Effectiveness of blended pedagogy for radiographic interpretation skills in operative dentistry - a comparison of test scores and student experiences at an undergraduate dental school in Pakistan

BACKGROUND

Utilizing Blended pedagogy (BP) in radiographic skills may prove to be an effective teaching strategy. However, studies on the use of BP in dentistry are quite limited in Pakistan, where teaching has mostly been via traditional Didactic Lectures (DL); and radiographic interpretation skills of undergraduate dental students are suboptimal. Therefore, this study aims to assess whether utilizing BP to teach radiographic interpretation skills is an effective teaching methodology in Pakistan.

METHODS

This mixed-method study was conducted on final year dental students at Jinnah Medical and Dental College (JMDC). Two groups of students were utilized for this study, one taught by traditional DL and the other taught by BP for the same module. BP was conducted over six weeks. A post-module test was conducted in both groups. Additionally, the BP group completed a modified Community of Inquiry (CoI) survey tool and volunteered to discuss their experiences through a focused group discussion (FGD). Descriptive statistics were computed and independent sample t-test was used to analyse the difference between the scores of the two groups. Thematic analysis was performed for the qualitative data.

RESULTS

The mean post-test scores were found to be significantly higher in the BP group (61.0 ± 10.2) compared to the DL group (44.4 ± 12.3) (p = < 0.001, CI = 95%, Cronbach Alpha > 0.8). The mean scores for the modified CoI instrument were 4.0 ± 0.29 for the whole instrument; 4.25 ± 0.22 for Teaching Presence, 3.71 ± 0.23 for Social Presence and 3.97 ± 0.16 Cognitive Presence, with all three having a Cronbach's alpha > 0.75. Thematic analysis revealed that BP students mutually agreed that BP method was beneficial with the appreciation of strong support from the facilitator. However, challenges like interrupted power supply and increased effort requirement from students were pointed out.

CONCLUSION

Students taught radiographic interpretation skills with BP in comparison to DL had higher test scores and expressed a positive experience demonstrated via a modified CoI survey and FGD. Considering the encouraging results found, dental schools should incorporate BP in their teaching methodology and follow-up studies are needed to further support the use of BP as an effective teaching methodology in Dentistry.

Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry

The dental operative microscope has been widely employed in the field of dentistry, particularly in endodontics and operative dentistry, resulting in significant advancements in the effectiveness of root canal therapy, endodontic surgery, and dental restoration. However, the improper use of this microscope continues to be common in clinical settings, primarily due to operators' insufficient understanding and proficiency in both the features and established operating procedures of this equipment. In October 2019, Professor Jingping Liang, Vice Chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, organized a consensus meeting with Chinese experts in endodontics and operative dentistry. The objective of this meeting was to establish a standard operation procedure for the dental operative microscope. Subsequently, a consensus was reached and officially issued. Over the span of about four years, the content of this consensus has been further developed and improved through practical experience.

An evaluation of the relationship between clinical requirements and tests of competence in a competency-based curriculum in dentistry

BACKGROUND

The development of competencies in dentistry is a complicated process that calls for the development of not just cognitive and psychomotor abilities but also behaviors and attitudes that change as technical proficiency increases and meaningful patient encounters occur. This study examined the relationship between the number of clinical requirements completed by dental students and subsequent performance on tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence.

METHODS

Retrospective assessment data for 81 students were used in this analysis. Data included the amounts of clinical requirements completed for operative dentistry, endodontics, periodontics, and fixed prosthodontics together with data on the respective performance in tests of competence. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements using a non-parametric Spearman's Rho test at an alpha level of 0.05.

RESULTS

Fixed prosthodontics and posterior endodontics were the least common procedures completed by dental students. Statistically significant weak correlations were found between the amounts of clinical requirements performed for posterior endodontic(p = 0.005) and operative procedures (p = 0.006) and associated performance in tests of competence. A moderate correlation was found between the number of fixed prosthodontic procedures completed and associated performance in tests of competence. This latter correlation, however, was not statistically significant (p = 0.654). A significant weak correlation was found between requirements completed for periodontics and the associated test of competence (p = 0.04). A highly statistically significant moderate correlation was found between clinical requirements for anterior endodontics and the associated performance in the tests of competence (p < 0.001).

CONCLUSION

The null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform.

Dental MRI-only a future vision or standard of care? A literature review on current indications and applications of MRI in dentistry

MRI is increasingly used as a diagnostic tool for visualising the dentoalveolar complex. A comprehensive review of the current indications and applications of MRI in the dental specialities of orthodontics (I), endodontics (II), prosthodontics (III), periodontics (IV), and oral surgery (V), pediatric dentistry (VI), operative dentistry is still missing and is therefore provided by the present work.The current literature on dental MRI shows that it is used for cephalometry in orthodontics and dentofacial orthopaedics, detection of dental pulp inflammation, characterisation of periapical and marginal periodontal pathologies of teeth, caries detection, and identification of the inferior alveolar nerve, impacted teeth and dentofacial anatomy for dental implant planning, respectively. Specific protocols regarding the miniature anatomy of the dentofacial complex, the presence of hard tissues, and foreign body restorations are used along with dedicated coils for the improved image quality of the facial skull.Dental MRI poses a clinically useful radiation-free imaging tool for visualising the dentoalveolar complex across dental specialities when respecting the indications and limitations.

Seroprevalence of SARS-CoV-2 in a Fully Operative Dentistry Academic Center in Madrid (Spain) During the De-escalation Phase of the COVID-19 Pandemic. Are Our Dentists at Greater Risk?

PURPOSE

To determine the prevalence of COVID-19 infection among dental professionals at an Academic Center in Madrid (Spain) at the beginning of the pandemic's de-escalation phase.

MATERIALS AND METHODS

A cross-sectional study was designed. COVID-19 infection was determined by membrane-based immunoassay qualitative detection of IgG and IgM antibodies in human whole blood. Age, sex, race and professional qualification were recorded, as were symptoms compatible with COVID-19 infection whenever present. Data collected were analysed by means of descriptive and qualitative (X2) statistical analyses.

RESULTS

A total of 195 individuals were included (40 administrative professionals and 155 dentists). Seroprevalence at the end of the de-escalation phase was 20.0% among all the participants. The highest prevalence was found among the orthodontists (34.8%), followed by the paediatric dentists (28.6%) and oral surgeons (14.7%). Most subjects were positive for IgG and negative for IgM (79.5%).

CONCLUSIONS

The seroprevalence of SARS-CoV-2 among dental professionals at the end of the de-escalation phase after the first wave of the pandemic was almost double the seroprevalence of the general population. Orthodontists had the highest rates of SARS-CoV-2 infection.

Modeling the Behavioral Response of Dentists to COVID-19 and Assessing the Perceived Impacts of Pandemic on Operative Dentistry Practices in Pakistan

COVID-19 pandemic has affected dentistry in unprecedented ways. This study investigates the perceived effects of the pandemic on operative dentistry procedures and dentistry profession in Pakistan and the factors that determine the behavioral changes among dentists to adapt to the “new normal.” A Capability Opportunity Motivation-Behavioral model (COM-B) was utilized to investigate the factors that determine the behavior of dentists in Punjab, Pakistan to adhere to COVID-19 standard operating procedures (SOPs). Using social media, an online questionnaire was sent to operative dentistry professionals in Pakistan, and 312 responses were received. 81.4% of the respondents believed that the COVID-19 pandemic has severely affected the level of care provided to the patients, 66% were extremely worried about the risk of contagion during clinical practices, and more than 75% of the respondents opined that the pandemic has led to an increased emphasis on disinfection and oral hygiene instructions. The multiple regression model suggests that the behavior of Pakistani dentists to adhere to the COVID-19 SOPs is significantly affected by their Capabilities (β = 0.358) and Opportunities (β = 0.494). The study concluded that dentists in Punjab, Pakistan are concerned about the risk of contagion and report a serious concern about consequences such as financial loss and inappropriate care of patients. The current study results can feed the policymaking in Pakistan and other developing countries. Facilities and training to improve dentists' opportunities and capabilities can improve their ability to cope with the COVID-19 challenges.

Analysis of Online Consultations and Emergent Treatments of Operative Dentistry and Endodontics during the COVID-19 Epidemic

BACKGROUND

The purpose of the present study is to evaluate the characteristics of online consultations and emergent dental treatments and analyze the status of diseases related to operative dentistry and endodontics (ODE) during the COVID-19 epidemic.

METHODS

Online consultations were collected from 3 February to 21 April 2020. The electronic medical record system was accessed to collect clinical diagnoses and emergent dental treatments from 9 January to 21 April 2020.

RESULTS

A total of 2419 patients visited us and received treatments 2 weeks before the lockdown. The number of patients decreased to 537 during the 76 days of the lockdown. Among them, dental examinations accounted for the majority of visits (88.83%). After 7 April, the outpatient number increased to 36.79 ± 6.63 per day, but the proportion of dental examinations and treatments did not change significantly. A total of 1218 online consultations were completed before the lockdown. The most common dental problem was pulpitis (48.1%). After 7 April, consultations surged from 23.15 ± 8.54 to 44.43 ± 12.63 per day. Consultations related to pulpitis, apical periodontitis, or dental caries remained stable.

CONCLUSIONS

Correct understanding, active treatments, and appropriate psychological interventions for the ODE staff during the COVID-19 epidemic are necessary. Our results may provide references to arrange staff and treat patients more efficiently for future epidemics.

Endoscopic removal of accidental aspirated and ingested dental foreign bodies: A cross-sectional study

The incidence of accidental ingestion and aspiration of foreign body (FB) is likely to occur. Many FBs are discharged spontaneously, but many dental FBs are often sharp and may remain in the pharynx, esophagus, and stomach, causing serious complications such as hemorrhage, asphyxia, perforation of the digestive tract, mediastinal emphysema, peritonitis, and ileus. We aimed to examine which type of dental foreign bodies can be removed by endoscope.In this study, we enrolled 32 patients who were evaluated at the Emergency and Critical Center between January 2014 and December 2019 and who accidentally ingested or aspirated dental FBs. Medical records were reviewed to determine the patients' sex, age, medical history, time from accidental ingestion of a FB to consultation, cause, location, occurrence status, nature of the FB, location of retained FB, treatment, complications, and outcome.We enrolled 32 patients (14 men, 18 women), with a mean age of 74.5 ± 12.8 years. Accidental ingestion at treatment was common. The most frequent site where the FB was retained was upper gastrointestinal tract (26 cases, 81.3%). In this study, endoscopic removal was indicated for dentures under the size of 43.3 mm, for dental FB (except dentures) more than 13.6 mm. In dentures, between the number of missing teeth, clasp, type, and endoscopic removal was not statistically significant.Dentures under the size of 43.3 mm was likely to be removed by endoscope. Dental FB (except dentures) more than the size of 13.6 mm was likely to be removed by endoscope. There were no indications for endoscopic removal except for size.

Personality, learning styles and handedness: The use of the non-dominant hand in pre-clinical operative dentistry training

AIM

This research was undertaken with the aim of using personality traits, learning styles and handedness to develop and evaluate a scale to measure a new concept in operative dentistry, symmetrisation. An initial hypothesis was proposed, stating that handedness, personality trait and learning style could be used to predict symmetrisation potential in the domain of operative dentistry.

METHODS

Participants completed three questionnaires: the Edinburgh handedness inventory assessment; the Keirsey Temperament Sorter-II (KTS-II); and the learning style assessment (VARK). Then, participants prepared a cavity on an artificial third molar tooth in the traditional phantom head using their non-dominant hand. For evaluation and comparison purposes, Standard Tessellation Language images were obtained from prepared teeth using a CAD/CAM scanner and then aligned against a reference "unprepared" tooth image using a custom software developed by the authors based on the Iterative Closest Point algorithm.

RESULTS

Extroverts, intuitive and participants characterised as relying on their feelings were more accurate compared to introverts, sensory and toughminded participants, respectively. Extroverts were faster to complete the task compared to introverts. Participants with a preference for read/writing learning style produced more errors than any of the other groups. Handedness, however, did not show any significant association with performance.

CONCLUSIONS

It was concluded that both the KTS-II and the learning style assessment (VARK) questionnaires possess potential as useful measures of symmetrisation potential and the ability to use the non-dominant hand in operative dentistry, as well as platform for continuing research.

Can an interactive case-based activity help bridge the theory-practice gap in operative dentistry?

INTRODUCTION

A theory-practice gap in pre-doctoral dental education is a common source of stress for dental students. An interactive, small-group, case-based activity was designed to bridge the gap between pre-clinical and clinical experiences. The aim of our study was to assess the effectiveness of the case-based activity by evaluating students' comfort level in operative procedures.

MATERIALS AND METHODS

Over 5 years, a total of 172 second-year students from the classes of 2017 through 2021 participated in the case-based activity delivered after the completion of the core operative dentistry course. The exercise included a pre-activity online quiz, an in-class case-based session and a laboratory exercise. Students' self-reported comfort levels in performing operative procedures were collected by surveys at three different times. They included the post-course survey distributed after the completion of the core operative dentistry course, the post-activity survey distributed after the completion of the case-based activity, and the follow-up survey distributed after students completed their first operative procedures in clinic.

RESULTS

There was a 93% response rate. The average rating of all eight statements revealed statistically significant increase in students' comfort level after completing the case-based activity and after performing their first operative procedures in the teaching practice.

CONCLUSION

This observation suggests that the case-based activity was effective in raising students' comfort levels. The activity may serve as an important tool in bridging the theory-practice gap between pre-clinical and clinical operative experiences.

Dental students' experience and perceived confidence level in different restorative procedures

PURPOSE

Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate self-perceived level of confidence of fifth-year dental students in different restorative-related tasks and the relationship between their clinical training and its corresponding confidence.

METHODS

Fifth-year graduate dental students (n = 202) were asked to fill a questionnaire that rated their level of confidence in different clinical restorative dentistry tasks. Additionally, they were asked about the number of times they performed tasks prior to attempting the equivalent competency and in which sub-specialty they felt the most confident.

RESULTS

Completed responses were received from 120 students giving a response rate of 59%. Students felt the most prepared and confident in direct restorations and simple endodontic treatment, and they seemed less confident in indirect restorations and complex endodontic treatment. Regarding the steps of indirect restorations, students expressed least confidence in crown preparation compared to impression making and try-in procedures (P < .05). Students rated their confidence highest in operative dentistry, followed by endodontics and lastly fixed prosthodontics.

CONCLUSION

The results highlight the areas in which students exhibit the least confidence. Enhancement of student clinical skills and directed exposure is necessary to raise the level of perceived confidence which will reflect positively on their current and future professional performance.

Knowledge and Opinions of French Dental Students in Operative Dentistry - Management of Deep Carious Lesions

PURPOSE

A questionnaire survey was recently undertaken among French dental students (FDSs) to investigate their practices, knowledge and opinions in various domains of minimal intervention (MI) in cariology. The present work focuses on management of deep carious lesions (DCLs).

MATERIALS AND METHODS

The questionnaire was administered (Spring 2018) to all the fifth-year students of the 16 French dental schools. Descriptive analyses were performed.

RESULTS

Among 1370 FDSs (response rate: 84.5%), hardness was the most commonly reported criterion for assessing the endpoint of carious tissue removal (53.9%), followed by firm dentin (40.0%). Regarding FDSs' opinion of leaving carious dentine under a restoration, 41.9% of the respondents agreed that carious tissues should always be removed completely. For an asymptomatic tooth with DCLs and exposed pulp, direct pulp capping was mainly chosen (93.9%). In a clinical case correctly diagnosed as a reversible pulpitis by 79.7% of respondents, nearly half of FDSs chose a one-step complete excavation (48.3%) followed by selective excavation (25.1%), then two-step complete excavation (20.9%) and a minority (5.7%) opted for pulpal therapy (biopulpotomy or endodontic treatment).

CONCLUSION

The present results suggest an inadequate dissemination of MI concepts among FDSs towards DCL management. The present results show the need for a harmonisation and a reinforcement of teaching evidence-based MI according to the latest European recommendations.

Inculcating research curriculum in Operative Dentistry - Endodontics residency programme: Experience and outcomes

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Determining defensible cut-off scores for dental courses

PURPOSE

Many countries and institutions have a fixed passing score of 60%. For example, this is a national policy in all Saudi universities where students at all levels must score 60% or higher to pass courses. The purpose of this study is to broaden the scope of standard-setting applications, using data from five major dental courses (Endodontics, Operative, Removable and Fixed Prosthodontics, and Pedodontics) in the 5th dental academic year for two consecutive years to determine the cut-off scores.

METHODOLOGY

Four expert raters conducted Angoff's method on final examinations of five dental courses to determine the cut-off scores for the two academic years (2015, and 2016). Cohort size of 2015 was 120 students, whilst that of 2016 was 142 students. The study was conducted at the faculty of Dentistry, at King Abdulaziz University (KAU) from December 2017 to June 2018.

RESULTS

All five dental courses yielded different cut-off scores than the fixed 60%. The cut-off scores for 2015 and 2016 examinations were 59.15%, 63.75% for Removable Prosthodontics, 51.86%, 53.75% for Fixed Prosthodontics, 47.42%, 50.5% for Pedodontics, 74.22%, 74.31% for Endodontics and 58%, 55.55% for Operative Dentistry.

CONCLUSION

Angoff method yielded different cut-off scores than the fixed 60% passing score currently used by the dental school, yielding a difference in pass-fail rates by as much as a staggering 41%. This finding provides support to use evidence-based standard-setting methods to determine the cut-off score for the courses in Dentistry programme.

'Evaluation of the introduction of a dental virtual simulator on the performance of undergraduate dental students in the pre-clinical operative dentistry course'

INTRODUCTION

Virtual reality-based platforms are becoming increasingly popular in education. The aim of this study was to evaluate the performance of undergraduate dental students with the introduction of the Moog Simodont dental trainer (VR) within the pre-clinical curriculum in the direct restoration module of the operative dentistry course using manual and digital methods.

METHODS

Thirty-two randomly selected year 2 undergraduate students were divided into two groups: group 1, exposed to the Moog Simodont dental trainer (VR) and group 2, no exposure to VR. All students were then evaluated in carrying out a Class I preparation in a single-blinded fashion. All preparations were evaluated by three assessors using a traditional manual approach and a digital software. Statistical analysis of the data was performed using chi-square test (alpha = 0.05).

RESULTS

The number of students who performed satisfactory preparations was more in group 1 (12/16), compared to group 2 (7/16). The percentage of satisfactory domains was significantly higher in group 1, compared to group 2, both in the manual evaluation (83.9% (94/112) and 59.8% (67/112) in groups 1 and 2, respectively) and in the digital evaluation (85.7% (96/112) and 55.4% (62/112) in groups 1 and 2, respectively) (P < .05). There was no significant difference between the manual and digital methods of evaluation with regard to the percentage of satisfactory or unsatisfactory preparations (P > .05).

CONCLUSIONS

The use of the Moog Simodont dental trainer (VR) significantly improved the satisfactory performance of students. The virtual reality simulator may be a valuable adjunct in the undergraduate direct restorations course and for remedial student.

Next generation of dentists moving to amalgam-free dentistry: Survey of posterior restorations teaching in North America

OBJECTIVES

The dental field is gradually reducing the use of amalgam and moving towards adhesive restoration. This change is in accordance with the advancement and improvement of composite resin materials and adhesion systems. Consequently, posterior cavity preparations teaching should be re-examined to determine whether dental schools are adapting their curriculum to fit the current trends in dentistry and what rationale supports their decisions.

METHODS

An online questionnaire was constructed to assess the time dedicated to teaching composite materials and amalgam, in addition to the principles of posterior preparations, for composite restorations in North American dental schools.

RESULTS

A total 33 schools responded to the questionnaire. A large variation was found in teaching methods and techniques of posterior restorations. The reasoning for teaching amalgam restorations was diverse as were the principles of composite resin preparation taught.

CONCLUSION

No agreed principles of cavity preparation for resin composite restorations were found, as opposed to explicit agreement on amalgam cavity preparations. The results demonstrate a lack of clear guidelines for cavity preparation of resin composite restorations. Dental schools may benefit when a consensus on this topic is achieved.

Prep-Along Facilitated Posterior Crown Preparation in the Preclinical Dental Setting: A Multimedia Approach

INTRODUCTION

Dental students often seek visual aids and demonstrations when attempting to perform new procedures. This video resource provides an adjunctive teaching tool for a crown preparation on an ivorine molar using the "prep-along" method. This method teaches crown preparation in a uniform, step-by-step manner while providing feedback to students after each step.

METHODS

Prior to the daily simulation clinic session, a calibration session was held for faculty. Following didactic instruction-including principles, criteria, and grading rubric-students participated in the laboratory portion of the course. During this laboratory portion, students viewed a segment of the video, the video was paused, and students attempted that portion of the preparation. The project continued in stages until it was completed. Upon completion, using an electronic grading system, each student performed a self-evaluation, the instructor then performed a blind evaluation, and both student and instructor compared assessments.

RESULTS

To obtain feedback, an electronic survey was sent to 285 third- and fourth-year dental students. Ninety-four students completed the survey; 94% responded favorably to this method of instruction. Individual comments were also predominantly positive.

DISCUSSION

Preclinical faculty at the Midwestern University College of Dental Medicine-Arizona use this prep-along for instruction of direct and indirect tooth preparations and restorations. Students participate in this step-by-step process while receiving feedback. Faculty are allowed a structured environment in which to give feedback and instruction at each segment of the preparation. The faculty found that this method of instruction created efficiency and excellence in training surgical hand skills.

The Potential of Different Origin Stem Cells in Modulating Oral Bone Regeneration Processes

Tissue engineering has gained much momentum since the implementation of stem cell isolation and manipulation for regenerative purposes. Despite significant technical improvements, researchers still have to decide which strategy (which type of stem cell) is the most suitable for their specific purpose. Therefore, this short review discusses the advantages and disadvantages of the three main categories of stem cells: embryonic stem cells, mesenchymal stem cells and induced pluripotent stem cells in the context of bone regeneration for dentistry-associated conditions. Importantly, when deciding upon the right strategy, the selection needs to be made in concordance with the morbidity and the life-threatening level of the condition in discussion. Therefore, even when a specific type of stem cell holds several advantages over others, their availability, invasiveness of the collection method and ethical standards become deciding parameters.