Research Articles (Prosthodontics)

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Oral health in children and adolescents with special healthcare needs in South Africa : a narrative review
(South African Dental Association, 2024-03) Njoroge, N.; Magan, A.; Hlongwa, Phumzile
Children and adolescents with special healthcare needs (CWSHCN) may experience disproportionately poorer general and oral health than healthy children. They are more at risk of common conditions such as dental caries and gingivitis resulting from poor oral health. They comprise of children and youth “with or at risk of chronic physical, developmental, behavioural or emotional conditions”, including, inter alia, intellectual disability (ID), cerebral palsy (CP), learning disability (LD), autism spectrum disorder (ASD), hearing impairment (HI), Down Syndrome (DS), physical disabilities (PD), visual impairments (VI) and epilepsy (EP). Globally, the prevalence of disabilities is increasing, even in developing countries such as South Africa (SA), resulting in a greater burden on healthcare systems.
Cervical margin relocation in indirect restorations
(South African Dental Association, 2024-05) Kok, J.; Sykes, Leanne M.; leanne.sykes@up.ac.za
Cervical margin relocation (CMR) is a technique used to raise the deepest portion of a cavity preparation from asubgingival to a supragingival level. This paper presents an overview of the technique and an analysis of current thinking and practices regarding the use of CMR when carrying out indirect restorations on teeth with deep subgingival margins. Despite promising results, the procedure is still controversial and most studies have been focused on laboratory-based testing of parameters such as bond strength, marginal integrity and fracture behaviour of the restorations. Although long-term clinical survival rates are reportedly high (96%), debate continues regarding the procedure’s impact on gingival health. This paper will explore the historical and clinical development of CMR, its indications, advantages and disadvantages, as well as the time and cost implications, and long-term prognosis. While CMR appears to be safe and effective in appropriately selected cases, with meticulous application techniques, further randomised controlled clinical trials are necessary to draw definitive conclusions.
Evaluation of different baseplate materials on casts with various palatal vault depths
(South African Dental Association, 2024-06) Sitoe, M.B.; Sykes, Leanne M.; Bradfield, C.
INTRODUCTION : The choice of baseplate material for a trial complete maxillary denture is a critical decision in prosthodontic practice. One significant factor to consider is the depth of the palatal vault, which can influence the suitability of the baseplate material. Close adaptation of the denture base is essential in preventing lateral denture movement and enhancing denture retention and support. AIMS AND OBJECTIVES : This study was undertaken to evaluate and determine the most suitable baseplate material to use on casts of various palatal vault depths. METHODS : A total of 120 casts with varying palatal vault depths categorized as shallow, moderate, and deep were fabricated (40 per group). Denture bases, all designed to a uniform 2-mm thickness, were created using four different commonly used materials: pink baseplate wax, self-cured acrylic resin, light-cured acrylic resin, and 3D-printed photo-polymerized resin. Both the casts and the fabricated denture bases were sectioned down the midline. Measurements of adaptation were taken from the left halves. Readings were taken of the gap between the denture bases and the casts at three predefined positions (I - incisive papilla, II - mid-palatal area and III - posterior palatal seal area. RESULTS: For shallow palates the best material (i.e., most closely adapted) in position I was light-cured acrylic, in position II was self-cured acrylic and in position III was light-cured acrylic. For moderate depth palates the best material in position I was light-cured acrylic, in position II was self-cured acrylic and in position III was light-cured acrylic. For deep palates the best material in position I was self-cured acrylic, in position II was self-cured acrylic and in position III was light-cured acrylic. CONCLUSIONS : For all three palatal depths, the material with the closest adaptation in position II (mid-palate) was the self-cured acrylic resin and in position III (the post-dam area) was the light-cured acrylic. In position I (incisive papilla) the light-cured resin performed slightly better in shallow and moderate palates and the self-cured resin in deep palates. It would thus seem that based on this study technicians and clinicians should consider using firstly light-cured acrylic resin or self-cured acrylic resin as opposed to the more commonly used pink baseplate wax for trial denture base plates.
Care and compassion in healthcare provision
(South African Dental Association, 2024-09) Sykes, Leanne M.; Bester, Janette; leanne.sykes@up.ac.za
The quality of patient care forms the basis of all doctor-patient relationships. However, it requires more than mere provision of what is necessary to maintain or restore their health, and should encompass an emotional connection, and a desire to help them. Care covers a wide range of activities and is often seen as the technical and procedural aspects of medicine, while compassion revolves around the relational aspects of patient care. It requires clinicians to be able to express empathy and understanding, share their patients' feelings, be available, communicate, try to provide support and encouragement, and treat them with respect and dignity. This paper discusses care and compassion and explores issues such as whether a person can be taught to care and/ or show compassion; if too much compassion could cloud a practitioner's judgement; if it's possible to deliver good care without being compassionate; and whether a person who has never experienced compassion can develop this ability. Care and compassion are essential components of effective medical practice, and need to be integrated into healthcare. Clinicians should adopt a patient-centred approach that prioritises the patient's values, needs and preferences during their decision-making process. At the same time, they must cultivate emotional intelligence, and identify when they need mental, emotional or physical support.
Women in leadership positions in dentistry : a scoping review
(Elsevier, 2024-02) Gangwani, Pooja; Bennie, Karen R.; Gupta, Avni; Koka, Sreenivas; Bompolaki, Despoina
BACKGROUND : The objectives of this scoping review were to calculate the prevalence of women in leadership positions in dentistry, present existing research on gender (male, female) disparities affecting dentistry globally, identify gaps in the literature that can drive future research, and provide recommendations for achieving gender parity in leadership positions. TYPES OF STUDIES REVIEWED : A search of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials databases was performed using search terms. The search strategies were developed to cover English-language articles from January 2016 through April 2022 that examined the prevalence of women in leadership positions in dentistry. Abstracts, newsletters, qualitative reports, and letters to the editors were excluded. RESULTS : Eighteen studies met all inclusion criteria and were included in the final analysis. Low prevalence was noted of women in leadership positions in dentistry globally. Multiple reasons that have led to gender disparities were identified and recommendations for decreasing gender disparities and achieving gender equity in dentistry were provided. PRACTICAL IMPLICATIONS : Over the years, several factors have contributed to gender inequalities in dentistry. However, during the past decade, gender equity, inclusion, and diversity have been recognized increasingly as core values of the dental profession. Presenting and analyzing all available data surrounding this topic are of paramount importance to start formulating appropriate strategies to achieve gender parity in all areas of dental leadership.
A comparative study of the cutting efficiency of diamond rotary instruments with different grit sizes with a low-speed electric handpiece against zirconia specimens
(Elsevier, 2024-01) Van Aswegen, Ane; Jagathpal, A.J.; Sykes, Leanne M.; Schoeman, Hermanus Stephanus
STATEMENT OF THE PROBLEM : The use of zirconia in dentistry has increased. However, little attention has been given to the difficulty experienced by clinicians when cutting zirconia restorations intraorally. Evidence for which grit size and type of rotary instrument is best for cutting zirconia intraorally is lacking. PURPOSE : The purpose of this in vitro study was to identify the most efficient diamond rotary instrument grit size for cutting zirconia intraorally. MATERIALS AND METHODS : Efficiency was measured by comparing the cutting depth of each rotary instrument into zirconia, analyzing zirconia specimens for surface damage after cutting, and measuring instrument deterioration. Thirty zirconia specimens of the same measurements were used as test specimens and cut with 30 diamond rotary instruments with different grit sizes. An electric handpiece was used with constant force (1.7 N), speed (40 000 rpm), time (1 min), and water flow rate (25 mL/min) to produce comparative data. The mean cutting efficiency values were compared by analysis, and the median values were compared by the nonparametric Kruskal-Wallis test (α=.05). Each test was followed up with pair wise comparisons of the mean or median values if significance was indicated. RESULTS : The greatest cutting depth was achieved with a fine-grit instrument with a mean cutting depth of 5.79 mm compared with 4.54 mm for the coarse-grit instrument (P=.032). The greatest damage to zirconia was done by the coarse- and supercoarse-grit instruments (both 33%), with no substrate damage by the superfine-, fine-, and medium-grit instruments. The greatest instrument deterioration was found on the supercoarse rotary instruments (9.05%). With only 3 exceptions, the power calculations were all sufficient and above 83%. CONCLUSIONS : The fine grit rotary instrument (between 40 and 50 µm) was the most efficient, achieving the greatest cutting depth, with no detectable macroscopic damage to the zirconia and minimal instrument deterioration. CLINICAL IMPLICATIONS : Contrary to the common perception that more abrasive rotary instruments would be more effective in cutting zirconia, the empirical findings in the present study found that fine-grit diamond rotary instruments were more effective than coarse-grit instruments for cutting zirconia intraorally. The study provided new insights into the efficient cutting of zirconia in clinical practice, ensuring maximum productivity (cutting depth) with minimum wasted time and expense (instrument deterioration and substrate fracture).
Situational awareness in the context of clinical practice
(MDPI, 2023-12-04) Feller, Shani; Feller, Liviu; Bhayat, Ahmed; Feller, Gal; Khammissa, Razia Abdool Gafaar; Vally, Zunaid Ismail
In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.
Race in health research : considerations for researchers and research ethics committees
(South African Medical Association, 2023-04) Van Staden, Werdie; Nienaber, A.; Rossouw, T.; Turner, Astrid Chrisilda; Filmalter, Cecilia Jacoba; Nel, Jan Gert; Bapela, S.; Beetge, Mia-Michaela; Blumenthal, Ryan; Castelyn, Camille De Villebois; De Witt-Jordaan, T.W. (Wilma); Dlagnekova, Antonia; Kotze, Carla; Mangwane, S.; Napoles, Lizeka; Somers, R.; Sykes, Leanne M.; Van Zyl, W.B.; Venter, Marietjie; Uys, Andre; Warren, Nichola
This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well as a presumed biological construct in genetic research.
Leadership diversity in prosthodontics: Number and percentage of women chief editors of journals publishing prosthodontic science
(Elsevier, 2022-09) Bennie, Karen R.; Koka, Sreenivas
STATEMENT OF PROBLEM : The number and percentage of women chief editors of journals publishing prosthodontic science is unknown. PURPOSE : The purpose of this observational study was to calculate and compare the number and percentage of women and men chief editors of journals publishing prosthodontic science. MATERIAL AND METHODS : A list of the dental journals, as ranked by impact factor, was obtained through the Web of Science Journal Citation Reports 2020 using the category “Dentistry, Oral Surgery, and Medicine.” Of the 91 journals listed in the Journal Citation Report, 28 published scientific findings related to prosthodontics. The chief editors of these 28 journals were identified, and their gender was recorded. The percentage of women and men chief editors was compared with the percentage of women and men members of the International Association of Dental Research (IADR) and the International College of Prosthodontists (ICP) by using the binomial test (α=.05). RESULTS : Of the 28 included journals, a total of 32 chief editors were identified; of whom, 4 (12.5%) were women and 28 (87.5%) were men. There were 7886 members of the IADR who reported their gender; of whom, 3448 (43.7%) were women. There were 906 members of the ICP; of whom, 248 (27.5%) were women. Compared with the percentage of women and men members of the IADR and ICP, women chief editors were significantly underrepresented (P<.001 and P=.039, respectively). CONCLUSIONS : The number and percentage of women chief editors of journals publishing prosthodontic science is of concern.
Self-reported substance use, in dental and oral hygiene students at a university in South Africa
(South African Dental Association, 2022-10) Madiba, Thomas Khomotjo; Mostert, Vanessa C.; Sykes, Leanne M.
BACKGROUND : A recent study amongst South African dental students found that a number of them had perceived moderate to severe stress and as a result, some have resorted to stimulant drugs. AIM : The aim of the study was to assess substance use by dental and oral hygiene students at a university in South Africa. DESIGN : A cross-sectional design was used and all dental and oral hygiene students registered in 2019 at a university in South Africa were asked to participate. MATERIALS AND METHODS : A pretested, validated self-administered questionnaire was used to achieve the aim. The objectives were to identify which substances were used, where they were obtained, frequency and reasons for use, as well as the self-perceived benefits and side effects experienced. Data was analysed using SPSS version 27. The data was confidential and anonymity was ensured. RESULTS : A total of 303 (88%) agreed to participate with ages from 17 to 36 years and a mean of 22.3 years. Over two thirds 206 (67.9%) used substances. Almost half of the group (44.6%) took one product, 16.5% took two, and 7% consumed between 3 and 5. The sources of substances ranged from peers, friends, acquaintances and pharmacies. Nearly twenty percent of the students used caffeine products, energy drinks, and methylphenidate. Almost 10% used anti-anxiety pills and anti-depressants whilst just above 11% used natural boosters and multivitamins. More than half of the students used the substances to stay awake and improve marks and 45(22%) of the users struggled to stop. CONCLUSIONS : Over two thirds of students used substances, with almost half using one substance. There were multiple sources of substances. More than half of the students used them to stay awake and improve marks.
Leadership diversity in science : women editors of dental journals are underrepresented compared to women editors of medical journals
(Elsevier, 2021-12) Bennie, Karen R.; Koka, Sreenivas
OBJECTIVES : Increasing numbers of women are entering dentistry and medicine and it is anticipated that global leadership positions represent this demographic. In this study, the proportion of women editors of prominent medical and dental journals was compared. METHODS : A list of dental and medical journals, ranked by impact factor, were obtained through Web of Science Journal Citation Reports 2020. Chief and associate editors of these journals were identified as either a woman or a man. RESULTS : Ninety one dental journals had 100 editors, 15 of whom were women. There were significantly less women chief editors than men (p < 0.0001) compared to the percentage expected (global proportion of women and men dental scientists [IADR] membership: 43.72% women). Of ninety one comparable medical journals ranked by impact factor, there were 103 chief editors, 41 of whom were women. There was no significant difference in the number of men and women chief editors for medical journals (p = 0.242). There were significantly fewer women chief editors for dental journals compared to medical journals (p < 0.0001). There was no significant difference between the mean impact factor for journals with women and men editors for dental (p = 0.556) or medical (p = 0.492) journals. For the 91 dental journals, there were a total of 828 associate editors, of whom 638 were men and 190 were women and this difference was significant (p < 0.0001). CONCLUSIONS : The results demonstrate that women in dental research have attained editor positions with less frequency than men indicating the presence of barriers to progress in scientific dental publishing.
Is “failure to treat” a treatment failure?
(South African Dental Association, 2021-10) Sykes, Leanne M.; Jagathpal, Avish J.; Bradfield, Charles F.; Cronje, Michael
Over-servicing in dentistry has been widely reported on and censured due to the potential physical, social and financial harms it can cause a patient. In contrast, under-treatment is less often noticed or raised as a concern as it seldom presents with overt signs of carelessness or disregard. In addition, it is usually not accompanied by any time or financial burdens, thus patients rarely complain about it. While some practitioners may argue that failure to treat is a form of negligence, this paper will explore if, and when it could be justified. While practitioners may never reach a consensus agreement, the ultimate message is that all treatment should be patient centred and should only commence following their educated, considered, autonomous, and voluntary consent.
"Wear your mask"
(South African Dental Association, 2021-02) Sykes, Leanne M.; Wood, Neil H.; leanne.sykes@up.ac.za
The current pandemic has made the wearing of masks a “necessary, if not life-saving, evil”. However, masks have been admired and worn throughout the world for centuries and play an integral part of many activities including customary rituals, cultural events, battles, entertainment, and for protection. They may hide identities, reveal certain personality traits, suggest moods, or act as a barrier between the wearer and the outside world. Masks and mask making has a striking number of similarities to dentistry, and so it seemed fitting to dedicate this year’s cover pages to various types of masks.
The “contagious” clinician
(South African Dental Association, 2021-04) Sykes, Leanne M.; Babiolakis, George P.; Boers, Bernice; leanne.sykes@up.ac.za
The many new airborne viral pathogens such as corona-virus (Covid-19), the novel variant (SARS-CoV-2), acute respiratory distress syndrome (ARDS), severe acute respiratory syndrome (SARS), and Middle East respiratory distress syndrome (MERS), have brought about a whole new avalanche of problems. These airborne pathogens are all highly contagious and transmissible, especially in the dental setting where the procedures and machinery used may generate enormous amounts of aerosol spray. This is an ideal vector for air/ droplet spread. Most dentists have implemented screening procedures to determine if their patients are well enough to be treated, and have begun wearing a full gamut of personal protective clothing (PPE). Nonetheless, a concern that has received limited attention in the literature is the "contagious clinician" who continues to work and who may pose a risk of infecting their patients. This paper explores both the patient's rights to quality care in a safe and healthy environment, as well as the clinician's rights to determine for themselves if they are mentally and physically competent to practice. It also poses questions about whether health care practitioners can be mandated to be inoculated against potentially life-threatening and highly infectious agents.
Technicians and dentists : a catch 22 situation?
(South African Dental Association, 2021-08) Sykes, Leanne M.; Bradfield, Charles F.; Babiolakis, George P.; Becker, Len
Dental technicians who regularly receive poor quality impressions and records are often faced with professional and ethical concerns as to how to handle the situation. They may choose to complete the task to the best of their abilities. Other options are to alter the casts to try to improve the situation and then complete the prescription, contact the dentist and discuss the issue, contact the patient, contact the medical aid, report the practitioner to the HPCSA, or refuse to do the work. Their latter actions have potentially negative implications for them, and will certainly sour working relationships. At worst, they may lose the dentist’s support. This paper explores ways in which dentists and techniciains can foster collegial and mutually beneficial relationships from early on in their careers. This will not only promote better communication, and improve the quality of work produced by them, but it will also serve the best interests of their patients and the profession as a whole.
Looking beyond the physical management of patients with head and neck cancer
(South African Dental Association, 2021-07) Sykes, Leanne M.; Ntseke, Tshegofatso V.; Nethononda, Portia; leanne.sykes@up.ac.za
Cancers of the head and neck region often leave patients with conspicuous defects, as well as limitations in physical and psycho-social functions. Rehabilitation is challenging and can never fully restore the anatomical, physiological, or functional characteristics that have been lost. Ideally newly diagnosed cancer patients should be managed by a multidisciplinary team of specialists from various allied fields who will be able to educate them and help them decide on the most appropriate and suitable treatment options. Patients must understand the processes, be of possible side effects and comprehend the limitations aware of rehabilitation. At the same time, clinicians may need to consider issues of distributive justice when deciding which patients will receive which resources, especially in financially limited institutions and countries. The biggest challenge to us as clinicians as well as community members is to try and treat all patients holistically and to address both their physical and psychosocial needs. This requires a fervent commitment to action, and that we all stand together and help each other through difficult times.
Is it better to be good or to do good?
(South African Dental Association, 2021-05) Sykes, Leanne M.; Babiolakis, George Paul; Evans, William G.; leanne.sykes@up.ac.za
People have contemplated what it entails to be good and to do good. Philosophers propose that being good is an idea about yourself or others, while doing good is an action, towards yourself or others. Other theorists feel that those who want to ‘be good’ actually want to ‘be seen as good’, while those who strive to ‘do good’ are more concerned with following some calling or moral character. If we consider the dental situation, it raises the question of whether the motivation to do good should reign over the practical delivery of good dental treatment. This brings up many new considerations related to being good and doing good, and whether we are looking at good in terms of the practical performance of the clinical work or in terms of addressing the patient’s best interests and welfare. This paper will explore some of the interesting dilemmas that clinicians may face in their daily practices. It aims to raise their awareness of the differences between patients’ demands, actual needs, as well as their own philosophy towards treatment provision.
Dentists and dental technicians - a united team or uncomfortable alliance?
(South African Dental Association, 2021-03) Sykes, Leanne M.; Bernitz, Herman; Becker, L.H.; Bradfield, Charles F.; leanne.sykes@up.ac.za
The effective practising of dentistry requires that dentists and dental technicians work hand in hand, having mutual respect for each other, while maintaining the highest standards in each of their respective disciplines. From a limited survey of dentists and dental technicians it seems that a small portion of our profession have misinterpreted the concept of “hand in hand” to be one of gross perverse incentives, corruption, collusion and dishonesty. This article may come as a shock to some and a revelation of what is known to be true to others. The issues discussed have generally been kept as “Dental family secrets”, however, the authors believe that these practices need to be uncovered if we want to put an end to this behaviour.
Alveolar bone resorption following tooth extraction characteristically illustrated
(South African Dental Association, 2021-10) Sykes, Leanne M.; Bradfield, Charles F.; Naidu, Karmisha; leanne.sykes@up.ac.za
Under normal physiological conditions, bone undergoes a constant, balanced and well- regulated process of renewal and remodelling. This is needed for growth, remodelling and maintenance of skeletal form, as well as for homeostasis of skeletal and plasma calcium levels. The alveolar bone grows along with tooth eruption, and thereafter its shape and volume are influenced by local mechanical as well as systemic factors. It is maintained by forces exerted on it via the periodontal ligaments, thus teeth are mandatory for its preservation and renewal. Following tooth loss, the socket becomes filled with a blood coagulum, which is later replaced by fibrous tissue. This healing process is associated with sizeable reduction in ridge height within the first two months that continues at a slower and variable rate throughout life. There are countless examples of patients who have lost teeth at an early age, presenting with severe alveolar bone loss bone in that area / jaw. The extent is even more dramatic if the edentulous space has been opposed by natural teeth. The cases illustrated in this paper serve to remind clinicians of the need to help patients maintain as many of their natural teeth as possible, while still being cognisant of their aesthetic and functional demands, and the possible health implications.
South Africa’s contribution in the field of forensic odontology - a textbook review
(South African Dental Association, 2021-08) Sykes, Leanne M.; Robinson, Liam; leanne.sykes@up.ac.za
This textbook represents an up-to-date, comprehensive compilation of the field of Forensic Odontology. The chapters have been uniquely structured to take the reader through all aspects of this discipline in a methodical and logical approach. Authors for each section were carefully selected as being internationally recognised experts and renowned amongst their peers in their particular field of Forensic Odontology.

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