Clinical evaluation of a universal adhesive in non-carious cervical lesions.

OBJECTIVES: To compare the clinical performance of a universal adhesive in class V non-carious cervical lesions (NCCLs) using two surface treatment protocols (self-etch [SfE] vs selective-enamel-etch [SelE]). MATERIAL AND METHODS: Thirty-three adults, each with ≥2 NCCLs, received one resin composite restoration utilizing a SfE universal adhesive and another utilizing the adhesive and SelE with 37% phosphoric acid. Restorations were evaluated for sensitivity, retention, marginal discoloration, marginal adaptation, and clinical acceptability through 24 months using Cochran-Mantel-Haenszel tests for stratified, ordered categorical outcomes. RESULTS: Sixty-six restorations (35 SfE, 31 SelE; 27 volunteers) were evaluated at 24 months. There were no significant differences between SfE and SelE for sensitivity, retention, marginal adaptation, or clinical acceptability. One SfE restoration was lost. Marginal adaptation was significantly worse at 24 months than baseline for SelE (P = 0.01), but not for SfE. Marginal discoloration was significantly worse for SfE (P = 0.02), but not for SelE. Sensitivity improved from baseline to 24 months for both groups (SelE P = 0.004, SfE P = 0.002). CONCLUSIONS: Twenty-four-month data indicated significantly reduced sensitivity for both groups, worse marginal discoloration for SfE, and worse marginal adaptation for SelE. No changes in retention or clinical acceptability were observed in either group. All retained restorations were clinically acceptable at 24 months. CLINICAL SIGNIFICANCE: Both self-etch and selective enamel etch techniques with a universal adhesive produced clinically acceptable results in resin composite restorations for NCCLs over 2 years.

Is a Picture Worth a Thousand Words? Effectiveness of iPad Technology in Preclinical Dental Laboratory Courses.

Dental educators should consider alternative modalities of instruction when experiencing difficulties conveying feedback to students. The aim of this study was to determine if integrating iPad technology as a visual learning tool would enhance the exchange of assessment information and improve academic performance in Indiana University School of Dentistry's preclinical curriculum. In 2016, the first-year Tooth Morphology (TM) and second-year Fixed Prosthodontics (Fixed) courses implemented a project using iPad images that allowed instructors to annotate acceptable and deficient areas of students' tooth wax-ups and preparations. In the two courses, all students (TM n=106 and Fixed n=105) and instructors (TM n=21 and Fixed n=17) were given pre-intervention surveys to report their perceived effectiveness of verbal feedback and were given post-intervention surveys to rate their experiences with iPad image feedback. Response rates for students in the two courses on the pre surveys were TM 87.7% and Fixed 85.7% and on the post surveys were TM 26.4% and Fixed 76.2%. Response rates for instructors on the pre surveys were TM 52.4% and Fixed 82.4% and on the post surveys were TM 76.2% and Fixed 76.5%. The results showed that a majority of both groups preferred the combination of verbal and iPad image feedback: 53% of responding students in TM and 51% in Fixed, and 75% of instructors in TM and 77% in Fixed. In the TM course, responding instructors had a statistically significantly higher agreement than students that feedback with iPad images was superior to verbal feedback alone (p=0.008). Furthermore, a multi-year analysis of TM practical examination grades found statistically significant lower change scores for the first and second exams in 2014 and 2015 compared to the 2016 scores when the iPad intervention occurred. These results suggest that verbal feedback combined with iPad images resulted in an enhanced exchange of information and increased student grades, particularly in the first-year dental curriculum.

New Clinical Faculty Training Program: Transforming Practicing Dentists into Part-Time Dental Faculty Members.

At Indiana University School of Dentistry, a New Clinical Faculty Training (NCFT) program was created with the primary goals of informing new part-time faculty members of clinical policies and assessment guidelines and thus developing qualified and satisfied faculty members. The aim of this study was to determine if participation in the training program improved the participants' satisfaction and competence in comparison to their colleagues who did not participate in the program. Two cohorts were compared: a control group of part-time faculty members who did not receive formal training when they were hired (n=21; response rate 58.3%); and the intervention group, who had participated in the NCFT program (n=12; response rate 80%). A survey of faculty members in the control group gathered information on their experiences when initially hired, and a pretest was administered to measure their knowledge of clinical policies. After the control group was given an overview of the program, their feedback was collected through post surveys, and a posttest identical to the pretest was given that found statistically significant increases on questions one (p=0.003) and four (p=0.025). In February 2014, 15 new faculty members participated in the pilot implementation of the NCFT program. Of those 15, 12 (the intervention group) completed follow-up surveys identical to the pre survey used with the control group. Statistically significant differences were found for the factors clinical teaching (p=0.005) and assessment training (p=0.008) with better responses for the NCFT group. These results suggest that participation in the program was associated with improved clinical teaching knowledge and job satisfaction.

Development and Implementation of an Electronic Clinical Formative Assessment: Dental Faculty and Student Perspectives.

A traditional summative grading structure, used at Indiana University School of Dentistry (IUSD) for more than 30 years, was identified by faculty as outdated for assessing students' clinical performance. In an effort to change the status quo, a feedback-driven assessment was implemented in 2012 to provide a constructive assessment tool acceptable to both faculty and students. Building on the successful non-graded clinical evaluation employed at Baylor College of Dentistry, IUSD implemented a streamlined electronic formative feedback model (FFM) to assess students' daily clinical performance. An important addition to this evaluation tool was the inclusion of routine student self-assessment opportunities. The aim of this study was to determine faculty and student response to the new assessment instrument. Following training sessions, anonymous satisfaction surveys were examined for the three user groups: clinical faculty (60% response rate), third-year (D3) students (72% response rate), and fourth-year (D4) students (57% response rate). In the results, 70% of the responding faculty members preferred the FFM over the summative model; however, 61.8% of the D4 respondents preferred the summative model, reporting insufficient assessment time and low faculty participation. The two groups of students had different responses to the self-assessment component: 70.2% of the D4 respondents appreciated clinical self-assessment compared to 46% of the D3 respondents. Overall, while some components of the FFM assessment were well received, a phased approach to implementation may have facilitated a transition more acceptable to both faculty and students. Improvements are being made in an attempt to increase overall satisfaction.

Introducing CAD/CAM into a predoctoral dental curriculum: a case study.

This article describes the decision making and implementation process used at Indiana University School of Dentistry to incorporate a CAD/CAM system into the predoctoral curriculum and presents data regarding the opinions of students and faculty members after one year. Using a non-validated survey instrument, D1 students rated their experience fabricating a CAD/CAM-generated crown. Eighty-eight of the 105 D1 students (84 percent response rate) responded to the four multiple-choice questions, and a varying number provided written responses. Eighty percent of the responding students rated the overall learning experience as good or excellent, and 43 percent judged that they were prepared to fabricate a crown independently. Students' comments about the experience were generally positive. The twelve supervising faculty members were also surveyed after the first year. When asked to evaluate the initial quality of the crowns at placement, they rated 89 to 98 percent of them good or excellent on the measures of marginal fit, axial contours, proximal contacts, and occlusal contacts. In their judgment, CAD/CAM-generated crowns were as good as or better than those received from commercial labs. After one year, the school's experience has been that the performance of these crowns is consistent with the literature and that they are a viable option. Also, the students are enthusiastic about this addition to the curriculum.

Including CAD/CAM dentistry in a dental school curriculum.

Shaping a clinical curriculum that is appropriate for novice dentists, is based on high-quality evidence of efficacy, yet reflects current practices is challenging. CAD/CAM units have been available to dentists since the late '80s. Recent improvements in the software, hardware and the clinical performance of available all-ceramic blocks have keyed a surge in interest. Based on a careful review of the systems available and, equally importantly, a review of the research regarding the longevity of reinforced glass ceramics, IUSD decided to add training on the use of the E4D CAD/CAM system to the curriculum. Students now receive lectures, preclinical hands-on training and clinical experience in fabricating all-ceramic restorations. At present any student who is interested in providing an all-ceramic restoration for his/her patient can do so using our CAD/CAM system. In a little less than one year our undergraduate dental students have provided 125 all-ceramic crowns to their patients. Clinical faculty have been impressed with the marginal fit and esthetics of the crowns. Finally, with students designing, milling, sintering and staining the restorations the CAD/CAM systems has reduced lab costs significantly.