Effect of augmented visual feedback from a virtual reality simulation system on manual dexterity training

Little research has been published about the impact of simulation technology on the learning process of novel motor skills. Especially the role of augmented feedback (FB) on the quality of performance and the transfer of the acquired behaviour to a no-augmented FB condition require further investigation. Therefore, novice dental students were randomly assigned to one of three groups and given the task of drilling a geometrical class 1 cavity. The FB group trained under augmented visual FB conditions, provided by the virtual reality (VR) system (DentSim). The no-FB group practised under normal vision conditions, in the absence of augmented FB. A control group performed the test sessions without participating in any training programme. All preparations were evaluated by the VR grading system according to four traditional (outline shape, floor depth, floor smoothness and wall inclination), and two critical, criteria (pulp exposure and damage to adjacent teeth). Performance analyses revealed an overall trend towards significant improvement with training for the experimental groups. The FB group obtained the highest scores. It scored better for floor depth (P < 0.001), whilst the no-FB group was best for floor smoothness (P < 0.005). However, at the retention tests, the FB group demonstrated inferior performance in comparison with the no-FB group. The transfer test on a traditional unit revealed no significant differences between the training groups. Consequently, drilling experience on a VR system under the condition of frequently provided FB and lack of any tutorial input was considered to be not beneficial to learning. The present data are discussed in view of the guidance hypothesis of FB, which refers to the apprentice's dependence on FB.

Experience with virtual reality-based technology in teaching restorative dental procedures

This article reports on extensive experience with advanced simulation at the University of Pennsylvania, School of Dental Medicine (UPSDM). Virtual reality-based technology (VRBT) or advanced simulation is currently available for the instruction of dental students in preclinical restorative procedures. UPSDM was one of the first schools in the world to have extensive experience with VRBT technology using an advanced simulation unit (DentSim) from DenX, Ltd. UPSDM's experience consists of several years of research using control and experimental groups, employing students to participate in an investigative project, and using the units for remediation and a supplement to the preclinical laboratory. Currently, all first-year students (Class of 2007 and Class of 2008) are receiving most of their preparative operative training on the VRBT units. UPSDM started with one (beta) version unit in 1998, which was later updated and expanded first to four units and recently to fifteen units. This communication is presenting the studies that were of fundamental importance in making the decision to acquire fifteen units in 2003. The areas of main interest to the SDM concerning this technology were its use in teaching, refreshing, and remediating students in restorative procedures and its effectiveness as a teaching methodology in relation to time, efficiency, and faculty. Several studies with varying parameters were performed at various time points. The limited statistical analysis conducted was not conclusive for all measures, and in some cases the data only suggest areas of possible significance. This is due to the low number of students who could access the limited number of available units and the change of protocols in response to student and faculty input. Overall, the results do suggest, however, that students learn faster, arrive at the same level of performance, accomplish more practice procedures per hour, and request more evaluations per procedure or per hour than in our traditional laboratories. Students' attitudes, as measured by surveys, group interviews, and private interviews, are mixed. Our overall evaluation of our experience with this technology has been positive and led to the purchase of additional units, its full incorporation into our curriculum, and curriculum revision to maximize its potential. Our conclusion is that this technology offers significant potential in the field of dental education and that further use and investigation are both desired and justified.

Creating a web-enhanced interactive preclinic technique manual: case report and student response

This article describes the development, use, and student response to an online manual developed with off-the-shelf software and made available using a web-based course management system (Blackboard) that was used to transform a freshman restorative preclinical technique course from a lecture-only course into an interactive web-enhanced course. The goals of the project were to develop and implement a web-enhanced interactive learning experience in a preclinical restorative technique course and shift preclinical education from a teacher-centered experience to a student-driven experience. The project was evaluated using an anonymous post-course survey (95 percent response rate) of 123 freshman students that assessed enabling (technical support and access to the technology), process (the actual experience and usability), and outcome criteria (acquisition and successful use of the knowledge gained and skills learned) of the online manual. Students responded favorably to sections called "slide galleries" where ideal and non-ideal examples of projects could be viewed. Causes, solutions, and preventive measures were provided for the errors shown. Sections called "slide series" provided cookbook directions allowing for self-paced and student-directed learning. Virtually all of the students, 99 percent, found the quality of the streaming videos adequate to excellent. Regarding Internet connections and video viewing, 65 percent of students successfully viewed the videos from a remote site; cable connections were the most reliable, dial-up connections were inadequate, and DSL connections were variable. Seventy-three percent of the students felt the videos were an effective substitute for in-class demonstrations. Students preferred video with sound over video with subtitles and preferred short video clips embedded in the text over compilation videos. The results showed it is possible to develop and implement web-enhanced and interactive dental education in a preclinical restorative technique course that successfully delivered information beyond the textual format.

Cariology in Japanese dental schools

AIM

The aim of this study was to evaluate the teaching of cariology in Japanese dental schools.

DESIGN

Postal questionnaires were sent to all Japanese dental schools.

PARTICIPANTS

Twenty-five of the 29 Japanese dental schools (response rate: 86%).

RESULTS

The results were in many areas similar to those reported from North America. The non-surgical approach to the management of primary caries predominated, but no schools used bacteriological tests in caries diagnosis and only one school recommended antibacterial treatment. Four of the 25 responding schools advocated the treatment of primary enamel lesions by surgical intervention while three awaited operative intervention until the lesions had reached the middle third of the dentine. Recommendation of fluoride treatment was less common than in North America. The use of electronic devices to diagnose occlusal caries lesions was more common than in North America, but 'explorer catch' was the most frequently used method to diagnose primary and secondary caries in dental schools in both regions.

CONCLUSION

Research in cariology over the years has led to altered views on how and when to treat caries lesions. The interpretation of research findings and the transfer of knowledge by teachers in dental schools have an impact on the practice of operative dentistry, but the diversity in the teaching of cariology indicates that the interpretation and implementation of modern principles in the treatment of caries differ quite markedly in Japanese dental schools.

An evaluation of two dental simulation systems: virtual reality versus contemporary non-computer-assisted

Contemporary dental simulation systems were developed to improve dental students' transition from the preclinical laboratory to the clinic. The purpose of this study was to compare the efficacy of a virtual reality computer-assisted simulation system (VR) with a contemporary non-computer-assisted simulation system (CS). The objectives were to determine whether there were differences between the two systems in the quality of dental students' preparations and the amount of faculty instruction time. Students who completed their first year of dental school and had no previous experience preparing teeth were group matched according to their performance in the first-year Dental Anatomy laboratory course and assigned to VR (n=15) or CS (n=13). In the summer, they spent two weeks (approximately 3 hrs/day) executing amalgam and crown preparations on typodont teeth. Short presentations describing the preparations were given to both groups; however, preparation criteria were available on the computer for the VR group, while the CS group received handouts. Both groups could request feedback from faculty, although VR also obtained input from the computer. A log was kept of all student-faculty (S-F) interactions. Analysis of the data indicated significant differences between groups for the following variables: mean number of S-F interactions was sixteen for the VR group versus forty-two for the CS group; and mean time of S-F interactions was 1.9+/-2 minutes versus 4.0+/-3 minutes (p<0.001) for VR and CS, respectively. Faculty spent 44.3 hours "interacting" with twenty-eight students, averaging 0.5 hours per VR student and 2.8 hours per CS student. Thus, CS students received five times more instructional time from faculty than did VR students. There were no statistical differences in the quality of the preparations. While further study is needed to assess virtual reality technology, this decreased faculty time in instruction could impact the dental curriculum.

Restorative treatment strategies reported by French university teachers

Disparities among dental schools concerning the teaching and practice of cariology and operative dentistry can lead to variations in students' treatment modalities that can have health and economic consequences for patients and third party providers. The purpose of this study was to assess caries management strategies taught in French dental schools employing a questionnaire used in a previous study involving private dentists. The study population consisted of 180 teachers of operative dentistry. Each teacher received a questionnaire and a reply-paid envelope. The questionnaire assessed their treatment strategies, knowledge and beliefs about selected aspects of diagnosis, and treatment of dental caries. After one reminder, the response rate was 49.1 percent. The results illustrate a wide disparity among French teachers concerning restorative treatment thresholds for approximal surfaces, opinions about the rate of caries progression, and the need to monitor lesions near the DEJ. The teachers' attitudes differed from those of private practitioners: they tended to intervene surgically at a later stage, but they would intervene earlier in the treatment of the carious process than would Scandinavian dentists. This study may help in encouraging dental faculties to develop a consensus on issues related to diagnosis and management of dental caries.

Taxonomy for competency-based dental curricula

The objective of this article is to propose a classification of dental competencies. Interest in dental competencies has grown consistently during the last three decades. However, the dental education literature suggests that the term "competency" is understood and used differently by dental schools around the world. The taxonomic classification of dental competencies we propose follows a systematic approach starting at the highest level of complexity, i.e., the professional profile the teaching institution envisions for its graduates, and following in a decreasing degree of complexity to competency function, task, step, movement, and moment. This taxonomy has proved to be useful for more than thirty years in the Dental School of the Peruvian University Cayetano Heredia. Graduates of this school are successful practitioners, teachers, and researchers in Peru and other countries. The classification proposed here should clarify terms, facilitate curriculum design and learning assessment, stimulate further discussion on the matter, and facilitate communication among the dental education establishment.

Reliability and validity of a manual dexterity test to predict preclinical grades

The University of California, San Francisco School of Dentistry wanted to determine if a predental school manual dexterity test predicts: 1) subsequent grades in preclinical restorative courses, and 2) faculty perceptions of satisfactory performance in these skills that would indicate the student is ready to advance to the clinic. The study population was comprised of all 244 applicants admitted to UCSF School of Dentistry's D.D.S. program from Classes of 2000 to 2002 and who matriculated into the program. The manual dexterity test (MDT) consisted of a two-hour block-carving test. Three preclinical faculty, three clinical faculty, and two basic science faculty graded the blocks. Even after instruction and calibration, faculty varied greatly in their grading (intra-rater reliability kappa statistics ranging from 0.34 to 1.00). Two of three preclinical raters gave No Passes for the MDT in 9.8 percent of the incoming, first-year dental students. Of these twenty-three students, only four (17 percent) were in the lower 10 percent of their classes according to their five preclinical restorative laboratory courses after two years, and four (33 percent) were among the twelve students the three preclinical laboratory directors identified as laboratory cautions. The MDT did not significantly (p=0.342) predict students in the bottom 10 percent after five restorative preclinical laboratory courses, above and beyond current admissions criteria. Among current admissions criteria, PAT score was the only item at least moderately correlated with preclinical average percentile class rank (Spearman correlation = 0.34). In conclusion, the MDT did not appear to add information to the current admissions criteria.

The amalgam-free dental school

OBJECTIVES

To review the change in teaching of Restorative Dentistry at Nijmegen dental school over the period 1986 to the present.

KEY POINTS

In 1986, class I and II resin composite restorations were included in the pre-clinical program. However, these courses still started with class I and II amalgam restorations. From 1990 on, the number of amalgam restorations placed in the clinic gradually decreased while the number of resin composite restorations increased. Meanwhile, resin composite had become the first choice for treatment of primary caries (class I and class II) lesions. Finally in 1994, the pre-clinical training started with resin composite restorations before dental amalgam was taught and the advantage of a minimal preparation was further emphasized. Since 2001 the teaching of dental amalgam ceased at the dental school. This was not an abrupt change but the result of a long transitional stage during which it was gradually substituted by resin composite. This step-by-step introduction allowed the acceptance of composite resin by the staff as an alternative for dental amalgam in posterior restorations. As in 2001 students placed only 2.5 amalgam restorations before graduation, it was decided to stop with the pre-clinical training program.

CONCLUSIONS

The introduction of resin composites meant an important change in teaching restorative dentistry at Nijmegen dental school. It was not just a change in materials and techniques but also a change in treatment philosophy. The reduced need for preparation and the strengthening effect on the remaining tooth were the principal reasons for the shift from dental amalgam to adhesive dentistry with resin composite at Nijmegen dental school.

Curricular issues changing from amalgam to tooth-coloured materials

OBJECTIVE

To provide an overview of curriculum issues in changing from amalgam to tooth-coloured materials.

KEY POINTS

Changing from amalgam to tooth-coloured materials in teaching the restoration of posterior teeth may be found to have a considerable enriching effect on the dental curriculum. Subject to meeting a number of prerequisites, the change from amalgam to tooth-coloured materials may cause relatively little curriculum disruption, with the added bonus of a consequential shift from reparative to preservative, minimal invasive dentistry.

CONCLUSION

Changing from amalgam to tooth-coloured materials may enrich the typical dental curriculum.

Reflective practice in the teaching of conservative dentistry to undergraduate dental students - perceptions derived from a pilot study using personal development diaries

The aim of this study was to explore final-year student perceptions to the use of personal development diaries (PDDs) and to compare the findings with an established system of competitive continuous assessment, using open display of score ratings displayed on a clinic notice board. Focus groups in conjunction with personal development diaries (PDDs) were used to investigate the teaching of conservative dentistry to senior dental undergraduates. Thirty per cent of the statements made reference to the positive aspects of PDDs, while a small percentage (6%) was negative. Nineteen per cent of the comments derived from the focus groups showed that the undergraduates disliked the open display of their marks on the conservation clinic notice board. This compared with only 2% who claimed that they enjoyed the competitive method. A further 22% of the comments related to the fact that open display of marks was stressful, whereas 3% were unaffected. Eighteen per cent of the responses indicated that clinical conservative dentistry was a stressful experience.

Dentocase - open-source education management system in dentistry

Since 2001, an interdisciplinary project on multimedia education in medicine has been sponsored by the Federal Ministry of Education and Research at the Charité. One part of the project is on dentistry. In the light of the results of a survey of dental students, an Internet-based education management system was created using open-source back-end systems. It supports four didactic levels for editing documentation of patient treatments. Each level corresponds to the learning abilities of the students. The patient documentation is organized to simulate the working methods of a physician or dentist. The system was tested for the first time by students in the summer semester of 2003 and has been used since the winter semester of 2003 as part of the curriculum.

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.

PREPassistant: a system for evaluating tooth preparations

Learning the widely differing forms of tooth preparation, especially in restorative dentistry, places high demands on both trainees and instructors with regard to precision, reproducibility, assessment, evaluation and three-dimensional conceptualization. In the past, evaluation of such preparations has been against subjective parameters and their interpretation by the assessor (usually the instructor). The use of CAD systems in teaching seminars and courses allows an objective assessment of tooth preparations and offers the trainee the possibility of measuring him/herself against a standard, of detecting errors, and of achieving perfection in the required tasks. The PREPassistant system described in this article is one such CAD-assisted learning system. It is recommended both for students in dental schools and for the continuing education of established dentists. Its strengths are that it produces a design for a tooth preparation, enables exact comparison with an ideal preparation, detects errors, and promotes improvements and perfection.

Integrating dental anatomy and biomaterials: an innovative use of composite resin

As part of the new integrated curriculum at the New York University College of Dentistry, a pilot program uses composite resins to teach dental anatomy. The Department of Biomaterials and Biomimetics, in conjunction with the Department of Cariology and Operative Dentistry, has created a teaching module to replicate the morphology of a central incisor through the manipulation and placement of a composite resin.

A preliminary study in using virtual reality to train dental students

This study compared virtual reality simulator-enhanced training with laboratory-only practice on the development of dental technical skills. Sixty-eight students were randomly assigned to practice their skills in either a traditional preclinical dentistry laboratory or in combination with a virtual reality simulator. The results indicate that students who trained with the virtual reality simulator between six and ten hours improved significantly more than did the students in the control group from the first examination of the year to the final examination of the year. These results indicate that the use of virtual reality simulators holds promise for the training of future dentists. Additional research is necessary to determine the ideal implementation of virtual reality simulators into traditional dentistry curricula.

Internal medicine education in dentistry: knowledge required varies according to dental specialty

BACKGROUND

With recent increases in the number of elderly and medically compromised patients, dentists are required to have a more comprehensive understanding of medical problems. There is, however, little awareness of the importance of internal medicine at dental schools in Japan.

OBJECTIVE

The aims of the present study were to examine whether dentists need medical knowledge, to examine how often they experience difficulties regarding internal medicine in dental practice, and to determine whether their specialty or career influences their needs or difficulties.

DESIGN

A questionnaire based on the above objectives was designed and was sent to all the faculty members in the department of dentistry at Tsurumi University and all dentists who work at the university hospital.

RESULTS

Of 408 surveys, 307 (75%) responded. Ninety-nine per cent of respondents recognized the necessity of internal medicine. The dentists specializing in gerodontology, dental anesthesiology or oral and maxillofacial surgery (group S) felt the need of knowledge of internal medicine more frequently than those of other specialties (group O) (Odds ratio 17.5, 95% CI: 2.4 approximately 129.9; P = 0.000). Seventy-four per cent of the dentists experienced difficulties in day-to-day practice caused by a lack of medical knowledge. Those in group S, experienced difficulties more frequently than those in group O (Odds ratio 5.3, 95% CI: 2.1 approximately 12.9; P = 0.000). While the more experienced dentists in group S encountered difficulties more often, the more experienced dentists in group O encountered difficulties less often.

CONCLUSIONS

The need for instruction in internal medicine varies according to dental specialty. Even very experienced dentists might fail to find solutions because of a lack of knowledge of internal medicine.

Esthetic techniques and restorative systems used in the second-year undergraduate dental curriculum

Metal-free tooth-colored restorative systems for fabricating indirect intracoronal and extracoronal restorations have been developed because of patients' demand for superior esthetics. During the past decade, long-term clinical studies have demonstrated the success of many of these types of restorations in terms of function and esthetics. Ceramic veneers, all-ceramic crowns, ceramic onlays, and composite-resin inlays are becoming an integral part of contemporary clinical practice. The constant evolution in bonding techniques, adhesive systems, and cements plays a major role in the success of these metal-free restorations. In addition, home-bleaching procedures have become an integral part of the esthetically oriented dental practice. This article discusses the rationale, scientific basis, and implementation of a new undergraduate preclinical esthetics course for second-year dental students at the Louisiana State University Health Sciences Center School of Dentistry.

Perceived competency at graduation among dental alumni of the University of the West Indies

The aims of this study were to describe levels of self-rated competency of dental graduates from the University of the West Indies (UWI) and to investigate relationships with gender and the effect of curriculum change. A thirty-two item self-reported postal questionnaire was sent to UWI dental alumni (1994-2002). The questionnaire included twenty-eight competencies that could be rated on a 5-point scale: 1 (not at all competent) to 5 (very competent). Overall preparedness for practice could also be rated from 1 (not at all prepared) to 5 (very prepared). The response rate was 77.4 percent, with a mean age of 29.3 years. Items with the highest mean scores were taking an adequate medical history (4.49), recognizing and treating dental caries (4.46), oral examination (4.36), and giving dental health education (4.35). Those with the lowest rating were designing and undertaking clinical research (2.29), dealing with practice management issues (2.52), designing and delivering crown and bridge work (3.33), and recognizing pathologic occlusions (3.33). Overall preparedness for practice was rated as 3.27. Female graduates rated four competencies significantly higher than males. Graduates exposed to the new curriculum perceived greater overall preparedness for general dental practice, suggesting the change to a competency-based curriculum was effective.

Application of rapid prototyping to operative dentistry curriculum

Computers are becoming an integral part of dental education and dental practice. Rapid prototyping is a technique for the production of solid objects from computer models. The variety of rapid prototyping devices and materials that can be processed is increasing all the time. In this article, the authors present a discriminative learning device and associated exercises for developing visual recognition skills and examine the potential for the application of rapid prototyping to the operative dentistry curriculum. Other rapid prototyping technologies as applied in dentistry are also discussed.

Postgraduate dental education in Nigeria: professional knowledge self assessed in relationship to skills among resident dental surgeons in Nigerian teaching hospitals

BACKGROUND

Improvement in any professional calling demands periodic assessment. The purpose of this study was to assess the professional knowledge in relation to skills of the resident dental surgeons in Nigeria in an attempt to contribute to their training needs analysis.

METHOD

A 33-item, self-evaluation one-page questionnaire focussing on their knowledge and skills in the different aspects of clinical dentistry was distributed to the residents in Nigerian teaching hospitals. Sixty-six residents consisting of 38 (57.6%) males and 28 (42.4%) females with age range of 27-46 years (mean 31.3 +/- 3.4 SD) completed and returned the questionnaires giving a 91.7% response rate.

RESULTS

The overall means for knowledge and skills of the residents were 70.1 +/- 13.8 (SD) and 67.3 +/- 12.0 (SD) respectively. Residents whose claims of professional knowledge and skills were found below average were 30 (45.5%) and 29 (43.9%) respectively. No statistically significant sex differences were found in the claimed knowledge and skills of the residents as well as in terms of their professional status (P > 0.05). The lowest grand means for knowledge and skills were found for orthodontics/paedodontics.

CONCLUSION

The study has shown that the resident dental surgeons in Nigeria claimed better professional knowledge than skills and needed most attention in orthodontics/paedodontics.

[Docimologic analysis of 4th-year preclinical exam questions]

Operative Dentistry and Endodontics' Department of the School of Dentistry of Abidjan experienced pre-clinical exam in fourth year of dentistry with MCQ following guided courses which aim was to lead student to be correctly in charge of the patients when they start their first clinical performance. The objective off his this work is to show how one's can analyse exams questions efficiently. In this work the authors present et discuss the results of the evaluation of this preclinical exam performed through calculation of index of success (Ir) which gives us information on the difficulty of a question for all the students who answered, the discriminative index (Id) which allow to determine when a question is selective enough to distinguish weak to strong students in a group. The mean to evaluate is well chosen because the questions asked has a Ir between 46% et 80% (satisfying Ir) and the average Id is between 0.30 and 0.53 (Id discriminates well among 0.30 et 1). This methodology allows an evaluation of a high number of students by stocked questions.

A virtual reality dental simulator predicts performance in an operative dentistry manikin course

This study was designed to test the ability of a virtual reality dental simulator to predict the performance of students in a traditional operative dentistry manikin course. Twenty-six dental students were pre-tested on the simulator, prior to the course. They were briefly instructed and asked to prepare 12 class I cavities which were automatically graded by the simulator. The instructors in the manikin course that followed were unaware of the students' performances in the simulator pre-test. The scores achieved by each student in the last six simulator cavities were compared to their final comprehensive grades in the manikin course. Class standing of the students in the simulator pre-test positively correlated with their achievements in the manikin course with a correlation coefficient of 0.49 (P = 0.012). Eighty-nine percent of the students in the lower third of the class in the pre-test remained in the low performing half of the class in the manikin course. These results indicate that testing students in a dental simulator, prior to a manikin course, may be an efficient way to allow early identification of those who are likely to perform poorly. This in turn could enable early allocation of personal tutors to these students in order to improve their chances of success.