Cork University Dental School and Hospital - Doctoral Theses

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Accuracy of computer-aided design/computer-assisted manufacture (CAD/CAM) fabricated dental restorations: a comparative study
(University College Cork, 2015) Nasruddin, Mohd Faiz; Burke, Francis M.; Ray, Noel J.; Theocharopoulos, Antonios; Universiti Teknologi MARA, Malaysia
Introduction: Computer-Aided-Design (CAD) and Computer-Aided-Manufacture (CAM) has been developed to fabricate fixed dental restorations accurately, faster and improve cost effectiveness of manufacture when compared to the conventional method. Two main methods exist in dental CAD/CAM technology: the subtractive and additive methods. While fitting accuracy of both methods has been explored, no study yet has compared the fabricated restoration (CAM output) to its CAD in terms of accuracy. The aim of this present study was to compare the output of various dental CAM routes to a sole initial CAD and establish the accuracy of fabrication. The internal fit of the various CAM routes were also investigated. The null hypotheses tested were: 1) no significant differences observed between the CAM output to the CAD and 2) no significant differences observed between the various CAM routes. Methods: An aluminium master model of a standard premolar preparation was scanned with a contact dental scanner (Incise, Renishaw, UK). A single CAD was created on the scanned master model (InciseCAD software, V2.5.0.140, UK). Twenty copings were then fabricated by sending the single CAD to a multitude of CAM routes. The copings were grouped (n=5) as: Laser sintered CoCrMo (LS), 5-axis milled CoCrMo (MCoCrMo), 3-axis milled zirconia (ZAx3) and 4-axis milled zirconia (ZAx4). All copings were micro-CT scanned (Phoenix X-Ray, Nanotom-S, Germany, power: 155kV, current: 60µA, 3600 projections) to produce 3-Dimensional (3D) models. A novel methodology was created to superimpose the micro-CT scans with the CAD (GOM Inspect software, V7.5SR2, Germany) to indicate inaccuracies in manufacturing. The accuracy in terms of coping volume was explored. The distances from the surfaces of the micro-CT 3D models to the surfaces of the CAD model (CAD Deviation) were investigated after creating surface colour deviation maps. Localised digital sections of the deviations (Occlusal, Axial and Cervical) and selected focussed areas were then quantitatively measured using software (GOM Inspect software, Germany). A novel methodology was also explored to digitally align (Rhino software, V5, USA) the micro-CT scans with the master model to investigate internal fit. Fifty digital cross sections of the aligned scans were created. Point-to-point distances were measured at 5 levels at each cross section. The five levels were: Vertical Marginal Fit (VF), Absolute Marginal Fit (AM), Axio-margin Fit (AMF), Axial Fit (AF) and Occlusal Fit (OF). Results: The results of the volume measurement were summarised as: VM-CoCrMo (62.8mm3 ) > VZax3 (59.4mm3 ) > VCAD (57mm3 ) > VZax4 (56.1mm3 ) > VLS (52.5mm3 ) and were all significantly different (p presented as areas with different colour. No significant differences were observed at the internal aspect of the cervical aspect between all groups of copings. Significant differences (p< M-CoCrMo Internal Occlusal, Internal Axial and External Axial 2 ZAx3 > ZAx4 External Occlusal, External Cervical 3 ZAx3 < ZAx4 Internal Occlusal 4 M-CoCrMo > ZAx4 Internal Occlusal and Internal Axial The mean values of AMF and AF were significantly (p M-CoCrMo and CAD > ZAx4. Only VF of M-CoCrMo was comparable with the CAD Internal Fit. All VF and AM values were within the clinically acceptable fit (120µm). Conclusion: The investigated CAM methods reproduced the CAD accurately at the internal cervical aspect of the copings. However, localised deviations at axial and occlusal aspects of the copings may suggest the need for modifications in these areas prior to fitting and veneering with porcelain. The CAM groups evaluated also showed different levels of Internal Fit thus rejecting the null hypotheses. The novel non-destructive methodologies for CAD/CAM accuracy and internal fit testing presented in this thesis may be a useful evaluation tool for similar applications.
Adolescent and parent perceptions of expected benefits of orthodontic treatment: a mixed-methods study
(University College Cork, 2021-06-30) Smyth, Joshua Peter Richard; Millett, Declan
Aims: 1: To investigate expected benefits of orthodontic treatment from both an adolescent and parent perspective. 2: To rank the expected benefits of orthodontic treatment identified by adolescents and parents in order of perceived importance. Materials and Methods: Ethical approval was granted to carry out both parts of this study. Part 1 used qualitative methodology with one-to-one semi-structured interviews by a trained interviewer. Twenty adolescents (10 males; 10 females) referred for orthodontic assessment and their parents (8 males; 12 females) were interviewed independently to explore expectations of the benefits of orthodontic treatment. Interviews were transcribed verbatim and interpretive phenomenological analysis carried out. Part 2 quantitatively assessed the benefits identified in Part 1. Twelve additional adolescents (6 males; 6 females) who were referred for orthodontic assessment and a parent (6 males; 6 females), completed a card ranking exercise to determine the rank order of the perceived importance of each benefit. The mean rank was then calculated and a two-sample t-test, with the level of significance set at P < 0.05, used to determine if a difference existed between adolescents and parents for the mean rank of any of the expected benefits. Results: The expected benefits of orthodontic treatment from both adolescent and parent perspectives included 11 benefits which could be grouped into four categories: oral health (improved appearance of teeth; ease of maintaining good oral health; improved jaw alignment; aiding dental development), psychosocial (improved self-confidence; improved perception of dental appearance by others), functional (improved ability to chew food; improved speech) and behavioural change (improved oral hygiene habits; improved diet; cessation of bad habits). Adolescents and parents placed a similar level of importance on these benefits with “improved self-confidence” ranked highest and “improved speech” ranked lowest. The only benefit where the mean rank differed significantly between adolescents and parents was “improved ability to chew food” (two-sample t-test; P = 0.042) which was ranked higher by adolescents. Conclusions: Adolescents and parents perceived 11 expected benefits from orthodontic treatment affecting oral health, psycho-social, functional and behavioural categories. Adolescents and parents ranked the expected benefits similarly with psycho-social ranked highest. Within functional benefits, speech improvement was ranked lowest by both but improved masticatory function was ranked of significantly greater importance by adolescents.
Adult orthodontics: internet information and a national survey
(University College Cork, 2015) McMorrow, Siobhán; Millett, Declan; Harding, Mairead
Aims: 1. To investigate the reliability and readability of information on the Internet on adult orthodontics. 2. To evaluate the profile and treatment of adults by specialist orthodontists in the Republic of Ireland (ROI). Materials and methods: 1. An Internet search was conducted in May 2015 using three search engines (Google, Yahoo and Bing), with two search terms (“adult orthodontics” and “adult braces”). The first 50 websites from each engine were screened and exclusion criteria applied. Included websites were then assessed for reliability using the JAMA benchmarks, the DISCERN and LIDA tools and the presence of the HON seal. Readability was assessed using the FRES. 2. A pilot-tested questionnaire about adult orthodontics was distributed to 122 eligible specialist orthodontists in the ROI. Questions addressed general and treatment information about adult orthodontic patients, methods of information provision and respondent demographics. Results: 1. Thirteen websites met the inclusion criteria. Three websites contained all JAMA benchmarks and one displayed the HON Seal. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/120. The average FRES score was 63.1. 2. The questionnaire yielded a response rate of 83%. The typical demographic profile of adult orthodontic patients was professional females between 25-35 years. The most common incisor relationship and skeletal base was Class II, division 1 (51%) and Class II (61%) respectively. Aesthetic upper brackets and metal lower brackets were the most frequently used appliances. Only 30% of orthodontists advise their adult patients to find extra information on the Internet. Conclusions: 1. The reliability and readability of information on the Internet on adult orthodontics is of moderate quality. 2. The provision of adult orthodontic treatment is common among specialist orthodontists in the Republic of Ireland.
Children and adolescents and modified twin block for Class II division 1 malocclusion compared to controls: quantitative and qualitative analyses
(University College Cork, 2021-07) O'Dwyer, Caroline; Millett, Declan
Aims • To evaluate the impact Modified Twin Block (MTB) treatment has on oral health related quality of life (OHRQoL), self-esteem, self-perception of aesthetic treatment need and 3D soft tissue facial changes in children with Class II division 1 malocclusion (II/1M) compared to children with II/1M awaiting treatment who served as controls. • To assess the effect MTB treatment has on family quality of life (QoL) and on both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls. • To assess the level of agreement of child OHRQoL and perception of aesthetic treatment need by child and parent between groups. Materials and methods Following ethical approval, 60 subjects (31 males; 29 females) received MTB treatment (MTB group) and 47 subjects (22 males; 25 females) with II/1M awaiting treatment served as controls (Control group). At baseline (T1) and following MTB treatment/recall (T2) all subjects completed the Child Perception Questionnaire (CPQ11-14), Child Health Questionnaire short from (CHQ-CF45) and self-assessed aesthetic treatment need (IOTN-AC). Each child also had a 3D facial image captured at rest. At the same time points, a parent of each child completed the Parent-Caregiver Perception Questionnaire (P-CPQ) and assessed their child’s aesthetic treatment need (IOTN-AC). Comparisons of patient demographics were made using ANOVA and Chi-square tests. ANOVA was used for comparisons in CPQ, P-CPQ, CHQ-CF45 and 3D soft tissue facial changes at T1 and T2 between groups and paired t-tests were used within both groups. Bowker’s symmetry test was used to compare IOTN-AC within groups and Fisher’s Exact test was used between groups. ANOVA was used to test for associations between CPQ, CHQ, IOTN-AC, and 3D soft tissue facial change. Results Forty-two subjects (20 males; 22 females) completed MTB treatment (average duration 8.5 months; range 5-12 months) and 35 untreated II/1M subjects (15 males; 20 females) were recalled after an average time of 11 months (range 9-13 months). At T1, groups were similar in age (p=0.1402) and gender (p=0.2973) but overjet in the MTB group was slightly greater (p=0.0016). At T2, there was a significant improvement in the MTB group in overall OHRQoL (p<0.0001) and self-perception of aesthetic treatment need (p=0.018) but there was no change in self-esteem (p=0.144). Significant improvements occurred in family QoL (p=0.0001), in parent’s perception of both their child’s OHRQoL (p<0.0001) and aesthetic treatment need (p<0.0001). In the MTB and Control groups and at both time points, the level of agreement between child and parent perception of the child’s OHRQoL was poor with parents rating it worse [MTB group T1, p=0.0001; T2, p=0.003]; [Control group T1, p=0.001; T2, p=0.008]. At T1, parents rated the aesthetic treatment need to be greater than their child in the MTB group (p=0.054) and Control group (p=0.04). At T2, the level of agreement between the child and parent in their aesthetic treatment need was similar (p=0.262) but in the MTB group children perceived their aesthetic treatment need to be greater than their parents (p=0.019). From T1 to T2, significant 3D soft tissue changes occurred at Pogonion in the MTB group 4.26 mm (p= 0.001) and in the Control group 3.29 mm (p=0.002) but the mean difference between the groups (0.97 mm; p=0.011) was not clinically significant. Conclusions • MTB treatment significantly improved the OHRQoL and self-perception of aesthetic treatment need in children with II/1M but had no significant impact on self-esteem or 3D soft tissue facial changes compared to controls. • MTB treatment significantly improved the family QoL and both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls. • In children following MTB treatment or awaiting treatment, poor agreement existed between the child and parent perception of OHRQoL and aesthetic treatment need.
Comparison between local anaesthetic agents, lidocaine and bupivacaine, in patients undergoing third molar extraction in terms of patient satisfaction.
(University College Cork, 2016) McCarthy, Caroline; Sleeman, Duncan
AIMS: (1) To determine if anaesthetic agent bupivacaine, has a prolonged effect on the period of acute postoperative pain when compared to lidocaine, a shorter acting agent. (2) To determine patient’s post-operative satisfaction and preference with regard to anaesthetic choice. METHODS: This double blind, randomised, interventional clinical trial included 85 patients. All patients had bilateral impacted lower third molars of removed under general anaesthetic. All patients received 0.5% plain bupivacaine on one randomly allocated side, with 2% lidocaine (with adrenaline) administered on the opposite side. Pain was measured using visual analogue scales at 0, 30, 60 minutes and 3, 4, 6 and 8 hours post-surgery. Pain was analysed for 1 week following surgery. Psychological evaluations and patient reported outcomes, including patient satisfaction were evaluated. RESULTS: A significant difference in pain (P=0.001) was seen during the 3-8 hour post-operative period. The upper limit of the 95% confidence interval was 10.0 or above at 3hours and 4 hours post-surgery. Two-thirds of patients preferred bupivacaine. CONCLUSION: Longer lasting anaesthetics such as bupivacaine offer a longer period of analgesia, and improve overall patient satisfaction.
Comparison of statural height growth velocity with chronological age and dental development at different cervical vertebral maturation stages in a contemporary Irish population
(University College Cork, 2021-07) Coffey, Diarmuid John; Millett, Declan
Aim: The aim of this study was to investigate if a correlation exists between CVM stage and statural height growth velocity, chronological age and dental development in a contemporary Irish population. Materials and Methods: Following ethical approval, a total of 269 subjects were recruited from the orthodontic treatment waiting list at Cork University Dental School and Hospital (CUDSH). All participants had a digital lateral cephalogram and DPT as part of their initial orthodontic records. Standardised standing height was also measured at this initial appointment and at subsequent 6 to 8 week intervals for approximately one year to calculate a mean annualised growth velocity (MAGV). A single calibrated observer assessed CVM stage from lateral cephalograms using the method described by Baccetti et al., (2005) and dental development stage of the mandibular second permanent molar from each DPT using Demirjian’s Index. Chronological age was determined from the subject’s chart. Statistical analysis of MAGV, chronological age and stage of dental development were performed using ANOVA, with CVM and gender as factors. Pairwise comparisons were made between CVM stages. Results: The final sample comprised of 218 subjects (121 females, 97 males), with a mean age of 14.02 (SD 1.97) years and age range of 8.82-18.77 years. Intra-observer (ĸ = 0.97) and inter-observer (ĸ = 0.94) reliability of CVM stage assessment were ‘almost perfect’. Intra-observer reliability for dental development stage was also ‘almost perfect’ (ĸ = 0.97). There was a statistically significant difference in MAGV between CVM stages (p<0.0001) and between genders (p<0.0001). The peak in statural height growth velocity occurred at CVM stage 3 in both males (mean age 13.39 (SD 0.75) years) and females (mean age 11.95 (SD 0.82) years). Chronological age exhibited significant differences between CVM stages (p<0.0001) and between genders (p<0.0001). There was also a statistically significant difference in the distribution of dental development stage between CVM stages (p<0.0001) and between genders (p=0.0292). Conclusions: • MAGV differed significantly between successive CVM stages in both males and females, with the peak in statural height growth velocity found at CVM stage 3. • Chronological age differed significantly between CVM stages, and these differences were dependent on gender. • The distribution of dental development stages differed significantly between CVM stages and between genders.
Dentofacial parameters associated with the unilateral palatally impacted canine
(University College Cork, 2015) Koshak, Lamis; Millett, Declan; Allen, P. Finbarr
Aims To investigate the relationship between unilateral PIC and specific dentofacial parameters. Materials and methods A sample of 216 subjects, with 108 subjects in the retrospective and prospective samples respectively. Dental parameters: The following dental parameters were assessed: Inter-canine and intermolar width; palatal depth and palatal area; anterior Bolton tooth-size discrepancy (TSD); maxillary arch shape and ratio and maxillary central and lateral incisor shape and ratio. Facial parameters: Three-dimensional (3D) images were taken for subjects in the prospective sample only, and were used to assess the following facial parameters: Face shape; face ratio and 3D distances and angles. Results Dental parameters: Inter-canine width was significantly smaller in the test group compared to the control group in the retrospective (p= 0.0002) and prospective (p= 0.0018) samples respectively. Anterior Bolton TSD was significantly higher in the prospective test group compared to controls (p= 0.0070). Arch ratio was significantly smaller in the test group than the control group for the retrospective sample (p= 0.0029), whereas no significant difference was recorded in the prospective sample (p= 0.1017). Arch shape distribution was significantly different in the retrospective sample (p= 0.009). Tooth shape distribution was significantly different for the maxillary right central incisor in the retrospective sample (p= 0.030). Tooth ratio showed no significant difference for both samples. Facial parameters: Basal width was significantly smaller in the test compared to the control group (p= 0.0001). No significant difference was found in all other 3D distances and angles measured. Conclusion Inter-canine width was significantly smaller in unilateral PIC subjects compared to controls. Anterior Bolton TSD was significantly higher in prospective unilateral PIC compared to controls. Maxillary arch ratio was significantly smaller in retrospective subjects. Square/tapered tooth shape was significantly more common in the retrospective group. Basal width was significantly smaller in subjects with unilateral PIC than controls.
Determining competence in prosthodontics in undergraduate dental school programmes: an international study
(University College Cork, 2022-12-09) Al Khalaf, Khaleel; Lynch, Christopher D.; Da Mata, Cristiane
Background and aims: In an era of increased attention on patient safety, as well as increased student mobility between many countries, it is of interest to investigate contemporary international trends in the teaching and assessment of prosthodontics. The aims of this PhD project were to investigate the teaching and assessment methods of the prosthodontics domains and to determine if it is possible to agree on competency standards in prosthodontics. Structure and methods: This thesis includes an introductory chapter (Chapter 1), a narrative review of relevant educational and prosthodontic literature (Chapter 2), four original quantitative (questionnaire-base) studies to assess the contemporary teaching and assessment methods of prosthodontics on international basis (Chapters 3-6), and a mixed-method Delphi approach among prosthodontic/restorative dentistry experts to obtain a consensus on the most suitable undergraduate teaching and assessment methods (Chapter 7). Chapter 8 includes a qualitative study using one-to-one interview to explore the perspectives and opinions of senior dental academics that did not reach consensus using the Delphi method. Chapter 9 contains a systematic review synthesising the response rates in dental literature of questionnaire-base studies. Finally, a brief conclusion of the thesis was presented (Chapter 10). Results: Narrative review: there was significant divergence among prosthodontic curricula in dental schools in terms of teaching methods, assessment criteria and how student competence is determined. Quantitative studies: Our findings from the quantitative studies reinforced the findings of the narrative review; there was a significant international divergence of undergraduate teaching and assessment trends among dental schools, including the preclinical and clinical course, of the prosthodontics divisions (complete denture, removable partial denture, fixed prosthodontics and dental implants). Divergence was evident in dental schools even within the same country. Mixed-method Delphi and qualitative studies: A total of 23 senior academic experts from 11 countries participated in the Delphi study. There was a high level (92.6%, 175 statements out of 189) of consensus agreement over three iterative rounds, whereas 14 statements (7.4%) did not achieve a consensus. A total of 12 senior dental academics from seven countries participated in semi-structured interviews, it was agreed that academic professors, consultants, or specialists were the most suitable staff members to supervise students during preclinical hands-on sessions in removable and fixed prosthodontics. In addition, participants mentioned the availability of suitable patients for treatment, dental schools’ curriculum and the level of students’ skills as factors influencing the starting point of clinical sessions in fixed prosthodontics. We also found differences among the participating schools in regard to course contents and extent of teaching on dental implants. The experts suggested tailoring the curriculum according to what is expected from the graduating dentists and allowing students to observe dental implant cases before treating simple cases. Systematic review of response rate: Overall, 133 studies with 149 response rates were included. The median response rate across the included studies was 77%, a significant negative correlation was observed between the response rate and the actual number of distributed questionnaires (sample size) (r = -0.4127; P<0.001). there was an association between the response rate and the area of distribution (e.g., national or international, P= 0.0012). Yet, it was unclear whether if there are correlations between the response rate and other variables (e.g., piloting, number of questions and the journal impact factor). Conclusions: This thesis highlighted the current divergence in teaching and assessment methods of undergraduate prosthodontics. However, this divergence can be minimized, and the international harmonization of the dental curricula is highly possible by reassessing and tailoring the dental curricula. We presented a list of senior academics’ consensus statements on the teaching and assessment methods of prosthodontics. In addition, multiple recommendations and challenge resolutions were suggested and introduced. Thus, our findings can be considered as guidelines and references to develop recommendations for stakeholders involved in undergraduate curricula among dental schools worldwide and in consistence with the local dental council recommendations, which will ensure dentists with the same level of competence at graduation.
Endodontic access in all-ceramic dental restorative crown materials
(University College Cork, 2018) Gorman, Catherine M.; Burke, Francis M.; Ray, Noel J.
A diagnosis of irreversible pulpitis can occur after a crown has been permanently cemented. This necessitates the need for endodontic treatment, often with the crown in situ. Increasing trends indicate that all-ceramic crowns are provided as the preferred restorative option to metal-ceramic crowns. This is because modern all-ceramic restorations can now provide excellent aesthetic solutions combined with high mechanical strength properties, compared with earlier, weaker ceramic materials. It is a considerable operative challenge for the dental practitioner to prepare an endodontic access cavity in vivo, due to the high mechanical properties of modern dental ceramic materials. The inherent nature of ceramic materials is that they are brittle, sensitive to damage and moisture, with failure occurring in an unpredictable manner. The difficulties in performing endodontic treatment in all-ceramic crowns and subsequently repairing the access cavity is relatively unexplored in the dental literature, more research is needed to inform clinical practice in this area. A systematic review of the literature aimed to identify influential treatment factors of endodontically accessed and repaired all-ceramic crowns and report the evidence of damage around the endodontic access cavity as a result of preparing the cavity in an all-ceramic crown. Eight studies were selected to address the aims. The inadequate volume of literature was highlighted with, the earliest relevant publication identified in 1962 and since the last electronic search (2016) only 26 additional references were identified in the subject area. Potentially noteworthy strength controlling factors were identified to be related to the crown material, its baseline strength, the grit size of the diamond bur used to create the access cavity, the ratio of access cavity to crown dimension, the cement used to lute the crown and the presence of radial cracks after access cavity preparation. The effect of two variables, namely, cavity dimension and modulus of elasticity of the resin composite repair material on the equibiaxial flexural strength of lithium disilicate glass-ceramic (IPS e.max® Press, Ivoclar Vivadent) material was investigated. Disc specimens with representative access cavities were used as a model system to examine these variables. Within the study limitations, the results indicate that cavity size and not the repair material, influence the equibiaxial flexural strength. The shear bond strength of the resin composite material used to repair the access cavity in a lithium disilicate glass-ceramic was determined to be comparable to those values as found in the literature (see Appendices). Model mandibular first molar crowns were fabricated from lithium disilicate glass-ceramic to examine the impact of cavity size on failure load. The failure load for the intact crowns and crowns with a rhomboidal (based on the presence of three-canals) or rectangular (based on the presence of four-canals) endodontic access cavity, with and without a resin composite repair were measured and analysed statistically. Within the limitations, the results show that a rectangular access cavity significantly reduces the failure load which was then restored to the original values upon repair with resin composite. The preparation of a rhomboidal access cavity did not reduce the failure load compared with the intact crown. The novel use of Finite Element Analysis (FEA) was successfully demonstrated in this subject area. Solid geometric models of lithium disilicate glass-ceramics (LDGC) crowns with three endodontic access options repaired with a resin composite (Tetric EvoCeram®, Ivoclar Vivadent) were modelled. The models were subsequently subjected to clinically relevant loads and a stress analysis was performed using FEA. This work showed that high curvature access cavity designs produced the highest stress scenario and therefore should be avoided. In an attempt to compliment the in vitro study computer models of LDGC discs were modelled using Finite Element (FE). The models were successfully validated, similar variables were modelled and concentric ring loading conditions were applied as per the in vitro study. It was determined that the size and not the stiffness of the repair material was more critical to the strength of LDGC discs. In conclusion, this study has addressed some of the aspects of problems encountered when endodontic access cavities are prepared in all-ceramic dental crowns, however it is an area where substantial literature is lacking and therefore further research is warranted.
Epidemiology, risk assessment, and treatment of root caries in older adults
(University College Cork, 2017) Hayes, Anne Martina; Allen, P. Finbarr; Burke, Francis M.; Health Research Board
Objectives This research had four objectives; 1 To assess the prevalence of, and risk indicators associated with, root caries in a cohort of independently living older adults. 2 To determine the root caries incidence over a two-year period in a cohort of independently living older adults and identify associated risk factors. 3 To evaluate the Cariogram as a risk assessment tool for the prediction of root caries in an older adult population. 4 To clinically evaluate a calcium silicate cement (Biodentine™, Septodont, Saint Maur de Fosses, France) in the restoration of root caries lesions in older adults and to compare it to the clinical performance of a high viscosity glass ionomer cement (Fuji IX GP® Extra, GC Corporation, Tokyo, Japan) and a resin modified glass ionomer cement (Fuji II LC®, GC Corporation, Tokyo, Japan). Methods Three hundred and thirty four participants were recruited in this prospective cohort study. Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables (DMFT, BPE, plaque index). Stimulated saliva samples were collected to determine salivary variables at baseline. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. The participants were recalled after 12 and 24 months for a repeat clinical examination. Data was entered into the Cariogram computer model to generate a risk assessment score. A nested randomised clinical trial recruited eighty-five participants. Each participant received at least two root surface restorations; one lesion was allocated to receive Biodentine™ and the other was allocated either Fuji IX GP Extra or Fuji II LC. One dentist placed all restorations. 303 were randomized with 151 lesions allocated to receive Biodentine™, 77 to Fuji IX GP® Extra and 77 to Fuji II LC®. Patients were reviewed by a calibrated dentist who was not involved in restoration placement and who was blinded to material allocation. Restorations were assessed according to a modified USPHS criterion. Results A total of 334 older dentate adults with a mean age of 69.1 years were examined at baseline. Of these, 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). 280 participants were examined at two-year follow up. One quarter (n=70) of participants had developed at least one new root caries lesion in this period. The mean root caries increment was 0.70 surfaces (Q3 0.75). The baseline variables xerostomia, coronal caries experience (≥2 teeth affected), root caries index (≥14) and number of exposed root surfaces (≥37) and low final education level were associated with new root caries development over a two-year period. New caries was observed in 55.6% of those categorised by the Cariogram in the highest risk group compared to 3.8% in the lowest risk group. The area under the ROC curve was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Restorations placed as part of the randomised clinical trial were assessed after one year. Restorations were clinically acceptable in 47.2% of the Biodentine™ group, 83.8% of the Fuji IX GP® Extra group and 84.9% of the Fuji II LC® group respectively. There was a significantly lower success rate in the Biodentine™ group compared to that of the other two materials Conclusions The prevalence and incidence of root caries was high in this cohort. The factors associated with new root caries development in this study should be examined in future studies. Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries. Biodentine™ cannot be recommended for the operative management of root caries. High viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option for the restoration of root caries.
Evaluation of the effect of submucosal dexamethasone injection on pain in patients undergoing third molar removal: a randomised controlled trial
(University College Cork, 2021-08-01) Crowley, Miriam; Gallagher, Catherine
Objectives Third molar removal is one of the most common oral surgery procedures performed in Ireland. Pain, swelling and trismus are well-documented, undesirable consequences following third molar removal. These sequelae have a negative impact on the patients’ quality of life post-operatively. We aimed to compare the effect of a submucosal injection containing 4mg dexamethasone on the post-operative pain experienced by the patient versus a control of standard surgical removal of a mandibular third molar on the contralateral side. We also analysed patient preference of treatment regime. Methods A randomised controlled trial was conducted involving 70 patients undergoing surgical removal of bilateral, symmetrically-impacted mandibular third molars under general anaesthetic in Cork University Hospital. Each patient acted as their own control in this split-mouth study, with all treatment carried out at one single visit. All subjects received standard local anaesthetic bilaterally in the form of inferior alveolar block and long buccal infiltration with 2% lidocaine with 1:80,000 epinephrine. The site randomised for intervention received a 1ml submucosal injection of 4mg dexamethasone in the buccal vestibule adjacent to the lower third molar following administration of local anaesthetic. Both the patient and investigator were blinded to the intervention site. The primary outcome measure of pain was self-reported and recorded by the patient for the right and left surgical site for seven days following intervention using a visual analogue scale. Results Pain and inflammation are normal physiological responses to tissue trauma such as surgery. The age range of the participants in the trial was 16 to 54 years of age, with the mean age being 22 years (SD 5.7 years) and median age 21 years. The study participants were comprised of 44 females and 26 males. We demonstrated that the reported pain scale (VAS 0-100mm) decreases moderately with the treatment intervention of 4mg dexamethasone as a submucosal injection (Estimate: -3.32, CI: -5.36 to -1.28, p < 0.01). Conclusion This trial demonstrated a minor but consistent improvement in analgesic effect when submucosal dexamethasone was administered in comparison to control supporting the alternative hypothesis. The effect size detected was minimal (estimated 3% improvement) and as such deemed not clinically meaningful for patients. Therefore, the routine use of submucosal dexamethasone injection in the extraction of impacted third molars should not be recommended.
Exploring patients' experience of dental implant surgery with or without intravenous conscious sedation: a qualitative study
(University College Cork, 2021) O'Dwyer, Sinead; Ni Riordain, Richeal
Aim: Little qualitative evidence is available regarding the patients’ experience of dental implant surgery and the influence of intravenous conscious sedation (IVCS) on the implant experience. The aim of this qualitative study was to explore patients’ experience of dental implant surgery with or without IVCS, with specific consideration given to understanding the patients’ preferences, motivations, needs and values. Methods: Purposive sampling was used to recruit patients from the Dental Surgery Unit of Cork University Dental School and Hospital. A trained facilitator convened the individual in-depth semi-structured interviews over the telephone 7 days’ post-surgery. Interviews were audio-recorded with a Dictaphone, manually transcribed and imported into a qualitative software tool (Nvivo). The data were then analysed using a thematic framework. Results: Eighteen semi-structured telephone interviews were conducted; 8 patients had dental implants placed under IVCS, while 10 had dental implants placed with local anaesthetic (LA) only. Thematic analysis revealed that emergent themes fitted appropriately with 3 different time points along the dental implant surgical journey (Pre-operative, Intra-operative and Post-operative experiences). Data and analysis were categorized, therefore, to follow the patients experience in chronological order. This facilitated narration of the patients accounts of the experience in an explicit way. Preoperative themes that emerged included the impact of tooth lost, motivations for seeking dental implants and dental anxiety. Intraoperative themes included confidence in the operating surgeon, local anaesthetic injections, the dental implant drill and being sedated. While post-operative themes that emerged were pain, postoperative instructions and follow up. Conclusions: This research offers clinicians deeper understandings of the patients’ experience of dental implant surgery, their preferences, motivations, needs and values, as well as the adjunctive effects of IVCS. Moreover, this research offers ways to improve clinical communications based on the patients’ views and suggestions and ultimately enhancing the quality of patient care.
The immediate effects of aligners and aesthetic fixed appliances on smiling and perceptions in young adults
(University College Cork, 2018) Clune, Jacqueline; Millett, Declan
AIMS • To evaluate, in young adults, the immediate effect of clear aligners (CAs) and aesthetic fixed appliances (AFAs) on the magnitude of rest to natural and rest to maximal smile • To evaluate, in young adults, the immediate effect of CAs and AFAs on intra-session reproducibility of rest to natural and rest to maximal smile • To evaluate, in young adults, the immediate perception of CAs and AFAs MATERIALS AND METHODS Forty Caucasian subjects (20 females, 20 males), aged between 18 and 25 years, with a Class I incisor relationship and no history of orthodontic treatment were recruited. 3D stereophotogrammetric images were captured of each subject without appliances and separately, in random order with either CAs or AFAs (Session 1), at rest, natural and maximum smile (Capture A). Following a rest period of 15 minutes, the images were retaken both without and with appliances (Capture B) to assess intra-session reproducibility. Four weeks later (Session 2), the same protocol was adopted as per Session 1, except that subjects who had been randomised to the CAs were allocated to the AFAs and vice versa. All images had 26 landmarks placed by 1 operator. The landmarking identification error was calculated by re-landmarking 10 percent of the original sample one month after initial images were landmarked and determining the difference in landmark placement. The mean magnitude of movement and reproducibility with each expression, rest to natural and rest to maximal smile, were compared and analysed across both genders. Four weeks after Session 2, a questionnaire was issued via email to all subjects to evaluate the immediate perception of CAs and AFAs. RESULTS The landmark identification error was 0.50 +/- 0.08 mm. For rest to natural smile, there was no significant difference in magnitude of movement with and without CAs (p = 0.6964). In contrast, for rest to maximal smile, the magnitude of movement differed significantly with and without CAs (p = 0.0001), with significantly greater movement recorded with the latter. For rest to natural and rest to maximal smile, there was a significant difference in magnitude of movement with and without AFAs (p = 0.0024 and p = 0.0002 respectively). Significantly greater mean movement occurred with AFAs, than with CAs, for both expressions. The mean magnitude for each smile was greater in males than in females (p = 0.0109). The order of randomisation of appliances made no difference to the mean magnitude of movement from rest to natural and rest to maximal smile (p = 0.0939). Without appliances, there was no significant difference in intra-session reproducibility of the magnitude of rest to natural and rest to maximal smile (p = 0.3601) but significant differences existed in intra-session reproducibility of the mean magnitude of each expression with appliances (p = 0.0290). Although statistically significant differences were recorded between appliances in magnitude and intra-session reproducibility for both expressions, these are unlikely to be of any clinical significance. Seventy-six percent of subjects preferred CAs to AFAs as they were deemed to be more discrete (43 percent) and more comfortable (33 percent). All subjects indicated the appearance of CAs was good or very good. Ninety percent of subjects indicated that they were likely or very likely to recommend CAs. CONCLUSIONS • Except for rest to natural smile with CAs, both appliances had an immediate and significant impact on the mean magnitude of movement for both expressions • CAs and AFAs had a significant immediate effect on intra-session reproducibility of rest to natural and rest to maximal smile • Young adults’ immediate perception was preference for CAs as they were reckoned to be more discrete and comfortable.
Impact of downward adjustment of water fluoride concentration on dental caries and fluorosis
(University College Cork, 2022-12-20) James, Patrice; Whelton, Helen; Harding, Mairead; O’Mullane, Denis; Perry, Ivan J.; Cronin, Michael; Health Research Board
Introduction: Community water fluoridation (CWF) was initiated in Ireland in 1964 at a concentration of 0.8 to 1 ppm fluoride. In 2007, in the context of ongoing reductions in dental caries with increasing prevalence and severity of dental fluorosis, water fluoride concentration in Ireland was adjusted to 0.6 to 0.8 ppm with the aim of reducing the prevalence and severity of dental fluorosis while maintaining reductions in dental caries. Aim: To determine the difference in dental caries and fluorosis levels following downward adjustment of CWF concentration. Methods: Ethical approval was obtained from the Clinical Research Ethics Committee (CREC) of the Cork Teaching Hospitals. A before and after study compared dental caries and fluorosis in random samples of 8-year-olds in Dublin (n=707) and Cork-Kerry (n=1,148) in 2016-17 with 8-year-olds in Dublin (n=679) and Cork-Kerry (n=565) in 2002. Dentinal caries experience in primary teeth (d3vcmft(cde)) and fluorosis in permanent teeth (Dean’s Index, whole mouth score) were clinically measured by trained and calibrated dentists. Standardised oral photographs were taken (8 seconds drying) for children in Cork-Kerry in 2016-17 and 2002. Fluorosis (Thylstrup-Fejerskov (TF) Index) in permanent maxillary central incisors was scored from the photographs in duplicate by two trained and calibrated dentists, blind to fluoridation status and year, with disagreements resolved by consensus. Person-level TF score was the highest score in the central incisors. Children were categorised as having lifetime or no exposure to CWF (Full-CWF/No-CWF). Effect of examination year on dental caries prevalence (d3vcmft(cde) > 0) and severity (mean d3vcmft(cde) among children with caries experience) and fluorosis prevalence (Dean’s ‘very mild’ or greater, TF 1 or greater and TF 2 or greater) were evaluated using multivariable regression controlling for the effects of other explanatory variables. Additional multivariable regression analyses evaluated the effect of CWF on dental caries prevalence and severity and fluorosis prevalence in 2002 and 2016-17, before and after the downward adjustment, respectively. Results: After controlling for the effects of other explanatory variables, children in Cork-Kerry in 2016-17, with lifetime exposure to CWF at 0.6 to 0.8 ppm fluoride, had lower caries prevalence (56% vs. 65%) and severity (mean d3vcmft(cde) 3.7 vs. 4.2) in primary teeth than their counterparts with No-CWF. Among children with Full-CWF, there was no statistically significant difference in caries prevalence or severity between 2002 and 2016-17. In 2016-17, caries prevalence was 55% in Dublin (Full-CWF) and 56% in Cork-Kerry (Full-CWF) and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Among children with No-CWF, caries severity was less in 2016-17 (mean 4.2) than 2002 (mean 4.9) (P = 0.039). The difference in caries severity between children with Full-CWF and No-CWF was less in 2016-17 than 2002 (Interaction P = 0.013), suggesting a reduced benefit for CWF in 2016-17. In 2016-17, fluorosis prevalence (Dean’s Index) was 18% in Dublin (Full-CWF) and 12% in Cork-Kerry (Full-CWF). Fluorosis was predominantly ‘very mild’ with no statistically significant difference between 2002 and 2016-17. Fluorosis prevalence in permanent maxillary central incisors was predominantly TF 1 and TF 2 and was lower in Cork-Kerry in 2016-17 than in 2002 at both case definitions. Among children with Full-CWF, prevalence of TF 1 or greater was 40% in 2016-17 and 75% in 2002 (OR 0.24, 95% CI [0.17, 0.34], P < 0.001) and prevalence of TF 2 or greater was 15% in 2016-17 and 27% in 2002 (OR 0.50, 95% CI [0.33, 0.75], P = 0.001). At both time points, fluorosis prevalence measured using Dean’s Index and the TF Index was higher among children with Full-CWF than their counterparts with No-CWF (2002 and 2016-17, P < 0.001). Conclusion: There was no reduction in fluorosis prevalence measured clinically using Dean’s Index in 2016-17 compared with 2002. However, fluorosis prevalence in the aesthetically important maxillary central incisors measured blind to year and fluoridation status from oral photographs was reduced following downward adjustment of water fluoride concentration. Based on the cross-sectional comparison of children with Full-CWF and No-CWF in 2016-17, the lower concentration of 0.6 to 0.8 ppm fluoride is an effective caries-preventive measure. However, the before and after study indicated that downward adjustment of water fluoride concentration may have reduced the caries-preventive effect of CWF in primary teeth. Further research is needed to evaluate the impact of the downward adjustment on dental caries in permanent teeth of children and adults with CWF.
Incidence of hypoxaemia with intravenous fentanyl and midazolam sedation in adult patients undergoing oral surgery procedures
(University College Cork, 2021-08-03) Mooney, Eimear; Brady, Paul
Objectives: Respiratory depression and airway compromise may result in serious consequences if untreated during conscious sedation. The primary aim of this study was to investigate the incidence of hypoxaemia (SpO2 ≤94%) in American Society of Anaesthesiologists physical status I & II patients undergoing intravenous sedation with fentanyl and midazolam. The secondary aims included determination of the onset time of hypoxaemic events and significant risk factors for hypoxaemia. Methods: This prospective observational study required 92 patients to achieve a power of 80% at the 5% significance level. A total of 96 patients, (57 female, aged 16-65) met the inclusion criteria and consented to participation. The operator-sedationist delivered a standard dose of 50μg of fentanyl followed by titrated midazolam (range 2-9mg), at a rate no greater than 1mg/min. Oxygen saturations were monitored via pulse oximetry and supplemental oxygen was not given routinely, unless indicated. Verbal or tactile stimulation was performed to encourage respiratory effort when SpO2 ≤94%. Monitoring continued for forty minutes from the time of sedation end point. Data were exported from the ‘BeneVision N12 Mindray’ monitor to Microsoft Excel. Statistical analyses (multi-variate logistical regression) were performed in SAS® (Version 9.4). Results: All participants successfully completed treatment and 94 patients were included in the analysis. 50 (53%) individuals developed hypoxaemia, with 19 (20%) proceeding to severe hypoxaemia (SpO2<90%). Following administration of fentanyl, 90% of hypoxaemic events occurred within 13.6 minutes; the majority (66%) were observed during the pre-operative period. The risk of hypoxaemia increased for each 1% reduction in SpO2 and 1kPa reduction in EtCO2 from baseline by 190% and 192%, respectively. The risk of moderate and severe hypoxaemia increased by 7% (p=0.0003) & 8% (p = 0.0002) respectively, for each added year of age. Conclusions: This study presents information on the incidence of hypoxaemia for multidrug sedation in ASA I & II patients in an outpatient oral surgery department. Whilst the hypoxaemia incidence was found to be 53%, all patients remained responsive to respiratory stimulation, consistent with the definition of conscious sedation. Heightened vigilance for desaturation is required for reductions in SpO2 and EtCO2 from baseline within the first 13.6 minutes following fentanyl administration and with advancing age.
Innovative strategies for teaching anatomy to dental students
(University College Cork, 2018) Lone, Mutahira; Downer, Eric J.; McKenna, Joseph P.; Toulouse, André; Cryan, John F.; University College Cork
Anatomy education is an integral component of the undergraduate and postgraduate dental curriculum. A detailed understanding of anatomy is a pre-requisite before examination, diagnosis and clinical treatment of patients in all aspects of the healthcare systems. Anatomy teaching is undergoing pioneering changes. Traditional Vesalius’ dissection-based teaching has evolved to include didactic lectures and nowadays incorporates digital teaching, e-learning and a wide range of 3D images and models. Furthermore, the current generation of dental students are using devices like smartphones and laptops for educational purposes. The focus of this PhD was to assess the efficacy of innovative teaching aids for teaching anatomy to dental students. We hypothesized that innovative tools are effective in enhancing students learning experience and improving academic performance. Firstly, a cranial nerve animation was developed and results show an increase in student’s knowledge of the topic after watching the animation (Chapter 2). The teaching of clinical skills was assessed using a soft-preserved cadaver (Chapter 3) which showed promising results. Furthermore, to aid in teaching tooth morphology a 3D quiz application was developed (Chapter 5) and results show that it was effective in teaching tooth morphology to dental students. Additionally, a survey was also undertaken to assess the staff involved in teaching tooth morphology to dental students in the UK and Ireland and the teaching aids employed for teaching and examination of tooth morphology (Chapter 4). Students’ feedback and perceptions were also gathered at the end of each study. The results show that innovative teaching aids can supplement the traditional teaching methods. Furthermore, students benefitted from using the innovative teaching aids and reported it as a positive learning experience. Hence, accepting the above stated alternate hypothesis that innovative tools were effective in enhancing students learning experience and improved their academic performance. In summary, the principles of anatomy are best taught through traditional teaching methods which are reinforced by the various innovative supplemental teaching aids available. A blended teaching model has been recommended with traditional methods complimented by innovative pedagogies. The introduction of these innovative technologies is vital in providing educational support to students and are successful when delivered alongside taught lectures and the use of the traditional teaching methods.
Interproximal reduction in orthodontics: a survey of specialist orthodontists and patients
(University College Cork, 2021-08-08) Donovan, Joey; Millett, Declan
AIMS: [1] To assess interproximal reduction (IPR) practices of specialist orthodontists in the Republic of Ireland (RoI). [2] To evaluate patient perceptions of IPR as part of orthodontic treatment. SUBJECTS AND METHODS: Ethical approval was granted by the Cork Teaching Hospitals Clinical Research Ethics Committee. Orthodontists on the Irish Dental Council’s specialist register and consecutive patients receiving IPR in Cork University Dental School and Hospital’s Postgraduate Orthodontic Unit were surveyed. Two de novo questionnaires were developed, pre-tested, piloted and distributed either electronically or by post to orthodontists and completed in-person by patients. Data with respect to demographic details, IPR use and technique employed, as well as patient perception were collected in the orthodontist survey. The patient survey collected demographic details, knowledge and perceptions of IPR. Descriptive statistics, Chi-squared tests, two-sample test comparison of means and correlation coefficients were used in analyses, with significance set at p≤0.05. Thematic analysis was performed independently by two assessors for qualitative questions in the Patient Questionnaire. RESULTS: Responses were received from 105 specialists (75%). Nearly all (98%) performed IPR, 44% reported increased use in the past five years. Handheld strips were most popular (37%), followed by burs (17%). Instrument use in postgraduate training was associated with subsequent use in practice (p<0.001 for abrasive strips in a holder; p=0.003 for burs). Lower labial segment teeth were most frequently reduced. IPR was most often employed with aligners (59%), pre-adjusted edgewise (33%) and self-ligating appliances (30%). Adult patients, followed by adolescents in the permanent dentition were most likely to be prescribed IPR, for the purposes of reshaping triangular teeth or restorations, resolving mild crowding and addressing tooth-size discrepancies or black triangles. Enamel removal, typically 0.3mm per surface anteriorly and 0.4mm per surface posteriorly, created 2-4mm of space in each arch (60%) and was done in <5 minutes (45%) over multiple visits (82%) without routinely recontouring, polishing or treating the teeth afterwards. Written information was not given (90%) and only 12% reported prior patient awareness of IPR. Pain was the most common risk discussed, although reported patient perception of pain (9%) was less than for discomfort (48%) with 71% indicating patient preference of IPR over extractions. Thirty patients (13 males and 17 females, mean age 16.2 ± 1.75 years) completed the questionnaire. Few (17%) had heard of IPR, but all reported understanding after explanation. Most (93%) ‘did not mind’ having IPR, 37% regarded it as ‘uncomfortable’ and 13% ‘painful’ (mean 2.3/10 on a visual analogue scale) and all would prefer IPR to extraction. Themes patients would tell a friend or family member about IPR were: pain, discomfort, comparison to extraction, speed, benefits, bleeding and side effects but would reassure and recommend the procedure. CONCLUSIONS: [1] Specialist orthodontists in RoI routinely performed IPR using handheld strips, mostly in the lower labial segment of the adult or adolescent permanent dentition, as part of aligner or fixed appliance treatment to reshape triangular teeth or restorations, resolve mild crowding and address tooth-size discrepancies or black triangles. [2] Conservative enamel reduction of <0.5mm per surface, creating 2-4mm of space per arch, in <5 minutes over multiple visits without subsequently polishing, recontouring or treating enamel was most commonly adopted. [3] Patients were rarely given written information on IPR, were perceived by orthodontists to be unfamiliar with IPR prior to treatment, found the procedure uncomfortable rather than painful and preferable to extractions. [4] Patients themselves were unfamiliar with IPR but found it easy to understand, did not mind having IPR done, found it uncomfortable rather than painful, expressed a preference for IPR over extraction and would provide mostly positive feedback on the procedure to others.
Magnitude and reproducibility of smiling in 12-year-old Caucasian children in the Republic of Ireland: a comparison of Class I and Class II malocclusions
(University College Cork, 2018) Ennis, Ciara Gabrielle; Millett, Declan
Aims:• To determine if malocclusion (Class I, Class II division 1 and Class II division 2) influences the magnitude, the immediate intra-session and the short-term inter-session reproducibility of the rest position to posed smile and the rest position to maximal smile. • To determine if gender influences the magnitude, the immediate intra-session and the short-term inter-session reproducibility of the rest position to posed smile and the rest position to maximal smile. Materials and Methods: One hundred and ten Caucasian volunteers (55 males; 55 females) aged 12 years, with no previous history of orthodontic treatment, identifiable syndrome or facial asymmetry, were recruited. Three malocclusion categories were assessed: Class I (20 males, 20 females), Class II division 1 (20 males; 20 females) and Class II division 2 (15 males; 15 females). Three-dimensional (3D) images of three facial expressions (rest position, posed smile and maximal smile) of each subject were captured using the Di3D system. These images were repeated 15 minutes later to assess immediate intra-session reproducibility and two weeks later to assess short-term inter-session reproducibility. Twenty-six landmarks were digitally placed on all the images. Landmark identification error was assessed by re-landmarking 10 percent of the images, one month after initial landmarking. The magnitude of movement from rest to posed smile and from rest to maximal smile averaged over all the landmarks was calculated for each session. Results: The magnitude of mean movement averaged over all the landmarks differed significantly between rest to posed smile and rest to maximal smile (p < 0.0001). This difference was found in both genders (p = 0.0012) but was greater in males than in females (p <0.0001). Immediate intra-session reproducibility (p=0.1677) was high for both rest to posed smile and rest to maximal smile. A statistically significant difference (p <0.0001) of 0.27mm in short-term inter-session reproducibility was found for both rest to posed smile and rest to maximal smile. This was, however, clinically insignificant. Malocclusion had no effect on magnitude of either smile (p = 0.8138) or immediate intra-session reproducibility (p = 0.3878) or short-term inter-session reproducibility (p=0.3396). Similar results were found when the 10 lower-face landmarks were assessed independently. Conclusion Rest to posed smile and rest to maximal smile differed in terms of magnitude of movement for both genders with males displaying a greater difference. The rest to posed smile and rest to maximal smile demonstrated immediate intra-session and short-term inter-session reproducibility in males and females. Malocclusion had no effect on the magnitude or reproducibility of smiling.
The oral microbiota of Irish children in health and disease: a longitudinal and cross sectional study
(University College Cork, 2017) Hurley, Eimear; O'Toole, Paul W.; Whelton, Helen; Kinirons, Martin; Health Research Board
The oral cavity harbours a very rich and diverse microbial community. In the last decade, the oral microbiota of children and adults has been studied in detail using continuously developing DNA sequencing methods. In particular focusing on the oral microbiome changes in the presence of diseases such as dental caries, periodontal disease and the relationship of the oral microbiome with oral health and disease states. The overall aim of these studies was to unravel the complexity of the oral ecosystem and the driving forces behind the imbalance of this ecosystem which leads to increased risk of disease and poor oral health. The oral microbiota of the edentulous neonate and infant is poorly characterised particularly the dynamics of the oral microbial changes of the neonate as it grows from birth to an older age. This is important as it would give researchers that study the oral health of children a better understanding of the foundation of the oral microbiome. An important addition would also be to explore the influence feeding modality (breast or formula), introduction of solid foods, eruption of teeth, antibiotic intake, fluoridation intake and oral hygiene habits all have on the infant oral microbiota. Gaining a better understanding of the dynamics and maturation of the oral microbiome of neonates from birth is important to identify any microbial factors which increase the risk of dental diseases in these children. In this ORALMET study, we recorded the oral microbial changes from birth to 2 years of age of infants (n=382) (year 3 data is not included in this thesis) born via C-section or Vaginal delivery. Factors included in our analysis of the oral microbiota of these infants included breast feeding duration and the influence of the maternal microbiota (saliva/skin or vaginal microbiota). We observed that breast feeding duration does not have an effect on the oral microbiota of infants, and birth mode has an effect on the oral microbiota of infants up to 4 weeks of age only, but not beyond that. The oral microbiota changes in composition are most apparent from 6 months of age to 2 years of age, with less microbial changes within the oral cavity from birth to 8 weeks of age. The oral microbiota composition is continually changing and developing up to 1 year of age and at 2 years of age, illustrating continuous maturation, with no evidence of stability by 2 years of age. The second part of the ORALMET study (cross-sectional study) compared the oral microbiota of children between 3-5 years with SECC (n=68) and without caries (n=70). We observed distinct microbiota differences in the caries microbiota of children with active ECC, and the presence of species in the salivary microbiota of children with active caries, but not in the salivary microbiota of children without caries. ORALMET is the first in depth longitudinal study of the oral microbiome from birth of the infant, together with the influence of the maternal microbiota and also the first microbiota study of Irish children with and without caries. Together these studies provide us with information of the infant oral microbiome and a better understanding of the microbial dynamics within the oral cavity of neonates, infants and children.
Personal experiences and social perception of a modified twin block appliance
(University College Cork, 2018) Bowe, John C.; Millett, Declan
Aims • To evaluate patient experiences over the first 6 months of Modified Twin Block Appliance (MTBA) treatment for the correction of Class II division 1 malocclusion. • To investigate whether social judgements are made by peers of patients with Class II division 1 malocclusion with and without an MTBA. Materials and methods • Following ethical approval, 50 children, with Class II division 1 malocclusion (overjet greater than 7 mm) were recruited. Treatment was undertaken with an MTBA and the children were followed up for 6 months. Two validated questionnaires were completed at prescribed time-points. One questionnaire recorded pain and discomfort scores; the second questionnaire, the Child Perception Questionnaire (CPQ), assessed the impact treatment with an MTBA had on the child’s OHRQoL. Statistical analysis was performed using SAS (Version 9.4) • Following ethical approval, a cross-sectional questionnaire study was conducted on 461 children from 30 randomly selected primary schools in Cork City and County. Each child was randomly assigned one full face smiling photograph of a boy or girl, with or without an MTBA in situ. Children were asked to make judgements concerning the subject’s social competence (SC), psychosocial adjustment (PA) and intellectual ability (IA). Four point Likert scales were used to record their opinions. Statistical analyses were performed using SAS (Version 9.4) Results • After fitting an MTBA, mean pain scores peaked in the incisors in the first 2 days, lip and soft tissue pain peaked on day 2, with the former greater than the latter. Discomfort in the jaws peaked on day 1. Over a 6 month period, the mean levels of pain and discomfort reported after fitting of an MTBA were mild. The frequency of headaches was lower after 6 months of MTBA treatment than before fitting the MTBA. • The mean CPQ scores were highest at the 6 week time-point (p=0.0155) in the OS, FL, SWB domains. Patients who reported wearing the MTBA full time (p=0.0070) or full time except while eating (p=0.0288) had lower CPQ scores than those with poor compliance. The larger the pre-treatment overjet, the greater the CPQ scores in the EWB and SWB domains (p=0.0258 and p=0.0458) respectively. • There was no significant difference between social competence (SC) (p=0.2614), psychosocial ability (PA) (p=0.6890), and intellectual ability (IA) (p=0.2564) for the presence or absence of an MTBA. For SC, 11 year old children gave a more positive rating than 12 year old children when the child in the photograph was male. For PA and IA, females tended to give more positive ratings than males, particularly when the child in the photograph was male. Conclusions • After fitting an MTBA, peak dental and soft tissue pain was experienced on day 1 and day 2 respectively. • Peak discomfort in the teeth and jaws occurred on the evening of fit and decreased after day 1. In general over the first 6 months after fitting an MTBA mean pain and discomfort levels in the teeth, soft tissues and jaws were mild. • MTBA wear had its greatest impact on OHRQoL at 6 weeks and those with good compliance had overall better OHRQoL than those with poor compliance. • Social perceptions of children do not differ in the presence or absence of an MTBA.

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