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It has been found that the plastic models significantly enhance the student's knowledge of the anatomy of teeth as it relates to operative dentistry. The fact that the models are three-dimensional eliminates guesswork as to the exact position of the pulp, and the rigidity of the plastic cast enhances the recovery of morphological features of the pulp as it existed in the natural tooth.
OBJECTIVE: The purpose of this study was to evaluate the teaching program of Class I and Class II resin-based composite (RBC) restorations in Brazilian dental schools and to observe if any differences were found from similar surveys conducted in North American, European, and Japanese dental schools. METHOD AND MATERIALS: A questionnaire containing 15 questions was distributed to 92 Brazilian dental schools, and 64 (70%) schools returned the questionnaire. The questions inquired the amount of time the curriculum dedicated to teaching of posterior RBC restorations, future expectation regarding the teaching time, limitation in extension of the occlusal width and the proximal box in Class II, contraindications for placing posterior RBC restorations, protocol for using bases and liners, brand of bonding agents and RBC used, instruments and techniques employed for finishing, cost relative to amalgam restorations, and biologic reactions related to the use of posterior RBC. The responses were calculated as percentages based on the number of schools that responded to the questionnaire. Where appropriate, the Chi-squared test and the Fisher exact test were used for statistical analysis. RESULTS: Of the dental schools that responded, 88% dedicated 10% to 50% of the teaching time in operative dentistry to posterior RBC restorations. A significant correlation (P = 0.041) was found between the percentage of time dedicated to the teaching of posterior RBC restorations and the higher cost of posterior RBC compared to amalgam restorations. Resin-based composite restorations cost 30% to 70% more than amalgam restorations in the 40% of dental schools that charged a fee. Posterior composites for large restorations in molars were used by 14% of the dental schools. Base and liner were not placed by 10% of dental schools in deep Class I or Class II RBC restorations. One school did not recommend acid etching of the dentin. CONCLUSION: No major differences were found in the teaching philosophy of posterior RBC restorations by comparing the Brazilian data to the data from similar surveys done in North America, Japan, and Europe.
Microdentistry is a science-based tool of operative dentistry, and is an alternative to traditional dentistry. The structures and substructures of teeth have been generally misunderstood. Once these structures are understood, the goal of the microdentist is to identify unsound tooth structure, which is a threat to the long-term stability of the tooth, and then neutralize or remove those structures with minimal disruption of the surrounding sound tooth structure. Minimal disruption of sound tooth structure provides the additional patient benefit of reducing or eliminating the pain associated with traditional dentistry. This article reviews some of the newly discovered structures in human teeth and discusses methods of microdentistry used to preserve these structures.
Operative Dentistry and Endodontics' Department of the School of Dentistry of Abidjan experienced pre-clinical exam in fourth year of dentistry with MCQ following guided courses which aim was to lead student to be correctly in charge of the patients when they start their first clinical performance. The objective off his this work is to show how one's can analyse exams questions efficiently. In this work the authors present et discuss the results of the evaluation of this preclinical exam performed through calculation of index of success (Ir) which gives us information on the difficulty of a question for all the students who answered, the discriminative index (Id) which allow to determine when a question is selective enough to distinguish weak to strong students in a group. The mean to evaluate is well chosen because the questions asked has a Ir between 46% et 80% (satisfying Ir) and the average Id is between 0.30 and 0.53 (Id discriminates well among 0.30 et 1). This methodology allows an evaluation of a high number of students by stocked questions.
The placement of resin composites in posterior teeth is now a common procedure in dental practice. The aim of this study was to investigate current teaching of this procedure in Canadian dental schools and to compare trends in teaching with those in the United States. This study complements other investigations in which we examined teaching of the use of posterior resin composites in dental schools in the United States, Ireland and the United Kingdom. A questionnaire was distributed by email to the faculty member in each of the 10 dental schools in Canada with responsibility for teaching the operative dentistry curriculum, including the placement of posterior resin composites. The response rate was 100%. More teaching of posterior resin composites was noted since the time of a survey in the late 1990s. The amount of teaching and clinical experience in the use of posterior resin composites in Canadian dental schools seems to be higher than in dental schools in the United States. As noted in surveys of other countries, variation among Canadian teaching programs was found to persist in relation to techniques and technologies used.
Though repeatedly proclaimed as an indispensable element of quality operative dentistry, the rubber dam is seldom used in private practice. This is because of numerous hazards and inconveniences for the patient and dentist which have been rarely mentioned. These dangers and more effective alternatives to the dam's use in modern dentistry are discussed.
It was the goal of this study performed in two subsequent technical courses of operative dentistry to find out if the first "professional" contact of dental students with amalgam resulted in a increased mercury excretion. At six different points in time urine analyses using (flame-free) cold vapor nuclear absorption spectroscopy were performed. At the first measurement, prior to working with amalgam, the median values were at 0.53 micrograms Hg/g creatinine (summer term 88) and 1.46 micrograms Hg/g creatinine (winter term 88/89). At the end of the course the median values have increased to 2.49 micrograms Hg/g creatinine (summer term 88) and 2.56 micrograms Hg/g creatinine (winter term 88/89). In the subsequent vacations the Hg values in the students' urine clearly decreased.
Dental education is burdened by outdated curricula, which are based on yesteryear's concepts. As a result, caries and restored teeth are still largely "managed" by traditional operative dentistry. This leads into a repeat restoration cycle, which fails to address the fundamental bacterial nature of caries, the primary raison d'être for this form of therapy. At the same time, many fundamental changes have taken place in the parameters that affect, or should affect, dental care. These range from an improved scientific understanding of the caries process, to a realization by society that maintaining oral health through regular preventive dental care, as opposed to ongoing restorative dental procedures, is a worthwhile and achievable goal. Dental education needs to rise proactively to the challenges presented by the new parameters of modern dental care, or it will be forced to make changes from a defensive position. The ultimate change, which most readers would not consider trivial, would be the closure of one or more of Canada's 10 dental schools.
Operation research techniques have successfully been applied to economical order situations. An Economical Recall System (ERS) model, based on this theory, is proposed for curative and preventive dental care. The ERS model assumes a preventive procedure with no lead time between application and initiation of effect, an immediate decline in morbidity level once the effect is initiated, and linear increasing rate of morbidity. The model also assumes a positive net present value of the prevention program and therefore the question approached is the optimal time sequence at minimal cost. The model supplies a valuable tool for analyzing the effect of the curative, preventive and administrative components of a program and how changes in each, or any combination, of these variables will affect the end results.
As part of an evaluation of Project ACCORDE a questionnaire survey was conducted of all U.S. dental school deans, heads, and selected faculty of operative dentistry departments, and selected directors and key faculty of dental hygiene and assisting programs. The survey was supplemented by on-site visits to four dental school operative dentistry departments and five dental auxiliary training programs where the Restoration of Cavity Preparations with Amalgam and Tooth-Colored Materials package was used. The visits included observation of instruction and interviews with faculty and students. This paper summarizes the results including: the extent to which the materials have been adopted, user and nonuser reactions, perceived costs and benefits, and implications for the future of Project ACORDE.
Disparities among dental schools concerning the teaching and practice of cariology and operative dentistry can lead to variations in students' treatment modalities that can have health and economic consequences for patients and third party providers. The purpose of this study was to assess caries management strategies taught in French dental schools employing a questionnaire used in a previous study involving private dentists. The study population consisted of 180 teachers of operative dentistry. Each teacher received a questionnaire and a reply-paid envelope. The questionnaire assessed their treatment strategies, knowledge and beliefs about selected aspects of diagnosis, and treatment of dental caries. After one reminder, the response rate was 49.1 percent. The results illustrate a wide disparity among French teachers concerning restorative treatment thresholds for approximal surfaces, opinions about the rate of caries progression, and the need to monitor lesions near the DEJ. The teachers' attitudes differed from those of private practitioners: they tended to intervene surgically at a later stage, but they would intervene earlier in the treatment of the carious process than would Scandinavian dentists. This study may help in encouraging dental faculties to develop a consensus on issues related to diagnosis and management of dental caries.
The term "Minimal Invasive (MI) Dentistry" can best be defined as the management of caries with a biological approach, rather than with a traditional (surgical) operative dentistry approach. Where operative dentistry is required, this is now carried out in the most conservative manner with minimal destruction of tooth structure. This new approach to caries management changes the emphasis from diagnosing carious lesions as cavities (and a repeating cycle of restorations), to one of diagnosing the oral ecological imbalance and effecting biological changes in the biofilm. The goal of MI is to stop the disease process and then to restore lost tooth structure and function, maximizing the healing potential of the tooth. The thought process which underpins this new minimal invasive approach can be organized into three main categories: (1) Recognize, which means identify patient caries risk, (2) Remineralize, which means prevent caries and reverse non-cavitated caries, and (3) Repair, which means control caries activity, maximize healing and repair the damage. The disease of dental caries is not just demineralization, but a process of repeated demineralization cycles caused by an imbalance in the ecological and chemical equilibrium of the biofilm /tooth interface (the ecological plaque hypothesis). Dietary and lifestyle patterns, especially carbohydrate frequency, water intake and smoking, play an important role in changing the biofilm ecology and pathogenicity. Tools for chairside assessment of saliva and plaque, allow risk to be assessed and patient compliance monitored. The remineralizing properties of saliva can be enhanced using materials which release biologically available calcium, phosphate and fluoride ions (CPP-ACP and CPP-ACFP). Use of biocides can also alter the pathogenic properties of plaque. Use of these MI treatment protocols, can repair early lesions and improve patient understanding and compliance. This review article introduces some of the key concepts and practical aspects of minimally invasive dentistry.
The aim of this study was to evaluate whether the skills of final-year dental students in the diagnostic interpretation of bitewing radiographs could be improved by additional didactic instruction. 6 consecutive classes of students in the same stage of education (last semester in the Department of Operative Dentistry) took part in the investigation from 1995 to 1998. At the beginning of each semester, the same in vivo made bitewing radiograph was demonstrated in a separate radiology revision lecture and interpreted with the students. The intensification of the training in the diagnosis of bitewing radiographs was made when the 4th class of students started. At the end of each semester, each student of the 6 consecutive classes was asked to evaluate the same bitewing radiograph, which had been demonstrated at the start of the semester. The students were not told that they had already diagnosed from this radiograph before. The results of the radiographic diagnosis were then analyzed using an evaluation system paying special attention to the treatment decision. True positive and true negative diagnoses were scored as correct and false positives and false negatives as incorrect. There was no significant difference (ANOVA) in the ability to diagnose from bitewing radiographs between the groups of students who received, and those who did not receive, additional training. The benefits of this type of additional instruction in the last semester in the Department of Operative Dentistry seem only to be important in some individual cases.
In conjunction with its problem-based learning curriculum, Harvard School of Dental Medicine (HSDM) developed a shortened preclinical restorative training curriculum. This study compared our curriculum with those in other dental schools and examined student reaction to it. Twenty-nine U.S. dental schools responded to a survey regarding the length of their preclinical course in Operative Dentistry. Nationally, preclinical courses ranged from 179 hours to 280 hours (mean +/- SEM = 193 +/- 9 hours; n = 29). In marked contrast, the new seventy-five-hour preclinical curriculum at Harvard was the lowest of any school, and significantly lower than the U.S. average (p < 0.01). In Harvard's previous curriculum, students spent 232 curriculum hours. Reactions of Harvard students to this compact preclinical curriculum were surveyed using a three-topic, three-category survey instrument. Results indicated that, prior to beginning clinical patient care, approximately 80 percent of students felt that the course was too short and 20 percent just right. Conversely, and retrospectively, after completing their dental school training, only 35 percent felt it was too short, and 65 percent felt it was just right. Retrospectively, in terms of clinical preparedness, 55 percent felt adequately prepared and 35 percent felt well prepared to treat their patients. No significant change was noted between Part II National Board scores following the change to the reduced curricula time. The average National Board Part II scores prior to initiating the new curriculum was 86.3, and afterwards, it was 86.2. Further, for the North East Regional Board, HSDM students in the past four years demonstrated a 98 percent overall success rate with 100 percent primary pass in the operative dentistry part of the examination. These results suggest that an abbreviated preclinical training is not only possible, but may make time available for training opportunities in other areas, such as aesthetic dental procedures and new biomaterials.
The use of virtual reality (VR) in the training of operative dentistry is a recent innovation and little research has been published on its efficacy compared to conventional training methods. Two groups of dental students, with no experience in operative dentistry, were trained solely by either VR or conventional training in the preparation of conventional class 1 cavities. The subjects all used the same operative armamentarium and phantom heads, and were allocated the same duration of practice periods. At the completion of these training periods, both groups produced two class 1 cavities on the lower left first molar, which were subsequently coded and blindly scored for the traditional assessment criteria of outline form, retention form, smoothness, cavity depth and cavity margin angulation. An ordinal score of 0-3 or 0-4 was assigned for each assessment criterion: the higher the score, the worse the evaluation. After initial independent scoring, the two examiners discussed any notable differences until an agreed score was reached. Once the codes were broken, non-parametric analyses were performed on the data. Wilcoxon Tests for the semiquantitative scores indicated significant differences between the VR and conventional training groups for outline form, depth and smoothness but not for retention or cavity margin angulation at P < 0.05 level, with the VR group receiving the higher, i.e. worse, scores. Cavity margin angulation approached significance with a P-value of 0.0536. The results indicated that VR-based skills acquisition is unsuitable for use as the sole method of feedback and evaluation for novice students.
In the recent years, the scope of conservative dentistry with emphasis on esthetics has increased by leaps and bounds in enhancing individual personality. Composite resins are important for aesthetic restorations in dentistry, specifically in operative dentistry. But without bonding agents the success of composite restorations is minimized. Researchers are constantly endeavoring to improve the quality of bonding agents. The advent of new bonding systems which are capable of bonding both enamel & dentin has opened new avenues in the field of restorative dentistry. With the market floating with new bonding agents claiming superior bonding properties, this study was undertaken to investigate the degree of bond strength produced by three commercially available bonding agents (Syntac, Scotchbond 1, & Clearfil SE) with composite resin (Esthet-X) taken for the experimental procedure.
Two areas of research will prosper and change operative dentistry in the future: developing light-cured glass ionomer technology further, and reinforcing direct composite resin technology. Successful development of restorative materials in these areas will have an immediate and long-term effect on the practice of operative dentistry in both affluent and poor countries of the world.
Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high success of conventional root canal treatment. Surgical intervention is required for cases where retreatment has failed or is not an option, and the tooth is to be retained rather than extracted. This article reviews the operation of apicectomy and how this minor oral surgical procedure has evolved. Recent modifications to techniques and materials are likely to improve its success, allowing conservation of previously unsaveable teeth.