Melbourne Dental School - Research Publications
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ItemPreparedness for practice of newly qualified dental practitioners in the Australian context: an exploratory study(BMC, 2022-08-18)BACKGROUND: The current study explored the perspectives of preparedness for dental practice from a range of relevant stakeholders (i.e., educators, employers, final-year students, graduates, practitioners, and professional associations) using an anonymous online survey in which participants described either their preparedness for practice, or the preparedness of graduates they have encountered, across six domains. RESULTS: A total of 120 participants completed the survey. Participants were from several Australian states and territories; regional, rural, and urban locations; and working in the public and private sector. Students and new graduates generally felt prepared for activities in all the identified domains. Stakeholders reported consistently that the knowledge of dental profession graduates was at the required level to enter practice in Australia in a safe way. Activities involving the knowledge of clinical entrepreneurship and financial solvency were the dimensions where students and graduates felt least prepared (e.g., explaining fees, negotiating finances). In the domains involving clinical and technical competencies, students and new graduates self-assessed as less prepared around managing dental trauma and medical emergencies. On the other hand, activities around social and community orientation, and to a lesser extent professional attitudes and ethical judgements, were the dimensions where students and graduates felt the most prepared. CONCLUSIONS: Present findings indicate that there appear to be good standards of preparedness for practice for graduate dental professionals. This exploratory study provides insights into the nature of preparedness for Australian dental professionals and provides a basis for targeting education and professional development to address areas of need.
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ItemPreparedness for practice of newly qualified dental professionals in Australia-educator, employer, and consumer perspectives(BMC, 2022-05-23)BACKGROUND: Limited data regarding the perspectives of other observers (i.e. those who educate, employ or receive care from) of new graduates' preparedness to practice is available. The present study aimed to explore perceptions of different observers regarding the preparedness to practice and work readiness of newly qualified dental professionals. This broader range of perspectives is crucial to inform the development of educational programs, including continuing professional development, for newly qualified dental professionals, by clarifying the skills, knowledge and behaviours expected by the dental profession and wider public. RESULTS: Nineteen individual qualitative interviews were undertaken. Interview participants included clinical demonstrators (n = 9; 2 Oral Health Therapists; 5 Dentists; and 2 Prosthetists), dental course convenors (n = 4), representatives of large employers (n = 2), and consumers (n = 4). According to this diverse group of respondents, dental students receive adequate theoretical and evidence-based information in their formal learning and teaching activities, which prepares them for practice as dental professionals. There were no specific clinical areas or procedures where preparedness was highlighted as a major concern. Notwithstanding this, specific graduate skills which would benefit from further training and consolidation were identified, including areas where higher levels of experience would be beneficial. Nonetheless, respondents indicated that new graduates were aware of their limitations and had developed self-discipline and ethics that would allow them to identify conditions/situations where they would not have the experience or expertise to provide care safely. CONCLUSIONS: From an observer perspective, dental students appeared to have gained adequate theoretical and evidence-based information in their formal learning and teaching activities to prepared them to commence practicing safely as dental professionals. Areas were identified in which new graduates were underprepared and when transitional support may be required.
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ItemIn vitro fracture strength and patterns in root-filled teeth restored with different base materials(WILEY, 2018-03)BACKGROUND: There is little research on the effects of an intermediate base on the fracture strength of root-filled teeth. This study compared the fracture strengths and patterns of root-filled teeth restored with intermediate bases of glass-ionomer cement (GIC), zinc polycarboxylate cement (ZPC), dual-cured resin composite (DCRC) and Biodentine® under resin composite. METHODS: Standardized cavities were prepared in 100 extracted human maxillary and mandibular premolars, and root canal treatment was performed. The teeth were stratified and randomly allocated to five groups (n = 20): (i) GIC; (ii) ZPC; (iii) DCRC; (iv) Biodentine; and (v) prepared but unrestored (control). The teeth were subjected to an oblique, ramped load until fracture. The fracture loads, level, mode and location were recorded. RESULTS: Mean fracture strengths of all restored groups were not significantly different amongst the groups. There were significant overall effects on mean fracture strength for tooth type (P = 0.002) and buccolingual width of the crown (P = 0.001). CONCLUSIONS: The four materials were appropriate intermediate bases. The laminate restorative technique promoted fracture strengths that are likely to withstand normal and maximum masticatory function. The base material can influence failure mode, which may have implications for the clinical presentation of fractures of root-filled teeth.
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ItemDentists' restorative decision-making and implications for an 'amalgamless' profession. Part 5: knowledge factors(WILEY, 2017-12-01)BACKGROUND: A phase-down of amalgam in Australia is possible given the Australian Government intends to ratify the Minamata Convention. There is little research as to the influence of a dentist's knowledge on decision-making, which may be of use when determining the impact of any change. METHODS: An online survey relating to aspects of and attitudes to use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association or Members or Fellows of the Royal Australasian College of Dental Surgeons. RESULTS: There were 408 respondents. Fifty-eight per cent agreed that there was consistency in undergraduate teaching. Fifty-two per cent stated that there was a difference between undergraduate teaching and the 'real world'. Postgraduate education was ranked the most important influence on decision-making. Ninety-six per cent stated that knowledge of the evidence base is important and 89% believed that they practised evidence-based dentistry. CONCLUSIONS: Dental schools need to maintain teachers' and students' understanding of the evolving technology of direct restorative materials. There is a perceived disconnect between undergraduate teaching and the 'real' world. The evidence base is viewed as confusing, contradictory and not readily understandable. The creation of clinical guidelines would be useful.
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ItemDentists' restorative decision-making and implications for an 'amalgamless' profession. Part 4: clinical factor(WILEY, 2017-09)BACKGROUND: The Minamata Convention embodies a worldwide reduction in the production and use of mercury and mercury-containing products and processes, including a phase-down of dental amalgam. This will change the approach to the use of direct restorative materials in the near future. There is little research as to the influence of clinical factors on dentists' decision-making which may be of use when determining the impact of any change. METHODS: An online survey relating to aspects of and attitudes to the use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association and/or members or fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. RESULTS: There were 408 respondents to the survey. Eighty-seven per cent of respondents (strongly) disagreed that amalgam was a technically more difficult material to place compared with resin composite, 82% (strongly) disagreed that placement time for amalgam was longer than that for resin composite and 69% (strongly) disagreed that amalgam was more difficult to finish than resin composite. Eighty-three per cent of respondents stated they were confident in their ability to place amalgam restorations. Where physical properties were of importance, indirect restorations were preferred (e.g. parafunction) 54%. The factors considered most important when choosing a direct restorative material included moisture control and aesthetics; least important factors were cost and time to place. CONCLUSIONS: There is consensus that amalgam is not more technically difficult to use, place or finish than resin composite and vice versa. There is recognition that both amalgam and resin composite have limitations in terms of physical properties. When choosing a direct restorative material, clinical factors considered to be of greatest importance are moisture control, aesthetics and the need to apply minimally invasive approaches. There is little difference in the opinions of users and non-users of amalgam with respect to these findings.
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ItemComparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995-2005 and 2006-2016 periods(WILEY, 2017-06)Composites are increasing in popularity as restorative materials. This growing role indicates the necessity of studies on their clinical outcome. In this study, clinical studies published on the performance of posterior composite restorations were included except those of less than a 24-month assessment period. Results of non-vital, anterior or primary teeth and cervical single-surface restorations were also excluded. Records about composite type, number of final recall restorations, failure/survival rate, assessment period and failure reasons were analysed for each decade. Overall survival/failure rates for studies in 1995-2005 were 89.41%/10.59% and for 2006-2016 were 86.87%/13.13%, respectively. In 1995-2005, the reasons for failure were secondary caries (29.47%) and composite fracture (28.84%) with low tooth fracture (3.45%) compared with reasons of failure in 2006-2016, which were secondary caries (25.68%), composite fracture (39.07%), and tooth fracture (23.76%). An increase in incidence of composite fracture, tooth fracture and need for endodontic treatment as failure reasons was noted in the latter decade in addition to a decrease in secondary caries, postoperative sensitivity, unsatisfactory marginal adaptation and wear. The overall rates of failure showed little difference, but the causes showed a notable change. This is believed to be a reflection of increased use of composites for larger restorations and possibly changes of material characteristics.
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ItemIncorporation of the microencapsulated antimicrobial agent phytoncide into denture base resin(WILEY, 2018-09)BACKGROUND: This study aimed to fabricate a denture base resin (DBR) containing phytoncide microcapsules (PTMCs) and determine the mechanical properties of the resin and antifungal activity. METHODS: Fifty-four heat-cured rectangular DBR specimens (64 × 10 × 3.3 ± 0.2 mm) containing nine concentrations of PTMC between 0 and 5% (wt/wt) were fabricated and subjected to a three-point bending test. A phytoncide release bioassay was developed using DBR containing 0% and 2.5% PTMCs (wt/wt) in a 24 well-plate assay with incubation of Porphyromonas gingivalis at 37 °C for 74 h. The antifungal activity of PTMCs against Candida albicans, in a pH 5.5 acidic environment was determined in a plate assay. RESULTS: Flexural strength decreased with increasing PTMC concentration from 97.58 ± 4.79 MPa for the DBR alone to 53.66 ± 2.46 MPa for DBR containing 5.0% PTMC. No release of phytoncide from the PTMCs in the DBR was detected at pH 7.4. The PTMCs had a minimal inhibitory concentration of 2.6% (wt/vol) against C. albicans at pH 5.5. CONCLUSIONS: PTMCs can be added to DBR 2.5% (wt/wt) without adversely affecting flexural strength. PTMCs released the antimicrobial agent at pH 5.5 at concentrations sufficient to inhibit the growth of the C. albicans.
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ItemDental educators' attitudes towards the teaching of dental amalgam(WILEY, 2020-05)OBJECTIVE: To ascertain dental educators' attitudes towards the teaching of dental amalgam at dental schools in Australia and identify preferred curricular approaches in a potentially "amalgamless" profession. METHODS: A mixed methods analysis was employed based on an open-ended response survey followed by a closed-ended questionnaire. Identification of key issues from the survey helped frame the questionnaire. Participants included those with expertise in operative and restorative dentistry, with direct involvement in curriculum development or delivery, at Australian dental schools. RESULTS: Participants numbered fifteen and represented seven of the nine dental schools in Australia. Key themes identified and explored included the following: (in)consistency of approach to teaching restorative dentistry; a perceived disconnect between undergraduate study and the "real world"; a need for a focus on teaching of alternatives to dental amalgam (80 per cent (strongly) agreeing); the contradictory nature of the evidence base and literature that is not readily understood; the need for more post-graduate education relating to adhesive restorative materials (86 per cent (strongly) agreeing); the need for dental amalgam to continue to be available; formal understandings (guidelines) as to the use of dental amalgam; dental schools in Australia being heard on these issues; and the relevance of this issue (100 per cent (strongly) agreeing the issue is topical and important). CONCLUSION: There is a broad consensus of dental educators at Australian dental schools as how best to approach the teaching of amalgam if a phase-down is to occur and the issues any such approach may face.
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ItemEffects of the exposure site on histological pulpal responses after direct capping with 2 calcium-silicate based cements in a rat model.(Korean Academy of Conservative Dentistry, 2018-11)Objectives: Direct pulp capping is a treatment for mechanically exposed pulp in which a biocompatible capping material is used to preserve pulpal vitality. Biocompatibility tests in animal studies have used a variety of experimental protocols, particularly with regard to the exposure site. In this study, pulp exposure on the occlusal and mesial surfaces of molar teeth was investigated in a rat model. Materials and Methods: A total of 58 maxillary first molars of Wistar rats were used. Forty molars were mechanically exposed and randomly assigned according to 3 factors: 1) the exposure site (occlusal or mesial), 2) the pulp-capping material (ProRoot White MTA or Bio-MA), and 3) 2 follow-up periods (1 day or 7 days) (n = 5 each). The pulp of 6 intact molars served as negative controls. The pulp of 12 molars was exposed without a capping material (n = 3 per exposure site for each period) and served as positive controls. Inflammatory cell infiltration and reparative dentin formation were histologically evaluated at 1 and 7 days using grading scores. Results: At 1 day, localized mild inflammation was detected in most teeth in all experimental groups. At 7 days, continuous/discontinuous calcified bridges were formed at exposure sites with no or few inflammatory cells. No significant differences in pulpal response according to the exposure site or calcium-silicate cement were observed. Conclusions: The location of the exposure site had no effect on rat pulpal healing. However, mesial exposures could be performed easily, with more consistent results. The pulpal responses were not significantly different between the 2 capping materials.
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ItemBiocompatibility and Osteogenic/Calcification Potential of Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride(ELSEVIER SCIENCE INC, 2018-03)INTRODUCTION: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with fluoride (CPP-ACFP) have been shown to provide bioavailable ions to promote mineralization. Hence, the aim of this study was to evaluate the materials' biocompatibility and osteogenic/calcification potential for endodontic applications. METHODS: Human and mouse osteoblast-like and fibroblast-like cell lines were incubated with 0.05%-3.0% w/v CPP-ACP and CPP-ACFP, and toxicity, proliferation, alkaline phosphatase, interleukin (IL)-1α, and IL-6 production, collagen type I, osteocalcin, and osteopontin production, and mineralization/calcification were determined. RESULTS: CPP-ACP and CPP-ACFP were non-toxic and had no significant effect on proliferation or production of the inflammatory cytokine IL-1α. Alkaline phosphatase activity of the osteoblast-like cells was significantly increased (P < .05) by CPP-ACP and CPP-ACFP, as was the production of the osteotropic cytokine IL-6, the formation of calcium mineral deposits, and the secretion of mineralization-related proteins (collagen type I and osteocalcin). CONCLUSIONS: CPP-ACP and CPP-ACFP are biocompatible and have the potential to induce osteoblastic differentiation and mineralization. Potential applications include apexification, perforation repair, vital pulp therapy, and regenerative endodontic procedures.