Rapid prototyping and 3D-virtual models for operative dentistry education in Brazil

Many dental students struggle for visual recognition when first exposed to the study of tooth cavity preparation in the operative dentistry laboratory. Rapid prototypes and virtual models of different cavity preparations were developed for the incoming first-year class of 2010 at the Dental School of Federal University of Uberlândia, Brazil, to help them to visualize the subtle differences in cavity preparations and are described in this article. Rapid prototyping techniques have been used in dental therapy, mainly for the fabrication of models to ease surgical planning in implantology, orthodontics, and maxillofacial prostheses. On the other hand, the application of these technologies associated with 3D-virtual models in dental education is waiting to be exploited, once they have significant potential to complement conventional training methods in dentistry.

Evaluation of new injection and cavity preparation model in local anesthesia teaching

The aim of this study was to evaluate a recently developed preclinical injection and cavity preparation model in local anesthesia. Thirty-three dental students administered an inferior alveolar nerve block injection in the model, followed by preparation on a tooth. The injection was evaluated by three observers, and the feedback from the model was registered. After completion of the practical session, the opinion of the dental students was explored with a ten-item questionnaire. Thirty dental students (91 percent) performed the injection correctly according to the feedback of the model, and twenty-eight students (85 percent) did so according to the expert opinion. The agreement between feedback from the training model and the expert opinion was high. The students were very satisfied with the opportunity to practice with the training model, as indicated by the high scores on each item of the questionnaire. These results suggest that use of this preclinical training model in anesthesia teaching may have beneficial effects on the administration of local anesthetics by dental students.

Atraumatic Restorative Treatment (ART) in pediatric dentistry residency programs: a survey of program directors

PURPOSE

The purpose of this study was to investigate the extent of clinical training on atraumatic restorative treatment (ART) among pediatric dentistry residency programs and assess program directors' attitudes toward ART.

METHODS

All U.S. Pediatric Dentistry residency programs' directors were asked to complete a web-based survey. Sixty-one of the 76 directors (80 percent) completed the survey, with no significant response bias.

RESULTS

Eighty-nine percent of the responding programs provided clinical instruction on ART. Of these, 30 percent provided ART training often/very often. ART was used mostly in single-surface cavities (43 percent) and as an interim treatment in primary teeth (57 percent). Factors associated with ART clinical training included not placing amalgams in primary teeth (P<.03) and having directors with positive attitudes toward ART (P<.001). Factors associated with directors' positive attitudes included believing that child's caries risk (P<.006), professional guidelines (P<.003), and patient insurance status (P<.04) were all important in selecting restorative treatment.

CONCLUSIONS

Atraumatic restorative therapy appears to be underused in pediatric dentistry residency programs in the United States. Residency directors' attitudes were highly predictive of the amount of clinical training provided, suggesting that directors need to be better informed about the use of ART.

Restorative dentistry productivity of senior students engaged in comprehensive care

In dental education, various clinical delivery models are used to educate dental students. The quantitative and qualitative measures used to assess the outcomes of these models are varied. Georgia Health Sciences University College of Dental Medicine has adopted a version of a general dentistry comprehensive care dental education hybrid model. Outcome assessments were developed to evaluate the effectiveness of this delivery model. The aim of this study was to compare the number of restorative procedures performed by senior dental students under a discipline-based model versus senior student productivity engaged in comprehensive care as part of a hybrid model. The rate of senior students' productivity in performing various restorative procedures was tracked over four years, and a comparison was made. In the first two years, the seniors operated in a discipline-based model, while in the last two years the seniors operated in a comprehensive care hybrid model. The results showed that there was a significant increase in productivity by the students in terms of direct and indirect restorations. This increase in productivity may indicate that the comprehensive care model may be a more productive model, thereby enhancing clinical experiences for the students, improving operating efficiency for the schools, and ultimately increasing clinical income.

Implementation of a new advanced graduate education program in oral implantology

The academic program for the Harvard School of Dental Medicine's Advanced Graduate Program in Oral Implantology is based on scientific evidence applied to educational quality, translational research, patient care, and service. The objective of the program is to enable highly motivated individuals with proven scholarship and excellence in patient care to achieve academic leadership in the clinical and scientific fields of implant dentistry and tissue regeneration. A detailed curriculum describing the academic program, as well as a business plan (which included a management plan describing the organizational structure, financial implications, and market forces) and implementation and communication plans, were developed before moving forward. With careful academic and business planning, the result was a vibrant implant program, in which all placements and restorations of implants are coordinated with regard to practice management. The program is integrated into the existing clinical care model and has been financially self-sustaining from its inception. Six students have participated in the last two years. On average, each student performed seventy-nine procedures on twenty-nine patients, generating over $46,000 in production. The curriculum includes didactics, hands-on clinical learning, and research activities. Research is a critical component as well. The results demonstrate that the time taken to develop a detailed curriculum and business plan for a new academic program, which anticipated and resolved potential barriers to success, was instrumental in the successful implementation of an oral implantology residency program.

Clinical pairing revisited: a study at the University of Malaya, Malaysia

This study is part of ongoing educational research conducted by the Department of Conservative Dentistry, University of Malaya, Malaysia, to evaluate the perception of clinical pairing. A thirteen-question survey was distributed to 148 dental students after they had experienced four-handed dentistry. The objectives were to identify the advantages, disadvantages, and the acceptance of the implementation of clinical pairing from the students' point of view. The responses from the open-ended questions were categorized into six main themes (areas of interest): quality-related (Q), patient-related (PT), partner-related (P), lecturer-related (T), infection control (IC), and learning environment (L). Data analysis was done using SPSS version 18. Results indicated that the students perceived they possessed enough knowledge regarding clinical pairing. However, it was found that they still preferred to work independently as compared to working in pairs. The benefits of clinical pairing may not be viewed in the same vein by both dental students and teachers. The quality-related theme was perceived by students as the main advantage of clinical pairing, whilst the partner-related theme was perceived otherwise. The study also revealed that students may have some preconceived notions about pairing that may have impaired their acceptance. As a consequence, some reluctance was seen in their responses.

Implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations in the private practice--a survey

OBJECTIVE

The purpose of the present survey was to evaluate the implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations by private practitioners who attended a hands-on continuing education course on this technique.

MATERIALS AND METHODS

In the years 2007 and 2008, 17 1-day continuing education courses on vertical bite reconstruction in the worn dentition by using direct resin composite restorations were attended by 310 participants. A 13-item questionnaire was posted to all course participants in April 2009 seeking information on the acceptance, implementation and experience of the presented technique in the private practice.

RESULTS

A total of 97 (31%) questionnaires were returned, whereas 67% of the respondents had used the presented technique. Analysis of the overall experience and satisfaction with the placed resin composite restorations using visual analog scale (VAS) revealed a mean VAS score of 7.2 ± 1.7 (0 = maximal unsatisfied, 10 = maximal satisfied). The direct resin composite restorations were predominantly rated 'good' within the assessed criteria surface texture, anatomical form, marginal integrity, marginal discoloration and color match. Ninety-eight percent of the private practitioners stated that they would continue to carry out vertical bite reconstructions according to this technique. The three most frequently observed clinical problems were related to marginal discolorations, bulk fractures and adhesive failures.

CONCLUSION

The presented restoration method was well accepted by private practitioners who used this treatment approach at least once after course participation, even though some clinical problems were observed.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.

An online community of inquiry for reflective practice in an operative dentistry course

Online learning communities are entering the realm of web-based learning as a means of reflective collaborative learning. The purpose of this article is to describe the formation of an online learning community using a community of inquiry (COI) conceptual framework. Operative clinical simulation dental students at the University of British Columbia in Canada have been involved in an online COI for the past five years. This descriptive article presents an overview of the experiences involved in developing this COI and provides a conceptual framework for an online COI.

Learning curves: what do dental students learn from repeated practice of clinical procedures?

It is generally accepted that repetition of procedures is necessary to develop clinical skill in dentistry. Although there is a rich empirical research tradition in medicine establishing competency levels for new procedures, investigations of the shape of learning curves for clinical techniques are rare in dental education. Data were reviewed from three classes (n=465) of students at the University of the Pacific Arthur A. Dugoni School of Dentistry in seventeen clinical skills in five departments for which test case (independent performance) data were available. It was hypothesized that a learning curve would be observed with gradually rising scores as a function of amount of repeated test case work and general practice experience. Other factors, such as faculty ratings and clinical GPA, could be expected to modify this curve. No evidence was found that test case performance was affected by number of previous test cases, number of practice (ungraded) procedures previously completed, faculty ratings of technical skill in the discipline by quarter, faculty ratings of patient management and of clinical judgment competencies, overall clinical GPA, and performance on initial licensure examinations. The absence of a pattern showing that amount of prior experience improves clinical performance raises questions about the practice of setting "requirements" for graduation and challenges dental educators to better explain the presumed relationship between practice and performance and the validity of clinical evaluation of performance based exclusively on the objective technical quality of work samples. The literature on learning curves and on competency-based education offer alternative insights into what students are actually learning but schools are failing to measure in the clinical experience.

Impact of a prior medical degree on students' dental school performance in Innsbruck, Austria

The purpose of this study was to identify the performance differences between two groups of Austrian dental students (one with a prior medical degree and one without a medical degree) during their dental school training and final dental licensure examination. A specific aim was to determine if having a medical degree is a predictive factor for dental students' scores on the Austrian Dental Admission Test (Austrian DAT), performance in the dental clinic, and scores on final exam. The study consisted of a retrospective analysis of 122 students (thirty-nine with a medical degree and eighty-three without a medical degree) who were enrolled in the Dental Clinic at Innsbruck Medical University, Innsbruck, Austria, between 2001 and 2006. Three performance categories were considered: Austrian DAT results, clinical performance after the first clinical year in dental school, and performance on the final dental licensure examination. Information on students' age, gender, and previous medical degree was collected from official records. Analyses with student's t-test and Pearson's chi-square test revealed that the students with a medical degree had significantly higher Austrian DAT total test scores, grade point averages after the first clinical year, and scores on the final exam. Additionally, those students had significantly better performance on the final exam in prosthodontics and oral and maxillofacial surgery. The linear regression analysis showed that a medical degree had an independent effect on average scores on the final exam, age, and Austrian DAT test scores, while gender showed no statistically significant effect. Overall, the study found that dental students with a prior medical degree had significantly higher Austrian DAT total test scores and performed significantly better in the first clinical year and on the final exam than those without a prior medical degree.

Teaching dental students how to deliver bad news: S-P-I-K-E-S model

Delivering bad news has traditionally been associated with life-threatening illness, the imminence of death, or communicating about the death of a loved one to a family member. The delivery of bad news in dentistry is rarely about life-threatening circumstances. However, the impact of the bad news such as the loss of an anterior tooth can be devastating for the patient. This article outlines the S-P-I-K-E-S protocol and discusses the teaching aims and methodology in applying the model in an undergraduate dental program in Ireland.

Acquiring psychomotor skills in operative dentistry: do innate ability and motivation matter?

OBJECTIVE

The acquisition of psychomotor skills is a key competence in the practice of dentistry, and innate abilities and motivation have been shown to influence motor performance. However, the explicit integration of these factors into the design of research projects about skill acquisition in dentistry has been limited. Therefore, the purpose of this study was to provide a comprehensive analysis of how dental students' abilities and motivation affected their performance in an operative task.

METHODS

A longitudinal study with two cohorts of dental students was conducted in laboratory classes forming part of an operative technique course. A range of standardised psychometric tests was used to assess different abilities before completing a cavity preparation on Frasaco teeth. This was followed immediately by completion of an Intrinsic Motivation Inventory.

RESULTS

Low but statistically significant correlations (P<0.05) were found between dental performance and psychomotor ability (r=0.22), and also dental performance and motivation (r=0.19). A significant difference (P<0.05) was found in the grades obtained for the cavity preparation exercise in one cohort between students with higher levels of psychomotor ability compared with those with lower levels (Tracing scores) (P<0.05). No significant differences in grades obtained for the cavity preparation exercise were found between students with higher and lower levels of motivation.

CONCLUSION

Both innate psychomotor ability and motivation showed only weak positive associations with dental performance on cavity preparation exercises. Our study suggests that student-related factors only provide limited information to explain differences in performance or to be useful as specific predictors of future performance by individuals.

Evaluation of two different approaches to learning shade matching in dentistry

STATEMENT OF THE PROBLEM

An important aspect of dental education is teaching and learning shade matching.

OBJECTIVE

To assess the success of two different strategies for learning shade matching.

MATERIALS AND METHODS

Seventy-one pre-clinical students (mean age 23; 33.3% men) were divided into two groups. One group (TTB) formed teams of two and they matched three pre-determined teeth on each other using the 3D-Master shade guide. After this exercise, they learned shade matching using a standardized device (Tooth Guide Training Box, TTB) by matching shade tabs in an artificial environment. The other group (GL) matched tooth color in a pre-defined clinical setting in groups of four students. After this, they matched the same teeth as before training, again in groups of two, similarly to group TTB. The reference tooth color was determined by two experienced prosthodontic clinicians. The L*a*b* values for the tabs were provided by the manufacturer and the color difference (ΔE(ab)) between the chosen tab and the reference was calculated. Linear general estimation equation models were used for statistical evaluation (p = 0.05).

RESULTS

In the TTB group, the difference between ΔE(ab) values before and after training was 0.03, which was not significant (p = 0.927; 95% CI: -0.70/0.77). In the GL group, ΔE(ab) was 0.98 smaller after training, which was significant (p < 0.001; 95% CI: 0.50/1.50).

CONCLUSION

The ability to match tooth color could be improved by using a group-learning approach in a clinical setting and implementation of such a training session should be considered in undergraduate and postgraduate dental education.

Effect of instruction on dental students&#8217; ability to light-cure a simulated restoration

OBJECTIVE

To measure the light energy that dental students delivered to a simulated Class I restoration before training, immediately after training and 4 months after training.

METHODS

Thirty-eight (38) dental students used a single light-emitting diode curing light (SmartLite iQ2, Dentsply) to cure, for 10 seconds, a simulated Class I restoration positioned in the Managing Accurate Resin Curing - Patient Simulator (BlueLight analytics inc.). The students then attended an instructional lecture and received individualized instruction on optimizing their light-curing technique. The students were retested immediately after instruction and again 4 months later (without further instruction). The irradiance and energy delivered during light-curing were calculated for each student at all 3 time points. Mean values were calculated and compared.

RESULTS

Before instruction, the students delivered between 0.1 and 7.2 J/cm2 of energy (mean ± standard deviation [SD] 4.1 ± 1.7 J/cm2). After instruction, the same students delivered between 5.8 and 7.5 J/cm2 of energy (mean ± SD 6.7 ± 0.4 J/cm2). Analysis of variance and Fisher's Protected Least Significant Difference tests showed that instruction with the patient simulator led to a significant improvement in the amount of energy delivered and that the students retained this information. When retested 4 months later, the students delivered between 4.2 and 7.9 J/cm2 of energy (mean ± SD 6.1 ±1.1 J/cm2). Although this was less energy than immediately after instruction, the decline was not significant (p = 0.44).

CONCLUSIONS

Provision of immediate feedback on light-curing technique and instruction on how to avoid mistakes led to a significant and lasting improvement in the amount of energy delivered by the students.

The use of haptics to predict preclinic operative dentistry performance and perceptual ability

The aim of this study was to test whether performance on a range of manual dexterity haptic simulator exercises was associated with preclinical operative dentistry examination and Perceptual Ability Test (PAT) scores. Thirty-nine first-year dental students were tested with three haptic exercises--straight line, circle, and mirror line--each performed twice. Haptic exercise outcomes for accuracy, time, and success rate were measured using commercially available computer software. Spearman correlation coefficients and Student's t-test were used to assess the results. PAT and exam scores were not significantly correlated. Significant correlations were observed between exam scores and both time and accuracy scores for the circle and mirror exams. These results suggest that haptic devices have a potential role in predicting performance in preclinical dental education. Further studies are warranted to develop and validate diagnostic testing strategies for dental students and to evaluate implementation of haptics in the dental teaching environment.

Predictors of academic performance for applicants to an international dental studies program in the United States

The number of U.S. and Canadian dental schools offering programs for dentists with degrees from other countries leading to the D.D.S. or D.M.D. degree has increased recently. This fact, along with the diversity of educational systems represented by candidates for these programs, increases the importance of identifying valid admissions predictors of success in international dental student programs. Data from 148 students accepted into the international dental studies program at the University of the Pacific from 1994 through 2004 were analyzed. Dependent variables were comprehensive cumulative GPA at the end of both the first and second years of the two-year program. The Test of English as a Foreign Language (TOEFL) and both Parts I and II of the National Board Dental Examination (NBDE) were significant positive predictors of success. Performance on laboratory tests of clinical skill in operative dentistry and in fixed prosthodontics and ratings from interviewers were not predictive of overall success in the program. Although this study confirms the predictive value of written tests such as the TOEFL and NBDE, it also contributes to the literature documenting inconsistent results regarding other types of predictors. It may be the case that characteristics of individual programs or features of the applicant pools for each may require use of admissions predictors that are unique to schools.

Use of mineral trioxide aggregate (MTA by postgraduates in restorative dentistry in the UK

All postgraduate trainees in Restorative Dentistry within the United Kingdom were contacted by e-mail and invited toparticipate in a structured on-line questionnaire regarding MTA usage. Responses were received from 46/65 (70.8%) postgraduate trainees. MTA was used by 15/46 (32.6%) trainees in the primary dentition and 46/46 (100%) in the permanent dentition. Barriers to the use of MTA in the permanent dentition related to material cost and in the primary dentition, the lack of an evidence base. Overall, 32/46 (69.6%) had received tuition during their postgraduate programme and 21/46 (45.7%) indicated an interest in further educational opportunities in material use.

Trends in material choice for posterior restorations in an Israeli dental school: composite resin versus amalgam

According to a recent American Dental Association survey, posterior composite resin restorations now outnumber amalgam restorations in the United States. Dental schools around the world vary considerably in the extent to which they teach the use of composite resins. We aimed to determine if there has been an increase in the placement of posterior composite restorations in an Israeli dental school and if faculty experience affects the type of posterior restoration placed. In this retrospective study, we recorded and analyzed all the restorations performed by undergraduate students in the last five academic years at the Hebrew University Hadassah School of Dental Medicine in Jerusalem. All clinical records of student treatments between 2004 and 2009 were screened, and direct restorations were registered. Out of 6,094 posterior restorations performed during the study period, 42.3 percent were made of composite resin, increasing from 36.8 percent in 2004-05 to 48.5 percent in 2008-09, an increase of 11.7 percent. When clinical instructors were asked to state their preference if they themselves were to undergo posterior restoration, similar results were obtained. Instructors with less than ten years' experience preferred posterior composite resin restorations in 54.8 percent of the hypothetical situations, compared with 37.2 percent preferred by instructors with ten years of experience or more. It appears that the use of composite resin was influenced mainly by the prevailing trend and was not based on scientific evidence. Dental faculties should define criteria, based on up-to-date clinical studies, for using new materials, taking into consideration differences among instructors regarding treatment concept.

Effectiveness of a five-step method for teaching clinical skills to students in a dental college in India

This study conducted at the PDM Dental College and Research Institute, Haryana, India, had the purpose of developing a teaching method based upon a five-step method for teaching clinical skills to students proposed by the American College of Surgeons. This five-step teaching method was used to place fissure sealants as an initial procedure by dental students in clinics. The sealant retention was used as an objective evaluation of the skill learnt by the students. The sealant retention was 92 percent at six- and twelve-month evaluations and 90 percent at the eighteen-month evaluation. These results indicate that simple methods can be devised for teaching clinical skills and achieve high success rates in clinical procedures requiring multiple steps.