'Bridging the gap.' Should the training of dental technicians be linked with that of the dental undergraduate?

OBJECTIVES

Improving communication and collaboration between members of the dental team is important to the long term aim of improving the quality of dental care for patients. For example, closer integration between trainee dental technicians and undergraduate dental students during their courses of training should both help to develop their own skills and foster an improved level of communication and understanding between these members of the dental team. The purpose of this study was to ascertain the number of dental teaching hospitals in Great Britain and Ireland currently involved with the training of dental technicians, and to find out how many of these bring trainee technician and undergraduate dental students together at some time during training as a matter of policy.

METHODS

Action research was carried out in the form of a linking exercise in the Newcastle upon Tyne Dental Hospital. This involved second year trainee dental technicians and third year undergraduate dental students working together to provide complete dentures for a patient within the formal undergraduate course in complete denture construction. The trainee technicians also attended a series of lectures relevant to this course alongside undergraduate dental students.

RESULTS

The main findings revealed that although a number of dental teaching hospitals were involved with the training of dental technicians and had encouraged links between undergraduate dental students and trainee technicians, few had formalised these links in any way.

CONCLUSION

The outcomes of the linking exercise were evaluated by means of focus groups, observations and semi-structured interviews. Results indicated that both the trainee dental technician and the undergraduate dental student benefited to some extent from closer collaboration during training.

Prosthodontics: a past with a future?

As one of the oldest dental specialties, prosthodontics has a long history of innovation and adaptability. This overview of the field presents landmarks in the development of prosthodontics from mediaeval times to the present and speculates on some future trends. It effectively sets the stage for the other articles in this issue, which explore the many facets of prosthodontic evolution.

Predoctoral implant dentistry curriculum survey: European dental schools

PURPOSE

In 2002 a survey of European dental schools was conducted. The purpose of the survey was to determine the curricular structure, teaching philosophies and materials used in predoctoral implant dentistry courses.

MATERIALS AND METHODS

Fifty-six European dental schools were randomly selected from the Association for Dental Education in Europe representing 33 countries. A questionnaire was mailed to the predoctoral implant dentistry director/chairperson of the selected European dental schools. Of these, 40 schools returned the completed survey, resulting in a response rate of 71%. The mean, median and range of responses were computed where applicable.

RESULTS

The results from this survey show that 80% of the responding schools required a course in implant dentistry. Between 1997 and 1999 over a third of responding schools (36%) incorporated a predoctoral implant dentistry course into their curriculum. Eighty-seven per cent of the schools have some prosthodontists teaching the course. Thirty-seven per cent of schools are offering a laboratory course in conjunction with the implant course. Sixty-three per cent of the schools are not restoring implant cases at the predoctoral level. However, 68% of schools reported students are required to be present during implant surgery. Ten per cent of schools require that the implant-related laboratory work be completed by the students.

CONCLUSIONS

Predoctoral implant dentistry educational programmes vary from school to school. Yet a large percentage of schools agree on certain topics, including the importance of including implant education in predoctoral dental programmes.

Quantitative evaluation of axial wall taper in prepared artificial teeth

The purpose of this study was to quantitatively evaluate the axial wall taper of prepared artificial teeth using a non-contact three-dimensional shape measuring system. A total of 54 artificial teeth prepared by pre-clinical dental students for complete cast restorations were evaluated. For quantitative analysis, five cross sections were computer-graphically placed perpendicularly to the z-axis. The surface coordinate values (x, y, z) of each cross section were converted into polar coordinate values (r, theta), which were then graphically rendered to a two-dimensional plane. At four points, each 90 degrees from the distal center point of the cross section, the axial wall taper was quantitatively calculated using a formula based on the differences in radius between the highest and lowest positions of the cross sections of the prepared tooth. The average calculated taper was 5.8 degrees in the distal region, 21.7 degrees in the buccal region, 14.9 degrees in the mesial region and 12.5 degrees in the lingual region. These results suggest that the axial wall taper of prepared teeth can be quantitatively evaluated using this measuring system.

Assessing the reliability of a digital preparation assistant system used in dental education

Use of a digital preparation assistant system may improve considerably the quality of preclinical dental education, provided the system works reliably. Thus, the purpose of this pilot study was to quantitatively assess the reliability of a new preclinical digital preparation assistant system (PREPassist, KaVo, Germany). The system was used to repeatedly scan four different unprepared and four different prepared teeth both with and without repositioning. Corresponding measurements were made to quantify accuracy, repeatability, and reproducibility. This was done by estimating the measurement error. Based on this estimation, respective limits of agreement were calculated. We used these ranges, along with assessments of the measurement's accuracy, to judge whether the results satisfy our expectations for clinically acceptable measurements. For preclinical laboratory instruction, the results indicate an acceptable accuracy (mean accuracy of 89 microm) of the measurements. This assessment applies as well to repeatability, given by the range of the respective limits of agreement (range <200 microm). However, in the case of reproducibility, the limits revealed discrepancies of practical importance (range >200 microm). Reproducibility of tooth repositioning in the available mounting device is unacceptable for preclinical laboratory instruction because of the observed range >200 microm. Thus, there is a need for the manufacture of new and more reliable mounting devices because reproducibility procedures are mostly encountered in preclinical instruction in restorative techniques. In contrast to reproducibility, accuracy and repeatability are acceptable for practical purposes. Balancing advantages and disadvantages, we conclude that, in general, the PREPassist system delivers reliable results.

Current concepts for determining the postpalatal seal in complete dentures

PURPOSE

In 2001, a survey of U.S. dental schools was conducted to determine the concepts and techniques used for establishing the postpalatal seal (PPS) in a predoctoral dental curriculum.

MATERIALS AND METHODS

The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 returned the completed survey, resulting in a response rate of 82%.

RESULTS

Results from this survey show that 80% of the schools are teaching a combination of phonation with other methods for locating the vibrating line. The 1 vibrating line concept for establishing the PPS is taught by 80% of schools; 77% of these schools locate the posterior termination of the maxillary denture on the vibrating line. Carving the PPS in the maxillary master cast is taught by 95% of the schools. Most of the schools teach the students to carve the PPS to a depth of 1.0-1.5 mm in the maxillary master cast. Compressibility of the palatal tissues is a consideration during PPS carving for 91% of the schools. The butterfly pattern is the most frequently (75%) described pattern for PPS carving.

CONCLUSIONS

There is some variability from school to school on performing the PPS in the maxillary denture, although some trends are evident.

Survey of recently board‐certified prosthodontists on the board‐certification process. Part 2: Preparation and impact

PURPOSE

A 2-part survey of recently board-certified prosthodontists was conducted in 2001. The first part of the survey, published in June 2003, determined the trends that assisted the candidates in attaining diplomate status. The second part of the survey was done to determine the preparation methods and resources used to prepare for the examination, the most difficult part of the examination, the most gratifying aspect of becoming board-certified, their current employment status, and whether board certification had any positive impact on their employment.

MATERIALS AND METHODS

A questionnaire was mailed to 176 diplomates who had become board certified between the years 1993-2001. Of these, 131 board-certified prosthodontists returned the completed survey, resulting in a response rate of 74%.

RESULTS

Results from this survey showed that 91% of the diplomates had taken the American College of Prosthodontists (ACP) Board Preparation course; most of the diplomates (41%) prepared for the boards by reviewing prosthodontic literature, reading textbooks, using the ACP Study Guide, and seeking the help of other board-certified prosthodontists; 89% of the diplomates felt that achieving board certification had a positive influence in their employment; 39% of the diplomates indicated that Part 2 of the examination was the most difficult to prepare for, and 41% indicated that Part 2 was the most difficult section; the majority of diplomates (31%) were employed by the military, and the most gratifying aspect of becoming board-certified was personal accomplishment (83%).

CONCLUSIONS

Trends were observed regarding prosthodontists who succeeded with their efforts to challenge the board examination. The majority of the diplomates were employed by the military. Most of the respondents indicated that they took the ACP Board Preparation course and found it helpful. The largest percentage of respondents reported that Part 2 was both the most difficult part to prepare for, as well as the most difficult to complete. The most gratifying aspect of becoming board-certified was personal accomplishment.

Introducing dental students to clinical patient care: The complete denture prosthodontics transition clinic

Using complete denture treatment as an introduction to clinical patient care for dental students, the purposes of the Complete Denture Prosthodontics Transition Clinic at the University of Colorado School of Dentistry are to reduce the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience, and to encourage development of student self-confidence and skills. In the 2002 spring semester, faculty at the University of Colorado School of Dentistry initiated the Complete Denture Prosthodontics Transition Clinic for DS-II (second-year) dental students, as an introduction to clinical patient care. Each patient was assigned to a team of two dental students. Three Division of Prosthodontics faculty members staffed each clinic session, providing a student-to-faculty ratio of approximately 6.6:1 and a patient-to-faculty ratio of approximately 3.3:1. All DS-II students in the Class of 2004 delivered their first complete dentures no later than 8 months (average, 184 days) after the last day of the preclinical complete denture prosthodontics course. The time from the diagnostic appointment through the denture placement appointment averaged 39 days for patients treated in this program, compared with an average of 98 days or more for previous classes. The program was successful in achieving the goal of reducing the time lapse between the preclinical complete denture prosthodontics course and the first denture patient experience.

The future of teaching of complete denture construction to undergraduates in the UK: is a replacement denture technique the answer?

Due to changes in the amount of curriculum time available for teaching complete denture construction to undergraduate students, course content requires reconsideration and possible modification. The idea that a replica complete denture technique may offer some advantages is explored. A review of the relevant literature fails to support many of the claimed benefits of this technique such as relative ease of adaptation by the elderly to new dentures. This article suggests that the replica denture technique should be considered as no more than an alternative method of making dentures. The relative demerits of the technique are discussed. A modification of the replica block technique to include important aspects of conventional complete denture courses is described. It is suggested that, because less clinical time is required, it may be a suitable way of introducing students to complete denture construction and educating them to a level which would encourage some to take further postgraduate study and would allow all graduates to treat routine cases or diagnose, treatment plan and refer to clinical dental technicians.

Current concepts and techniques in complete denture final impression procedures

PURPOSE

In 2001, a survey of U.S. dental schools was conducted to determine which concepts, techniques and materials are currently prevalent in the teaching of final impression procedures for complete dentures in the predoctoral clinical curriculum.

MATERIALS AND METHODS

The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey resulting in a response rate of 82%.

RESULTS

Results from this survey show that the majority of schools (71%) teach the selective-pressure technique for final impression making; the majority of the schools (64%) use modeling plastic impression compound for border molding the final impression tray; 39% of the schools do not place vent holes in the final impression tray, 30% of schools place more than one hole and 27% place one hole only; the majority of the schools (98%) are using custom trays for final impressions. Ninety-eight percent of the schools are border molding the custom tray and 70% of schools are using a visible light-cured (VLC) composite resin material to make the trays. Thirty-six percent of the schools are teaching the Boucher impression technique and 34% are teaching the modified Boucher impression technique.

CONCLUSIONS

Predoctoral clinical complete denture educational programs agree on many aspects of final impression making, however, there is variability in their teachings regarding the impression philosophy and the materials used.

Convergence angle, occlusal reduction, and finish line depth of full-crown preparations made by dental students

OBJECTIVE

To measure the convergence angle, incisal/occlusal clearance, and finish line depth, which indicate the amount of axial reduction of full metal-ceramic crown preparations made by final-year dental students.

METHOD AND MATERIALS

A total of 157 preparations were assessed. Convergence angle and finish line depths were measured by Tool Maker Microscope, while crown height was measured using a digital caliber.

RESULTS

The mean convergence angle, faciolingually and mesiodistally, was 22.4 and 25.3 degrees, respectively. The mean for molars was statistically significantly greater than that for other teeth. The incisal/occlusal reduction ranged from 1.8 to 2.2 mm and averaged 2 mm. Buccal shoulder finish line depth averaged 0.86 mm, and mean chamfer finish line depth was 0.74 mm lingually, 0.7 mm mesially, and 0.66 mm distally. The buccal shoulder for mandibular anterior teeth was significantly smaller than for other teeth and averaged only 0.45 mm.

CONCLUSION

The mean convergence angle was clinically acceptable. However, shoulder depth was less than the recommended depth of 1.0 to 1.5 mm for metal ceramic crowns. Incisal/occlusal reduction was clinically adequate to provide enough structural durability and color matching.

One year's experience with virtual reality preclinical laboratory simulation at the University of Tennessee

Virtual reality-based preclinical simulation learning is a new teaching modality with significant potential. The University of Tennessee Health Science Center, College of Dentistry has completed its first year of student experience using 40 DentSim simulators, in conjunction with an 80-unit traditional simulation laboratory. This article describes this experience and relates both the positive and negative aspects as they impacted on the students, staff and school. The purpose of the article is to relay information pertinent to this new educational modality to other educational institutes interested in pursuing virtual reality dental simulation. The results of the first-year experience were encouraging, although certain areas proved problematic and frustrating for both students and staff.

A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension

STATEMENT OF PROBLEM

Measuring vertical dimension is a soft-tissue measurement. Therefore, inaccuracy may occur.

PURPOSE

The purpose of this study is to compare the accuracy of the Willis gauge method with the caliper method.

MATERIALS AND METHODS

The Willis gauge measures the distance between the septum of the nose and the chin. The caliper method measures the distance between reference points on the tip of the nose and the chin. Twenty predoctoral students applied both methods 10 times in measuring the rest vertical dimension (RVD) and the occlusal vertical dimension (OVD) of a single edentulous patient. The measurements obtained from one experienced clinician were selected as controls for the interocclusal distances (IOD) for the Willis and the caliper methods, respectively. One-sided t tests and a 1-sided nonparametric test were used to determine significant differences between the 2 methods (alpha=.05).

RESULTS

The variances in the RVD values for the Willis gauge method were higher than for the caliper method for most students. A Wilcoxon signed rank test showed that the accuracy of the OVD measurements for the caliper method was significantly better than for the Willis gauge method (P=.001). This was not the case for the RVD measurements (P=.073). The average IOD for the Willis method was significantly higher than the control IOD (P=.026). The average IOD for the caliper method was not significantly larger than the control (P=.1303).

CONCLUSION

This study showed that the use of the caliper method by predoctoral students was a significantly more reliable method of measuring the OVD for the patient evaluated.