIER SCI LTD, 2021-10)OBJECTIVES: Hypomineralised second primary molars (HSPM) are common developmental enamel defects. The aims of this study were to use surface-level data to explore the clustering of HSPM at four levels (family, child, tooth, surface). METHODS: This study of 172 twin pairs was nested within the Peri/postnatal Epigenetic Twin Study. HSPM was measured by standardised oral examinations at age 6 years. Multilevel logistic regression models were fitted to assess the correlation structure of surface level data and variation in HSPM. The associations between surface level risk factors and HSPM were then explored using the multilevel logistic regression model using the best fitting correlation structure. RESULTS: The prevalence of HSPM was 68 (19.8%) children, with a total of 141 (10.3%) teeth and 264 tooth surfaces (6.3%) affected. Multilevel models revealed that a hierarchical structure accounting for correlation at the family, child and tooth level best accounted for the variation in HSPM. The estimated variances from the best fitting model (Model 3) were largest at the family level (12.27, 95% CI 6.68, 22.51) compared with 5.23 at the child level and 1.93 at the tooth level. Application of regression analysis utilising this three-level correlation structure identified tooth/surface level factors in addition to the previously identified familial and individual risk factors for HSPM. CONCLUSION: In addition to familial (environmental and genetic) and unique child-level factors, the aetiology of HSPM is likely to be influenced by local tooth-level factors.
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ItemNo Preview AvailableRoot canal instrumentation efficacy of non-fused and fused primary molar roots: a micro-computed tomography study(SPRINGER, 2021-10)PURPOSE: Pulpectomy may be indicated in restorable primary teeth exhibiting irreversible pulpitis or pulpal necrosis. The purpose of this study was to compare the cleaning and shaping efficacy of NiTi systems (Reciproc® Blue and MTwo®) with manual stainless-steel instrumentation in primary molars using micro-CT analysis. METHODS: Fifty-seven maxillary second primary molars were scanned using micro-CT. Teeth with three divergent roots were divided randomly (n = 15) according to instrument type (K file, MTwo®, and Reciproc® Blue). Teeth with root fusion were instrumented manually as a separate group (n = 12). Pre- and post-instrumentation micro-CT images were superimposed, and the instrumentation area (IA) and procedural complications were recorded. RESULTS: No statistically significant differences in IA between file systems was observed in the non-fused teeth. The mean IA of fused roots was significantly lower than in the non-fused distobuccal (p = 0.003) and palatal (p < 0.001) roots. The root segment had a significant effect on IA (p < 0.001) and the highest mean IA was observed in the apical third. Manual instrumentation had fewer procedural complications compared with rotary systems. CONCLUSION: No differences were determined in the cleaning and shaping effectiveness of all systems in non-fused teeth. Uninstrumented areas (> 60%) occurred in both non-fused and fused primary teeth with fewer procedural complications observed after manual instrumentation.
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ItemNo Preview AvailableStructural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial(ELSEVIER SCI LTD, 2021-02)OBJECTIVE: To evaluate the influence of fluoride varnish (FV) therapies or resin infiltration (RI) to maintain the structural integrity of Molar Incisor Hypomineralization (MIH) -affected teeth. METHODS: Fifty-one children aged 6-12 years with at least one incisor and one first permanent molar with yellow/brown MIH opacities were included. Patients were randomly allocated into three groups: FV - Fluoride Varnish (Duraphat); FV+etch - Fluoride Varnish (Duraphat) after enamel etching with 37% phosphoric acid; or RI - Resin Infiltration system (Icon). Opacities were monitored for 18 months. The primary outcome was the loss of integrity due to post-eruptive enamel breakdown (PEB). Covariables included sex, age, DMFT index, opacity colour, plaque index, number of MIH-affected teeth, and number of MIH-affected surfaces. Fisher's Exact was used to test the association of treatments with PEB, the Kaplan-Meyer method analysed the survival rates and Cox-regression determined which covariables would predict failure (α=0.05). RESULTS: From a total of 235 teeth, the PEB rate for RI (6.1%) was significantly lower (p<0.05) than FV (17.9%; OR 3.0, 95%CI 1.07, 8.48) and FV+etch (17.3%; OR 3.1, 95%CI 1.13, 8.73). DMFT index >3, brown opacities, cusp involvement, and age between 6-8 years predicted PEB (p<0.05). CONCLUSIONS: Resin infiltration positively influenced the structural integrity maintenance of MIH-affected teeth by decreasing the risk of enamel breakdown over18 months follow-up. Registry of Clinical Trials (RBR-8wwk3n). CLINICAL RELEVANCE: Resin infiltration proved to be a more efficacious intervention to maintain the structural integrity of MIH-affected teeth than fluoride varnish therapies.
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ItemIdentifying factors that promote and limit the effective use of real-time patient experience feedback: a mixed-methods study in secondary care.(BMJ, 2021-12-08)OBJECTIVES: The Friends and Family Test (FFT) is commissioned by the National Health Service (NHS) in England to capture patient experience as a real-time feedback initiative for patient-centred quality improvement (QI). The aim of this study was to create a process map in order to identify the factors that promote and limit the effective use of FFT as a real-time feedback initiative for patient-centred QI. SETTING: This study was conducted at a large London NHS Trust. Services include accident and emergency, inpatient, outpatient and maternity, which routinely collect FFT patient experience data. PARTICIPANTS: Healthcare staff and key stakeholders involved in FFT. INTERVENTIONS: Semi-structured interviews were conducted on 15 participants from a broad range of professional groups to evaluate their engagement with the FFT. Interview data were recorded, transcribed and analysed for using deductive thematic analysis. RESULTS: Concerns related to inefficiency in the flow of FFT data, lack of time to analyse FFT reports (with emphasis on high level reporting rather than QI), insufficient access to FFT reports and limited training provided to understand FFT reports for frontline staff. The sheer volume of data received was not amenable to manual thematic analysis resulting in inability to acquire insight from the free text. This resulted in staff ambivalence towards FFT as a near real-time feedback initiative. CONCLUSIONS: The results state that there is too much FFT free text for meaningful analysis, and the output is limited to the provision of sufficient capacity and resource to analyse the data, without consideration of other options, such as text analytics and amending the data collection tool.
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ItemMedical and dental characteristics of children with chromosome 22q11.2 deletion syndrome at the Royal Children's Hospital, Melbourne(WILEY, 2021-11)BACKGROUND: Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a multifaceted syndrome with a variable phenotype. Few studies have described the associated dental characteristics and their relationship with medical co-morbidities; and no Australian data exist. AIM: To determine the clinical manifestations and correlations between oral and medical conditions in children with 22q11.2DS. DESIGN: A retrospective observational study. Children genetically diagnosed with 22q11.2DS at the Royal Children's Hospital Melbourne were selected; their medical and dental characteristics were collated and analysed. RESULTS: The study population (n = 57; mean age 11.5 years, range 2-27 years) experienced a range of medical conditions involving multiple medical systems; of whom 44 (77.2%) had caries experience, 7 (12.3%) developmentally missing teeth, and 31 (54.4%) developmental defects of enamel (DDE). Smaller proportions of primary teeth were affected by DDE in children with congenital heart disease (2.2% vs 9.7%; P = .02), and cardiac surgery (0.2% vs 9%; P = .001). Conversely, children with hypoparathyroidism (n = 2) had significantly higher proportions of primary teeth affected by DDE (27.5% vs 4%; P = .02). CONCLUSIONS: Significant associations existed between medical conditions (congenital heart disease, history of cardiac surgery, and hypoparathyroidism) and primary dentition DDE in children with 22q11.2 DS.
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ItemPrevention of incipient carious lesions with various interventions during fixed and removable orthodontic treatment. A systematic review and meta-analysis(SCIENDO, 2021-07)Abstract Objective: To systematically review and quantify the effectiveness of interventions in reducing caries development during orthodontic treatment and evaluate the quality of evidence for the development of clinical guidelines. Materials and methods: A comprehensive literature search of the Cochrane, EMBASE and MEDLINE databases was conducted to identify eligible randomised controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias (RoB 2) tool. In order to facilitate the development of clinical guidelines, the quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 18 RCTs were included in the qualitative synthesis, of which 10 had a high risk of bias, and eight had minor concerns. Three RCTs that investigated the efficacy of fluoride interventions during fixed orthodontic treatment were included in the quantitative synthesis. The pooled effect size resulted in a risk reduction of 0.23 (95% CI: -0.35, -0.11,p< 0.001) in the intervention group compared to controls. The GRADE evaluation identified the evidence as moderate due to the limited number of RCTs and moderate heterogeneity (I-squared statistic of 49.3%). Conclusions: Although fluoride is the most effective evidence-based preventive intervention during orthodontic treatment, large RCTs are required to provide high quality evidence. Further studies are needed to evaluate the caries preventive effects of oral hygiene programs, chlorhexidine, CPP-ACP and other interventions.
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ItemCariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol(BMC, 2021-07-01)BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.
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ItemMinimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study(WILEY, 2020-01)AIM: To assess the efficacy of treatment using a minimally invasive approach (selective removal of carious tissue, restoration and preventive strategies) in immature permanent molars with MIH. DESIGN: A total of 281 patients, aged 6-8 years, with carious lesions (ICDAS 5-6), severe MIH, and incomplete root formation (one tooth/patient) were included. After clinical and radiographic examinations, selective carious tissue removal was performed, and the teeth received interim restoration for 6 months and were then restored with composite resin. Clinical and radiographic follow-up was undertaken, 6, 12, 18, and 24 months. A protocol of preventive oral care measures was established and repeated at each follow-up, including diet counselling, oral hygiene instruction, dental plaque control, and topical application of fluoride varnish containing CPP-ACP. All clinical procedures and evaluations were done by a single operator. RESULTS: Clinical and radiographic success was observed 24 months after treatment in 96.8% of the cases. Failures were due to enamel fracture at restoration margins, resulting in pulpitis and absence of apex closure. CONCLUSION: Selective removal of carious tissue, interim, and subsequently definitive restoration, combined with home and professional preventive measures, maintained marginal integrity of restorations in immature permanent molars with severe MIH, confirmed by pulp vitality and occurrence of apexogenesis.
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ItemNo Preview AvailableThe effect of sodium hypochlorite enamel pretreatment on the shear bond strength of fissure sealant using a resin-modified glass ionomer cement and a fluoride-releasing self-etch resin adhesive.(Medknow, 2021)BACKGROUND: The relative high caries risk of pits and fissures highlights the importance of protecting these areas. The aim is to determine the effect of sodium hypochlorite (NaOCl) on the shear bond strength (SBS) of resin-based pit and fissure sealant (RBPFS) material to enamel using resin-modified glass ionomer cement (RMGIC) and fluoride-releasing self-etch resin (FRSE) adhesives. MATERIALS AND METHODS: In this in vitro study extracted third molar teeth without carious lesions or defects were divided into five experimental groups (n = 20). Group A: (Control group) etch (35% phosphoric acid) for 15 s and RBPFS applied. Group B: Etch for 15 s, FRSE and RBPFS applied. Group C: Pretreated with 5% NaOCl and similar steps to Group B. Group D: Etch for 15 s then RMGIC bonding agent and RBPFS applied. Group E: Pretreated with 5% NaOCl and then similar steps to Group D. SBS was determined using a universal testing machine. The tested specimens were examined under a field-emission scanning electron microscope. Data were analyzed using one-way ANOVA and post hoc Tukey's tests (P=0.05). RESULTS: A statistically significant difference between the test groups was observed; Group C showed the highest SBS mean value (7.52 ± 2.74 MPa) and Group D showed the lowest (4.48 ± 1.81 MPa) (P < 0.001). Pretreatment with NaOCl increased the SBS of fissure sealant when Riva bond LC was used (P = 0.049). CONCLUSION: The use of NaOCl as pretreatment can increase the SBS of RBPFS to enamel using RMGIC adhesive. FRSE adhesive did not show improvement in SBS values using pretreatment.
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ItemThe COVID-19 pandemic and its global effects on dental practice. An International survey(ELSEVIER SCI LTD, 2021-11)OBJECTIVES: A multicentre survey was designed to evaluate the impact of COVID-19 outbreak on dental practice worldwide, estimate the COVID-19 related symptoms/signs, work attitudes and behaviour and the routine use of protective measures and Personal Protective Equipment (PPE). METHODS: A global survey using a standardized questionnaire with research groups from 36 countries was designed. The questionnaire was developed and pretested during April 2020 and contained three domains: 1) Personal data; 2) COVID-19 positive rate and symptoms/signs presumably related to the coronavirus; 3) Working conditions and PPE adopted after the outbreak. Countries' data were grouped by the Country Positive Rate (CPR) during the survey period and by Gross-National-Income per capita. An ordinal multinomial logistic regression model was carried out with COVID-19 self-reported rate referred by dental professionals as dependent variable to assess the association with questionnaire items. RESULTS: A total of 52,491 questionnaires were returned with a male/female ratio of 0.63. Out of the total respondents, 7,859 dental professionals (15%) reported symptoms/signs compatible with COVID-19. More than half of the sample (n = 27,818; 53%) stated to use FFP2/N95 masks, while 21,558 (41.07%) used eye protection. In the bivariate analysis, CPR and N95/FFP2 were significantly associated (OR = 1.80 95%CI = 1.60/2.82 and OR = 5.20 95%CI = 1.44/18.80, respectively), while Gross-National-Income was not statistically associated with CPR (OR = 1.09 95%CI = 0.97/1.60). The same significant associations were observed in the multivariate analysis. CONCLUSIONS: Oral health service provision has not been significantly affected by COVID-19, although access to routine dental care was reduced due to country-specific temporary lockdown periods. While the dental profession has been identified at high-risk, the reported rates of COVID-19 for dental professionals were not significantly different to those reported for the general population in each country. These findings may help to better plan oral health care for future pandemic events.