Elaborative feedback in clinical dental teaching-An assessment from the students' perspective.

INTRODUCTION: The aim of this prospective learning research study is to examine the impact of structured elaborative feedback in clinical dental skills teaching from the students' perspective. MATERIAL AND METHODS: A total of 60 dental students participated in the study. The mean average age was 23 years (20-40 years), of which 37 were female (61.7%) and 23 male (38.3%). The participants were randomly divided into a study and control group (n=30 each). The curriculum for clinical tooth-shade differentiation is a complete educational module. Recording of shade taking was carried out on the phantom patient using clinically simulated settings with elaborative feedback in the study group. Pre-test (begin of module T1) and post-test (end of module T2) questionnaires were used to assess knowledge and interest in connection with elaborative feedback. Subjective learning success from the students' perspective and the acceptance of the learning environment were recorded using a questionnaire at the end of the module. The responses corresponded to a Likert scale. The STATA program (Stata/MP 12, StataCorp, CollegeStation, USA) was used for statistical analyses (p<0.05). RESULTS: A clear improvement in the quality of response in both groups was observed for questions regarding knowledge of the content and interest (p<0.001). The highest values were achieved at reference time T2 for "Practical steps with digital tooth-shade measurement devices" in the study group. Subjective success in terms of learning and the acceptance of the learning environment tended to be rated more highly in the study group. These results corresponded with the reduction of errors during the practical exercises. All participants (100%) in the study group found individual feedback to be helpful.

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.

Concept of computer-assisted clinical diagnostic documentation systems for the practice with the option of later scientific evaluations.

Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense ("effective anonymization"). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices.

Computer-aided examination reports in clinical functional analysis of TMD.

Clinical functional analysis is the first step in the diagnostic cascade in the diagnosis of craniomandibular dysfunction (CMD). This examination comprises palpation of the muscles, auscultation of noises in the temporomandibular joint, registration of jaw mobility as well as the search for dysfunctional contact relations in static and dynamic occlusion. The structured evaluation of these findings enables an initial diagnosis to be made as the basis for further diagnostics and therapy. Because of the complexity of the material, both the referring dentists and the patients expect a meaningful examination report. However, writing it is extremely time-consuming. New software for the semi-automatic generation of such illustrated medical reports has therefore been developed to reduce internal costs and provide quality assurance. The CMD medical report assistant (dentaConcept) imports the examination data and initial diagnoses through a standardized interface from the dentaConcept diagnostic software CMDfact. The CMD medical report assistant assigns matching texts to the findings on the basis of random number generators and combines these findings-dependent texts with illustrations of the most important findings as well as standard texts. The software transfers the multi-page examination report to the standard Microsoft Word for Windows word processing program, saves the data by means of an individualizable file name generator and uses the Word functions for the color printout.

The linear shade guide design of Vita 3D-master performs as well as the original design of the Vita 3D-master.

Visual tooth colour assessment by use of the Vita 3D-Master(®) (3D; Vita Zahnfabrik, Bad Säckingen, Germany) is well documented. To improve handling, a new linear arrangement of the shade tabs has been introduced (LG; Linearguide 3D-Master(®) ). The purpose of this study was to investigate whether the linear design has an effect on shade matching. Fifty-six students underwent identical, theoretical and practical training, by use of an Internet learning module [Toothguide Training Software(®) (TT)] and a standardised training programme [Toothguide Training Box(®) (TTB)]. Each student then matched 30 randomly chosen shade tabs presented in an intra-oral setting by a standardised device [Toothguide Check Box(®) (TCB)]; 15 matches were made using the 3D and 15 using the LG shade guide system, under a daylight lamp (840 matches for each guide). It was recorded to what extent the presented and selected shade tabs, or the lightness group of the tabs, matched, also the needed time for colour matching. The results showed that 35% of perfect matches were observed for the 3D and 32% for the LG. The lightness group was correct in 59% of cases for 3D and 56% for LG. Mean time needed for matching of tabs and lightness group was no different between groups (no significant difference for any assessment). Within the limitations of the study design, the colour assessment with regard to performance and time needed in shade matching was not different with the LG or the 3D. Therefore, the user should choose which shade tab arrangement is more applicable.

Development of a bibliographical search matrix exemplified by a computer-assisted literature search on the evidence of condyle position analysis.

Apart from monographs, textbook publications and publications on websites, scientific studies have also been published concerning the method of condyle position analysis. Determination of the current research status, which can serve as basis for further scientific publications, would therefore be helpful. Accessing the texts published on this subject in scientific journals is comparatively difficult, since a keyworded search term by which the subject area can be narrowed down directly is not available in the dline" database. The development of a computer-assisted bibliographical search matrix, which facilitates clear identification of relevant publications in scientific journals through "Medline", is described in this paper as an example. This search matrix can be used in corresponding web services and can also be imported into research software and saved for future computer-assisted searches. The currently available scientific studies on condyle position analysis have been found and structured with regard to contents on the basis of the search matrix and with the aid of other research sources. The matrix describing the structure of the contents serves as a logical classification on the basis of which the publications have been classified. In addition to the classification by subject, the evidence levels were determined for the scientific studies - on the basis of their concept - and thus the external evidence on condyle position analysis as a procedure was developed.

Development of a computer-assisted system for model-based condylar position analysis (E-CPM).

Condylar position analysis is a measuring method for the three-dimensional quantitative acquisition of the position of the mandible in different conditions or at different points in time. Originally, the measurement was done based on a model, using special mechanical condylar position measuring instruments, and on a research scale with mechanical-electronic measuring instruments. Today, as an alternative, it is possible to take measurements with electronic measuring instruments applied directly to the patient. The computerization of imaging has also facilitated condylar position measurement by means of three-dimensional data records obtained by imaging examination methods, which has been used in connection with the simulation and quantification of surgical operation results. However, the comparative measurement of the condylar position at different points in time has so far not been possible to the required degree. An electronic measuring instrument, allowing acquisition of the condylar position in clinical routine and facilitating later calibration with measurements from later examinations by data storage and use of precise equalizing systems, was therefore designed by the present authors. This measuring instrument was implemented on the basis of already existing components from the Reference CPM und Cadiax Compact articulator and registration systems (Gamma Dental, Klosterneuburg, Austria) as well as the matching CMD3D evaluation software (dentaConcept, Hamburg).

Condylar position analysis with a new electronic condylar position measuring instrument E-CPM: influence of different examiners and a working bite on reproducibility.

PURPOSE: Condylar position analysis facilitates a quantitative comparison of the condylar position with and without a bite record, different records and changed influencing factors. Handling by the examiner when positioning the model is a significant factor with regard to the accuracy of the examination. Measurement accuracy could be improved when positioning the models by using special working bites, hence the objective of the experiments described in this study consisted in examining the extent to which the measuring results are influenced by different examiners and by using working bites. MATERIALS AND METHODS: In the first trial, one examiner performed ten measurements without and with an interposed working bite for five model pairs in each case. In the second trial, nine examiners (three specialized dentists, three dental assistants, three students) performed ten measurements in each case without and with an interposed working bite. The three-dimensional position was read digitally with the E-CPM (Gamma Dental, Klosterneuburg/Vienna, Austria), recorded by means of spreadsheet software (Microsoft Excel) and diagnostic software (CMDfact, CMD3D module, dentaConcept, Hamburg), and evaluated with graphing software (Sigma Plot, Systat Software, USA). RESULTS: In the first trial, it was shown that the reproducibility of mounting was improved markedly (p <0.01) by using bite records in the form of working bites. In the second trial, it was shown that the mean error increased significantly (p <0.01) when several examiners performed the measurements compared with the results of one examiner alone. No significantly different results occurred (p < 0.01) in the comparison of the different groups of examiners with different educational and training backgrounds. This applied for the mounting methods without and with working bite. On the other hand, the reproducibility of mounting improved distinctly (p<0.01) in every group of examiners when working bites were used. CONCLUSIONS: Reproducibility of condylar position analysis was improved significantly by mounting the models with special working bites. This applied for operators of different professional background (dentists, dental assistants and dental students), while there were no significant differences between results of the three groups.

Evidence-based development of a diagnosis-dependent therapy planning system and its implementation in modern diagnostic software.

The prerequisite for structured individual therapy of craniomandibular dysfunctions is differential diagnostics. Suggestions for the structured recording of findings and their structured evaluation beyond the global diagnosis of "craniomandibular disorders" have been published. Only this structured approach enables computerization of the diagnostic process. The respective software is available for use in practice (CMDcheck for CMD screening, CMDfact for the differential diagnostics). Based on this structured diagnostics, knowledge-based therapy planning is also conceivable. The prerequisite for this would be a model of achieving consensus on the indicated forms of therapy related to the diagnosis. Therefore, a procedure for evidence-based achievement of consensus on suitable forms of therapy in CMD was developed first in multicentric cooperation, and then implemented in corresponding software. The clinical knowledge of experienced specialists was included consciously for the consensus achievement process. At the same time, anonymized mathematical statistical evaluations were used for control and objectification. Different examiners form different departments of several universities working independently of one another assigned the theoretically conceiveable therapeutic alternatives to the already published diagnostic scheme. After anonymization, the correlation of these assignments was then calculated mathematically. For achieving consensus in those cases for which no agreement initally existed, agreement was subsequently arrived at in the course of a consensus conference on the basis of literature evaluations and the discussion of clinical case examples. This consensus in turn finally served as the basis of a therapy planner implemented in the above-mentioned diagnostic software CMDfact. Contributing to quality assurance, the principles of programming this assistant as well as the interface for linking into the diagnostic software are documented and also published here.

Computer assistance in clinical functional analysis.

The use of computers in the dental practice has been primarily restricted to the acquisition of billing data. Additional possibilities for use of PCs exist in diagnostic data acquisition and evaluation; clinical functional analysis seems a particularly suitable application. Such software is now available: CMDfact. Dentally, it is based on a previously developed and published examination and documentation system, the graphic user interface of which is used in the newly developed software. After the examination data have been acquired by mouse click or numerical entry, these are available for evaluation. A special function, the "Diagnosis pilot" is integrated to support the user. This helps in the assignment of the appropriate "Initial diagnoses", since it brings together the individually existing principal symptoms and suitable diagnoses for the initial diagnosis in question and also states which diagnoses "would be appropriate" for this, but are not available. With 3D animation, the software also helps the dentist to explain aspects of CMD to patients. The software also assists the dentist with a detailed multimedia help system, which provides context-sensitive help for every examination step. These help functions explain the sense of the relevant examinations, their performance and evaluation in the form of short texts and explanatory photographs and videos.

[Influence of surface conditions on the results of Periotest value. An in vitro and in vivo study]. / Der Einfluss äusserer Randbedingungen auf das Ergebnis der Periotest-Messung. Eine in vitro- und in vivo-Untersuchung.

In several experiments it was examined, whether slight deviations from the using reglementation for the PERIOTEST-device alter the measurement results. Tilting of the handpiece against ground or variation of the distance between handpiece and the surface of the tooth within the suggested intervals did not alter the PERIOTEST-value. If the measurement was done more incisal then specified, the PERIOTEST-value increased, if the measurement was done more cervical, the value decreased. Tilting the handpiece against the tooth surface within +/- 8 degrees in horizontal and +/- 6 degrees in vertical direction gave only little effect on the PERIOTEST-value on clinical firm upper front teeth.

[Chewing force discrimination in a biofeedback experiment]. / Uber das Kaukraftdifferenzierungsvermögen im Biofeedbackversuch.

Chewing forces were measured in a needle point tracing while the patients could view their actual and the proposed chewing forces (5 N, 10 N and 30 N) on a computer screen (biofeedback). Most probands used less than the proposed forces in the experiments. All probands approached the proposed level of force step by step. Fatigue of the chewing muscles led to a change in the Fourier-transformation of the recorded samples: An increase in short-waved components (frequencies of approximately 1 Hz) was found.

[Suitability of various materials for indexing needle point registrations]. / Die Eignung verschiedener Materialien für die Verschlüsselung der Stützstiftregistrierung.

Acrylic, plaster and polyether were evaluated for their accuracy in indexing needle point registration. Additionally, a new experimental system was tested, that permits the dentist do immediately verify the accuracy of the recording. Best results were obtained when the indexes were not removed from the occlusal plane plates. When the indexes were dislodged, acrylic and plaster demonstrated the most accurate results in repositioning the occlusal plane plates. The experimental system demonstrated comparable accuracy to both, acrylic and plaster.

[Cross-sectional study on the prevalence of prosthodontic reconstructions in young men]. / Querschnittstudie zum Umfang der prothetischen Versorgung junger Männer.

The prevalence of prosthetic reconstructions among 1534 German recruits (mean age 21.8 years) was evaluated. Of the total number of single crowns (n = 552), 72% were found in the upper jaw. Forty-one per cent of the crowns were situated in the upper incisor region. Four per cent of the probands received mostly three-unit-bridges and 0.9% removable partial dentures. In 3.7% of the cases all missing molars of a quadrant were not prosthetically replaced. The number of single crowns and bridges was not associated with the final school education, which in its term is closely associated with the social stratum. Between the level of school education and the need of prosthetic treatment a highly significant association was found.

[Presentation of an expert system for planning partial dentures]. / Vorstellung eines Expertensystems zur Planung von partiellem Zahnersatz.

An expert system for treatment planning in cast clasp partial denture cases is presented. The system may be used both to verify the construction principles of proposed clasp constructions and to develop new constructions. At first, it is intended to use this expert system for teaching in university dental schools.

[Measurement of the clenching force during needle point registration in dentulous patients]. / Messung der aufgewendeten Kieferschlusskraft während der Stützstiftregistrierung bei vollbezahnten Probanden.

In this study the clenching force was measured, which 12 patients used, while the needle-point tracing was in progress. The patients were not instructed about the measurement. The results show, that 10 of 12 test persons used higher clenching forces, when they had to do border movements according to verbal instructions then when doing free movements of the mandibula. All test persons showed peaks in the level of the clenching force, which were clinically accompanied with swallowing.

[The result of the needle point tracing in dependence of the clenching force and changed needle position in the transverse direction]. / Das Ergebnis der Stützstiftregistrierung in Abhängigkeit von Kraft und veränderter Stiftposition in der Transversalen.

The effect of the positioning of the needle in the horizontal plane and the applied clenching force on the result of the needle point tracing was investigated. The results show a strong influence of the applied clenching force. The results on the variation of the needle position leaded to the conclusion, that in the progress of the needle point tracing the lower jaw is balanced over the central bearing point.

[Experimental investigations about the influence of the gnathological force on the results of the tracing pin registration]. / Experimentelle Untersuchungen zum Einfluss der Registrierkraft auf das Ergebnis der Stützstiftregistrierung.

With the help of video- and computer techniques is investigated in what respect the forces operating in intraoral tracing pin registration have an influence on the mandibular movement at the sagittal plane. The results significantly show this dependence.

[Studies on the mobility of soft tissue marks of the lower face]. / Untersuchugen zur Mobilität von markierten Weichteilpunkten im Untergesicht.

The mobility of soft tissue points used for measuring the rest vertical dimension was assessed in 29 probands with full dentitions and 24 edentulous subjects. A video-aided procedure was used for recording the measuring pictures. Similar results were obtained with fully dentulous and edentulous subjects. For the upper jaw the point of the nose was the mark undergoing the least fluctuations, due to the action of the mimic muscles. For the lower jaw the least mobile skin area was between the labiomental sulcus and the gnathion.

[Methods and materials for the construction of complete dentures]. / Arbeitsweisen und Materialien bei der Herstellung totaler Prothesen.

In a survey the methods and materials used for making complete dentures were collected from 603 dentists. The impression material most frequently used for primary impressions was alginate and elastic impression material for functional impressions. Compared with an earlier survey the percentage of dentist using needle point tracing for recording jaw relations increased from 6 to 40%. Remounting complete dentures was done by 64% of the dentists whenever required; 9% applied this method as a routine.