Mark Woolford

Three-year clinical evaluation of two ceramic crown systems: A preliminary study

STATEMENT OF PROBLEM The clinical performance and failure mechanisms of recently introduced ceramic crown systems used to restore posterior teeth have not been adequately examined. PURPOSE The purpose of this prospective clinical study was to evaluate and compare the clinical performance of 2 new ceramic crown systems with that of metal ceramic crowns using modified United States Public Health Services (USPHS) criteria. MATERIAL AND METHODS Ninety posterior teeth requiring crown restorations in 48 patients were randomized into 3 equal groups (n=30) for which different crown systems were used: an experimental hot-pressed glass ceramic based on a modified lithium disilicate ceramic (IPS e.max Press), an alumina-coping-based ceramic (Procera AllCeram), and a metal ceramic (Simidur S 2 veneered with IPS Classic Porcelain). The crowns were assessed over 3 years using the modified USPHS criteria. Crowns that developed visible cracks were sectioned and removed, and the surfaces were analyzed using a scanning electron microscope (SEM). The data were analyzed using the Kruskal-Wallis nonparametric statistical test, followed by the Mann-Whitney test with Bonferroni correction (alpha=.05). RESULTS USPHS evaluation showed that the IPS e.max Press and metal ceramic crowns experienced fewer clinical changes than Procera AllCeram. Visible roughness, wear, and deformity were noticed in occlusal contact areas of Procera AllCeram crowns. SEM images showed well defined wear facets in both ceramic crown systems. Kruskal-Wallis tests showed a significant difference (P<.05) in Alpha scores among the 3 crown systems. Mann-Whitney tests showed significant differences among groups. CONCLUSIONS IPS e.max Press crowns demonstrated clinical behavior comparable to Procera AllCeram and metal ceramic crowns, but the wear resistance of this crown type was superior to the Procera AllCeram crowns, according to modified USPHS criteria.

Threshold concepts in dental education.

The paper presents a conceptual framework to inform dental education. Drawing from a vast body of research into student learning, the simple model presented here has an explanatory value in describing what is currently observed to happen and a predictive value in guiding future teaching practices. We introduce to dental education the application of threshold concepts that have a transformative role in offering a new vision of the curriculum that helps to move away from the medieval transmission model of higher education towards a dual processing model that better reflects the way in which professionals operate within the discipline. Threshold concepts give a role for the student voice in offering a novice perspective which is paradoxically something that is out of reach of the subject expert. Finally, the application of threshold concepts highlights some of the weaknesses in the competency-based training model of clinical teaching.

Outreach clinical dental education: the Portsmouth experience – a 4-year follow-up study

BACKGROUND The Portsmouth Dental Academy (UPDA) was opened in September 2010 and was a development from the highly successful School of Professionals Complementary to Dentistry (2004-2010). The aim of the Academy was to provide integrated team education for all dental professionals in a primary care setting. The dental students are on outreach from Kings College London, and the dental care professional students are registered at the University of Portsmouth. OBJECTIVES To evaluate the dental students response to the residential outreach educational experience at the UPDA. METHODS A 49-item questionnaire divided into nine domains that provided both qualitative data and quantitative data were administered at the end of the longitudinal 10-week placement, to four successive cohorts of students in 2010-2014. RESULTS A 95% return rate was achieved. Students valued highly the quality of the clinical teaching. Through their experience, they felt they understood fully the role of the dentist in care planning in primary care and felt well prepared for dental foundation training. This educational success is unpinned with successful maintenance factors including a well-organised induction period and giving the students a sense of belongingness, empowerment and autonomy for their personal development as new graduates. CONCLUSION Within the limitations of the questionnaire study over the 4-year period, the students were very positive about all the aspects of this residential outreach education at the UPDA but particularly valued the immersion in clinical dentistry and the bridging from dental school to their dental foundation training.

Clinical Skills Acquisition: Rethinking Assessment Using a Virtual Haptic Simulator

This study was the fourth study (Study 4) of four consecutive cohort studies (2007/2008, 2008/2009, 2009/2010 and 2010/2011) of over 520 dental undergraduate first year students at King’s College London as part of their 5-year undergraduate programme. The study reported in this paper is a 2-year longitudinal investigation of 140 first year students (and subsequent second year) who were being trained to develop their clinical dental skills. In this study students used both the traditional Phantom-head laboratory and a haptically simulated virtual reality systems (HapTEL) laboratory to develop their basic clinical skills. Pre- and post-psychometric tests were used to measure their spatial reasoning and manipulation skills. The test scores and traditional clinical examinations results showed significant improvement in their psychomotor skills especially in the area of spatial awareness within a 3-months period (one term) of pre-clinical training. The results showed that using psychometric tests can reveal specific skill development amongst students not identified by traditional assessment methods. This study complements the previous studies in showing the development of psychomotor skills by practising virtual reality simulators can be monitored and measured through stages of skill acquisition more accurately and objectively. These results confirmed the consistency of skill improvement through the three phases of skill acquisition although more analysis is needed of the specific types of tests which reliably measured these skill phases. The result of this research could therefore inform the development of formative and summative dental clinical skills’ assessment to measure and monitor the student’s psychomotor training with more regular and instant feedback in an objective way using computers along with the traditional Phantom-head mannequin.

Innovations in Teaching and Learning Strategies to Improve the Effectiveness of Using Haptic Simulators in Higher Education for Dental Students and Other Health Care Disciplines

This paper briefly reviews the teaching and assessment strategies developed over ten years of trials with over 1200 undergraduate students to make effective use of virtual haptic simulators in higher education disciplines such as dentistry and nursing. In the last five years (2012–17) these strategies have evolved to include a range of technology enhanced learning resources (TEL) in a blended learning setting to assess the performance progression of students’ learning cavity preparation skills. Every students’ performance outcomes were retrieved from the hapTEL simulator log files for each task including the percentage of caries, healthy tissue and pulp removed. The use of a blend of video recorded short lectures followed by face to face teaching, pair working, haptic, visual images and sound feedback, and individual student assessment record keeping showed an improved reliability in performance of the work-stations and a consistently higher rate of student’s log files records compared with previous years. Records of students’ performance collected over two years showed that the HapTEL system enabled students to perform better at cavity preparation after practising over two sessions.

The future of dentistry

The challenge this paper seeks to address is to look beyond the immediate and medium-term issues facing dental education and training in the next 10 years1 and to scope anticipated trends and changes to be considered in longer term strategic planning for dental workforce development. Despite its limitations (and flaws), future scoping is important, especially when considering investment in infrastructure and succession-planning, which involves programmes of training and development extending over many years. Of course, the further into the future one goes, the greater the risk of unforeseen developments and events that can adversely affect the predictions; the vision articulated in this paper must therefore be interpreted with caution. Welcome to the world of tomorrow…

Training tomorrow’s dentists

Dental schools have an immense responsibility.They train dentists and typically other oral healthcare professionals for the future, which for many, if not most, can be 30–40 years hence. Exactly what will be required over this time is impossible to predict, judging by the range and impact of advances seen in recent years.The programme of instruction leading to initial registration is, and will remain, a foundation for life-long professional development rather than an end-point in itself.The need for continuing professional development and the soon to be introduced arrangements for revalidation are fundamental to the best interests of patients, let alone the future of the profession.A simple truth is that the undergraduate programme can never teach a dentist all that needs to be known about the clinical practice of dentistry, especially to a level of ‘competence’. Notwithstanding core knowledge and competencies, many topics are introduced into learning and teaching, leaving the learner to expand and develo...