BACKGROUND:The rapid development of artificial intelligence systems (AIS) in prosthodontics requires an overview of their applications, capabilities, opportunities and challenges. METHODS:This narrative review provides insights into AIS in prosthodontics and their applications. AI systems were classified into five main categories: (1) automated image handling and annotation; (2) classification and decision support; (3) visualisation and modelling; (4) optimisation and simulation; and (5) recording and communication. RESULTS:These AIS in prosthodontics can be used to delineate restorative margins in computer-aided design and manufacturing workflows, digital restoration design to generate crown proposals from intraoral scanning data, or conversational interfaces to provide clear, accessible and personalised explanations to patients. These systems offer significant capabilities, such as in diagnostic and treatment planning support, optimisation of prosthetic design, improved efficiency of digital workflows and enhanced patient communication. However, important challenges must be considered including the risk of automation bias, the lack of system transparency and explainability, issues related to equity and data protection and the ethical and medico-legal uncertainties surrounding accountability in the event of treatment failure. CONCLUSIONS:These systems offer significant capabilities in prosthodontics, but important challenges must be considered.
Digital impressions are now central to contemporary dental workflows, driven by advances in CAD/CAM manufacturing and intraoral scanning technologies. In parallel, rapid progress in artificial intelligence (AI)-particularly deep learning-has led to its widespread integration into digital impression systems. AI already provides tangible clinical benefits, including real-time artefact removal, improved scan stitching, and more efficient three-dimensional data acquisition. However, these same techniques introduce new risks, most notably the silent modification or completion of scan data in regions of low confidence. Such inferred geometry may appear anatomically plausible while no longer representing a faithful record of the patient. This article examines where AI currently enhances digital impression accuracy and efficiency, and where it may compromise clinical validity. By distinguishing between beneficial data filtering and potentially misleading data inference, the aim is to support clinicians in making informed decisions and maintaining appropriate scrutiny of AI-assisted digital impressions.
Non-odontogenic orofacial pain (OFP) is a common presentation in oral medicine and frequently co-occurs with sleep disturbances. Health-related and oral health-related quality of life (HRQoL/OHRQoL) are clinically meaningful outcomes; however, the relationship between sleep disturbances and quality of life (QoL) across non-odontogenic OFP conditions has not been comprehensively synthesised. This systematic review investigated the relationship between sleep disturbances and non-odontogenic OFP in adults and assessed their impact on HRQoL and OHRQoL. The review was conducted in accordance with PRISMA 2020 guidelines. PubMed, MEDLINE, EMBASE and CINAHL Ultimate were searched from inception to November 2025. Eligible studies included adults with non-odontogenic OFP, assessed sleep disturbance using validated or self-reported measures, and reported QoL outcomes. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Due to heterogeneity, results were synthesised narratively. Nine studies were included, encompassing temporomandibular disorders, burning mouth syndrome, painful post-traumatic trigeminal neuropathy, and other chronic non-odontogenic OFP conditions. Across studies, poorer sleep was consistently associated with reduced QoL, including lower vitality, impaired daily functioning, greater emotional distress and increased pain-related interference. Sleep disturbances were consistently associated with reduced HRQoL/OHRQoL in adults with non-odontogenic OFP. Sleep disturbances are frequently reported in adults with non-odontogenic orofacial pain and are associated with meaningful reductions in both health-related and oral health-related quality of life. This review highlights the importance of considering sleep as a clinically relevant component of the assessment of chronic orofacial pain conditions, including temporomandibular disorders, burning mouth syndrome and painful post-traumatic trigeminal neuropathy. Incorporating routine enquiry regarding sleep may facilitate identification of patients with greater functional, psychological, and pain-related burden, supporting a more comprehensive biopsychosocial approach to patient management. Recognition of sleep-related impairment may also assist clinical decision-making, improve communication with patients, and support timely interdisciplinary referral where indicated. TRIAL REGISTRATION: PROSPERO Registration: CRD420251071445.
BACKGROUND:Casein phosphopeptide-amorphous calcium phosphate is a biomimetic remineralizing agent but is unsuitable for individuals with a milk-protein allergy. This exploratory ex vivo study compared low-concentration slurries containing mineralization-promoting peptide-3, sodium fluoride plus mineralization-promoting peptide-3, vehicle cream or casein phosphopeptide-amorphous calcium phosphate on demineralized enamel. METHODS:Forty-eight permanent molars were randomly allocated to four groups. Formulations were applied as 0.1% weight/volume slurries once daily for 10 days after 28-day pH cycling. Surface microhardness was measured at baseline, after demineralization and on Days 5 and 10. Micro-computed tomography grey-level units were assessed at baseline, after demineralization and on Day 5. Between-group comparisons used surface microhardness change and percentage recovery. RESULTS:No significant between-group differences were detected for surface microhardness change on Day 5 (p = 0.126) or Day 10 (p = 0.412), or for percentage recovery on Day 5 (p = 0.543) or Day 10 (p = 0.406). All groups showed significant recovery from post-demineralization to Day 10. Grey-level units increased descriptively in all groups by Day 5. CONCLUSIONS:Under this low-concentration model, all formulations produced partial surface microhardness recovery without evidence of differential efficacy. The findings are exploratory and do not demonstrate equivalence or clinical effectiveness.
This scoping review explored the prevalence of work-related psychological and physical health issues among Australian dental practitioners, mapped across key occupational hazard domains (psychosocial/organisational, physical/ergonomic and environmental/infection-related) and summarised reported impacts on practitioner well-being and workforce outcomes. Databases including Embase, PsycINFO and PubMed were systematically searched from 2015 to March 2025 to capture contemporary practice and COVID-19 pandemic period. Eligible studies focused on Australian dental practitioners and reported the prevalence of psychological or musculoskeletal outcomes, and risk or protective factors. Data were synthesised narratively in line with a hazard-outcome framework. Sixteen studies met inclusion criteria (nine pandemic-era, seven pre-pandemic). Across these studies, dental practitioners frequently reported psychological outcomes (distress, burnout, anxiety, depression, suicidal ideation) and musculoskeletal symptoms related to awkward postures and repetitive tasks, particularly when exposed to high workload pressures, emotional demands and limited support. Pandemic-related infection-control and workload pressures were associated with additional stress and fatigue. Reported protective factors included resilience, emotional regulation and supportive workplace or peer environments. This scoping review indicates persistent and overlapping psychosocial, ergonomic and infection-related hazards that may place Australian dental practitioners at risk of mental and physical health challenges, emphasising need for integrated, multi-level strategies and tailored workplace interventions to foster psychologically safe workplaces.
BACKGROUND:An increasing number of children are being admitted to hospitals for dental general anaesthesia (GA). This study investigated the effects of a chronic disease management (CDM) protocol on rates of dental treatment under GA for Early Childhood Caries (ECC). METHODS:A 24-month study was conducted in New South Wales, Australia. Children aged < 72 months with ECC were managed utilising a CDM protocol. Rates of treatment completed in the chair vs. GA were compared to historical controls. The effect of silver fluoride treatment on avoiding the need for GA in the prospective group was also analysed. RESULTS:GA was avoided and treatment completed in the chair for 47% of the children in the prospective group (who were 9.6 times more likely to avoid a GA) compared to 15% in the retrospective control group. For participants in the prospective cohort who were initially referred for GA, silver fluoride application was associated with significantly increased odds of avoiding GA and completing treatment in the chair compared with those who did not receive silver fluoride (OR 5.51, 95% CI: 2.09-14.57). CONCLUSION:The CDM protocol was effective in reducing the number of dental treatments under GA for ECC in select public dental clinics. CLINICAL RELEVANCE:Implementation of a CDM protocol in public dentistry has resulted in a seismic shift in the management of caries in young children. Prospective patients referred for treatment under GA were nine times more likely to have their treatment completed in the dental chair and avoid a GA compared to historical controls. Silver fluoride played a vital role in the CDM protocol. Patients that received silver fluoride treatment were five times more likely to avoid a GA. The CDM protocol was highly effective in incorporating disease management visits within the existing appointment framework avoiding the need for additional appointments overall.
BACKGROUND:While limited research has explored the experiences of this workforce, oral health practitioners in rural areas face distinct cultural and personal challenges that influence workforce sustainability and delivery of care. This study aims to understand the cultural and personal experiences of oral health practitioners working in rural New South Wales and identify factors influencing their cultural capabilities, personal wellbeing and workforce sustainability. METHODS:A cross-sectional survey was conducted among oral health practitioners across three rural Local Health Districts in New South Wales. The survey included items on sociodemographic characteristics, cultural capabilities and awareness, and personal experiences. Data was analysed using descriptive statistics and subgroup comparisons made based on profession (dentists vs. other oral health practitioners) and years of experience (less or more than 10 years). RESULTS:Nineteen participants completed the survey, primarily dentists and oral health therapists, with few dental therapists. Most reported initial cultural awareness training; however, less than half reported ongoing training. Most participants reported personal growth associated with their role. Dentists reported greater access to support systems and training opportunities than other oral health practitioners. CONCLUSION:There is need for continuous cultural capability training and equitable support systems to strengthen rural oral health workforce sustainability. Despite small participant numbers, this study provides valuable insight into practitioner experiences and identifies opportunities for a culturally safe and wellbeing-focused workforce in rural NSW.
BACKGROUND:This study evaluated the marginal and internal fit, surface roughness and fracture resistance of three hybrid crown materials fabricated using milling and 3D-printing. METHODS:A maxillary premolar typodont tooth was prepared and scanned to produce 30 cobalt-chromium dies through selective laser melting 3D printing. Thirty crowns were fabricated from two milled materials (Vita Enamic; Cerasmart) and one printed material (Irix Max) (n = 10). Marginal and internal fit were assessed using a three-dimensional superimposition technique, while surface roughness was measured with an optical profilometer. After cementation, specimens underwent thermocycling for 3600 cycles, followed by 720,000 mechanical loading cycles. Fracture resistance was tested using a universal testing machine and failure modes were recorded. Statistical analysis was performed using one-way ANOVA test. RESULTS:No statistically significant differences were observed in marginal fit among the groups. Cerasmart showed significantly higher internal gaps but smoother surfaces than Vita Enamic and Irix Max. Vita Enamic exhibited significantly greater fracture resistance compared to Cerasmart. All failures were catastrophic. CONCLUSION:All crowns exhibited comparable marginal fit. Cerasmart demonstrated smoother surfaces but inferior internal adaptation and fracture strength, whereas Vita Enamic provided superior mechanical performance.
BACKGROUND:The Therapeutic Goods Administration is responsible for the Regulation of manufacture and supply of all medical devices including dental implants. Medically, the patient is given a 'Patient Implant Card' (PIC). It is recommended to monitor the performance of devices in an implant registry. METHODS:The TGA Regulations were reviewed. The detailed methodology to establish a National Dental Implant Registry is presented and initial analysis performed. RESULTS:The placement of dental implants in Australia is not as regulated as other comparable medical devices. Currently the Registry has 43 clinics with 44 participating dental practitioners. The DIR has recorded dental implant related information from 4842 patients with 9429 devices (Australian and New Zealand data). Patients were usually over 60 years of age, more female and more implants were placed in the maxilla. The Australian replacement rate of dental implants was 1.83% and 1.42% for prostheses. CONCLUSIONS:Improving the regulatory framework by introducing the issuing of Patient implant cards (PICs) so the specific device information type is transferable and retained long term and establishment of long-term independent monitoring in a Dental Implant Registry, crucial in identifying problems with the aim of improving outcomes for patients and dental professionals should be considered.
BACKGROUND:Antimicrobials are an adjunctive therapy in clinical dentistry. In dentoalveolar surgery, antimicrobials are not routinely required for surgical prophylaxis. This retrospective analysis of the Australian Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) dataset aimed to evaluate the guideline compliance and appropriateness of antimicrobial prescribing for dentoalveolar procedures in Australian hospitals. METHODOLOGY:Deidentified Surgical NAPS data for dentoalveolar procedures (tooth extractions and implant placements) between 2016 and 2022 were extracted. Procedures outside the scope of a general dentist were excluded. Prescribed antimicrobials for surgical prophylaxis, including procedural prophylaxis doses and post-procedural prescriptions, were assessed for guideline compliance and appropriateness according to the Surgical NAPS algorithm. RESULTS:1345 surgical episodes with dental procedures were included. This comprised 1077 procedural prophylaxis doses and 555 post-procedural prescriptions. Of the post-procedural prescriptions, 478 (86%) were for prophylaxis. Guideline compliance was demonstrated in 35.3% of procedural doses and 14.6% of post-procedural prescriptions. Rates of appropriateness were 33.5% for procedural doses and 12.6% for post-procedural prescriptions. Most procedural doses and post-procedural prescriptions were deemed inappropriate as they were not required (72.5% and 93.0%, respectively). CONCLUSIONS:Suboptimal guideline compliance and appropriateness of antibiotic prescribing for dentoalveolar surgery reinforces the need for antimicrobial stewardship interventions.
OBJECTIVES:Dental caries remains the most common chronic childhood condition and in Australia persists as a leading cause of potentially preventable hospitalisation. Despite various public health initiatives and improvements in oral health among the wider community, significant disparities exist among refugee families due to the unique challenges they face. Beyond the effects on a tooth level, dental caries profoundly influences a child's oral health-related quality of life (OHRQoL) which encompasses the physical, psychological and social impacts oral health has on daily life, an area that is often overlooked. This study explores the OHRQoL of Western Australian refugee children who experience childhood caries. METHODS:This nested study was conducted within a larger randomised controlled trial (ACTRN12616000456459) investigating caries arrest in newly resettled refugee children. Participants were recruited from the tertiary paediatric Refugee Health Service (RHS), where demographic information, clinical dental examination findings and OHRQoL data were collected using the Early Childhood Oral Health Impact Scale (ECOHIS). Non-parametric methods were employed to assess differences in total and domain-specific ECOHIS scores across stratification groups, including caries burden, caries depth, age and geographical region. RESULTS:A total of 223 children were included with a mean age of 4.6 years. Approximately, 65% of the children had high caries burden (> 5 affected teeth), and 160 out of 223 (72%) had frank dentine lesions. The mean (SD) total ECOHIS score was 6.52 (6.68). Parental distress had the highest mean score among the ECOHIS domains (1.79), while the symptoms domain score was unexpectedly low (0.96), despite participants experiencing severe and extensive caries. CONCLUSION:Refugee children experience a high burden of caries, yet reported symptoms were low, suggesting under recognition of oral pain. Conversely, high parental distress scores reveal the significant psychological impact on families. These findings highlight the need for early, culturally appropriate dental care within a family-centred model of care.
BACKGROUND:Trauma-informed care (TIC) is a patient care framework that recognises the widespread impact of trauma. While the likelihood of dental practitioners encountering patients with trauma is significant, there is limited guidance on TIC in dental care, highlighting the need for a clearer understanding. This scoping review was conducted to synthesise the literature to date concerning TIC practice for dental practitioners. METHODS:A search across six electronic databases and a manual search were conducted to find literatures from January 1992 to September 2025 that met inclusion criteria following the Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Of 176 identified papers, 27 papers informed this review. RESULTS:Identified TIC practices were categorised and synthesised according to 'the four R's' of TIC, such as safety and trust and other additional recurring TIC themes. This scoping review synthesised key concepts of TIC with the aim of informing clinical practice for dental practitioners. CONCLUSION:The review highlights core TIC themes in the literature and identifies priorities for future research. As trauma is pervasive and often undisclosed, TIC practice by dental practitioners is recommended as a universal precaution approach in all patient care.
AIM:This project aims to systematically review and synthesise the data found in the literature regarding the survival of implants, complications, and gain in bone height using the hydraulic pressure technique to elevate the maxillary sinus floor. METHODS:A comprehensive literature search was conducted using databases including PubMed, Scopus, Embase, and Cochrane, covering studies from 2005 to July 2024. A total of 24 studies were included, comprising randomised control trials, cohort studies, and case series. The main outcomes evaluated were implant survival, complication rates, and endo-sinus bone gain. RESULTS:The review included 3053 implants placed in 2290 Sinuses of 2231 patients. The patients' ages ranged from 23 to 84, with a mean of 51.6 years. The included studies reported a pooled implant survival rate of 98.40% over follow-up periods ranging from 6 months to 8 years. The rate of sinus membrane perforation was relatively low (2.05%), and other complications, such as hematoma, sinusitis, nasal discharge, or oedema, occurred in 0.49% of cases. The average endo-sinus bone gain achieved using this technique was 6.72 mm. CONCLUSION:The hydraulic pressure technique for sinus floor elevation is one of the many proposed solutions to provide predictable, safe, and efficient sinus floor elevation. The results from this review provide some cause for optimism, with high survival rates, low complication rates, and adequate gain in bone height. There is still a need for further long-term, high-quality research by independent third parties to confirm the effectiveness and safety of this technique. CLINICAL RELEVANCE:There is limited information available for the hydraulic pressure technique for sinus floor elevation. It has only been briefly mentioned in a limited number of literary reviews, none of which quantify the available data. This study presents the first systematic review of the hydraulic pressure technique, synthesising the available data and suggesting that the hydraulic pressure technique demonstrates high success and safety. PROSPERO:This review is registered in PROSPERO under ID: 1070614.
BACKGROUND:Static computer-assisted guided implant placement (sCAIP) has been shown to enhance accuracy and predictability; however, little is known about the multifactorial decision-making processes impacting use among clinicians. METHODS:An exploratory cross-sectional electronic survey was distributed to implant practitioners across Australia and New Zealand, including general dentists and specialists (periodontists, prosthodontists, oral surgeons, and oral and maxillofacial surgeons) involved in implant placement. Items covered demographics, training profiles, clinical experience, utilisation patterns, and attitudes towards sCAIP, with free-text reflections. Quantitative data were analysed using descriptive statistics, factor analysis, and t-tests; qualitative data underwent thematic analysis. RESULTS:Thirty-three respondents completed the survey, with 90.9% reporting current use of sCAIP. Sixteen respondents (48.5%) were classified as analytical decision-makers and 17 (51.5%) as intuitive. Factor analysis identified seven components that explained 84.2% of the variance in decision-making, including surgical complexity and soft tissue conditions, case timing, aesthetic site sensitivity, cost, anatomical risk, training exposure, and clinical experience. Internal consistency across items was high (Cronbach's alpha, α = 0.95). Analytical decision-makers placed significantly more weight on anatomical risk and bone quality compared to intuitive decision-makers (p = 0.038, d = 0.93). Intuitive decision-makers reported higher levels of training exposure (p = 0.04, d = 0.80). Thematic analysis revealed three key influences on sCAIP use: clinician capability, surgical planning and risk mitigation, and restorative outcomes. In addition, several barriers were identified including financial cost, workflow integration, and attitudinal factors. CONCLUSION:Clinicians with an analytical decision-making style placed greater emphasis on anatomical risk and were more likely to adopt sCAIP in complex or high-risk cases. Because intuitive clinicians reported higher training exposure, education alone did not explain these patterns, indicating that cognitive style and risk appraisal are central determinants of sCAIP adoption.
BACKGROUND:The aims of this study were to assess and compare trends in microbial cultures and antibiotic resistance in individuals admitted with severe odontogenic infection in Auckland, New Zealand and South Australia, Australia. METHODS:A retrospective audit was completed on all adults ( ≥ 19 years of age) admitted with severe odontogenic infection in the Auckland and South Australia public oral and maxillofacial surgical teams, 2019-2023. Data was collected on demographic information, antibiotic prescribed at discharge, length of admission, number of procedures required, microbes isolated in cultures and antibiotic sensitivity, where completed by the laboratory. RESULTS:The total combined population of individuals admitted for severe odontogenic infection was 924. Auckland admitted more individuals for severe odontogenic infection (n = 542), compared to South Australia (n = 382) from a similar general population size. Moderate rates of resistance to penicillin (13.4% and 8.8%) and clindamycin (13.9% and 9.4%) in Auckland and South Australian cohorts, respectively were identified. CONCLUSIONS:There was a higher presence of microbes that were resistant to antibiotics in the Auckland population compared to the South Australian population for individuals admitted for severe odontogenic infection. The presence of resistant microbe(s) was associated with an increasing trend of length of admission and likelihood of repeat surgical procedure(s).
BACKGROUND:This study investigated the experiences and approach to practice of New Zealand (NZ) general dental practitioners (GDP) providing root canal treatment (RCT) for older adults. METHODS:A national online survey collected data from GDPs managing older adults including their approaches to pulpal diagnosis and RCT techniques. Questions also explored informed consent, specialist referrals, confidence, treatment outcomes and engagement with continuing education. Data were analysed descriptively and bivariate analysis of categorical variables used Chi-square and Fisher's exact tests. RESULTS:A total of 382 GDPs participated (response rate 23.6%). RCT for older adults was common, and most dentists felt confident and incorporated contemporary techniques, although they were less comfortable managing polypharmacy or complex medical conditions. Verbal consent was usual. Almost three-quarters had updated their endodontic knowledge and skills within the previous 2 years through continuing professional development. Around two-thirds found diagnosis challenging; however, RCT was viewed as successful. Females were less confident, and a proportion did not treat molars. CONCLUSION:Older adults commonly require RCT, and enhancing GDPs' knowledge and skills to manage patients with a range of medical conditions is important. Written consent is advised for RCT when patient or tooth factors are complex, or where patients' capacity may be impaired.
PURPOSE:Traumatic dental occlusion (TDO) is a multifactorial and dynamic clinical condition that extends beyond localised tooth wear and has been reported to be associated with alterations in temporomandibular joint biomechanics, neuromuscular function and overall masticatory system performance. While acute dental trauma often receives greater clinical attention, chronic occlusal trauma may remain underrecognised in routine practice, despite its potential to influence mandibular movement patterns, modify joint loading and contribute to patient-reported functional complaints. BASIC PROCEDURES:This narrative review synthesises current concepts from the literature regarding the proposed etiologic factors, functional implications and long-term clinical consequences of traumatic dental occlusion. Particular emphasis is placed on the adaptive nature of the masticatory system and the variability of individual responses to occlusal disturbances. Contemporary digital diagnostic tools, occlusal analysis technologies and CAD/CAM-assisted restorative workflows are discussed as adjunctive modalities that may support clinical assessment and treatment planning rather than as definitive solutions. MAIN FINDINGS:The review outlines commonly applied clinical approaches used in the management of TDO-related structural and occlusal changes, including tooth wear and variations in occlusal vertical dimension, with reference to provisional strategies, indirect restorations and minimally invasive interventions. PRINCIPAL CONCLUSIONS:By providing an expert narrative synthesis and acknowledging ongoing controversies within occlusion and temporomandibular disorder research, this review aims to enhance clinician awareness, support cautious and patient-centred decision-making and encourage further research to clarify the clinical relevance of traumatic dental occlusion within contemporary dental practice.
