The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education

Cross-Sectional Survey to Assess Dental Students' Perception of the Utilization of a Case Difficulty Assessment Form during Various Stages of Root Canal Therapy

Background

Several endodontic difficulty assessment forms are available to help dental students and general dentists estimate the difficulty of the case before initiating the endodontic treatment.

Objectives

This study aimed to assess if the American Association of Endodontics (AAE) case difficulty assessment form affects the dental student's perception of the difficulty encountered while performing root canal treatment (RCT).

Materials and Methods

This was a cross-sectional online survey. After obtaining IRB approval, an electronic questionnaire was sent to dental students enrolled in the 4th and 5th years at King Saud University (KSU) and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. The questionnaire was divided into informed consent, demographic data, the use of the AAE case assessment form, RCT steps, diagnosis, local anesthesia administration, tooth isolation, and endodontic procedure.

Results

A total of 195 dental students participated in the study. There were 101 (52%) females, and 139 (71%) were from KSAU-HS. A positive association was found between students who used the AAE assessment form and who did not with their ability to reach the correct diagnosis (p=0.005), tooth isolation (p=0.03), and endodontic procedure difficulty score (p=0.018).

Conclusion

The use of the AAE form by dental students enabled them to differentiate between complicated and uncomplicated cases, thus lowering the difficulty encountered during RCT.

Before and after: COVID-19 impacts on dental students' well-being, clinical competency and employment opportunities

INTRODUCTION

The onset of COVID-19 challenged dental schools worldwide, impacting clinical training. In Australasia, New Zealand adopted a COVID-19 'elimination strategy', involving nationwide lockdowns that halted face-to-face education. The 'elimination strategy' adopted at the pandemic onset, which permitted return to 'normal life' in 2021, allowed the pandemic impacts and those related workforce transition to be teased out. This study aimed to evaluate perceived impacts of the COVID-19 pandemic on health and well-being, clinical competency and employment opportunities of dental students.

MATERIALS AND METHODS

Two surveys were distributed to final year dental students (n = 94; age range 20-35): one during their final semester and the second six months following graduation. Surveys included open and closed ended questions on participants' self-perceived impacts of COVID-19 on health and well-being, clinical competency and employment opportunities. Average percentages were calculated and descriptive statistics performed.

RESULTS

Pre-graduation, participants reported COVID-19 negatively impacted their mental and social health. Slightly lower scores on all dimensions of health post-graduation were likely due to transitioning to the workforce. Pre-graduation, less than half of participants felt prepared to provide the full scope of dental treatment; post-graduation most felt confident to do so. Most participants expected COVID-19 would negatively impact employment opportunities for their cohort, despite all participants being employed when the second survey was conducted.

CONCLUSION

Participants self-rated health and clinical competency scores were lower post-graduation when NZ returned to 'normal life', meaning lower scores were related to workforce transition. Dental schools need to be prepared to provide alternative forms of dental education and help mitigate mental health impacts of future major course disruptions.

Dental and endodontic-related stress amongst undergraduate students before and during the COVID-19 pandemic: A mixed-methods study

AIM

To determine and explain the principal sources of stress among preclinical and clinical dental undergraduate students with a particular focus on the stressors linked to endodontics.

METHODOLOGY

A mixed-methods study, with an explanatory sequential design, was employed. Volunteer students of second, third and fourth years were asked to complete both the Dental Environment Stress (DES) questionnaire and a bespoke questionnaire for endodontic-related stress assessment, which had 21 questions in common with the DES. The results were analysed by Kruskal-Wallis and Marginal Homogeneity tests. In the second part of the study, a qualitative phase was conducted through focus group interviews of students from each academic year included in the study. Interviews were analysed by inductive content analysis.

RESULTS

The DES questionnaire determined that for all years the most stressful domains were 'performance pressure', 'workload' and 'clinical training'. According to the endodontic stress questionnaire, the most stressful domains were 'self-efficacy beliefs', 'endodontic clinical training' and 'faculty and administration' in early years, while they were 'endodontic patient treatment', 'performance pressure in endodontics' and 'clinical training' in later years. Comparing questions common to both questionnaires revealed that the stress score was lower for the endodontic stress questionnaire than in the DES questionnaire for 17 questions, being significantly lower for 13 questions (p < 0.05) and significantly higher for no question. The qualitative study showed that students' dental and endodontic-related stress was linked to different domains: patient, clinical procedure, organization, staff, academic education, evaluation and COVID-19-related issues. Qualitative aspects highlighted the important role that patients and COVID-19 have played in student stress. However, they suggested a possible explanation for the lower endodontic stress observed in this dental university hospital, which was based on: the nature of the teaching in endodontics, the consensus between endodontic supervisors, the use of a logical, progressive procedure and the considerable experience that students gain over the years.

CONCLUSION

Students considered endodontics stressful; however, education can play a central role in reducing stress, particularly during the early parts of the undergraduate course.

Self-assessment skills of undergraduate dental students in the preclinical course of complete removable prosthodontics at Tehran University of Medical Sciences

INTRODUCTION

This study evaluated the self-assessment skills of third-year dental students regarding their performance in complete removable prosthodontics (CRP) preclinical course.

METHODS AND MATERIALS

This cross-sectional study was conducted on all third-year dental students attending the International Dental College of Tehran University of Medical Sciences. The students were requested to self-assess their performance in primary impression making, custom tray fabrication, border moulding, final impression making, master cast fabrication, record-base fabrication and tooth arrangement in CRP preclinical course. The performance of dental students in each step was scored by themselves and their mentors. Data were analysed by the Mann-Whitney U, Pearson's correlation and t-tests (α = 0.05).

RESULTS

Totally 25 male (55.6%) and 20 female (44.4%) dental students were evaluated. Significant differences were noted between male and female dental students in self-assessment scores regarding adequate extension of the custom tray (p = .027), the correct position of tray handle (p = .020), visibility of vestibular width and depth on the cast (p = .011), the coincidence of upper and lower midlines (p = .005) and correct orientation of maxillary and mandibular planes in the articulator (p = .036). The mean self-assessment score of female students was significantly higher than that of male students (p = .01). The scores given by the mentors were not significantly different for male and female students (p = .975). The difference between the self-assessment score of students and the mentor score was not significant (p = .067) either in males or in females (p > .05).

CONCLUSION

Undergraduate dental students favourably self-assessed their performance in all steps of the preclinical course of CRP, comparable with their mentor assessment.

Prevalence and reasons for referrals to the Endodontics Specialty Clinic at the Piracicaba Dental School

Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients' electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis.

Students' experience and perceptions of undergraduate endodontic education in New Zealand

This study investigated the clinical experience and perceptions of New Zealand graduating dental students (2019 and 2020) towards endodontic teaching and their clinical learning outcomes using an online survey and clinical scenarios. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically. Responses were similar for both cohorts (response rates 74%, 2019; 73%, 2020). Endodontic teaching was valuable and interesting but difficult compared with other disciplines. Molar endodontics, finding canals and managing posture were challenging. Students felt more confident and less anxious when supervised by clinicians experienced in endodontics. Time management was the most anxiety-inducing factor and significantly related to clinical experience (p < 0.001). Overall, students appropriately applied knowledge in most areas of endodontics while holistic problem-solving in complex scenarios was variable. Maximising clinical experience and supervision from teachers experienced in endodontics are important for learning, improving confidence and reducing anxiety.

Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study

AIMS AND BACKGROUND

To assess the procedural errors committed by undergraduate students at RAK College of Dental Sciences, during root canal treatments and the factors associated with these errors.

MATERIALS AND METHODS

In this cross-sectional study, 180 self-administered questionnaires were distributed, each comprising 26 questions, among 4th and 5th-year students. Participants were requested to report their endodontic mishaps based on feedback from their supervisors. The questionnaire assessed the frequency and types of procedural errors, considering patient, operator, and tooth-related factors. Data were collected tabulated and analyzed using the Chi-square test.

RESULTS

A total of 124 root canal-treated teeth exhibiting iatrogenic errors done by students were assessed. Out of which, 53% were performed by 5th-year students, and 69% were conducted by female operators. About 62% of errors occurred in the upper teeth and 68% in the posterior teeth. The most prevalent errors during the rubber dam isolation step were soft tissue trauma (21%) and isolation leakage (20%), significantly associated with limited mouth opening, excessive salivation, and tooth malalignment (p < 0.05). Apical blockage (15%) emerged as the most frequent error during instrumentation phase, showing a significant association with canal dimension and curvature (p < 0.05). For access cavity and obturation phases, under-extended cavity (9%), and under-extended filling (11%) were the most reported errors, respectively.

CONCLUSION

Tooth isolation emerges as a particularly challenging aspect for dental students, particularly when dealing with patients exhibiting limited mouth opening and excessive salivation.

CLINICAL SIGNIFICANCE

Clinical instructors should caution the undergraduates about the heightened risk of endodontic procedural errors when dealing with patients exhibiting limited mouth opening, excessive salivation, tooth misalignment, and narrow canals. Addressing these challenges is crucial for enhancing the proficiency of undergraduate students in performing successful root canal treatments. How to cite this article: Elsayed MA, Islam MS, Saleh DR, et al. Endodontic Procedural Errors and Associated Factors among Undergraduate Dental Students: A Cross-sectional Study. J Contemp Dent Pract 2023;24(12):998-1007.

Digital evaluation of occlusal reduction of metal crown preparations in students in the COVID-19 era: A cross-sectional study

Introduction

Occlusion of extra-coronal restorations depends on the reduction achieved during crown preparation. Ensuring adequate reduction is therefore essential for the success of the final restoration. The objective of this study was to digitally quantify the occlusal reduction performed by preclinical undergraduate dental students and to compare their performance across the year and using a hybrid teaching approach developed because of the COVID-19 pandemic.

Methods

Eighty full metal crown preparations on typodonts were scanned using the KaVo Arctica 3D Optical scanner. Occlusal reduction was measured using Autodesk Fusion 360 v2.0 by superimposing an unprepared tooth over the preparation and taking measurements at six occlusal points (mesio-buccal (MB), disto-buccal (DB), mesio-lingual (ML), disto-lingual (DL), mesial fossa (MF), and distal fossa (DF)). A general linear model was used to compare student performance in the mid vs final year exams and in 2018/19 vs 2020/2021.

Results

The adequacy of occlusal reduction was variable. Occlusal reductions of the MF (p = 0.014) and DF (p = 0.011) were significantly lower in the final exam than the mid-year exam in 2018/2019. There was also occlusal under-reduction at all six occlusal points in 2020/2021 compared with 2018/2019.

Conclusions

Students must be encouraged to use verification guides throughout the procedure to ensure adequate reductions. These verification methods can be as simple as putty indices or as advanced as optical scanners. The use of verification methods alongside a hybrid virtual and live teaching approach may guarantee the best results.

A bibliometric comparison of undergraduate and postgraduate endodontic education publications: The topics, trends, and challenges

OBJECTIVES

This study employs bibliometric analysis to compare knowledge units and main topics in undergraduate and postgraduate endodontic education, aiming to identify similarities, differences, and connections. The insights gained are expected to inform the future of two-stage education to enhance continuity, highlighting evolving trends, challenges, and development directions.

METHODS

Citation data were retrieved from the Web of Science Core Collections (WOSCC) database and non-WOSCC databases with two separate search formulas. VOSviewer and CiteSpace were used to analyze the distribution of research by publication years, citation-sources, co-authorship network of authors and countries, and clusters of keywords.

RESULTS

The focus on undergraduate education preceded postgraduate education by nearly a decade. The United Kingdom has emerged as the most prominent contributor to endodontic literature at both levels, with the International Endodontic Journal representing the most voluminous and cited resource in this domain. Dummer is recognized as the most prolific author in undergraduate endodontic education, while Gulabivala spearheads the most extensive cluster of postgraduate education. Keywords clustering analysis reveals that undergraduate education places greater emphasis on fundamental knowledge, while postgraduate education concentrates more on clinical practice. Descriptive analyses from non-WOSCC databases align with the topics and findings from WOSCC-based bibliometric analysis.

CONCLUSION

This bibliometric analysis revealed the emphasis on fundamental knowledge and teaching techniques at the undergraduate level versus advanced clinical knowledge and techniques at the postgraduate level, which originated from different learning aims and contexts. Updating the curriculum to meet the latest practices and innovations is crucial for aligning learning objectives with current and future needs, and the connection between the two levels remains a central challenge in endodontic education.

Teaching rotary root canal instrumentation using a Peyton teaching approach

INTRODUCTION

The aim of the study was two evaluate the effectiveness of a Peyton teaching approach for rotary root canal instrumentation, in comparison to the traditional "see one-do one" method.

MATERIAL AND METHODS

Forty undergraduate students were randomly divided into two groups (n = 20). Students of the first group (G1) were taught how to use rotary instrumentation using a modified Peyton method, whilst the second group (G2) watched a teaching video (30 min) on the same subject. Both groups instrumented a plastic block and subsequently both mesial canals of an extracted lower molar. The quality of the root canal instrumentation was analysed by 2 blinded observers on video recordings and x-rays.

RESULTS

Interobserver correlation was 0.917 (p < .0005; Pearson) for the assessment of the video recordings; students of G1 received significantly more total points (83.55 ± 6.82 points) compared to G2 (69.76 ± 13.82) (p = .001; t-test), the gender had no significant effect on the overall results (p = .444; two-way ANOVA). Significant differences were detected for the categories "initial scouting," "coronal enlargement," "glide path preparation," "preparation using X2 file," "preparation using X3 file" (p < .05; t-test) as well as for the subcategories "sequence of rinse, recapitulation, rinse" (p = .001; t-test) and "recapitulation" (p < .002; t-test). No differences between groups were observed for the radiographic evaluation with respect to working length and canal straightening.

CONCLUSION

Teaching rotary instrumentation by using the Peyton approach resulted in improved performance of undergraduate students assessed with a checklist-based process analysis. Enhanced implementation of rotary instrumentation could result in better long-term results of students' root canal treatment.

Investigation of fracture prevalence of instruments used in root canal treatments at a faculty of dentistry: a prospective study

Objectives

The aim of this study was to examine the use of hand or rotary files by pre-graduation (fourth- and fifth-year) and postgraduate students in endodontic treatments and to determine the incidence of file fracture and the management of cases with broken instruments.

Materials and Methods

A total of 2,168 teeth undergoing primary endodontic treatment were included in this study. It was determined that 79 of these teeth resulted in broken tools. In the case of broken tools, the education level of the treating clinician, the tooth that was being treated, the canal and fracture level, the curvature of the tooth and the management of the broken instrument were recorded. Periapical radiographs of the patients were used to calculate curvature following the Schneider method.

Results

There was no significant difference in the incidence of broken tools according to education level (p > 0.05). The incidence of file fracture in molar teeth (73.4%) was higher than in other teeth (p < 0.05). More files were broken in the mandibular molar MB canal (20.25%) and in the apical third of the canals (72.1%). The risk of instrument fracture was high in teeth with moderate (44.3%) and severe (38%) curvature canals. The management of apically broken (80%) files mostly involved lefting (p < 0.05).

Conclusions

There was no statistically significant difference between fourth-year students, fifth-year students and postgraduate students in terms of instrument fracture.

Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study

Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.

Evaluating the stress of root canal treatment in patients and dentists compared to other dental treatments: A systematic review and meta-analysis

This systematic review aimed to investigate whether root canal treatment caused greater stress than other dental treatments for patients and dentists. All peer-reviewed literature published in English between January 1990 and January 2023 was included. This included randomized/non-randomized control trials, cohort studies, case-control studies, and cross-sectional studies. An electronic search used PubMed, Scopus, Medline, Cochrane Collaboration, and Embase. Hand searching supplemented the screening pool. Studies examining physiological or psychological stress measures within patients or providers of dental treatment (dentists, dental specialists, and dental students) were eligible. The study must have reported on the stress outcome for root canal treatment and at least one other dental procedure. After screening 3639 eligible records, there were 23 studies included, varying from very-low to low certainty of evidence. This review found that root canal treatment was more psychologically stressful for patients than routine restorative or cleaning procedures. However, the stress of root canal treatment relative to other dental procedures, especially extractions, was inconclusive for both dental patients and providers. Since patients regard root canal treatment as more stress-evoking than other routine dental procedures, providers should endeavour to minimise their own bias toward root canal treatment when providing adequate information for an informed treatment choice.

Perception of Dental House Officers regarding Endodontic File Separation during Endodontic Treatment

Background

Despite of having improved endodontic file designs as well as the reinforced metal alloy file structure, intracanal endodontic file separation (EFS) is still a very problematic and worrisome dental incident, which usually occurs without any visible signs of permanent deformation. Further, there have been conflicting reports regarding the clinical significance of leaving separated files within root canals.

Aims

The aim of this study was to look into the current perceptions and awareness about file separation during endodontic treatment among the dental house officers (DHOs).

Materials and Methods

A novel validated questionnaire comprising of 15 close-ended questions was distributed anonymously via Google Forms through email to 1100 DHOs across Pakistan. The questionnaire consisted of two parts: the first component (Section I) collected demographic data and the second component (Section II) investigated the causes of EFS during root canal treatment. Following the completion of socioeconomic information, including age and gender, the DHOs were asked to answer a few questions about the various reasons for endodontic instrument fracture.

Results

A total of 800 responses were recorded, with an effective rate of 72.8%. The majority of the DHOs (p value < 0.001) perceived that endodontic instrument fracture occurred in the posterior (61.5%) and apical third of the canal (50.5%) and in older permanent dentition (67.3%), possibly due to patient anxiety (62%). Better choice of instrument (61.15%), operators' experience (95.3%), knowledge (87.5%), and proper root canal cleaning (91.1%) are believed to be the vital steps in reducing endodontic file separation/fracture. Furthermore, majority of them (p value < 0.001) perceived that stainless steel was a superior alloy for filing instruments. Manual files tend to be more prone to fractures due to repeated use than rotary files.

Conclusion

This study demonstrated that young DHOs had adequate knowledge and awareness regarding the potential predisposing factors and handling techniques for EFS. This study thereby provides an evaluating tool to access the insights of the current perceptions and awareness of DHOs concerning EFS.

Effect on undergraduate student self-confidence in using 3D printed primary molars for root canal treatment simulation training

PURPOSE

The main purpose of this study was to assess the effect of a root canal treatment (RCT) practical simulation-based session using 3D printed primary molars on the self-confidence of fourth-year undergraduate dental students. Our study was also designed to explore student experiences with both manual and rotary RCT procedures and to investigate the association between the self-confidence in undertaking an RCT and the quality of the RCT.

METHODS

Student global self-confidence in undertaking an RCT on a healthy, cooperative child aged 4-5 years was evaluated 2 h before, 1 month after, and 11 months after the simulation training session. Once each instrumental procedure had been completed, the students were also asked to score the level of confidence (specific self-confidence) they felt regarding the use of RP and MP. After each training session, the quality of the RCT was radiographically evaluated by two trained, independent investigators.

RESULTS

Overall, student global self-confidence in undertaking an RCT increased significantly immediately after the practical session and remained stable for the ensuing eleven months. The students declared a clear preference for RP and were more self-confident in undertaking an RCT after RP than after MP. The proportion of RCTs considered of good quality was the same for the manual (31.5%) and rotary (30.3%) procedures.

CONCLUSIONS

Simulation training is a good way to train dental students who are confident in undertaking RCTs. However, confidence is not directly related to competence. Teachers should be encouraged to develop a comprehensive simulation training program, including feedback, debriefing, and repetitions.

How Well Prepared Are Dental Students and New Graduates in Pakistan-A Cross-Sectional National Study

The transition of an undergraduate dental student to an actual practicing dentist is a crucial phase and ensuring the preparedness of graduates for the complexity and demands of contemporary dental practice is a challenging task. This study aimed to evaluate the self-perceived preparedness of undergraduate dental students and house officers in the dental colleges of Pakistan. A cross-sectional national study was planned to collect information from dental students and new graduates in Pakistan. The pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) was used. A purposive sampling technique was utilized to recruit house officers and undergraduate dental students from 27 dental schools in Pakistan. The data analysis was carried out using the R statistical environment for Windows (R Core Team, 2015). A total of 862 responses with 642 females and 219 males were analyzed in the study. Overall, the clinical skills score was 30.56 ± 9.08 and the score for soft skills was 30.54 ± 10.6. The mean age of the participants was 23.42 ± 1.28. Deficiencies were reported in various soft skills and clinical skills attributes. The results highlighted the strengths and weaknesses of dental students and new graduates in Pakistani dental institutions. The findings may be used to further develop and strengthen the teaching and training of dental students in Pakistan.

Evaluation of anxiety-provoking situations related to clinical training in dental education

INTRODUCTION

The aims of this study were to evaluate the situations that cause anxiety in clinical training and to discuss the precautions that can be taken to reduce clinical anxiety in dental education.

MATERIALS AND METHODS

This multi-centred survey-based study was created through Google Docs, and 3rd, 4th and 5th grade dental students were included. The students were asked to rate their reactions on a 4-point Likert scale "not anxious" to "very anxious" for 27 questions related to academics, communication and interaction, diagnosis, dental treatments, deficiencies and mistakes in the treatments.

RESULTS

1332 students were reached, and 1320 students completed the questionnaire. Whilst extracting wrong tooth (3.53 ± 0.83), getting infected by patient (3.39 ± 0.85) and getting diagnosis wrong (3.31 ± 0.83) were identified as the 3 most anxiety-provoking situations, taking panoramic radiograph (1.48 ± 0.71) and communication with patients and dental assistants/nurses (1.76 ± 0.87; 1.64 ± 0.76) were identified as 3 situations that cause the least anxiety. Female students reported higher anxiety levels than male students in most of the questions (p < .05). A statistically significant difference was observed between the grades of the students (p < .05). 3^rd grade students showed statistically higher anxiety levels than higher grades in 16 out of 27 questions. No statistical significance was observed according to the status of the university (p > .05).

CONCLUSION

Questions related to diagnosis, delivery of the dental treatments, deficiencies and mistakes in the treatments caused higher anxiety levels amongst dentistry students. As experience and time in the clinical training increase, the anxiety level of the students decreases. Orientation programmes and establishing an effective communication between grades are recommended. Also, gender-based solutions must be taken into consideration.

Quality of endodontic record-keeping and root canal obturation performed by final year undergraduate dental students: An audit during the COVID-19 pandemic

BACKGROUND

To assess the quality of endodontic record-keeping and root canal obturation performed by undergraduate final year dental students during the COVID-19 pandemic.

MATERIALS AND METHODS

Dental records and dental radiographs of patients who received endodontic treatments between March 2020 and March 2022 by undergraduate students during the COVID-19 pandemic were included. The audit data were collected based on the European Society of Endodontology guidelines retrospectively via assessing the patient's clinical records and intraoral periapical radiograph. Root canal obturation quality was evaluated based on the following parameters: adaptation, length, taper, and mishap. A root filling is defined as satisfactory only when all four parameters were graded as acceptable. Subsequently, the data were recorded and analysed using Chi-Square test with the level of significance set at p = 0.05.

RESULTS

A total of 111 patient records with 111 root canal-treated teeth were evaluated. The highest percentage of documented evidence was noted in the patient's general records, while the endodontic treatment records showed the lowest percentage of documented evidence. 78 (70.3%) of root canal-treated teeth were deemed satisfactory with acceptable adaptation, length, taper, and absence of mishap. Moreover, no statistical significance in terms of root canal filling quality was noted between anterior and posterior teeth, and between maxillary and mandibular arch.

CONCLUSIONS

Although patient records and root canal fillings quality were deemed satisfactory in most cases, strict documentation requirements and continuing dental education in audit training are necessary for quality assurance.

Dental students' observations about teaching of endodontic access cavities in a French dental school

INTRODUCTION

Teaching in French universities has undergone deep changes for several years. Dental studies are no exception to the rule. Endodontics is one of the most difficult fields requiring good knowledge of anatomy before performing clinical procedures. The access cavity is the key step of endodontic therapy. The aim of this study was to collect and understand what students feel and expect from theoretical and practical training on endodontic access cavity.

MATERIALS AND METHODS

A questionnaire survey on the teaching and learning of endodontic access cavities in a French dental school was sent by e-mail to the 4th-year students (n = 66). The questionnaire consisted of 13 questions of different formats. Qualitative variables were analysed using a word cloud according to the words of the participants. Students were also asked how to improve teaching with new educational tools.

RESULTS

60 students answered the questionnaire (response rate of 90.9%). When students were asked which stage of endodontic treatment they feared the most, performing access cavity came in 3rd place. Upper molar (71%) and lower molar (58%) appeared to have the most difficult endodontic access cavities. Within the word cloud gathered after students' answers analysis, the words "fear," "perforation," "cavity" and "axis" were highlighted. Amongst the 3 new educational tools proposed to students, most were in favour of realistic models of teeth with their ideal endodontic access cavity (79%).

DISCUSSION

This study highlighted the feelings of students during their hands-on training on endodontic access cavities. Although they seemed satisfied with practical classes on endodontic access cavities, this step seemed to be stressful for students especially because of the great internal anatomical variabilities of teeth. To help them better understand the root canal anatomy and improve their training, students asked for new educational resources, especially macro-models of teeth with their optimal access cavities.

CONCLUSION

This study showed that students are seeking for innovative resources in addition to traditional resources that would make it easier for them to visualise the root canal system and help them feel more comfortable and facilitate learning when performing endodontic access cavities.

3D-Printed Teeth in Endodontics: Why, How, Problems and Future-A Narrative Review

Three-dimensional printing offers possibilities for the development of new models in endodontics. Numerous studies have used 3D-printed teeth; however, protocols for the standardization of studies still need to be developed. Another problem with 3D-printed teeth is the different areas of literature requested to understand the processes. This review aims to gather evidence about 3D-printed teeth on the following aspects: (1) why they are advantageous; (2) how they are manufactured; (3) problems they present; and (4) future research topics. Natural teeth are still the standard practice in ex vivo studies and pre-clinical courses, but they have several drawbacks. Printed teeth may overcome all limitations of natural teeth. Printing technology relies on 3D data and post-processing tools to form a 3D model, ultimately generating a prototype using 3D printers. The major concerns with 3D-printed teeth are the resin hardness and printing accuracy of the canal anatomy. Guidance is presented for future studies to solve the problems of 3D-printed teeth and develop well-established protocols, for the standardization of methods to be achieved. In the future, 3D-printed teeth have the possibility to become the gold standard in ex vivo studies and endodontic training.

The objectives and instructional design of undergraduate endodontic program: multicenter cross-sectional study in Saudi Arabia

BACKGROUND

Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.

METHODS

The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher's exact tests.

RESULTS

The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students' performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).

CONCLUSION

The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.

Present status and future directions - Minimal endodontic access cavities

In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.

The effect of COVID-19 pandemic on final year dental students' self-confidence level in performing clinical procedures

BACKGROUND

The outbreak of COVID-19 pandemic in 2020 has dramatically changed teaching approach in dental schools due to the switch to distance learning and the lack of practice training in direct contact with patients with possible impact on clinical skills of students. The aim of the study was to assess the level of the 2020 final year dental students' self-confidence in performing different dental procedures through specially designed questionnaire and compare it to self-confidence of the 2019 final year students.

MATERIALS AND METHODS

An anonymous questionnaire consisting of 40 questions regarding self-confidence level in performing 40 different dental procedures and based on five points Likert-like scale was distributed during November 2020 to final year dental students whose studies were disrupted by the COVID-19 pandemic lockdown in one semester. The study group comprised their answers. The comparison was done with the control group that consisted of students' answers on the same questionnaire from previous 2019 year conducted as a part of regular internal educational evaluation.

RESULTS

Response rate was 74.2% in study group and 89.3% in control group. Mean level of self-confidence reported by 115 students in study group was significantly lower than that reported by 100 students in control group (3.28±1.08 vs. 3.58±0.88, respectively) and the distribution of self-confidence scores were different in observed groups. Graduates from study group felt less confident than those from control in 8 clinical skills.

CONCLUSION

Abrupt changes in teaching modalities caused by COVID-19 pandemic had significant impact on final year dental students' self-confidence indicating additional educational needs in postgraduate period.

The change in self-efficacy of novice dentists in Endodontics within the first year following graduation from Aarhus University or the Academic Centre for Dentistry Amsterdam

AIM

To understand whether the self-efficacy of novice dentists in Endodontics changes within the first year following their graduation, and to reveal factors related to a possible change.

METHODOLOGY

Data were obtained from dental graduates from Aarhus University, Denmark or from the Academic Centre for Dentistry Amsterdam, the Netherlands. The 60 participants filled out the Endodontic General Self-Efficacy Scale questionnaire close to their graduation (baseline) and 1 year following their graduation (follow-up). Additionally, data on their experience in Endodontics within the first year following graduation were gathered, as well as data on their work environment, their referral behaviour and the postgraduation education they attended. For comparisons, chi-square tests, Fisher's exact tests, Mann-Whitney tests, and t-tests were used. Referral behaviour and the change in self-efficacy were studied by multiple regression analyses.

RESULTS

Most participants showed an increase in self-efficacy after graduation. The increase in self-efficacy was higher for those whose baseline self-efficacy was lower, and lower for those whose baseline self-efficacy was higher. Self-efficacy increased with experience in performing root canal treatments within the first year following graduation. Participants with higher average self-efficacy (i.e. mean of baseline and follow-up self-efficacy) referred patients for endodontic surgery more often than participants with lower average self-efficacy did.

CONCLUSIONS

The self-efficacy of novice dentists in Endodontics generally increased within the first year following their graduation. The increase in self-efficacy was greater for those who had low self-efficacy at graduation than for those who already had high self-efficacy. Performing root canal treatments was an important factor in increasing self-efficacy.

Influence of Preclinical Training on Root Canal Treatment Technical Quality and Confidence Level of Undergraduate Dental Students

Objectives

The aim of this study was to investigate the influence of exposure to additional preclinical endodontic training on undergraduate students' technical quality of root canal treatment and overall confidence levels in endodontics.

Methods

Technical quality of root canal treatment performed clinically by fifth-year undergraduate students was evaluated and divided into two groups: Group 1, teeth treated by students who had attended both a preclinical endodontic block course and an elective preclinical course. Group 2: teeth treated by students who had not attended the elective preclinical course. All students were also invited to participate in a survey to rate their undergraduate endodontic training and confidence levels performing endodontic treatment. Statistical analysis of data was performed using Person chi-square test, Fisher Freeman Halton exact test, and t-test. A p-value <0.05 was considered statistically significant.

Results

There was no significant difference between the two groups in overall obturation quality (p=0.619). However, more teeth treated by attendees were of adequate obturation length (p=0.015) and lacked procedural errors (p=0.004). Significantly more elective course attendees rated their undergraduate endodontic training as adequate (p=0.002), but there was no significant difference in the level of confidence between the attendees and the non-attendees.

Conclusion

Within the limitations of this study, additional preclinical training showed minimal effect on overall quality of root canal treatment performed clinically by undergraduate students and did not enhance their confidence levels; however, it was associated with more satisfaction with their undergraduate endodontic education.

Making use of three-dimensional models of teeth, manufactured by stereolithographic technology, in practical teaching of endodontics

INTRODUCTION

Making use of 3D printed teeth models in teaching students offers an innovative approach. The mistakes made by the students at the access cavity stage were assessed with the aid of 3D models, and their overall, hands-on learning progress was evaluated.

MATERIAL AND METHODS

Ninety 3D models of teeth were constructed using stereolithographic technology and then randomly divided into 9 groups. One dentistry student was randomly assigned to each group and then performed primary access cavity in 10 identical 3D models. Then the teeth were evaluated in the order of their preparation, relative to the model tooth.

RESULTS

The material of 14 (15.5%) out of 90 teeth models sustained significant damage during the preparation. As regards the remaining 76 (84.5%) 3D models, the students committed the greatest number of mistakes on the incisors, and fewer on the molars and the least in the premolars. The difference in the number of errors between particular groups of teeth was statistically significant (P = .0001). The number of errors committed in subsequent repetitions amongst all students was significantly different for the incisors (P = .00215) and premolars (P = .00383), whereas insignificant in the case of molars (P = .77116).

CONCLUSIONS

Thanks to perfect representation of teeth anatomy; making use of 3D models in the teaching of endodontics may well be recommended as holding substantial potential in improving overall quality of training at the pre-clinical stage, with a view to appreciably reducing overall risk of encountering complications during the actual clinical work.

Practice with confidence: Analyzing confidence level of final year dental students from four Saudi dental colleges in Riyadh

Objective

To investigate the confidence level of final year dental students in Riyadh.

Materials

Cross-sectional study was conducted at four dental colleges in Riyadh (N = 312, 220 and 70,5% responded). Oneway ANOVA and post hoc Tukey-Kramer was used.

Results

The greatest self-reported confidence scores were for pit fissure sealent (4.6(0.7)). Whereas, students reported least confidence in conducting surgical extractions (2.7 (1.2)). Females were found more confident in conducting preventive resin restorations, oral hygiene instructions, and rubber dam placement as compared to male who were more confident in surgical extraction, copy dentures, veneer preparation and managing orthodontic emergencies.

Conclusion

All students were confident in performing essential dental procedures however higher confidence was observed in performing simple procedures compared to more complex ones.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Curriculum setting and students' feedback of pre-clinical training in different dental schools in China-A national-wide survey

INTRODUCTION

Adequate time and effective training facilities are essential for undergraduate dental students participating in pre-clinical dental practice to ensure them providing safe treatment for patients in the future. The study aimed to explore the current status of pre-clinical dental training in China in relation to the curriculum setting and students' feedback of pre-clinical training in different dental schools and thus provide information for further standardise curricula.

MATERIALS AND METHOD

An online questionnaire was distributed electronically to undergraduates in 44 Chinese dental schools of different levels according to China Discipline Ranking (CDR). The questionnaire collected information in relation to the training hour and student to facility ratio of four main dental courses (cariology and endodontics, periodontology, prosthodontics and oral surgery), as well as the application and effect of virtual reality (VR) simulator in pre-clinical dental practice in different schools. Students' feedback was also collected.

RESULTS

A total of 565 valid questionnaires were recruited. Results of this cross-sectional survey show that training hour of periodontology course was the lowest, and oral surgery course showed most prominent shortage of facilities. The application of VR simulator amongst schools is uneven. Students from A and A+ level schools showed higher satisfaction with their pre-clinical courses and reported a more positive attitude towards the use of VR simulator than other students. (p < .05).

CONCLUSION

Pre-clinical dental training in China remained imperfect in insufficient training time, training facility and students did not have access to standard pre-clinical training and quality assurance. VR technique has potential values in pre-clinical dental practice in China.

Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland

Introduction The governing bodies for dentistry in the UK and Ireland require dentists, at graduation, to possess the knowledge, skills and attributes which enable them to practise safely, without supervision. The means by which dental schools achieve this may differ and may undergo modification in response to changes in the expectations of governing bodies and challenges within the teaching environment. It is therefore important to identify which of these approaches works well and to disseminate good practice described in the literature.Objectives To use a scoping review to identify from the published literature the methods used to teach clinical dental skills, including innovations, motivations for changes, and factors affecting the delivery and quality of teaching.Method Scoping review methodology was used to select and analyse 57 articles published between 2008 and 2018.Results Innovations in didactic teaching were facilitated by advances in IT and development of virtual learning environments, which promoted independent, self-directed learning. Pre-clinical practical teaching took place in clinical techniques laboratories utilising mannequin heads, with a minority of dental schools using virtual reality simulators in addition. Clinical experience was gained mainly in multi-disciplinary clinics and offsite outreach teaching centres. Insufficient numbers of suitable patients, increasing student numbers and a fall in teaching staff contributed to a reported reduction in clinical experience of certain treatments.Conclusions Contemporary clinical dental skills teaching produces new graduates who possess excellent theoretical knowledge, are prepared and confident in basic clinical skills, but are lacking in experience of complex treatments which may result in a reduced preparedness for independent practice.

An investigation into security, self-confidence and gender differences related to undergraduate education in Endodontics

AIM

To analyse responses from dental practitioners (DPs) on how secure they felt as a newly graduated dentist, level of confidence or self-efficacy when performing root canal treatment (RCT), and if undergraduate (UG) education in Endodontics adequately met their needs in a dental practice.

METHODOLOGY

An electronic questionnaire was sent to 459 dentists who graduated from the University of Bergen, Bergen, Norway, between 2008 and 2018. The survey consisted of questions with closed-end options and Likert scale (1-5). An open-ended free text option was always provided.

RESULTS

A total of 314 (68.4%) DPs answered the questionnaire. Of these, 87 (27.8%) were men and 224 (71.3%) were women. Three respondents did not disclose their gender. As a newly graduated dentist, 37.3% of the respondents felt secure when performing RCT, 30.7% felt indifferent, and 32.0% felt insecure. The majority (72.4%) of respondents were either confident or very confident when performing RCT, 21.3% were indifferent, and 6.3% had little or no confidence. A majority of DPs (84.4%) self-evaluated the quality of their root fillings as good or very good, and 15.2% were indifferent. Only one DP selected 'not good' and none selected 'bad'. There were significant gender differences where male DPs felt more secure than female DPs when performing RCT (P < 0.001). A significantly larger number of men were very confident compared to women (P < 0.001). A logistic regression analysis using confidence as a dependent variable to predict self-efficacy revealed that DPs who felt secure when performing RCT as a newly graduated dentist had about 8 times more self-efficacy (odds ratio = 8.49) than those who were insecure or indifferent. Respondents who rated their quality of root fillings as good or very good had forty times more self-efficacy (odds ratio = 40.06) when performing RCT. UG education in endodontics was considered inadequate by 71.3% of the respondents where a significantly larger number of DPs (70%) wanted more clinical training (P < 0.05). About half the DPs (47.7%) stated that there was a need for lifelong learning with majority preferring hands-on courses and continuing dental education organized by dental associations.

CONCLUSIONS

The results of this study suggest that there is a need to promote self-efficacy during UG education in Endodontics. Hands-on training is the preferred form of lifelong learning for DPs.

Formative feedback generation in a VR-based dental surgical skill training simulator

Fine motor skill is indispensable for a dentist. As in many other medical fields of study, the traditional surgical master-apprentice model is widely adopted in dental education. Recently, virtual reality (VR) simulators have been employed as supplementary components to the traditional skill-training curriculum, and numerous dental VR systems have been developed academically and commercially. However, the full promise of such systems has yet to be realized due to the lack of sufficient support for formative feedback. Without such a mechanism, evaluation still demands dedicated time of experts in scarce supply. To fill the gap of formative assessment using VR simulators in skill training in dentistry, we present a framework to objectively assess the surgical skill and generate formative feedback automatically. VR simulators enable collecting detailed data on relevant metrics throughout a procedure. Our approach to formative feedback is to correlate procedure metrics with the procedure outcome to identify the portions of a procedure that need to be improved. Specifically, for the errors in the outcome, the responsible portions of the procedure are identified by using the location of the error. Tutoring formative feedback is provided using the video modality. The effectiveness of the feedback system is evaluated with dental students using randomized controlled trials. The findings show the feedback mechanisms to be effective and to have the potential to be used as valuable supplemental training resources.

Frightened of the pulp? A qualitative analysis of undergraduate student confidence and stress during the management of deep caries and the exposed pulp

AIM

To evaluate sources of student confidence and stress during the management of deep carious lesions and the exposed pulp during undergraduate clinics. Further aims were to identify barriers and facilitators, which could result in educational or practical improvements in the delivery of teaching and provision of treatment in this area.

METHODOLOGY

A exploratory qualitative study design was used, based on recorded focus group interviews, guided by 12 predetermined questions. The discussions were transcribed verbatim and analysed by inductive qualitative content analysis. Common categories were identified to aid understanding. Forty undergraduate dental students from 4th and 5th years in Dublin Dental University Hospital participated in the study.

RESULTS

Student stress and confidence were multifactorial and broadly linked to specific domains: clinical procedure, academic education, clinical training, evaluation/grading, organization and equipment, vital pulp biomaterial and the patient. Most students expressed a preference for one-stage selective carious removal to soft dentine rather than potential pulp exposure in deep carious lesions, noting that although it helped to decrease their immediate stress, it also caused longer-term concern by leaving caries close to the pulp. Nevertheless, their confidence was affected by limited clinical experience of carrying out selective removal procedures in deep caries. A recurrent finding was students citing high levels of stress after pulp exposure. Feelings including anger, fear, embarrassment and denial were associated with pulp exposure during deep caries management. Generally, the students felt able to manage pulp capping procedures, but were less certain about partial pulpotomy, suggesting that although they are aware of its advantages, they were unsure about the appropriate volume of pulp tissue to remove. To reduce stress, students suggested that laboratory teaching should employ new 3-D printed solutions and clinics should establish clear consensus amongst supervising teachers about the best way to manage the exposed pulp.

CONCLUSIONS

Students lacked confidence as they neared the pulp and prefer selective caries removal techniques, which reduce the likelihood of pulp exposure. Students identified stressors and suggested improvements in several domains that would improve confidence. These ameliorations could lead to enhancements in student ability to perform these conservative techniques, and improve the provision of treatment in this area.

Students' self-confidence and perceived quality of prosthodontics education: A study in the Faculty of Dental Medicine of the University of Porto

INTRODUCTION

Oral rehabilitation with removable dentures (RDs) is still a viable choice for the edentulous population. Fostering students' confidence in prosthodontic procedures should be a major concern in dental schools. This study has three purposes: (a) to measure the self-reported confidence levels of undergraduate dental students when performing removable prosthodontic treatments; (b) to evaluate the students' perceived quality of removable prosthodontics education; and (c) to assess the students' suggestions to improve removable prosthodontics education.

MATERIALS AND METHODS

An anonymous questionnaire was delivered to third-, fourth- and fifth-year students of the Faculty of Dental Medicine of the University of Porto (FMDUP) (n = 176). Data from quantitative questions were statistically analysed with IBM SPSS Statistics for Windows (V.24.0), whilst qualitative data were clustered into topics and analysed in Excel.

RESULTS

With a 100% response rate, most students felt "confident" and "very confident" in RD clinical procedures. Overall, the 5th-year students had higher confidence than 4th-year ones, except when surveying diagnostic casts. Our findings also revealed that students considered the removable prosthodontics education "Good" and "Very good," and their main suggestions were related to increasing the time allocated to clinical practice.

CONCLUSIONS

Students' confidence in carrying out removable prosthodontic procedures grew as they progressed through the course. Overall, the students' evaluation of the quality of prosthodontics education was positive, and their main suggestion to improve their confidence levels was increasing the clinical experience.

Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia

AIM

To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice.

METHODS

One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05).

RESULTS

A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P < 0.001). Overall, 97% of students reported the new system helped their understanding of root and canal morphology compared with the Vertucci classification (P < 0.001). Over 97% of students recommended the use of the new system in teaching, pre-clinical courses and clinical practice (P < 0.001). Except for two schools, no significant difference was detected between the responses of students for all questions at the different schools (P > 0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05).

CONCLUSIONS

The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.

Self-efficacy of undergraduate dental students in Endodontics within Aarhus and Amsterdam

AIM

To understand whether the self-efficacy of undergraduates is associated with the extent of the endodontic education they received.

METHODOLOGY

Data were obtained from three undergraduate endodontic programmes in two universities: Aarhus University (AU), Denmark and the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands. Just before their graduations in 2016 or 2017, students completed a questionnaire that contained the Endodontic General Self-Efficacy Scale and questions on how they valued the education they received in Endodontics. The information on the number and type of root canal treatments participants had performed on patients was collected from dental clinic management systems. Data were ana-lysed using non-parametric tests and multiple regression analyses.

RESULTS

The median number of treated root canals on patients per student was 5 in the standard programme at ACTA, 10 in AU, and 14.5 in the extended programme at ACTA. Students' self-efficacy increased with the number of treated root canals; however, retreatments and root canal treatments in molars were negatively associated with self-efficacy. All students wanted more experience in performing root canal treatment on patients.

CONCLUSIONS

The endodontic self-efficacy of students from the standard programmes of the two participating universities was comparable. Students' self-efficacy was influenced mostly by their clinical experience when performing root canal treatment. It seems that the more root canal treatments students perform on patients, the greater their self-efficacy is at graduation. However, treating difficult cases (molars and retreatments) might reduce their self-efficacy.

Perception of Undergraduate Students at the Faculty of Medicine in Hradec Králové Regarding Their Endodontic Education and Suggested Improvements

AIM

The aim of this study was to assess the perception of undergraduate dentistry students at Charles University, Faculty of Medicine in Hradec Králové, the Czech Republic regarding their endodontic education within the context of the Undergraduate Curriculum Guidelines for Endodontology by the European Society of Endodontology (ESE). The secondary aim was to compare this perception among students in the Czech and English groups.

METHODOLOGY

A questionnaire survey was conducted among fifth year students at the very end of their studies.

RESULTS

The students returned 60 filled questionnaires, making the response rate of 75.9%. More than two thirds of the respondents declared that they were competent at or had knowledge of most of the major competencies defined by the ESE. Eighty seven percent of respondents felt competent to perform a root canal treatment on anterior teeth; 86.7% on premolars; and 48.3% on molars. Nearly all respondents (98.3%) recommended more opportunities to practice on patients.

CONCLUSIONS

The overall perception of the students was that their endodontic education was sufficient and largely conformed to the guidelines. Insufficient exposure to endodontic practice on patients was identified as a deficiency. There were no significant differences in perceptions between the two study groups.

Self-reported confidence and anxiety over endodontic procedures in undergraduate students-Quantitative and qualitative study

PURPOSE

The current literature shows a growing interest to assess the feelings and perceptions of students associated with the performance of elective endodontic procedures. This study aimed to evaluate the students' anxiety and self-perceptions related to performing such treatments.

METHODS

Forty-five students participated in the research (G1 = 22 beginners students; G2 = 23 senior students). Demographic data, STAI-State and Numerical Rating Scale (NRS) for pre-operative anxiety were completed before the appointment with patient. The STAI-Trait; NRS for post-operative anxiety; previous experiences in endodontics; and level of confidence in each stage of endodontic treatments were collected after appointment. Focal groups for qualitative data collection were performed on separate occasion.

RESULTS

Both groups showed higher scores in STAI-State than for STAI-Trait scale. G1 showed higher levels of anxiety in the pre-operative, compared with post-operative moment in the NRS scale. G2 reported feeling more confidence to insert intracanal medication and to restore teeth between appointments than G1. In both focus groups, participants reported insecurity in performing endodontic procedures due to difficulty in visualisation and to anatomic complexities. G1 reported that all the confidence they had was based in pre-clinical experience, and G2 mentioned concern about the end of graduation.

CONCLUSION

The participants' anxiety diminishes as they gain more experience in performing endodontic procedures. However, as they approach the end of the course anxiety levels increase. Greater availability of elective courses in endodontics could be a valuable alternative to provide students with more exposure to and experience with these procedures.

Difficulty levels of extracted human teeth used for pre-clinical training in endodontics in an Australian dental school

This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P < 0.001). The inter- and intra-examiner strength of agreement were 0.78 and 0.86, respectively. More than 50% of the teeth were categorised as moderate complexity. Almost one-quarter of the total sample, in particular molars, was classified as high complexity, thus unsuitable for undergraduate pre-clinical training.

Pre-clinical endodontic education outcomes between artificial versus extracted natural teeth: a systematic review

AIM

To compare the educational outcomes using artificial teeth versus extracted teeth for pre-clinical endodontic training.

DATA SOURCES

Literature searches of PubMed, Scopus, Cochrane Library, Trip Database, Web of Science and Open Grey databases were conducted from their inception until November 2018 with no language restriction. Hand searching of most likely relevant journals was performed. The review followed the PRISMA guidelines.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS

Studies that compared pre-clinical endodontic training using extracted teeth and artificial teeth were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

The quality of included studies was appraised by Joanna Briggs Institute Critical Appraisal tools. The findings were tabulated and summarized according to their outcomes with distinct narrative syntheses.

RESULTS

Five studies were included. The component studies included 359 operators in total, mainly consisting of undergraduate students (97%, n = 349) and 10 endodontists (3%). Forty-seven per cent (n = 170) operated on artificial teeth only, whilst 19% (n = 67) worked primarily on extracted teeth, with the final treatment outcome being evaluated by independent observers using objective criteria. Operators in two studies (34%, n = 122) used both artificial teeth and ET and compared their experiences in surveys. Regarding technical outcomes, no significant differences between training with artificial teeth and extracted teeth were found, but the performance tended to be better in artificial teeth than extracted teeth. Operators trained solely on artificial teeth appeared to be adequately educated for subsequent root canal treatment (RCT) in the clinical setting.

LIMITATIONS

Due to the scarcity of research on the topic overall, and the methodological variation between the studies, it was not possible to perform a quantitative analysis (meta-analysis).

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Based on the available evidence, the use of artificial teeth for pre-clinical endodontic training achieved similar educational outcomes compared to extracted teeth. However, the experiences reported by the operators diverged. Further studies assessing other artificial teeth available in the market testing other RCT procedures are necessary.

Experiences during the execution of emergency endodontic treatment and levels of anxiety in dental students

PURPOSE

This study aims to evaluate the experience of dental students and assess their anxiety levels when performing emergency endodontic treatments.

METHODS

Undergraduate students completed the STAI-Trait/State and a questionnaire to assess their confidence level to perform each step of an emergency endodontic procedure. They also answered a numerical scale (NRS) for anxiety before and after emergency care. Ten randomly selected students from the same sample further participated in a focus group aimed at obtaining qualitative data on their perception of endodontic treatments' conduction and the learning process necessary to perform them.

RESULTS

A total of 23 students joined the study. The majority of the participants reported feeling "confident" when performing local anaesthesia (57.6%), rubber dam placement (57.6%) and coronal sealing (72.7%). However, a small number reported feeling "little confident" to perform access cavity (15.2%) or pulpotomy/pulpectomy (24.2%). Students who scored above the 3rd quartile of STAI-Trait/State were classified as "highly anxious," and comprised 26.1% of the sample. The values of NRS scale were higher in the preoperative when compared with the post-operative assessment. All students classified as "highly anxious" reported low confidence in performing "access cavity" and "pulpotomy/pulpectomy."

CONCLUSION

Both quantitative and qualitative analysis showed different anxiety levels in dental students. It can possibly contribute to a reduction in confidence prior to emergency endodontic procedures. The current findings suggest it might be important to rearrange activities in order to allow for more practical classes in Endodontics.

An assessment of endodontic treatment completion rate in a University-based student clinic and the factors associated with incomplete treatment

Incomplete endodontic treatment is potentially a public health issue. The aim of this retrospective study was to evaluate the endodontic treatment completion rate at a University student clinic and to identify the factors associated with completion rates. The records of all patients who commenced an endodontic treatment (code 415) from January 2015 to December 2015 were extracted. A total of 783 records were available for analysis of which 86% received complete endodontic treatment. Maxillary first molars were significantly associated with incomplete endodontic treatment (IET). Patients requiring an additional visit (code 455) were 1.5 times more likely to have an IET. The endodontic treatment completion rate at the School of Dentistry at the University of Queensland is higher than those reported in other international university-based student clinics. Focus group surveys of students and supervisors are required to identify the reasons for higher IET with maxillary first molars and code 455.

Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning

Objectives

To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs.

Methods

Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training.

Participant

Dentists working in and patients treated in primary dental care in London.

Intervention

Twenty-four-month training in endodontics.

Comparison

Dentists enrolled in the training at different time points.

Outcome

Measuring outcome of endodontic treatment.

Results

Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up.

Conclusions

Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

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.

Influence of Method of Teaching Endodontics on the Self-Efficacy and Self-Perceived Competence of Undergraduate Dental Students

Objective:

This study assessed whether self-efficacy and the self-perceived competence of undergraduate dental students had been influenced by the method of teaching endodontics.

Methods:

Certain modules of the undergraduate endodontic programme at the Academic Centre for Dentistry Amsterdam (ACTA) including the tutorials, the clinical training and the assessment were revised. The self-efficacy and self-perceived competence close to graduation of an intermediate cohort of 24 students who attended all or some of the former modules or the revised modules were assessed. Additionally, the performance of students in performing root canal treatments was assessed according to predetermined criteria. Data were analysed using Cohen’s Kappa, Cronbach’s Alpha, Mann-Whitney and T-tests.

Results:

Self-efficacy and the self-perceived competence of students who followed the former modules of clinical training and assessment were similar to those of students who followed the revised modules. The revised module with higher number of tutorials increased students’ self-perceived competence, but did not influence their self-efficacy statistically significantly. Not the entire number, but the number of root canal treatments performed under supervision of endodontists was related with an increase in students’ self-efficacy and self-perceived competence. The performance of students in performing root canal tretaments was not statistically significantly related to their self-efficacy and self-perceived competence.

Conclusion:

Among the modules and their components assessed in the present study, only the number of tutorials and the number of root canal treatments performed under supervision of endodontists influenced the self-efficacy and the self-perceived competence of students.

A Comparative Study of ProTaper Universal and ProTaper Next Used by Undergraduate Students to Prepare Root Canals

INTRODUCTION

The purpose of this study was to determine whether final-year undergraduate dental students achieved better shaping outcomes using the new ProTaper Next (PTN; Dentsply Sirona, Ballaigues, Switzerland) system to prepare root canals for the first time compared with the existing ProTaper Universal (PTU, Dentsply Sirona) system on which they had trained. A secondary aim was to explore the attitudes and preferences of the students toward both systems.

METHODS

Forty students prepared 1 simulated S-shaped canal using PTN and another with PTU. Images of the canals were saved before and after preparation, and the outcomes assessed included the formation of aberrations and the amount of resin removed at specific points along the canal length. Student opinions relating to PTN and PTU were collected via a questionnaire completed immediately after using the systems. For statistical analysis, the McNemar test was used to compare the incidence of aberrations, and a paired t test was used to analyze the width measurements. Responses to the questionnaire were analyzed using frequencies. Thus, the McNemar test was used for paired binary data and the marginal homogeneity test for categoric data when more than 2 categories were used. Finally, the overall preferences (either PTN or PTU) were analyzed using the sign/binomial test, which is a standard statistical test that allows us to determine if the proportion preferring one or the other is equal or not.

RESULTS

Canal ledges were formed in 30% of the canals prepared with PTU, whereas no ledges were formed with PTN (P < .001). A middle constriction, a form of canal aberration, was created by both systems although it occurred significantly (P = .006) more often with PTN. The "number of files" was judged by students to be significantly higher (P < .001) for PTU compared with PTN. Even though using PTN for the first time, students were more likely to recommend the system to other students for preparing S-shaped canals than PTU (P = .018) and preferred to use PTN in the future (P < .001).

CONCLUSIONS

The students who had previous experience with the use of PTU were able to produce comparable shaping outcomes when they used PTN for the first time. For the preparation of S-shaped canals, the students preferred PTN over PTU in terms of the number of files and would prefer to use it in the future.