Preclinical motor chunking and fine motor skill learning in fixed prosthodontics: Contribution of 3D printing and satisfaction of dental students

INTRODUCTION

In fixed prosthodontics, simulators are essential to students for a progressive transition from preclinical to clinical condition. With the 3D printing technology, we developed resin bars allowing students to better visualise by motor chunking technique. Main objectives of this work were to describe this teaching methodology used in preclinic among different promotions of second, third and fourth dental years and to evaluate students' feedback.

MATERIALS AND METHODS

Two hundred seventy resin strips were digitally designed and printed in resin. All participants from second, third and fourth had to fulfil a User Experience Questionnaire (UEQ) after the preclinical work. The scales of this questionnaire covered the complete impression of the user experience. Both classical aspects of usability (efficiency, insight and reliability) and aspects of user experience (originality, stimulation) were measured.

RESULTS

For the second dental years, 'Attractiveness', 'Stimulation' and 'Novelty' were considered 'Excellent'. For the third dental year, novelty average was considered as 'Excellent'. For the fourth dental year, 'novelty' was considered as 'Good'.

DISCUSSION

The resin plates used in this study are original and stimulating for the students, especially for the second-year dental students who found the exercises useful for their learning. This method can also be used by creating scenarios close to the clinical situations encountered in dentistry departments (more dilapidated teeth, preparation of inlays, post and core, etc.). This 3D printed simulation model is not intended to replace the Frasaco® models but is a complement to the learning process.

Exam evaluation in prosthodontics across preclinical and clinical years from students' perspective: A cross-sectional study

INTRODUCTION

The purpose of this study was to explore the students' perceptions and performance in prosthodontics theory exam.

METHODS

A cross-sectional descriptive study was conducted on 560 (80.82%) students of different levels (third, fourth and fifth years) to explore their opinions and performance with regard to a number of issues on a prosthodontics theory exam (exam evaluation, exam preparation, exam material, exam timing). Demographic data were also collected. Descriptive statistics were generated and Chi-square test, independent sample t-test, ANOVA test and Pearson's correlation coefficient were used to examine the associations between different variables. The significance level was set at p < .05.

RESULTS

Students' responses regarding exam evaluation was influenced by their gender, study level, high-school Grade Point Average (GPA) and undergraduate cumulative GPA. Perceived exam difficulty was significantly affected by gender (p = .03) and study level (p < .001), and negatively correlated to both high-school GPA (p < .001) and university GPA (p = .03). The vast majority (88.2%) depended on lecture hand-outs and lecture notes for study. Exam material and preparation were not significantly affected by any of the demographic variables with most respondents (76.8%) thinking that the lectures blended with prosthodontics laboratories/clinics would improve their understanding of the exam material. The suggested best time to conduct the exam was early afternoon (31.6%). Student performance was significantly affected by the study level (p < .001) and cumulative GPA (p < .001) with significant positive correlation between the high-school GPA and the mark in the exam (r = .29, p < .001) and by the amount of time students spent for exam preparation (p < .001). Those students who reported using textbooks to prepare for the exam got significantly higher marks (66.1 ± 8.7) compared to the students who did not (62.8 ± 9.7) (p = .03).

CONCLUSIONS

Course level, GPA and gender were identified as the most influential factors in different aspects of exam evaluation and students' performance. Regular study and use of textbooks were demonstrated to improve academic performance. Additional orientation and guidance relating to the exam (especially for third year students) would be welcomed, as would alternate teaching methods such as small group discussions or study groups.

Modular training model for education of students in restorative and prosthodontic dentistry

INTRODUCTION

At the moment, no commercial model solution is available for the individualisation of the dentition depending on the clinical case scenario. Furthermore, the realistic training of most restorative and prosthodontic procedures on a single dental study model is not possible. The aim of this study was the creation of a new training model to fill this gap.

MATERIALS AND METHODS

Complete upper and lower jaw models were created based on existing scans and radiological data from a patient. All components for 100 complete models and 1128 teeth for the training were produced with a SLA-printer. Overall, 94 voluntary students attending the first and second preclinical course in prosthodontics tested the functionality of the model with three different tooth types against a standard dental study model and real teeth. After the training, the model was rated in a questionnaire.

RESULTS

The production of the models and teeth was feasible. The overall rating of the different teeth was worse for type I (Ø 3.6 ± 1.1), significantly better for type II (Ø 2.5 ± 1.0) and type III (Ø 2.4 ± 1.0) than a standard typodont tooth (Ø 2.7 ± 1.1). The new model was rated significantly better overall (Ø 2.6 ± 1.0) than the standard training model (Ø 3.0 ± 1.1).

CONCLUSIONS

The aim of this study was fulfilled. A superior training model was created with equivalent and better tooth types. The new teeth were outstanding in terms of cost-efficiency, appearance and feeling during preparation.

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.

Setting the boundaries and scope of practice for the two sister specialities of dentistry: Operative dentistry-endodontics and prosthodontics

Dental academia in Pakistan has recently achieved an important milestone. The name of Operative Dentistry speciality has been changed to Operative Dentistry & Endodontics (ODE). It was a much-needed change that was first felt about two decades ago. However, with the correction of name, there are certain challenges that this speciality has to manage now. These include improving the curriculum, setting up standards, and lastly, setting up its boundaries and scope of practice as some of its scope overlaps with a sister speciality called Prosthodontics. This overlapping of the boundaries of dental disciplines is a problem that is unique to Pakistan, India, and some East Asian countries where Operative Dentistry or Conservative Dentistry is combined with Endodontics. This paper aims to discuss the objective delineation of dental procedures and suggest a model of peaceful co-existence of sister dental specialities.

A survey on utilization and barriers of digital removable prostheses in the US dental education

PURPOSE

Gaining knowledge on the extent of digital technology implementation in dental education and the barriers to it will help inform future directions to promote the use of such technology and will enhance dental education. This study aimed to investigate the utilization of digitally fabricated removable prostheses and the potential obstacles to implementing such technology in US dental schools.

METHODS

A survey was developed and distributed to the restorative dentistry department chairs and postdoctoral prosthodontic program directors. The survey delivery protocol included follow-up emails 1 week, 3 weeks, and 4 weeks after the initial email. The collected data were analyzed descriptively.

RESULTS

The response rate was 85% and 45% for predoctoral and postdoctoral prosthodontic programs, respectively. The results showed that 88.06% of the predoctoral programs and 95.65% of the postdoctoral prosthodontic programs implement digital complete dentures in the curriculum; however, the digital removable partial dentures implementation rate was recorded at 70.77% in predoctoral programs and 61.9% in postdoctoral prosthodontic programs.

CONCLUSIONS

Dental schools are challenged by cost, design software limitations, IT and laboratory support, and faculty training. Multifaceted support is instrumental in further implementing digital removable prosthodontics into dental education.

Profile of prosthodontics program directors in North America

PURPOSE

To develop a current profile of prosthodontics program directors (PPDs) in United States dental schools and describe the current challenges and responsibilities of those serving in the position and assess the professional needs of the program directors (PDs) to better support them in their roles.

MATERIALS AND METHODS

A survey was sent to 51 participants who were identified as PPDs in North America via Qualtrics in 2019 to assess the professional needs of PDs to better support their roles. The survey consisted of 29 items organized into six sections: (1) demographic information; (2) hours and time spent in various areas of the job; (3) greatest challenges; (4) perceived importance of specific competencies; (5) opinions on the greatest rewards of the position; (6) their needs for support from the American College of Prosthodontists and advice for the future PD.

RESULTS

The response rate for this survey was 88.3%. Of the 45 respondents, the majority were white/non-Hispanic, followed by Asian/Pacific Islanders. The two largest and equal numbers of participants who worked for more than 10 years and between 1 and 3 years were observed with approximately 29% each, and PDs who worked less than a year occupied the least amount. Overall, 34% of PDs are on the tenure track and 80% of those are tenured. Teaching and clinical services took away the greatest time with approximately 42% and 22.1%, respectively. Thirty-five (78%) PDs listed the greatest challenge they encountered was the workload of the role. Skills listed in leadership and personnel competencies were all rated more important than most of the skills listed in management.

CONCLUSIONS

There is a wide gender gap and a lack of racial diversity among the PPDs. The biggest challenge faced by them is the amount of workload followed by budget and fiscal constraints. And for their improved efficiency, they gave emphasis on learning time management and continuous clinical training of newer advances.

Declarative knowledge in oral health: The case of the term 'centric occlusion'

INTRODUCTION

The lack of academic agreement in the practical or clinical use of declarative knowledge can generate unnecessary confusion and miscommunication. The concept Centric Occlusion (CO) is part of the body of declarative knowledge in dentistry, but its definition remains unclear.

OBJECTIVE

To ascertain the CO concept in articles published in dental journals as a study case for the dentistry "corpus" of declarative knowledge.

METHODOLOGY

The alternative definitions of CO used by the GPT (Glossary of Prosthodontic Terms) from 1956-1977, 'CO as a synonym for maximum intercuspal contact (MIC)', or by the GPT from 1987-2017, 'CO may or may not coincide with MIC', were searched in the articles. The association between the CO definition used and variables such as article aims, journal scope and authors specialty was assessed.

RESULTS

Eight hundred and twelve articles were analysed. The widespread use of CO as synonym of MIC was the main finding and was significantly associated to the Orthodontics field. The CO definition according to the GPT 1987-2017 was less frequently observed but appeared in all dentistry fields, showing a significant association with the Oral Rehabilitation field. The difficulty of incorporating the current definition of CO (by GPT) into the main clinical discussions was evidenced all the long of the review process.

CONCLUSION

The lack of consensus in the concept use was confirmed by the present study case, showing the influence of specific fields in Oral Health declarative knowledge. This methodology can provide a tool to the academy to assess controversial terms or concepts in Oral Health education, thus facilitating the critical and reflexive learning by students.

Study of the use in autonomy of intraoral scanning systems to optimise dental students' performances in fixed prosthodontics practical learning in second year

AIM

The purpose of this study was to evaluate if the use of intraoral scanner analysis could help students to optimise their performance and their self-assessment abilities in prosthetic preparation without the teacher's assistance in the preclinical course.

MATERIALS AND METHODS

Ninety-five second-year dental students were randomly divided into three groups: Control group (C), CeRec group (CR) and PrepCheck group (PC). Group C only use silicon keys to control the preparation thickness. The students in Group CR analysed their work with Cerec™ software. The Group PC use a pedagogic software (PrepCheck™) which allowed comparison with the "master" preparation. They used control tools preparations for three consecutive training sessions. Then a final assessment session without control tool to evaluate their performance was organised. All preparations were objectively evaluated thanks to stl. analysis software (Geomagic® Control X). Each preparation was compared with the master preparation by defining tolerance ranges. An objective overall score out of 20 was assigned to each preparation according to their degree of correspondence. In addition, a questionnaire was performed to analyse the students' perceptions regarding the use of intraoral camera.

RESULTS

During the assessment session, no significant difference was revealed between the different groups with respect to the students' performance. The comparative analysis between the self-assessment scores and the objective scores using Geomagic® software showed that digital control tools did not help the student to improve their self-assessment abilities without the teacher's assistance.

CONCLUSIONS

The intraoral cameras and specific pedagogic software in autonomy could not improve students' performance for teeth preparation and self-assessment abilities in second year. These digital tools facilitate objective feedback on preparation defects, but constructive criticism needs human reflection. The teacher's opinions and advice remain essential to develop their students' performance and self-assessment skills. The use of digital tools must be integrated in dentistry course to develop the interpret of the results and optimise feedback.

A pilot study on the use of a novel digital real-time evaluation system in undergraduate preclinical training of tooth preparation in fixed prosthodontics

INTRODUCTION

In the light of the digital teaching, it is necessary that the effectiveness of a new digital real-time evaluation system in the preclinical training of tooth preparation be evaluated.

MATERIALS AND METHODS

Forty undergraduate dental students of the fourth year were randomly divided into the control group and the experimental group to complete the training task of tooth preparation for porcelain fused to metal (PFM) crown restoring the upper right central incisor. The control students received conventional training with instructor's guidance. The experimental students received training with the digital system without instructor's guidance. Every student exercised preparation in two resin incisors in 3 h training by respective training methods. A third incisor was prepared on a dental model in the simulated head phantom by each student as the test on the next day. All students' tooth preparations were scored by the same two experienced experts. The experimental students were asked to answer a questionnaire regarding their attitudes and opinions on the digital evaluation system in preclinical training.

RESULTS

There was no significant difference between the scores of the experimental group and the control group (p > .05). The students of two groups obtained the similar scores in the test (p > .05). Most of the students were supportive of the application of digital training system in the preclinical tooth preparation training course.

CONCLUSIONS

The digital real-time evaluation system could provide effective training effects for the dental undergraduate students in the preclinical training of tooth preparation in fixed prosthodontics.

Dental school quality assessment: Effect of student calibration on the outcomes of fixed prosthodontic cases

BACKGROUND

Quality assurance (QA) of predoctoral dental student laboratory work is an essential part of the learning process that involves evaluating the student's ability, providing constructive feedback, helping develop the students' ability to self-assess, and promoting collegiality and communication among students, faculty, and laboratories. Faculty calibration, while often difficult to coordinate, is also necessary to providing consistent student feedback.

AIM

The purpose of this study was to evaluate whether periodic calibration exercises with the fourth-year dental students and faculty impacted the number of student cases rejected during Quality Assurance evaluation of fixed prosthodontic cases submitted to The Dental College of Georgia laboratory tracking.

CONCLUSION

Findings from this study provided evidence that ongoing calibration did result in a reduced number of incoming QA rejections in all periods reviewed except for one in which there was significant turnover among department faculty affecting QA calibration for that time period.

Computer-aided design software-enabled preclinical prosthodontic training: A digital education technique

The prosthodontics preclinical training modules involve textbook-based two-dimensional (2D) ideal images and practicing on manikin models to emulate ideal tooth preparations and teeth arrangements. Relying solely on 2D images as objectives for preclinical exercises limits the trainee's creative skills to instructions of textbooks and clinical instructions received. With advancements in digital dentistry, dental trainees should have early exposure to the three-dimensional (3D) rendering of ideal preclinical objectives. A dental education technique using computer-aided design software and smartphones is described that will allow 3D rendering of ideal prosthodontic training assignments allowing early exposure to digital dentistry for dental training students.

A comparative evaluation of student experience with artificial teeth used in pre-clinical fixed prosthodontics post-core undergraduate teaching programs

INTRODUCTION

Research is lacking in the use of artificial teeth for post-core techniques in undergraduate fixed prosthodontics pre-clinical education. The aim of this study was to compare the reasons for selection and explore the direct student experiences with artificial teeth used in two pre-clinical fixed prosthodontics post-core technique teaching programs conducted in consecutive years.

MATERIALS AND METHODS

Fourth year undergraduate dental students who had completed the fixed prosthodontics pre-clinical program were invited to complete an anonymous online surveys. Information was requested on the use and direct student experiences with artificial and natural teeth for post-core techniques. Quantitative data was summarised and qualitative data was clustered into topics. The reasons for selection and use of artificial and natural teeth were compared within and between the two programs.

RESULTS

36% of 70 respondents in 2020 chose to use one or more artificial teeth for the post-core exercises in the pre-clinical program compared with 94% of 77 respondents in 2021 (p < .05). The use was driven by difficulty in sourcing appropriate natural teeth. Respondents reported "ease of use" as the dominant positive user experience with the main negatives being "unrealistic simulation of natural teeth" and "different surface texture/feel when cutting."

CONCLUSION

Artificial teeth were reported to provide an appropriate and realistic simulation experience compared with extracted natural teeth and were easier to source. Students focussed on the practicalities of sourcing artificial teeth, associated costs and ease of use ahead of conceivable educational benefits. Cost limited the more widespread use of artificial teeth.

Overview and knowledge of prosthodontic diagnostic aids among interns and post graduates - A cross-sectional questionnaire study

Aim

This study aims to evaluate and compare the knowledge of prosthodontic diagnostic aids among interns and postgraduates.

Settings and Design

A questionnaire survey was conducted to assess and compare the knowledge of prosthodontic diagnostic aids among interns and postgraduates. Based on the pilot study with alpha error 5% and a power of study 80%, the sample size was estimated to be 858 for each group.

Materials and Methods

The self constructed questionnaire consisted of 3 sections, of which each section had 5 questions, a total of 15 questions validated by a team of 6 experts. The questionnaire was distributed electronically among interns and postgraduates in various dental colleges across India. Data were collected and subjected to statistical analysis.

Statistical Analysis

All outcomes of this survey were analyzed using an independent t test. The Mann- Whitney test was used to determine the significance of two groups.

Results

From the results obtained, it was found that interns (mean: 6.90; standard deviation: 2.442) had less knowledge regarding diagnostic tools than postgraduate students (mean: 8.76; standard deviation: 1.818).

Conclusion

Diagnostic aids simplifies the process of diagnosis and treatment planning. Moreover, the knowledge of diagnostic aids among younger generation permits them to redefine the way dentistry is practiced and at the same time helps to provide better treatment results and achieve the utmost for the profession. Adequate knowledge of diagnostic aids is the need of the hour. Dental professionals should constantly update knowledge regarding various diagnostic aids in Prosthodontics, so as to arrive at optimum diagnosis and treatment plan with longer prognosis.

Introducing dental students to complete denture treatment in times of COVID-19: Students' responses

OBJECTIVES

The COVID-19 pandemic required changes in the complete denture courses to comply with lock-in and social distancing requirements. The objectives were to assess (a) dental students' interest in a required complete denture course and the prosthodontics specialty, (b) how much time students spent on studying background, lab, and clinical content, and (c) how difficult and helpful course components were. Additionally, open-ended responses concerning what the students liked and what they wanted to have changed were analyzed as well.

METHODS

After this "complete denture" course, 81 of 109 students responded to a web-based survey with questions about course content and design. This hybrid course consisted of weekly asynchronous virtual lectures, in-person simulated laboratory (sim lab) exercises, and synchronous virtual workshops.

RESULTS

Exactly 53.7% were much/very much interested in this course, with nobody considering prosthodontics as their specialty. The students studied on average of 79.61 minutes for 1 hour (of background-related lecture, 69.92 minutes for a lab-based lecture, and 77.00 minutes for a clinical-content lecture (p < 0.001). They evaluated clinical content as most difficult, lab content as less difficult, and background material as least difficult (3-point scale with 1 = not at all difficult: means = 1.90/1.85/1.80; p < 0.001). They rated background lectures as least helpful, clinical material as more helpful, and lab content as most helpful (5-point scale with 1 = most helpful: means = 2.33/2.67/2.96; p < 0.001). Open-ended answers showed exceptionally positive responses for content and pedagogy of sim lab and clinical content.

CONCLUSIONS

Gaining a better understanding of students' responses to hybrid "complete denture" courses is critical for optimally teaching this material in times of COVID-19.

Influence of a major pre-clinical programme restructure on undergraduate student fixed prosthodontics clinical unit completions

INTRODUCTION

Research is limited in measuring the effectiveness of pre-clinical programmes in preparing students for fixed prosthodontics clinical practice. The aim of this retrospectively study was to assess the influence of a major pre-clinical programme restructure on undergraduate student fixed prosthodontics clinical unit completions.

MATERIALS AND METHODS

The fixed prosthodontics treatment registers from 2011 to 2020 were reviewed, and units completed per student (UCS) and units completed per student per session (UCSS) were calculated in the years before (2011-2013) and after (2014-2020) a major pre-clinical programme restructure (PR). Data were summarised in Microsoft Excel software (version 2016), and Student's t-test and paired t-tests were performed to determine the significance of difference in UCS and UCSS in the years before and after the PR.

RESULTS

There was a significant difference in the UCS (p < .05) and UCSS (p < .01) in the years before and after the PR. The average UCS in the years before the PR was 2.20 units compared with 3.86 units after the PR, an increase of 75% per student. The average UCSS in the years before the PR was 0.15 units compared with 0.28 units after the PR, an increase of 87% per session.

CONCLUSION

The fixed prosthodontics pre-clinical programme restructure resulted in statistically significantly increased student clinical unit completions.

Application of a multimedia-supported manikin system for preclinical dental training

AIM

In this study, we aimed to describe a multimedia-supported manikin system, compare the new manikin with the traditional manikin and evaluate its effectiveness in preclinical dentistry training.

METHODS

A total of 150 students participated in this study. Amongst these students, 71 in the 2015-year group used traditional manikins (Group TM) for preclinical training courses (endodontics training courses and prosthodontics training courses), and 79 in the 2016-year group used manikins with a multimedia system (Group MM). The scores of the training courses between the two groups were compared. A questionnaire survey was used to collect opinions of the students in Group MM on their experience of using the multimedia-supported manikin system in the preclinical training.

RESULTS

In the endodontics training courses, the scores of Group MM were higher than those of Group TM, but there was no significant difference (P = 0.379 > .05). However, the scores of prosthodontics training courses in Group MM were significantly higher than those in Group TM (P = 0.018 < .05). The questionnaire results indicated that the students in Group MM were satisfied with the device in usability, clarity, effectiveness and improvement in operation proficiency.

CONCLUSIONS

In the groups studied, for preclinical dental training, the multimedia-supported manikin system was a good alternative to traditional manikin in preclinical dentistry training.

Comparison between conventional teaching and blended learning in preclinical fixed prosthodontic training: A cross-sectional study

INTRODUCTION

Blended learning utilizes technology with reduced face-to-face time and promotes a student-centred learning environment that excites the learning process. However, studies on blended learning in fixed prosthodontics is still lacking. This study aimed to compare students' performance in easy and difficult level of fixed prosthodontic preclinical projects given by either blended learning or conventional teaching.

METHODS

A cross-sectional study was conducted on 72 s-year dental students, who attended preclinical fixed prosthodontic training. Participants were randomly segregated into conventional teaching (n = 36) and blended learning (n = 36). All participants were evaluated for learning preferences using Visual-Aural-Read/Write-Kinesthetic (VARK) questionnaire and performed a project as their baseline skill assessment. They performed another two preclinical projects (easy and difficult level) after the allocated teaching approach. Learning preferences were analysed using Fisher's exact test and performance in preclinical projects were analysed with an independent t test (significant at p < .05).

RESULTS

The highest prevalence of learning preferences was the quad-modal preferences (50.7%), which were visual, auditory, reading/writing and kinesthetic. There were no significant differences in baseline skills and learning preferences (p > .05) between groups. No significant differences found between both teaching approaches for easy (p = .319) and difficult projects (p = .339). In the blended learning group, no significant difference was found in both difficulty level of projects (p = .064).

CONCLUSION

The participants performed equally on both teaching approaches. However, blended learning for preclinical fixed prosthodontics is anticipated as the new norm of learning, especially in the current pandemic with reduced face-to-face time.

Perceptions and challenges of a first-year dental student - A cross-sectional study

INTRODUCTION

Undergraduate dental training is demanding and rigorous, unaware students face a lot of challenges after entering the course. Thus, the study aims to find out from a dental sophomore the challenges they face during the first year of dental school.

METHODOLOGY

An e-questionnaire study was conducted on 932 second-year Bachelor of Dental Surgery students of India. The questions help us gauge problems and hurdles faced by a dental sophomore like information related to difficulty levels, laborious nature and so on. Chi-square test is to find out relativity and association between the variables.

RESULTS

Pre-clinical prosthodontics was found the most laborious and a gender-wise significant difference (P < 0.01) was noted amongst females (437, 71.06%) and males (157, 49.53%).

CONCLUSION

This study highlighted that students are usually unaware about the course, the type of content reading, learning, laborious nature of practical work and so on.

Agreement between two raters' evaluation for integrated Traditional Prosthodontic Practical Exam with Directly Observed Procedural Skills in Egypt

PURPOSE

It aimed to determine the agreement between two raters evaluating students at prosthodontic clinical practical exam integrated with directly observed procedural skills (DOPS).

METHODS

A sample of 76 students was monitored by two raters to evaluate the process and the final registered maxillomandibular relation for completely edentulous patient in Mansoura Dental School, Egypt at practical exam of the Bachelor students on May 15, till June 28, 2017. Each registered relation was evaluated from total 60 marks subdivided to three score-categories: occlusal plane orientation (OPO), vertical dimension registration (VDR), and centric relation registration (CRR). The marks of each category included mark of DOPS. The marks of OPO and VDR for both raters were compared by graph method to measure reliability using the Bland and Altman analysis. The reliability of CRR marks was evaluated by Krippendorff's alpha ratio.

RESULTS

The results revealed similarity between raters for OPO (mean = 18.1) and closes of limits of agreement (0.73 and -0.78). For VDR, there were closeness of means (mean= 17.4 and 17.1 for examiner 1 and 2 respectively); with limits of agreement (2.7and-2.2). There was a strong correlation (Krippendorff's alpha ratio= 0.92; 95% CI [0.79-0.99]) among raters at evaluating CRR.

CONCLUSION

The two raters' evaluation of clinical traditional practical exam integrated with directly observed procedural skills revealed not to be different to evaluate candidate at the end of the clinical prosthodontic course. The limits of agreement between raters would be optimum at exclusion subjective evaluation parameters and complicated cases from examination procedures.

Pilot study on the effectiveness and students' attitude towards undergraduate training provided by industry

INTRODUCTION

Rapid developments in CAD/CAM technology necessitate the adaptation of curriculum content. Limited resources hinder institutions in holding state of the art equipment available for student training.

MATERIALS AND METHODS

A workshop given by an industry partner was organised as part of the final pre-clinical course in prosthodontics for the academic years 2015 and 2016. The workshop on dental ceramics and CAD/CAM technology comprised of lectures and practical demonstrations. Multiple-choice examinations prior to and after the workshop as well as questionnaires were used for assessing effectiveness and students' perception. The test scores and evaluation results were compared using Fisher's exact test of homogeneity (α = 0.05).

RESULTS

The workshop improved students' performance in the written examination. With the exception of 1 question, students having attended the workshop performed significantly better (P < .05). The majority of students felt that the workshop fostered their knowledge in the field of dental ceramics and CAD/CAM. Whilst only a small portion (<10%) disapproved industry-supported education, up to 45% of the participants considered the workshop as sales promotion. The students were undecided on whether or not competitor companies should be invited to present on the same topic and whether or not more industry-supported courses would be beneficial.

DISCUSSION

Industry-supported education appears to be a necessity in the field of CAD/CAM dentistry, but care has to be taken to select adequate partners, and the content of courses has to be controlled.

Rubric system for evaluation of crown preparation performed by dental students

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Effect of Too Much Caring: A Preliminary Study

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

DISCUSSION

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

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

INTRODUCTION

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

AIM

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

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

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

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

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

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

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

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

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

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

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Teaching of Fixed Prosthodontics: A Paradigm Shift

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

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

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

Characteristics Identified for Success by Restorative Dental Science Department Chairpersons

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

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

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

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

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

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

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

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

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

Development of a Drilling Simulator for Dental Implant Surgery

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

Utilizing CAD/CAM to Measure Total Occlusal Convergence of Preclinical Dental Students' Crown Preparations

Traditionally, faculty assessment of preclinical crown preparations occurs by visualizing preparation features. However, contemporary CAD/CAM tools have the ability to more precisely evaluate preparation features, which is beneficial for psychomotor development. Taper is one of the most challenging features to objectively assess. The aim of this study was twofold: first, to validate the software's ability to distinguish differences in taper, and second, to compare traditional faculty assessment with digital assessment of taper. In the study, 30 all-metal crown preparations were created on typodont teeth with varying degrees of axial reduction and placed into three groups based on amount of taper (minimum, moderate, or excessive). Each tooth was scanned with the D4D scanner, and the taper was analyzed using E4D Compare. A second experiment used 50 crown preparations of tooth #19, which were done as a formative exercise. A comparison faculty assessment with CAD/CAM assessments of taper was performed. The results showed that when the taper was varied, E4D Compare was able to distinguish those differences; the Tukey post-hoc test revealed a significant difference (p=0.001). The qualitative analysis comparing faculty grading to CAD/CAM grading demonstrated a trend for CAD/CAM to be more precise. These results suggest that E4D Compare is an effective means of quantitatively measuring the amount of total occlusal convergence or taper on a crown preparation and that digital assessment may be more precise than faculty visual grading.