Comparison of Digital Self-Assessment Systems and Faculty Feedback for Tooth Preparation in a Preclinical Simulation

Effectiveness of a digital educational system on the learners' performance in preclinical fixed prosthodontic training

OBJECTIVES

The purpose of this study was to evaluate the effectiveness of the digital education system on the crown preparation performance of dental students in repetitive preclinical training sessions, and students' perceptions of the digital software in fixed prosthodontic practice.

MATERIAL AND METHODS

Forty dental students in the third year were recruited for the preclinical training of all-ceramic crown preparation on the lower right first molar in seven sessions. The first session (S1) included the initial didactic course and the first crown preparation practice with the instructor's guidance. The second session (S2) comprised training in using the pedagogical Dental Teacher system. Students participated in five consecutive practice sessions (S2-S6), receiving only digital feedback. The seventh session (S7) was conducted with no digital or instructor support for all students. The abutment teeth were compared to the original tooth and measured via Exocad software. Each preparation received ten component scores corresponding to ten specific areas of the tooth and an overall score (out of 10) based on how well it matched the criteria. Participants were asked to complete a questionnaire survey to investigate their perception of the digital education software.

RESULTS

In the occlusal surface, the scores significantly differed in the third/fourth session compared to the first session (p = 0.037), and this difference remained throughout the study (p = 0.002 for the fourth session and p < 0.001 for the fifth, sixth, and seventh sessions). No significant difference was found for the buccal and lingual surfaces. In the proximal surfaces, the reduction scores of the occlusal second differed significantly between sessions 1 and 5 and between session 1 and session 6. However, no difference in scores from the last and first sessions was found. In the cervical second, no score difference was observed during the study. The overall scores of tooth removal rose from a baseline of 6.52 ± 0.79 to 7.14 ± 0.67 in session 5 (p = 0.033) and 7.35 ± 0.75 in session 6 (p < 0.001), before falling to 7.05 ± 0.74 in the last session (p = 0.203). Participants using digital software reported high satisfaction (92.5-95.0%) and expressed interest in future use for prosthodontic training (100%). However, over 50% of students assumed that digital software was incapable of substituting for teachers for guidance or assessment of crown preparation.

CONCLUSION

The findings showed that the digital software improved students' overall performance in preclinical prosthodontics and facilitated precision in some specific areas of tooth preparation. Preclinical crown preparation training benefits from the utilization of digital evaluation software; however, this digital pedagogic system cannot entirely replace the teachers' roles.

Tooth Preparation Assessment Criteria for All-Ceramic CAD/CAM Posterior Crowns: An Evidence Map

BACKGROUND

An evidence map review was used to determine universal criteria for all-ceramic CAD/CAM posterior crowns to ensure standardized assessments by dental faculty, students, and practitioners.

MATERIALS AND METHODS

Covidence was used to perform the evidence map review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web of Science (WOS), Embase, Dentistry and Oral Sciences Source (EBSCO), and MEDLINE (Ovid) were searched over a 10-year range (January 2012-December 2023), English only. This was complimented by a manual search. Descriptive statistics (i.e. frequencies and modes) and a chi-square goodness of fit test were used.

RESULTS

A total of 640 articles were identified, out of which 73 were selected for review across six reduction parameters: occlusal reduction, axial reduction, finish line reduction, total occlusal convergence (TOC), preparation surface finish, and anatomic form. Zirconia was excluded from this analysis. Significant differences were found between the observed and expected frequencies of consolidated parameters associated with occlusal reduction and finish line shoulder parameters at the p ≤ 0.05 level. There were no significant differences found between the observed and expected frequencies of the consolidated reduction parameters associated with finish line chamfer, axial reduction, surface finish, or TOC (p > 0.05).

CONCLUSIONS

Recommendation parameters for all-ceramic CAD/CAM posterior crown preparations are 1.5-2.0 mm for the occlusal reduction and 1.0 mm for the reduction of the shoulder finish line. Recommendations of at least 1.0 mm for the chamfer reduction, 12° for the TOC, 1.0-1.5 mm for the axial reduction, and a smooth preparation surface finish with internally rounded angles were also made, though none of these results were statistically significant. The literature review revealed the "finish line" category is multi-dimensional suggesting a more encompassing term as "finish boundary profile (FBP)."

A Digital-Conventional Integrated Teaching Method Used in Preclinical Full Crown Preparation Courses: A Randomized Controlled Trial

PURPOSE/OBJECTIVES

The purpose of this study was to evaluate the effects of the digital-conventional integrated teaching method on prosthetics preclinically in full crown preparation courses.

METHODS

Fifty-eight undergraduate dental students were randomly divided into a conventional group (CG) and a digital-conventional integrated group (DG). The preclinical course was composed of two phases. In the first phase, students from both groups were trained in full crown preparation with the conventional teaching method. In the second phase, the students in the CG group were still trained with the conventional teaching method, whereas the students in the DG group practiced with a digital real-time training and evaluation system. The crown preparation test was conducted after training. The reduction amount, margin, taper, undercuts, finishing status and protection of the adjacent tooth and gingiva were evaluated by senior experts. Crown preparations were also graded by a digital assessment system. Students' opinions were investigated with questionnaires.

RESULTS

The differences between the scores for the CG and DG groups were not significant, as evaluated by experts (p = 0.398) and a digital assessment system (p = 0.075). The questionnaires response rate was 100%. The digital-conventional integrated teaching method had a significantly higher score for the preparation sequence (p = 0.002), according to the questionnaires. The conventional teaching method had significantly higher scores for efficiency (p < 0.001), posture (p = 0.010) and preference (p < 0.001).

CONCLUSIONS

The digital-conventional integrated teaching method can achieve the same effect as the conventional teaching method in crown preparation training. It is beneficial for students to master the preparation sequence and is likely to be promising in preclinical full crown preparation courses.

A study on digital tooth preparation assessment software in undergraduate pre-clinical skills teaching

INTRODUCTION

Aims This research aims to evaluate the effectiveness and efficiency of the PrepCheck digital system as an additional feedback tool in enhancing undergraduate dental students' tooth preparation skills and its potential to enhance students' learning experience.

MATERIAL AND METHODS

A total of 55 BDS3 students attending the "Crowns Course" and divided into three groups participated in the study. One group (n = 24) was randomly selected as the case group and received feedback using the digital tooth preparation analysis system, PrepCheck, alongside standard visual assessment. The other two groups (n = 31) served as controls and only received standard visual feedback. All students' tooth preparations for the final test were digitally assessed using PrepCheck against a faculty-approved master preparation. The tooth preparation quality was compared between the case and control groups, employing two distinct grading methods. Additionally, a questionnaire was provided to students who used the digital system to gather their feedback.

RESULTS

The findings revealed a positive trend in performance among the case group when using the PrepCheck system. However, the analysis showed no statistically significant differences between the groups in both the tutor assessment only and tutor assessment in addition to using the PrepCheck report. Despite the absence of statistically significant differences, qualitative feedback from participants indicated a favourable reception of the digital system.

CONCLUSIONS

While the PrepCheck digital system displayed potential in complementing traditional teaching methods and enhancing the learning experience, its integration posed challenges, particularly concerning time constraints. Further research is recommended to investigate further the potential longer-term effects and potential useful applications for integrating digital systems like PrepCheck into dental education.

Qatar dental student perceptions of Sirona prep-check software for learning crown preparations

BACKGROUND

Contemporary dental education requires swift assimilation of technological advancements to prepare the future generation of dentists. Integrating digital tools, such as prepCheck software in crown preparations offers a promising avenue for enhancing the learning experiences of dental students. This study aimed to evaluate the perceptions and experiences of undergraduate dental students regarding the use of PrepCheck software for learning crown preparations.

METHODS

An interventional study design was employed to investigate the perceptions of undergraduate dental students regarding the use of Sirona prepCheck software their learning experiences in the prosthodontics course at the College of Dental Medicine. were recruited using purposive sampling. Participants received training on crown preparations using standard didactic and practical teaching methods. A total of 64 dental students (Mean age 22.4 years) participated in the study. They were randomly assigned to two groups, 32 participants each. The study group utilized prepCheck software and the control group relied solely on supervisor feedback. Both groups completed their crown preparation labs concurrently, ensuring consistency in training and assessment conditions.

RESULTS

Out of a total number of 66 students enrolled on the course, 64 participated in the study giving a response rate of 96.96%. The overall mean score for all items was 1.01 (95%CI 0.77-1.25), indicating positive perceptions of the participants about prepCheck software. Analysis of variance revealed no significant variation by gender. Thematic analysis of open-ended items identified key themes related to the advantages and challenges of using prepCheck. Advantages included immediate self-evaluation, objective analysis, and feedback, while challenges included operational difficulties and cost concerns.

CONCLUSION

This study provides insights into the effectiveness of prepCheck in dental education, offering perspectives derived from both quantitative and qualitative analyses. A majority of the participants recommended that digital assessment should be integrated with conventional methods, underscoring the importance of human input through supervisor feedback. The study demonstrates the potential of prepCheck software in enhancing participants' learning experiences in crown preparation assessment. While digital tools offer advantages such as self-evaluation and objective analysis, they need to be supported with input and feedback from the supervisors.

Comparing the reliability of inter- and intra-grader using digital scanning vs. traditional visual method for evaluating preclinical class II composite preparation

Objective

This study aimed to evaluate the intra- and inter-grader reliability of four evaluators using three different digital intraoral scanners and visual methods for typodontic Class II composite preparations.

Materials and methods

Ninety-five typodont teeth of Class II composite preparations were evaluated using traditional visual grading methods (VGM) and digital grading methods (DGM) using the same rubric. Three intraoral scanners were used to scan the Class II cavity preparation for the composite: i700 (Medit, Korea), Trios 4 (3Shape, Denmark), and Shinning 3D (Shinning 3D, China). The same rubric was used to score the visual and digital evaluations by calibrated examiners. Two-way ANOVA was used to compare method- and evaluator-based scores, accounting for the scanner type used.

Results

The scores of the prepped typodont teeth were subjected to an interaction between the examiner and the evaluation technique. In addition, the mean total prepped teeth scores differed between examiners using VGM. A statistically significant interaction emerged between examiners and the evaluation technique employed to assess the total score of the prepped teeth: F(9, 1504) = 3.893, P = 0.001, partial η2 = 0.023. The total prepped tooth score differed between the VGM and DGM groups. Lower (P < 0.05) intra-grader consistency was observed for the final scores when Class II preparations were evaluated using the VGM; however, this consistency improved when using the DGM.

Conclusion

Examiners and evaluation methods affect student performance in Class II cavity preparations. The DGM may be more reliable and consistent within and between evaluators than the VGM is.

Evaluating Case-Based Learning to Enhance Dental Student Performance in Cavity Preparation: A Pilot Study

Background The transition from theoretical knowledge to clinical competency in operative dentistry is an ongoing challenge in dental education. Undergraduate students often face a significant gap between understanding theory and applying practical skills for diagnosing and preparing cavities, which leads to decreased confidence, increased stress, and potential errors in clinical practice. Case-based learning (CBL), an active learning strategy that emphasizes real-world scenarios, has shown promise for improving clinical skills and knowledge retention in other healthcare disciplines. This pilot study explored the potential of CBL to address the theory-practice gap and enhance confidence among undergraduate dental students in performing cavity preparations. Methods This pilot study utilized a pre and post-intervention design and involved 30 second-year dental students. Participants completed confidence surveys at three points: before CBL activity, immediately after CBL activity, and following their first clinical cavity preparation procedure. The CBL activity consisted of two components: interactive case discussions and hands-on laboratory exercises designed to simulate real-world dental procedures. The interactive discussions focused on diagnostic and treatment planning while laboratory exercises provided practical experience in cavity preparation. Data were analyzed using repeated-measures analysis of variance (ANOVA) to assess the changes in confidence levels across the three survey points. Results CBL significantly increased students' confidence across multiple dimensions (p < 0.05). Confidence in modifying cavity preparations increased from a mean of 2.91 (SD = 0.292) before CBL to 5.12 (SD = 0.331) post-CBL and further to 5.52 (SD = 0.556) after clinical practice. Similarly, confidence in understanding the basic concepts of caries removal improved from 4.82 (SD = 0.528) pre-CBL to 5.45 (SD = 0.564) post-CBL, and to 5.61 (SD = 0.556) post-clinic. However, confidence in performing cavity preparations without faculty guidance remained relatively low, increasing from a baseline mean of 2.67 (SD = 0.478) to 2.91 (SD = 0.384) post-CBL and 3.64 (SD = 0.603) post-clinic. Conclusion Incorporating CBL into the curriculum can significantly improve undergraduate students' confidence in performing cavity preparation. This approach may help bridge the theory-practice gap and better prepare students for the clinical environment. This pilot study provides promising initial data, and further research is needed to determine the long-term impact of CBL and the optimal implementation strategies.

Efficacy of Virtual Preparation Simulators Compared to Traditional Preparations on Phantom Heads

BACKGROUND

Virtual simulators are increasingly being introduced in dental education. This study investigates whether virtual simulators offer comparable or superior educational efficacy when compared to traditional phantom simulators.

MATERIALS AND METHODS

Participants were randomly allocated into groups: Virtual Preparation (SIM; n = 30) and Traditional Preparation (FRA; n = 30). Students were tasked with preparing tooth 36 for a full-cast crown during free practice for four days. Faculty staff provided feedback to both groups. Examinations were administered and graded by three examiners (preclinical and clinical consultants and a dental surgery consultant). Additionally, a survey was conducted to assess each training concept.

RESULTS

The FRA group achieved significantly better grades in the preparation exam evaluations by all three examiners, compared to the SIM group. Interrater reliability showed only moderate agreement, with the clinical examiner giving better grades than the other two. The questionnaire results indicate that while participants managed with the virtual system, they preferred the analog system for exams and patient preparation.

CONCLUSION

Virtual simulators do not seem to be as good when it comes to practicing for a preparation exam or clinical preparation, especially for unexperienced students. However, they still appear to be useful as an additional tool for introducing students to the topic of preparation.

Automated scoring and augmented reality visualization software program for evaluating tooth preparations

STATEMENT OF PROBLEM

Tooth preparation is an essential part of prosthetic dentistry; however, traditional evaluation methods involve subjective visual inspection that is prone to examiner variability.

PURPOSE

The purpose of this study was to investigate a newly developed automated scoring and augmented reality (ASAR) visualization software program for evaluating tooth preparations.

MATERIAL AND METHODS

A total of 122 tooth models (61 anterior and 61 posterior teeth) prepared by dental students were evaluated by using visual assessments that were conducted by students and an expert, and auto assessment that was performed with an ASAR software program by using a 3-dimensional (3D) point-cloud comparison method. The software program offered comprehensive functions, including generating detailed reports for individual test models, producing a simultaneous summary score report for all tested models, creating 3D color-coded deviation maps, and forming augmented reality quick-response (AR-QR) codes for online data storage with AR visualization. The reliability and efficiency of the evaluation methods were measured by comparing tooth preparation assessment scores and evaluation time. The data underwent statistical analysis using the Kruskal-Wallis test, followed by Mann-Whitney U tests for pairwise comparisons adjusted with the Benjamini-Hochberg method (α=.05).

RESULTS

Significant differences were found across the evaluation methods and tooth types in terms of preparation scores and evaluation time (P<.001). A significant difference was observed between the auto- and student self-assessment methods (P<.001) in scoring both the anterior and posterior tooth preparations. However, no significant difference was found between the auto- and expert-assessment methods for the anterior (P=.085) or posterior (P=.14) tooth preparation scores. Notably, the auto-assessment method required significantly shorter time than the expert- and self-assessment methods (P<.001) for both tooth types. Additionally, significant differences in evaluation time between the anterior and posterior tooth were observed in both self- and expert-assessment methods (P<.001), whereas the evaluation times for both the tooth types with the auto-assessment method were statistically similar (P=.32).

CONCLUSIONS

ASAR-based evaluation is comparable with expert-assessment while exhibiting significantly higher time efficiency. Moreover, AR-QR codes enhance learning and training experiences by facilitating online data storage and AR visualization.

3D-printed coloured tooth model for inlay preparation in pre-clinical dental education

INTRODUCTION

Accurate inlay preparation is extremely important in pre-clinical training. However, there is a lack of tools to guide students to efficiently practise inlay preparation. Therefore, a 3D-printed coloured tooth model for inlay preparation was designed to guide beginners to practise inlay preparation by themselves according to different colour prompts. This study aimed to evaluate the benefits of using a 3D-printed coloured tooth model in the pre-clinical training on inlay preparation.

MATERIALS AND METHODS

Twenty-eight students in their fourth-year undergraduate dental program participated in this study. The participants were randomly assigned to two groups for the inlay preparation. Group 1 prepared a plain tooth model for the first and fourth attempts and a 3D-printed coloured tooth model for the second and third attempts (n = 14). Group 2 prepared four plain tooth models (n = 14). The first and fourth tooth models prepared by both groups were scored using an evaluation system (Fair Grade 2000, NISSIN). Next, questionnaires answered by students were used to evaluate the benefits of using a 3D-printed coloured tooth model and self-evaluate hands-on ability using a grading system (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). The scores were evaluated statistically using the Mann-Whitney U test, and the given grades are displayed as percentages and mean values.

RESULTS

There was an overall increase in the clinical confidence of all students after repeated attempts to prepare an inlay; however, students from group 1, who had used the 3D-printed coloured tooth model, had more positive experiences and comments. The 3D-printed coloured tooth model for inlay preparation has been widely praised by participants. Comparing the average score of the first and fourth preparations, the average score of group 1 increased by 12% (Ø 54.46 ± 8.33, Ø 61.11 ± 7.13, p = .090), while that of group 2 increased by 0.72% (Ø 56.39 ± 9.59, Ø 56.80 ± 8.46, p = .925).

CONCLUSION

Students favoured the use of the 3D-printed coloured tooth model, and this improved the average score for inlay preparation. The 3D-printed coloured tooth model for inlay preparation is expected to play an important role in dental education in the future.

Objective evaluation of tooth carving using homologous models

PURPOSE/OBJECTIVES

Tooth carvings are evaluated subjectively. However, subjective evaluations are associated with low intra- and inter-evaluator reliability in providing feedback for the fabrication of better tooth carvings. Therefore, this study aimed to analyze the relationship between subjective evaluation and the morphological characteristics of tooth carvings and their morphological characteristics using the feedback method in the low-scoring group.

METHODS

Between April 2013 and September 2021, 120 maxillary left first molar carvings fabricated by undergraduate students were subjectively evaluated by an experienced instructor using a five-point scale. The tooth carvings were scanned to obtain three-dimensional shape data and divided into two groups, the high- and low-scoring groups, for principal component analysis. Homologous models with dimensions matching those of the average model were created, and principal component analysis was performed to evaluate the morphological characteristics of the tooth.

RESULTS

Principal component analysis indicated that an objective evaluation was possible using homologous model. On increasing the subjective evaluation, the occlusal inclination angle and the cervical region of the tooth became steeper, and the shape of the occlusal surface resembled a parallelogram. In addition, large morphological differences were observed in the position of the cervical region of the tooth, height of contour, and shape of the occlusal surface in the low-scoring group, whereas no such difference was observed in the high-scoring group.

CONCLUSION

Objective evaluation of tooth carving was possible using homologous model. The evaluation of tooth morphological characteristics could be effective in providing feedback to undergraduate students.

A Novel Self-Assessment Method for Training Access Cavity on 3D Printed Endodontic Models

BACKGROUND

New technologies can facilitate the transition from pre-clinical to clinical settings. We investigate students' satisfaction with a novel learning method adopted in access cavity exercises.

METHODS

Students performed their access cavity on inexpensive, in-house 3D printed teeth. Their performances were evaluated by scanning the prepared teeth with an intraoral scanner and visualized using a mesh processing software. Then, the same software was used to align the tooth prepared by the student and the teacher's one for self-assessment purposes. Students were asked to answer a questionnaire about their experiences with this new learning method.

RESULTS

From the teacher's perspective, this novel learning approach was easy, straightforward and affordable. Overall, student feedback was positive: 73% found that access cavity assessment by scanning was more useful compared to a visual inspection under magnification and 57% reported that they had a better understanding of errors and mishaps. On the other hand, students pointed out that the material used to print teeth was too soft.

CONCLUSION

The use of in-house 3D printed teeth in pre-clinical training is a simple way to overcome some of the drawbacks associated with extracted teeth, such as limited availability, variability, cross-infection control, and ethical constraints. The use of intraoral scanners and mesh processing software could improve student self-assessment.

Preclinical dental students self-assessment of an improved operative dentistry virtual reality simulator with haptic feedback

To test and evaluate the second installment of DENTIFY, a virtual reality haptic simulator for Operative Dentistry (OD), on preclinical dental students, by focusing on user performance and self-assessment. Twenty voluntary unpaid preclinical dental students, with different background experience, were enrolled for this study. After the completion of an informed consent, a demographic questionnaire, and being introduced to the prototype (on the first testing session), three testing sessions followed (S1, S2, S3). Each session involved the following steps: (I) free experimentation; (II) task execution; S3 also included (III) completion of questionnaires associated with the experiment (total of 8 Self-Assessment Questions (SAQ)); and (IV) guided interview. As expected, drill time decreased steadily for all tasks when increasing prototype use, verified by RM ANOVA. Regarding performance metrics (Comparisons by Student's t-test and ANOVA) recorded at S3, in overall, a higher performance was verified for participants with the following characteristics: female, non-gamer, no previous VR experience and with over 2 semesters of previous experience of working on phantom models. The correlation between the participants' performance (drill time), for the four tasks, and user self-assessment evaluation, verified by Spearman's rho analysis, allowed to conclude that a higher performance was observed in students who responded that DENTIFY improved their self perception of manual force applied. Regarding the questionnaires, Spearman's rho analysis showed a positive correlation between the improvement DENTIFY inputs on conventional teaching sensed by students, also enhancing their interest in learning OD, their desire to have more simulator hours and the improvement sensed on manual dexterity. All participating students adhered well to the DENTIFY experimentation. DENTIFY allows for student self-assessment and contributes to improving student performance. Simulators with VR and haptic pens for teaching in OD should be designed as a consistent and gradual teaching strategy, allowing multiplicity of simulated scenarios, bimanual manipulation, and the possibility of real-time feedback to allow for the student's immediate self-assessment. Additionally, they should create performance reports per student to ensure self-perception/criticism of their evolution over longer periods of learning time.

Influence of the Operator`s Experience, Working Time, and Working Position on the Quality of the Margin Width: In Vitro Study

Background and Objectives: Appropriate tooth preparation is mandatory to obtain a perfect marginal fit of fixed restorations. The heavy chamfer is the most commonly used finish line, especially for minimally invasive tooth preparation. The aim of the study was to compare the width of the finish line obtained during tooth preparation performed by experienced (university lecturers) and inexperienced persons (dental students) in different working times and positions. Materials and Methods: Forty left upper-second molars were prepared on the simulator by each participant, totalizing 160 prepared teeth. A new round-end tapered diamond was used to obtain the 0.5 mm width of the heavy chamfer. The prepared teeth were photographed using a Canon D5300 camera with a macro lens attached to a tripod. The measurements were made with the Image-Pro Insight software selecting the same eight reference points. From these points, perpendicular lines were drawn above the finish line to the axial walls and the distance between the chamfer's outer edge and the axial wall's inner edge was measured. GraphPad Instat and NCSS Dowson Edition software were used. The statistical significance was set at p < 0.05. The mean (M) and standard deviation (SD) were calculated. The used tests: one sample t-test, ANOVA test, and Tukey-Kramer Multiple Comparisons Test. Results: Statistically significant differences were obtained according to the experience of the participant, preparation time, patient's position, and the chamfer width on the prepared tooth different surfaces. Conclusions: Daytime or weeklong tiredness and patient position do not affect the width of the heavy chamfer prepared by experienced and inexperienced persons. The experience and the operator's working position influence the width of the prepared finish line.