Rubric system for evaluation of crown preparation performed by dental students

OBJECTIVE

This study aimed to investigate the use of an analytic rubric system for the evaluation of all-ceramic crown preparation on the right maxillary central incisor performed by the dental students.

MATERIALS AND METHODS

Seventy-two-third-year students and 8 faculty members from prosthodontics participated in this double-blind study. The students prepared an ivorine tooth # 11 for all-ceramic crown. The students were given clear instructions regarding the all-ceramic crown preparation and informed about the criteria for the assessment of the preparation. An analytic rubric based on 10-point scale for assessment of various preparation parameters was used by the 8 examiners. Descriptive statistics, ANOVA and post hoc Tukey tests were used for statistical analysis.

RESULTS

One-way analysis of variance indicated significance amongst the examiners for all the parameters except for time management. The overall mean scoring by examiners was 7.60 ± 1.18, with highest and lowest mean scores for Examiner 1 (8.02 ± 1.06) and Examiner 4 (6.82 ± 1.50), respectively. The highest number of interexaminer variation (difference) in scoring was found for two plane reduction, and the least difference amongst the examiners was observed for finishing of margins and walls of the preparation. Examiner 4 had the highest number of significant difference with the rest of the examiners. The students scored least marks in axial reduction (56.33%) and preservation of adjacent teeth (66.9%).

CONCLUSIONS

Criteria-based assessment using analytic rubric for crown preparations in pre-clinical fixed prosthodontics is an effective tool for finding the errors/weak areas of dental students.

Effect of individual structured and qualified feedback on improving clinical performance of dental students in clinical courses-randomised controlled study

AIM

Analysis of the effect of individual structured and qualified feedback (FB) on practical skills development of dental students during clinical courses.

METHODS

Fifty-three final-year dental students at Jena University Hospital participated in this prospective randomised controlled interventional study. Two calibrated assessors evaluated 128 pre- and post-assessments of 4 different dental treatment steps performed by dental students during the integrated clinical course in restorative dentistry and prosthodontics and the clinical course paediatric dentistry. The assessment included direct observation, graded and non-grading evaluation and was documented with a specific FB assessment tool. Dental students in the intervention group (IG) received an elaborated, structured and qualified FB after the pre-assessment that focussed on individual strengths and weaknesses, providing specific suggestions for improvement and establishing a personal learning goal. Participants were randomly allocated to the IG and the control group (CG).

RESULTS

In both groups, dental students significantly enhanced their performance, but the difference was higher in the IG than in the CG. Large effect sizes (ES) were observed in all observed items, but FB had largest effect size in improving technical skills (ES = 1.6), followed by management (ES = 1.3) and communication skills (ES = 0.8). Factors with the highest influence on FB in enhancing dental students' clinical performance were their insight into their own mistakes or omissions, the observed dental treatment step and the duration of FB.

CONCLUSION

Individual structured and qualified FB is an effective method to enhance dental students' professional performances and to individually guide the learning process.

The Effect of Too Much Caring: A Preliminary Study

PURPOSE

To determine the presence of burnout and psychiatric morbidity among prosthodontic residents and prosthodontists working in a maxillofacial prosthetic clinic and to compare these outcomes between those treating cancer patients and those not treating cancer patients.

MATERIALS AND METHODS

Two questionnaires were used: the Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12). MBI assesses the three components of burnout (emotional exhaustion, depersonalization, and personal accomplishment), and the GHQ-12 screens for nonpsychotic psychiatric morbidity. Six residents and four specialists involved in managing head and neck cancer patients were referred to as cancer clinicians to distinguish them from the specialists not involved in managing cancer patients (noncancer clinicians), who served as controls for other stressors within this work environment.

RESULTS

Twelve (86%) questionnaires were returned. There were no statistically significant (P = .89) differences between the cancer and noncancer clinicians from the GHQ-12 results; however, the cancer clinicians showed increased levels of exhaustion and depersonalization. These differences were not statistically significant (P = .36 and P = .41, respectively), but the effect sizes (Cohen's d) were moderate. For personal accomplishment both groups scored in the moderate burnout range, with the noncancer clinicians scoring higher.

CONCLUSION

There is no doubt that the clinicians participating in this preliminary study were under some stress, and a moderate effect size indicated that cancer clinicians experience this to a greater extent.

Implementing a new curriculum for computer-assisted restorations in prosthetic dentistry

INTRODUCTION

Computer-aided design/computer-aided manufacturing (CAD/CAM) of fixed prosthetic restorations has gained popularity in the last decade. However, this field of dentistry has not been integrated in the dental curriculum at most universities.

MATERIAL AND METHODS

According to the method of Kern, a curriculum was designed and established on a voluntary basis in the prosthetic education of a German dental school. The success of the implementation was measured by evaluation carried out by the participants on a visual analogue scale. Furthermore, the clinical performance of the fabricated restorations was evaluated.

RESULTS

Ninety-four percent of all students participated in the CAD/CAM curriculum indicating considerable interest. Nearly half of all students used the acquired knowledge to design crowns for their patients. All restorations fabricated by participants of the new CAD/CAM programme showed good clinical performance.

DISCUSSION

By phasing-in the CAD/CAM training programme, independent CAD/CAM-based fabrication of all-ceramic crowns increased student's self-confidence in tooth preparation. A tendency was found that students using CAD/CAM technology prepared more teeth than their fellow students who did not use CAD/CAM technology. Further studies are required to investigate the influence of independent CAD/CAM-based single-crown fabrication on the quality of the preparation.

MasterOnline Periodontology and Implant Therapy-revisited after seven years: A case study of the structures and outcomes in a blended learning CPD

INTRODUCTION

There is a great need for postgraduate training and continuing professional development (CPD), specifically in the field of periodontology. Despite the plenty of periodontal CPDs, there is a lack of information about the performance of CPDs in a blended learning setting. This study is a case study of the structures and outcomes in a blended learning CPD programme in periodontology, the MasterOnline Periodontology and Implant Therapy hosted by the University of Freiburg's Dental School.

MATERIAL AND METHODS

The structures of the blended learning CPD were analysed with the aims to (i) make explicit how various innovative educational methods and ICT tools can be successfully applied to a Web-supported postgraduate periodontology training programme, (ii) identify the programme's impact on learning transfer in students' dental practices and (iii) identify other outcomes, synergies and any changes required during the existence. Using qualitative interviewing, the various types of learning transfer and elements of the study programme that foster transfer could be exemplified.

RESULTS

A period of 7 years was analysed. In this duration, 50 students successfully graduated to a master of science. Qualitative interviews were performed with six students and four teachers affirming the learning transfer in a blended learning setting.

CONCLUSIONS

This case study shows that blended learning can be a successful approach for CPD in dentistry.

The confidence of undergraduate dental students when carrying out prosthodontic treatment and their perception of the quality of prosthodontic education

INTRODUCTION

Despite the falling number of edentulous patients within the UK, there is still a large demand for the provision of removable prostheses. On qualification, dentists should have the knowledge and skills to provide these prostheses, but previous studies have shown that final-year dental undergraduate confidence in treating denture patients is lacking.

AIM

To explore undergraduate dental student confidence whilst carrying out prosthodontic treatment, and to explore their perceptions of the quality of their prosthodontic education.

METHOD

An anonymous questionnaire was distributed to all (n=203) dental undergraduates in Years 3 to 5 at the University of Bristol. The questionnaire utilised a range of data collection methods including confidence interval ranked responses and qualitative measures. The data were analysed using SPSS.

RESULTS

The response rate was 51%. Undergraduate perception of confidence increased throughout the years of study (P<.001). There was also an increase in the number of partial and complete denture cases treated as students progressed through the course (P<.001). Overall, students were satisfied with their prosthodontic teaching, although students thought that too much time was allocated to laboratory teaching, and that increasing their clinical experience would be most beneficial in increasing their confidence levels.

CONCLUSION

Student confidence in carrying out prosthetic treatment increased as students progressed through the course, and confidence levels would be increased further with increased clinical experience.

Development of an analytical prepCheck-supported approach to evaluate tutor-based assessments of dental students' practical skills

The aim of the present study was to develop an analytical computer-supported assessment concept for the objective evaluation of students' practical skills, and to investigate the assessor-dependent differences by setting tolerance limits applied during the 'glance and grade' evaluation. A sample of 54 conventionally supervised dental undergraduates were given training in the preparation of a macroretentive Class II cavity. The course participants then took a mandatory practical examination. Three (plus one) course instructors performed the visual evaluations of the examination tasks according to predefined assessment criteria, followed by optical impressions (quadrant scan using Omnicam; Cerec; Dentsply Sirona, Wals, Austria) and subsequent assessment of the prepared cavities (tooth 46) using the prepCheck application (Dentsply Sirona). In this course, the maximum permissible deviation was set at ± 10% from the predefined assessment criteria. If no tolerance was applied, the statistical analysis revealed a significant difference between the actually achieved cavity dimensions and the predefined values of a master preparation (P = 0.0001; Student's t-test), thus leading to an overall failure rate of 100%. The application of the initially targeted 10% tolerance led to an insignificant reduction (96.3%), while the stepwise elevation of the permissible deviation up to 35% finally matched with the result of the visual assessment (total failure rate of approximately 20%). Unlike the pronounced subjectivity of the tutors during the assessment of students' practical skills, the utilization of the prepCheck application enables precise evaluations. Further studies are clearly warranted to investigate the possible educational outcome of an advanced interactive computer-supported training with implemented tolerance corridors.

Performance of two different digital evaluation systems used for assessing pre-clinical dental students' prosthodontic technical skills

INTRODUCTION

Proper integration of newly emerging digital assessment tools is a central issue in dental education in an effort to provide more accurate and objective feedback to students. The study examined how the outcomes of students' tooth preparation were correlated when evaluated using traditional faculty assessment and two types of digital assessment approaches. Specifically, incorporation of the Romexis Compare 2.0 (Compare) and Sirona prepCheck 1.1 (prepCheck) systems was evaluated. Additionally, satisfaction of students based on the type of software was evaluated through a survey.

MATERIAL AND METHODS

Students in a second-year pre-clinical prosthodontics course were allocated to either Compare (n = 42) or prepCheck (n = 37) systems. All students received conventional instruction and used their assigned digital system as an additional evaluation tool to aid in assessing their work. Examinations assessed crown preparations of the maxillary right central incisor (#8) and the mandibular left first molar (#19). All submissions were graded by faculty, Compare and prepCheck.

RESULTS

Technical scores did not differ between student groups for any of the assessment approaches. Compare and prepCheck had modest, statistically significant correlations with faculty scores with a minimum correlation of 0.3944 (P = 0.0011) and strong, statistically significant correlations with each other with a minimum correlation of 0.8203 (P < 0.0001). A post-course student survey found that 55.26% of the students felt unfavourably about learning the digital evaluation protocols. A total of 62.31% felt favourably about the integration of these digital tools into the curriculum.

CONCLUSIONS

Comparison of Compare and prepCheck showed no evidence of significant difference in students' prosthodontics technical performance and perception.

Using Standardized Patients to Teach Complete Denture Procedures in Second Year of Dental School

Second-year dental students are commonly instructed on the process of complete denture fabrication with a traditional didactic lecture and preclinical dental laboratory education model. The problem with this limited mode of instruction is that dental students often fail to understand the various chairside procedures required to fabricate a complete denture. The aim of this study was to investigate the use of standardized dental patients to enhance students' understanding of the procedures involved with each appointment in the complete denture process. The Midwestern University College of Dental Medicine-Arizona created an event using standardized patients in four simulated chairside dental appointments for complete denture instruction of second-year dental students. Each appointment simulated the various sequential chairside procedures required to fabricate complete dentures. Following the didactic and dental laboratory instruction and the standardized patient event, a survey was conducted requesting the students' response to six statements regarding their understanding of the denture fabrication process. Of the 110 students who participated in the instructional events, 107 responded to the survey (97% response rate). These students responded very favorably to the simulated appointments, with the majority agreeing or strongly agreeing that their best understanding of the complete denture process was obtained through the standardized patient experiences. The use of standardized patients in simulated denture fabrication appointments enhanced the educational experience of these students when added to the traditional didactic lecture and preclinical laboratory education format. The experience has since been incorporated into the school's second-year oral health science laboratory curriculum.

Mobile learning app: A novel method to teach clinical decision making in prosthodontics

BACKGROUND

Prosthodontics involves replacing lost dentofacial structures using artificial substitutes. Due to availability of many materials and techniques, clinician's clinical decision-making regarding appropriate selection of prosthesis requires critical thinking abilities and is demanding. Especially during graduate training years, learners do not receive the exposure to a variety of cases, thus their clinical reasoning skills are not developed optimally. Therefore, using the trend of incorporating technology in education, we developed a mobile learning app for this purpose. The aim of this study was to evaluate learners' perceptions of this app's utility and impact on their clinical decision-making skills.

METHODS

After taking informed consent, interns of the Department of Prosthodontics of VSPM Dental College, Nagpur, India, during the academic year May 2015-May 2016 were sent the link for the app to be installed in their Android smartphones. Their perceptions were recorded on a feedback questionnaire using 5-point Likert scale. The script concordance test (SCT) was used to check for changes in clinical reasoning abilities.

RESULTS

Out of 120 students who were sent the link, 102 downloaded the link and 92 completed the feedback questionnaire and appeared for the SCT (response rate: 76%). The overall response to the app was positive for more than two-thirds of interns, who reported a greater confidence in their clinical decision-making around prostheses through this app and 94% of the students felt that this app should be regularly used along with conventional teaching techniques. Mean SCT scores were pretest 41.5 (±1.7) and posttest 63 (±2.4) (P < 0.005).

DISCUSSION

Clinical decision-making in prosthodontics, a mobile learning app, is an effective way to improve clinical reasoning skills for planning prosthodontic rehabilitation. It is well received by students.

Does the Sequence of Preclinical Dental Crown Type Preparations Affect Evaluation Scores?

Preclinical dental students must demonstrate aptitude in the preparation of teeth for treatment with several types of fixed dental prostheses. The optimal sequence of instruction and examination of these crown preparations in preclinical fixed prosthodontics is unknown. The aim of this study was to determine if grading scores by faculty and students were affected by changing the sequence of crown type preparations. Practical exams of two successive student cohorts (n=89 in 2014; n=92 in 2015) at one U.S. dental school using three crown preparations (full cast, porcelain fused to metal, and all-ceramic) in different order were analyzed by faculty grades and student self-assessment. All of the models indicated that the sequence in which the crown type preparations were taught did have an effect on the grades. The 2014 cohort had overall higher grades and particularly higher grades for the all-ceramic crown preparations. Evaluation scores were affected by the sequence in which the different crown type preparations were taught and tested. Although the overall results suggested that students may perform better if the all-ceramic crown preparation is taught last, this tendency may differ between years.

Survey of Advanced Education in Prosthodontics Directors and Residents on Practices in Esthetic Dentistry

The aim of this study was to determine the difference between the intended education by advanced education in prosthodontics (AEP) program directors and the perceived education received by AEP residents with respect to concepts of esthetic dentistry. Residents' confidence levels and current practices were also determined based on program level, with first- and second-year residents combined into "junior residents" and third- and fourth-year residents combined into "senior residents." Surveys were distributed to all U.S. and Canadian AEP program directors (N=52) in 2014 and residents (N=393) in 2015. The seven questions asked of directors and 20 asked of residents assessed resident training. The response rate for directors was 59.6% and for residents was 27.3%. Statistically significant results were found between the responding program directors' perceived education on esthetic principles and the responding residents' perceived education. The senior-level residents were more confident in each of the categories than residents at the junior level, although the difference was only significant for selecting porcelain systems to match inherent translucency, transfer of information to the laboratory, and surface staining or characterization. There was a difference between the program directors' intended teaching and the residents' perceptions with regards to bleaching, shade matching, selection of porcelain systems, transfer of information to the laboratory, and surface staining or characterization. The residents' confidence levels were higher at the senior level than those at the junior level in selecting porcelain systems, transfer of information to the laboratory, and staining/characterization. Faculty members in advanced prosthodontics programs may be able to use these findings to improve their residents' education in these areas.

Quality of Impressions and Work Authorizations Submitted by Dental Students Supervised by Prosthodontists and General Dentists

Preclinical fixed prosthodontics is taught by Department of Prosthodontics faculty members at Virginia Commonwealth University School of Dentistry; however, 86% of all clinical cases in academic year 2012 were staffed by faculty members from the Department of General Practice. The aims of this retrospective study were to quantify the quality of impressions, accuracy of laboratory work authorizations, and most common errors and to determine if there were differences between the rate of errors in cases supervised by the prosthodontists and the general dentists. A total of 346 Fixed Prosthodontic Laboratory Tracking Sheets for the 2012 academic year were reviewed. The results showed that, overall, 73% of submitted impressions were acceptable at initial evaluation, 16% had to be poured first and re-evaluated for quality prior to pindexing, 7% had multiple impressions submitted for transfer dies, and 4% were rejected for poor quality. There were higher acceptance rates for impressions and work authorizations for cases staffed by prosthodontists than by general dentists, but the differences were not statistically significant (p=0.0584 and p=0.0666, respectively). Regarding the work authorizations, 43% overall did not provide sufficient information or had technical errors that delayed prosthesis fabrication. The most common errors were incorrect mountings, absence of solid casts, inadequate description of margins for porcelain fused to metal crowns, inaccurate die trimming, and margin marking. The percentages of errors in cases supervised by general dentists and prosthodontists were similar for 17 of the 18 types of errors identified; only for margin description was the percentage of errors statistically significantly higher for general dentist-supervised than prosthodontist-supervised cases. These results highlighted the ongoing need for faculty development and calibration to ensure students receive the highest quality education from all faculty members teaching fixed prosthodontics.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

Tooth Shade-Matching Ability Between Groups of Students with Different Color Knowledge

PURPOSE

The aim of this study was to evaluate the effect of gender and knowledge of color in dentistry on the visual shade-matching ability of dental students with no experience in shade matching and without identification skills.

MATERIALS AND METHODS

A total of 32 color-normal participants, 16 female (F) and 16 male (M), completed all phases of the experiment. The control group did not listen to a 60-minute lecture (FNL = females that did not listen; MNL = males that did not listen); the other group listened to a lecture about color in dentistry (FL = females that listened; ML= males that listened). The Toothguide Training Box (TTB) (VITA Zahnfabrik) was used. The final exam consisted of a total of 15 lightness-chroma-hue tasks. The correct selection of lightness (L*), chroma (C*), and hue (h*) was observed, as was the computed shade-matching score, ΣΔE*ab, for each participant. Mann-Whitney U test was used for statistical analysis of the data (α = .05) (SPSS 22.0 for Windows [IBM]).

RESULTS

Gender was found to play an important role in shade matching. The FL group selected L* better (L* = 12.11) in comparison with the MNL group (L* = 11.00), which is not significantly different (P = .19). The FL group selected L* better in comparison with the ML group (L* = 10.57), which is not significantly different (P = .10). The FNL group selected C* statistically significantly better (C* = 9.86) than did the ML group (C* = 8.57) (P = .016). The shade-matching score, ΣΔE*ab, for group FL (ΣΔE*ab = 22.50) and group ML (ΣΔE*ab = 31.79) was marginally statistically significant (P = .06).

CONCLUSION

A 60-minute lecture from the field of color in dentistry has a minimal impact on tooth-shade matching, whereas gender plays an important role.

Comparison between flipped classroom and team-based learning in fixed prosthodontic education

PURPOSE

We previously investigated the effects of team-based learning (TBL) on fixed prosthodontic education and reported that TBL could have higher efficiency with high student satisfaction than traditional lecture. In the current report, we introduced flipped classroom to the fixed prosthodontic education and compared their effectiveness based on the final examination score in addition to TBL.

METHODS

Participants were 41 students from Tokushima University School of Dentistry who attended a fixed prosthodontics course. The first six classes adopted the flipped classroom style while the latter eight classes adopted TBL. To evaluate the relationship between learning styles and their effectiveness, we compared results from the term-end examination between the curriculum covered by flipped classroom and TBL-style classes. To draw comparisons, a referential examination with the same questions was conducted to eight faculty members who had not attended any of these classes.

RESULTS

Term-end examination results showed that TBL classes had slightly higher scores than flipped classroom classes. Referential examination results also showed higher scores for the same curriculum and no significant interaction was found between class formats and the term-end and referential examination scores. Analysis revealed no noticeable difference in the effectiveness of the class formats.

CONCLUSION

Our previous study reported that TBL had higher efficiency than traditional style lecture. In the current study, there was no statistical difference in the examination score between flipped classroom and TBL. Therefore, we conclude that both styles are highly effective than traditional style lecture and constitute valid formats for clinical dental education.

Teaching of Fixed Prosthodontics: A Paradigm Shift

Restorative dentistry is experiencing a significant shift towards a rising usage of tougher all-ceramic materials. This trend must be incorporated into existing fixed prosthodontics academic curricula through the integration of lithium disilicate and zirconium oxide crown preparation guidelines. In addition, crown fabrication techniques have also evolved for these newer materials through digitization of preparations and impressions and their computer-assisted manufacturing. This article reviews current crown preparation and cementation guidelines while describing the teaching program in fixed prosthodontics at the University of Tennessee Health Sciences College of Dentistry.

Relationship Among Dental Students' Class Lecture Attendance, Use of Online Resources, and Performance

This study aimed to evaluate the relationship among dental students' attendance at class lectures, use of online lecture materials, and performance in didactic courses. The study was conducted with second-year predoctoral students at Tufts University School of Dental Medicine during the fall semester of 2014. Three basic science and three preclinical dental courses were selected for evaluation. Online usage for each participant was collected, and a survey with questions about attendance and online behavior was conducted. The final grade for each participant in each selected course was obtained and matched with his or her online usage and attendance. Out of a total 190 students, 146 (77%) participated. The results showed no significant relationship between students' grades and their class attendance or online usage except for a weak negative relationship between class attendance and online usage for the Epidemiology course (p<0.001) and the overall preclinical dental courses (p=0.03). Although the results did not show strong relationships among class attendance, online usage, and course grades, most of the students reported that having the online resources in addition to the lectures was helpful.

Characteristics Identified for Success by Restorative Dental Science Department Chairpersons

The primary aim of this study was to determine the characteristics that current chairpersons in restorative dentistry, general dentistry, prosthodontics, and operative dentistry departments in U.S. dental schools feel are most relevant in contributing to their success. The secondary aim was to determine these individuals' rankings of the importance of a listed set of characteristics for them to be successful in their position. All 82 current chairs of the specified departments were invited to respond to an electronic survey. The survey first asked respondents to list the five most essential characteristics to serve as chair of a department and to rank those characteristics based on importance. Participants were next given a list of ten characteristics in the categories of management and leadership and, without being aware of the category of each individual item, asked to rank them in terms of importance for their success. A total of 39 chairpersons completed the survey (47.6% response rate; 83.3% male and 16.2% female). In section one, the respondents reported that leadership, vision, work ethic, integrity, communication, and organization were the most essential characteristics for their success. In section two, the respondents ranked the leadership characteristics as statistically more important than the management characteristics (p<0.0001) for being successful in their positions.

Comparing Integrated and Disciplinary Clinical Training Patterns for Dental Interns: Advantages, Disadvantages, and Effect on Students' Self-Confidence

In China, the five-year program of undergraduate education for stomatology consists of four years of lecture courses and one year of internship focused on clinical training. Dental schools provide this clinical training either in their own clinics (referred to as the one-stage pattern because all forms of practice are completed together) or by placing students in external clinics usually at non-affiliated hospitals (referred to as the three-stage program because the three primary areas are taught separately). The aims of this study were to investigate differences in teaching effect between the one-stage and the three-stage patterns and to evaluate advantages and disadvantages of the two patterns. A three-section, 31-item questionnaire was designed to assess basic and clinic information about the interns' training and their self-confidence in performing clinical procedures. The survey was administered to graduates who finished the fifth-year internship in 2012-14. Of the 356 individuals invited to participate, 303 graduates who spent their intern years in 43 academic dental institutions returned completed surveys (response rate of 85%). The one-stage group (n=121) reported longer independent operation time than the three-stage group (n=182) (p<0.01). No significant difference was found between the groups for assessment of clinic infrastructure (p=0.121). The interns were most confident in oral hygiene instruction and scale and polish (overall median=5), but showed low confidence in rubber dam placement and four other procedures (overall median=2). The one-stage group rated their confidence level higher than the three-stage group on comprehensive skills such as arranging appointments and managing patients and procedures needing long treatment periods such as molar endodontics. The three-stage group showed higher confidence on more specialized procedures such as surgical extractions and suturing. This study found that both of the two intern patterns had advantages and shortcomings in clinical training in various procedures. Combining the two could be a way to improve clinical education in China.

Learning Shade Differentiation Using Toothguide Trainer and Toothguide Training Box: A Longitudinal Study with Dental Students

The positive training effect achieved with the Toothguide Training Box (TTB) has been demonstrated in previous studies. The aim of this study was to investigate the training effect with the TTB at six and 12 months using standardized color tests. The study involved 101 dental students. The participants were divided into two study groups and one control group. Ten standard color samples were determined under uniform environmental conditions with VITA 3D-Master. The control group (N=30) took the color test after one week. Study group 1 (N=49) took the color test after six months and study group 2 (N=22) at 12 months for the first time by following the TTB curriculum. The control group achieved an average ΔEt1=0.85. In study group 1, the ΔEt2 was 2.29, and in study group 2, ΔEt3=2.25. The results after six and 12 months were highly significant compared to the control group (α=0.001). Dependence was determined only with regard to gender. In this study, the TTB quickly led to an improvement in tooth color differentiation among students. After six months, there was a decrease in the training effect. These results suggest that the TTB curriculum should be provided at the end of preclinical training.

Impact of Digital Tooth Preparation Evaluation Technology on Preclinical Dental Students' Technical and Self-Evaluation Skills

The aim of this study was to evaluate the effect of digital tooth preparation imaging and evaluation technology on dental students' technical abilities, self-evaluation skills, and the assessment of their simulated clinical work. A total of 80 second-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=20). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Three outcomes were measured: faculty technical score, self-evaluation score, and E4D Compare scores at 0.30 mm tolerance. Correlations were determined between the groups' scores from visual assessment and self-evaluation and between the visual assessment and digital scores. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p>0.05). Overall, correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). These results suggest that the use of digital tooth preparation evaluation technology did not impact the students' prosthodontic technical and self-evaluation skills. Visual scores given by faculty and digital assessment scores correlated moderately in only two instances.

Clinical Teaching of Prosthodontics in Undergraduate Courses in a German Dental School: Patients, Visits, Efforts, and Incentives

It is unknown what disadvantages are faced by patients deciding for a prosthodontic treatment by inexperienced students. Commonly, the related extra effort and time are compensated by cost reduction of treatment fees. Thereby, the dental schools subsidize treatments to teach clinical prosthodontics. The aim of this study was to clarify the benefits to patients as well as the efforts of the dental school. Data collected from three courses in a dental school in Germany were patient gender, age, occupation, zip code, number of visits, scope of treatment including costs, financial discount, and remaining copayment. Travel costs were calculated based on zip code. Balance of travel costs and treatment discount was defined as financial benefit. The results showed that 185 patients (95 male) aged 32 to 82 years (median=58) were treated with fixed restorations (FR, n=110), telescopic dentures (TD, n=87), complete dentures (CD, n=17), or other (RD, n=3). The mean number of visits was 11 for FR, 12 for TD, and 9 for CD. Single distance to the clinic ranged from 0.6 to 65 miles (median=12). Total costs of prosthodontics were reduced by 19% on average. The mean financial benefit was 429 USD (median=298, min=-482, max=4025). The financial benefits were found to differ widely, including additional expenditures of patients. Participation, travel burden, and copayment did not depend on age, gender, or occupation. The financial benefit was relativized because students needed at least twice the sessions of a dentist. As a result, the financial efforts of dental schools are significant and compromise a cost-covering education.

Development of a Drilling Simulator for Dental Implant Surgery

The aim of this study was to develop and evaluate a dental implant surgery simulator that allows learners to experience the drilling forces necessary to perform an osteotomy in the posterior mandibular bone. The simulator contains a force-sensing device that receives input and counteracts this force, which is felt as resistance by the user. The device consists of an actuator, a load cell, and a control unit. A mandibular bone model was fabricated in which the predicted forces necessary to drill the cortical and trabecular bone were determined via micro CT image-based 3D finite element analysis. The simulator was evaluated by five dentists from the Department of Implantology at Tokyo Dental College. The ability of the evaluators to distinguish the drilling resistance through different regions of the mandibular bone was investigated. Of the five dentists, four sensed the change in resistance when the drill perforated the upper cortical bone. All five dentists were able to detect when the drill made contact with lingual cortical bone and when the lingual bone was perforated. This project successfully developed a dental implant surgery simulator that allows users to experience the forces necessary to drill through types of bone encountered during osteotomy. Furthermore, the researchers were able to build a device by which excessive drilling simulates a situation in which the lingual cortical bone is perforated--a situation that could lead to negative repercussions in a clinical setting. The simulator was found to be useful to train users to recognize the differences in resistance when drilling through the mandibular bone.