The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study.

BACKGROUND: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. OBJECTIVE: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. METHODS: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants' knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. RESULTS: The results showed a significant improvement in the participants' knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. CONCLUSIONS: The findings indicated a notable enhancement in the participants' understanding of restorative dentistry. The participants' high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field.

Scaffolding Self-Regulated Learning in Operative Dentistry Through Self-Assessment Training.

OBJECTIVES: This study aimed to investigate how effective self-assessment training is in improving the self-regulated learning (SRL) ability of operative dentistry students. The secondary aim was to explore students' attitudes towards self-assessment in clinical settings. INTRODUCTION: Self-assessment has been the focus of dental education research for decades and has been claimed to be cornerstone in the SRL process. METHODS: This is quasi-experimental study conducted at Damascus University Faculty of Dental Medicine, Syria. A modified direct observation of procedural skills (DOPS) assessment protocol with a self-assessment component was applied to a convenience sample of students across five clinical encounters in 2022. Data were collected during clinical training on the DOPS form and at the end of the experiment using a structured questionnaire with a single open-ended question. The qualitative part of the study followed a deductive theory-informed content analysis approach, relying on Zimmerman SRL theory. RESULTS: A total number of 32 students participated in the study, eight of whom were male. During the experiment assessment, participants showed overwhelming positive attitudes towards the utility of self-assessment (m ≥ 3.5; max:4) and the overall assessment method (3.3 ≥ m ≥ 3.5; max:4). Cronbach's alpha for the post-experiment questionnaire was 0.888. A total of 84.4% of the participants strongly agreed that self-assessment is useful in clinical training. Data collected (qualitative and quantitative) from participants revealed the positive effects of self-assessment on all three phases of SRL, especially the reflection phase. CONCLUSION: Self-assessment practice and training showed positive results in terms of improving SRL and performance in a clinical context; SRL appeared to be affected by self-assessment in all phases (forethought, performance, and reflection). Participants' perceptions of self-assessment were generally very positive. These findings imply the potential benefits of applying self-assessment training interventions to foster the SRL ability of learners within the clinical context.

Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment.

BACKGROUND: Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees' self-assessment of operative procedures. METHODS: A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%. RESULTS: Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants' self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants' attitudes towards the assessment method were positive. CONCLUSIONS: The findings suggest that the self DOPS method was effective in developing participants' ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.

Measurement of Humanity Among Health Professionals: Development and Validation of the Medical Humanity Scale Using the Delphi Method.

BACKGROUND: Despite the importance of humanism in providing health care, there is a lack of valid and reliable tool for assessing humanity among health professionals. OBJECTIVE: The aim of this study was to design a new humanism scale and to assess the validity of this scale in measuring humanism among Syrian health professional students. METHODS: The Medical Humanity Scale (MHS) was designed. It consists of 27 items categorized into 7 human values including patient-oriented care, respect, empathy, ethics, altruism, and compassion. The scale was tested for internal consistency and reliability using Cronbach α and test-retest methods. The construct validity of the scale was also tested to assess the ability of the scale in differentiating between groups of health professional students with different levels of medical humanity. A 7-point Likert scale was adopted. The study included 300 participants including 97 medical, 78 dental, 82 pharmacy, and 43 preparatory-year students from Syrian universities. The Delphi method was used and factors analysis was performed. Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sample adequacy were used. The number of components was extracted using principal component analysis. RESULTS: The mean score of the MHS was 158.7 (SD 11.4). The MHS mean score of female participants was significantly higher than the mean score of male participants (159.59, SD 10.21 vs 155.48, SD 14.35; P=.008). The MHS mean score was significantly lower in dental students (154.12, SD 1.45; P=.005) than the mean scores of medical students (159.77, SD 1.02), pharmacy students (161.40, SD 1.05), and preparatory-year students (159.05, SD 1.94). However, no significant relationship was found between humanism and academic year (P=.32), university type (P=.34), marital status (P=.64), or financial situation (P=.16). The Kaiser-Meyer-Olkin test (0.730) and Bartlett test of sphericity (1201.611, df=351; P=.01) were performed. Factor analysis indicated that the proportion of variables between the first and second factors was greater than 10%, confirming that the scale was a single group. The Cronbach α for the overall scale was 0.735, indicating that the scale had acceptable reliability and validity. CONCLUSIONS: The results of this study suggest that the MHS is a reliable and valid tool for measuring humanity among health professional students and the development of patient-centered care.

Evaluation of the Undergraduate Learning Environment at Dental Schools in Syria.

OBJECTIVE: The learning environment plays a vital role in dental education. A positive learning environment could improve students' satisfaction, psychosocial well-being, and academic achievement. This study set out to measure the quality of the learning environment according to the Dundee Ready Educational Environment Measure (DREEM) at different dental schools in Syria. METHODS: The study included dental schools at Damascus University (DU), Tishreen University (TU), and University of Hama (HU). DU and TU are considered 2 of the largest universities in Syria. Students across all years of study were invited to complete an Arabic version of the DREEM questionnaire. RESULTS: In total, 1205 students completed the questionnaire: 650 were from DU, 309 from HU, and 243 from TU. Cronbach's alpha value of the DREEM instrument was 0.927. The total DREEM score for all universities was 108.8 ± 31.5 (n = 1205), which is 54.4% of the total score; DU scored the lowest on the DREEM scale (105.9 ± 28.5) followed by TU (111.1 ± 34.3) and HU (113.3 ± 34.4). There was a significant difference amongst the 3 universities (P = .001) with a small effect size (eta-squared = 0.01). At the subscale level, students' perception of learning (SPL) at DU and TU was perceived unfavourably, and the social self-perception of students (SSP) was negatively perceived across all universities. Clinical students scored significantly lower than their preclinical counterparts. No significant difference emerged between male and female students. CONCLUSIONS: This study provides a baseline data on the learning environment at dental schools in Syria. Although the study suggests a more positive than negative perception of the learning environment, Syrian dental schools scored considerably lower than their Arab and international counterparts. Aspects related to SPL and SSP were the most serious areas requiring improvement, and future research should focus on designing proper interventions to address them.

Revealing the significant shortcomings in the learning environment at the three largest medical schools in Syria: what's next?

BACKGROUND: Medical education in Syria still adopts a traditional, teacher-centered curriculum to this day. These elements imply the existence of issues in the learning environment (LE). This study aims to provide the first evaluation of the LE at the largest medical schools in Syria using the DREEM inventory. METHODS: The three largest medical schools in Syria are the ones at Damascus University (DU), University of Aleppo (AU), Tishreen University (TU). The Arabic version of the DREEM questionnaire was used. Students across all years of study except year 1 were approached. Both paper-based and electronic surveys were conducted. RESULTS: A total of 1774 questionnaire forms were completed (DU:941, AU:533, TU: 300). The overall DREEM score at DU, AU, and TU were 100.8 ± 28.7, 101.3 ± 31.7, and 97.8 ± 35.7 respectively with no significant difference (P = 0.254) between the three universities. DREEM subscales concerning Learning, Atmosphere, Academic Self-perception and Social Self-perception had a low score across all universities. Clinical-stage students reported significantly lower perception (P ≤ 0.001) of the LE in comparison to their pre-clinical counterparts across all subscales. CONCLUSIONS: The findings of this study highlight the significant shortcomings of the medical LE in Syria. If not addressed properly, the academic, clinical, and professional competence of the healthcare workforce will continue to deteriorate. Moreover, the negative LE might be a predisposing factor for medical students' exodus. The Syrian medical education system requires leaders who are willing to defy the status quo to achieve a true educational transformation.

Major Stress Sources Amongst Dental Students at Damascus University, Syria.

INTRODUCTION: Stress amongst dental students is frequently reported. Various environmental, socioeconomic, and cultural factors affect students' perceived stress levels. The aim of this study was to investigate stress levels and sources amongst undergraduate dental students at Damascus University, Syria. METHODS: A cross-sectional design was used. A questionnaire was undertaken in 2019 at the Faculty of Dentistry at Damascus University. Students participated voluntarily in the survey. The sample comprised students at the preclinical and clinical stage. A modified 29-item version of the validated Dental Environmental Stress (DES) questionnaire with a 5-point scale (1 = not stressful to 5 = extremely stressful) was used as the measurement tool. Ethical approval was granted by Damascus University. RESULTS: In all, 365 students participated in the study, with a response rate of 96% (365/379). Cronbach's alpha was 0.83, indicating good reliability of the measurement tool. The overall mean score of the perceived stress was 2.64 (95% confidence interval [CI], 2.5-2.7). The mean scores for clinical factors, academic work, educational environment, personal factors, and living accommodation were 3.22 (95% CI, 3.1-3.3), 3.17 (95% CI, 3.1-3.2), 2.99 (95% CI, 2.9-3.0), 2.15 (95% CI, 2.1-2.2), 2.15 (95% CI, 2.0-2.2), respectively. The specific stressors with the highest mean scores were lack of dental equipment and difficulty in finding requested clinical cases; the respective means were 4.1 (95% CI, 4.0-4.2) and 3.9 (95% CI, 3.8-4.0). CONCLUSIONS: The findings revealed moderate stress levels amongst students. The major stress factors pertained to stressors from the clinical, academic, and educational environment domains. Certain clinical and environmental stressors, such as difficulty in finding clinical cases and lack of dental equipment, were more powerful than the strongest academic stressors, such as examinations and grades and amount of assigned work.

Three-Dimensional Finite Element Analysis of Worn Molars With Prosthetic Crowns and Onlays Made of Various Materials.

Background/Purpose Restoration of worn teeth represents a challenge for practitioners in terms of preserving dental tissues, achieving restoration requirements, and choosing the most appropriate material. This study aimed to evaluate the effect of both preparation and restoration type on stress distribution in modeled first mandibular molars when functional and parafunctional occlusal forces were applied. Materials and methods The study sample consisted of 40 three-dimensional computer models of restored lower first molars with full crowns (gold, nickel-chrome, lithium disilicate, BruxZir® zirconia, and porcelain fused to metal) and onlays (gold, nickel, chrome, lithium disilicate, and direct and indirect composites). Forces of different intensities and directions were applied, and then finite element analysis was carried out based on the von Mises equivalent stress theory to predict the failure that could occur in the restoring materials and luting cement or bonding agent. Results In functional forces groups, zirconia crowns showed the lowest value of the failure risk, while the highest value was in veneering porcelain with values close to the rest of the models. For onlays, gold onlays represented the best stress distribution with the lowest value of the failure risk, in contrast to the composite onlays that had the highest failure risk. In parafunctional forces groups, the preference remained for zirconia and gold crowns, as well as for metal onlays, with greater differences in the values of the failure risk. Conclusion Gold alloy exhibited better behavior in the stress distribution. All restorations showed similar behavior when applying functional forces; however, when applying parafunctional forces, both gold and zirconia crowns have shown the best results.

Replacement of Congenitally Missing Maxillary Lateral Incisor with Two-Buccal-Retainer Resin-Bonded Fixed Dental Prosthesis Modified by Proximal Boxes.

A 21-year-old male patient with congenitally missing maxillary right lateral incisor presented to Fixed Prosthodontics Department at the Faculty of Dentistry, Damascus University (Damascus, Syria). A two-buccal-retainer lithium disilicate glass-ceramic resin-bonded fixed dental prosthesis (RBFDP) was chosen to replace the missing tooth. This clinical report describes a novel preparation design of two-buccal-retainer lithium disilicate glass-ceramic RBFDP modified by proximal boxes. A recall appointment after 3 years showed no fracture, no de-bonding, no secondary caries, and no staining in prosthesis margins. Color matching with natural teeth was excellent, and the patient was satisfied.

Peer-assessment ability of trainees in clinical restorative dentistry: can it be fostered?

OBJECTIVES: The study was conducted to investigate whether peer-assessment among dental students at the clinical stage can be fostered and become closer to that of experienced faculty assessors. METHODS: A prospective pilot study was conducted in 2021 at the Faculty of Dentistry, Damascus University. Sixteen 5th year clinical students volunteered to participate in the study. A modified version of the validated Peer Direct Observation of Procedural Skills (Peer-DOPS) assessment form was used together with a grading rubric. Participants undertook peer-assessment on their colleagues across three encounters. The difference between peers and faculty assessment was the main variable. RESULTS: The mean difference between peers and faculty assessment decreased after each encounter with a significant difference and a medium effect size between the first and third encounters (p = 0.016, d = 0.67). Peer-assessment was significantly higher than faculty, however, the overestimation declined with each encounter reducing the difference between peer- and faculty assessment. Peers' perception of the educational benefit of conducting assessment was overwhelmingly positive, reporting improvements in their own performance. CONCLUSION: This pilot study provides preliminary evidence that dental students assessment ability of their peers can be fostered and become closer to that of experienced faculty assessment with practice and assessment-specific instruction.

Bridging the gap between self-assessment and faculty assessment of clinical performance in restorative dentistry: A prospective pilot study.

PURPOSE/OBJECTIVES: The current study was undertaken to investigate whether self-assessment of clinical skills of undergraduate dental students could be bridged with faculty assessment by deliberate training over an extended period. A secondary aim was to explore students' perception of self-assessment and its effect on their learning and motivation. MATERIAL AND METHODS: A prospective pilot study was conducted at the Department of Restorative Dentistry at Damascus University. Sixteen students participated in the study, ranging in age between 22 and 23 years. A modified Direct Observation of Procedural Skills form with a grading rubric was used to register and guide students' self-assessment; both were pretested on four students before the study. In total, four clinical encounters were completed by each student. Students were trained on how to conduct proper self-assessment before and after each clinical encounter. A postcourse questionnaire was used to investigate students' perception of self-assessment. RESULTS: Bias in self-assessment decreased consistently after each encounter, and the difference in bias between the first (bias = 0.77) and the last encounter (bias = 0.21) was significant with a medium effect size (p = .022, d = 0.64). The percentage of disconfirming performance dimensions decreased from 39.7% to 26.9%. Students' ability to exactly pinpoint strengths improved consistently and significantly. However, their ability to pinpoint areas of improvement was volatile and showed no significant difference. Bland-Altman graph plots showed higher levels of agreement between self-assessment and faculty assessment. Moreover, students' perception of self-assessment was very positive overall. CONCLUSIONS: These findings suggest the possibility that the gap between self-assessment and faculty assessment could be bridged through deliberate training. Future longitudinal research using a larger sample size is still required to further explore whether self-assessment can be actively bridged with faculty assessment by deliberate training.

Gauging the learning environment at Damascus University Pharmacy School in Syria using the DREEM questionnaire: A cross-sectional study.

Introduction: This study was undertaken to provide the first record of evaluation of the educational environment of the Bachelor of Pharmacy program at Damascus University (DU), Syria using the internationally adopted Dundee Ready Education Environment Measure (DREEM) tool and compare it with other pharmacy schools around the world. Methods: A cross-sectional study was conducted at DU Pharmacy School in 2022. The validated DREEM 50-item inventory was added to Google Forms and used to collect data electronically. River sampling and snowball sampling methods were used. Data was collected during the second term between April 2022 and June 2022. Students from all years were included. Results: A total of 269 students completed the questionnaire; that is about 6.7% of the total population. The Cronbach's alpha of the DREEM questionnaire was 0.94. The total DREEM score was 89.8±32.1/200. Senior students scored significantly less on the DREEM scale than their younger counterparts. DU Pharmacy School scored significantly less on the total DREEM score than its other counterparts around the world with a large effect size (d>0.80). All subscales scored below 50% and the lowest scoring subscales were students' perception of learning (SPL=41.8%) and students' perception of the social environment (SSP=42.5%). Conclusions: The findings implied that the educational environment is in need of major improvement, especially in areas related to teaching and learning practices and the general social environment; failure to address the current issues in the learning environment might hinder learning and clinical practice of the future generation of pharmacists. This study provides a quality improvement map which could be used preciously address the areas that need most attention at DU Pharmacy School.

An auxiliary factor for increasing the retention of short abutments.

BACKGROUND: Retention is an essential factor in the sustainability of the prosthesis, especially for short abutment. Despite, the availability of several auxiliary applications, achieving a clinically good retention for cast crowns in prepared short teeth remains a major challenge for the practicing dentist. OBJECTIVES: This study tests a new method for applying frustum-shaped grooves on short prepared abutments and compares them with traditional setting grooves. METHODS: Forty-eight copper machine-milled short dies with 3.5 mm length and 12o conversion with a chamfer finish line of 0.7 mm were prepared to mimic short prepared molars and distributed into 4 groups. A control group with two opposing setting grooves and two groups with dual opposing frustums, one of which was prepared to receive two integrated metal protrusions inside the casting that fit the frustums. Frustums were prepared with Komet bur No. 807 with dimensions 0.9 mm at the base and 0.7 mm at the occlusal surface. A direct wax-up was carried out on all dies and all castings were cemented with zinc phosphate cement. A pull-off test was applied until separation. Data were analysed to compare the correlation of the four groups using one-way ANOVA and Bonferroni test (p ≤ 0.05). RESULTS: The mean retentive values in Newton were as follows: the control group, 457.80; the setting grooves group, 461.07; the frustum group, 597.59; and the frustum group with the two metal protrusions, 919.80. The retention was increased by 65% in frustum group and doubled in frustum group with the metal protrusions. CONCLUSIONS: The results showed a statistical significance in retention in the frustum groups with and without metal protrusion over the retention of the control and the setting grooves groups.

Interventions for the restorative care of amelogenesis imperfecta in children and adolescents.

BACKGROUND: Amelogenesis imperfecta (AI) is a tooth development disorder in which the teeth are covered with thin, abnormally formed enamel. This enamel is easily fractured and damaged, which affects the appearance of the teeth, especially if left untreated. Negative psychological outcomes, due to compromised appearance and function, in patients with AI, have been found to compromise a person's attractiveness and reduce social interaction. The treatment used depends on the severity of the problem. OBJECTIVES: To compare the success rates of different restorative materials and techniques used for the restoration of anterior and posterior teeth with AI in terms of patient satisfaction (aesthetics and sensitivity) and function. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 18 April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE via OVID (1946 to 18 April 2013), EMBASE via OVID (1980 to 18 April 2013), CINAHL via EBSCO (1980 to 18 April 2013), Abstracts of the Conference Proceedings of the International Association for Dental Research (2001 to 18 April 2013) and reference lists of relevant articles. There were no restrictions on language or date of publication in the electronic searches. SELECTION CRITERIA: Randomised controlled trials where children and adolescents with AI who required restoration of teeth were allocated to different restoration techniques would have been selected. Outcomes which would have been evaluated were patient satisfaction, aesthetics, masticatory function and longevity of restorations. DATA COLLECTION AND ANALYSIS: Two review authors would have extracted data and assessed the risk of bias in included studies independently. Disagreement between the two authors would have been resolved by consulting a third review author. First authors were contacted for additional information and unpublished data. MAIN RESULTS: No studies met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: We found no randomised controlled trials of restorative treatments for children and adolescents with AI, and therefore there is no evidence as to which is the best restoration. Well defined randomised controlled trials which recruit children and adolescents and focus on the type and severity of the disorder should be undertaken to determine the best intervention for restoring teeth affected by AI.

An evaluation of the performance of cast gold bonded restorations in clinical practice, a retrospective study.

OBJECTIVES: To evaluate the performance of cast gold bonded restorations in clinical practice. MATERIALS AND METHODS: The records of all patients treated with cast gold bonded restorations between 1997 and 2004 of The Dental Hospital of Newcastle upon Tyne were reviewed. The following data were recorded: sex of patient, location of teeth (anterior or posterior), position of teeth (upper or lower) and type of cement (glass ionomer, zinc phosphate or resin cement). The survival time was calculated for each restoration; and the reason for failure (either debond or change of treatment plan) identified for each case. The restorations were stratified according to the age of the patient into 10-year age bands and survival analysis was used to identify variables associated with increased risk of failure. RESULTS: Restorations luted with resin cement showed the highest rate of survival after 7 years of follow-up. The alternative lutes had significantly worse survival (p<0.05). Restorations on anterior teeth had poorer survival than on posterior teeth but there were no differences between those placed in the mandible and the maxilla. CONCLUSIONS: Within the limitations of this study resin cements are most appropriate for this type of restoration with 80% survival at 7 years. Restorations placed on posterior teeth survived better.