Perception of occlusal plane that is nonparallel to interpupillary and commissural lines but with the maxillary dental midline ideally positioned.

STATEMENT OF PROBLEM: How disparities in parallelism between the occlusal plane and the interpupillary (IP) or commissural facial front lines are perceived is unclear. PURPOSE: The purpose of this observational study was to examine the perceptions of laypersons, dental students, and dentists regarding disparities of the anterior occlusal plane (AOP) and posterior occlusal plane (POP) with respect to the IP and commissural line (CL) with the maxillary dental midline ideally positioned. MATERIAL AND METHODS: A model of a symmetric female face was digitally created with the IP and CL parallel and the facial midline coincident with the maxillary dental midline. Two groups of images were created, one with the POP modified in 1-degree increments, in which both the maxillary dental midline and the position of the maxillary central incisors were not manipulated, and the other with the POP modified in the same increments but with the position of both maxillary central incisors lengthened to follow the inclination of the occlusal plane. Participants (N=312) were asked to rate the images on a 1-to-6 scale. The Kruskal-Wallis medians test and ordinal logistic regression were used to analyze the ratings. RESULTS: Group median ratings for different occupations gradually decreased with increased inclination of the occlusal plane. Significant differences were found for inclinations from 2 to 5 degrees. Significant odd ratios were found for age and sex. CONCLUSIONS: Dental professionals detected smaller POP disparities. The dentist and dental student groups gave lower ratings in proportion to the amount of POP inclination. Laypersons gave lower ratings only after 3 degrees of POP inclination but still graded all the images as esthetically pleasant. Older people and men tended to give higher ratings to the same image.

Typodont versus live patient: predicting dental students' clinical performance.

In this study, the authors evaluated the accuracy and precision of non-clinical testing for dental students' crown preparation proficiency on a manikin-mounted typodont as a predictor of performance on patients. Eighty-six seniors at Baylor College of Dentistry were evaluated by three calibrated senior faculty members from the general dentistry department. Four areas of interest were evaluated: occlusal reduction; axial reduction; margins, design, and finish line; and operative environment. Standardized grading scales were utilized to evaluate these preparation components. The kappa agreement statistic was used to assess agreement for the areas, which were then compiled to get an overall performance score. A Bland-Altman plot was generated and analyzed for agreement on overall performance between typodont and patient. Results of the analyses showed weak agreement between the two measurements for all four areas of interest with large variation in the differences. When the pairs of overall performance scores were compared, the Bland-Altman plot indicated that the typodont composite score was often larger than the patient composite score, especially for poorer performing students. The authors conclude that students' clinical performance on typodonts is a poor predictor of their clinical performance on patients since the students performed much worse on the clinical crown examination than on the typodont examination.

Nonsurgical management of interdental papillae loss following extraction of anterior teeth.

When a tooth is extracted, the interproximal papilla recedes and the buccal bone collapses; as a result, restoring an edentulous space in the esthetic zone becomes a challenge. Various surgical reconstructions can be performed with different levels of risk and predictability. This article examines three nonsurgical approaches utilized to manage the same problem. One option involves placing a temporary bridge with an ovate pontic at the time of extraction to support the proximal papillae, the facial soft tissue, and the healing gingival tissue. If some time has passed since the extraction, the soft tissue can be sculpted with radiosurgery (or a laser) before an ovate pontic is used. In some instances, tissue-colored porcelain may help to achieve optimal esthetics.

Grading dental students in a "nongraded" clinical assessment program.

This article details how Baylor College of Dentistry (BCD) merges graded and nongraded aspects of student assessments into grade point averages (GPAs); explains the use of its assessment tools to evaluate students, faculty, and curriculum simultaneously; and calls for continuous progress and quality improvement toward educational excellence among all levels of the oral health education community. "Nongraded" student assessments at BCD are only applicable to preclinical and chairside activities that involve direct patient care. We further summarize how we have attempted to improve the accuracy of grading while providing objective numeric grades to measure student performance and generate a class rank. We suggest that faculty evaluation and curricular change require appropriate evaluation methods and continuous quality improvement based on the chosen assessment methodologies. We then summarize how we merge graded and nongraded assessments into a final student evaluation that realistically discriminates among students' performance and present our numeric-to-letter grade conversion table. We conclude that 1) multiple strategies are required, available, and adequate to provide graduates with the numerical GPAs demanded by postdoctoral programs and that 2) continuous quality improvement among all levels of the oral health education community should be vigorously pursued by administration and faculty alike.

Non-graded clinical evaluation of dental students in a competency-based education program.

The objective of this article is to report the development, implementation, and early results of a non-graded normative dental student clinical performance assessment system based on our competencies documents. The normative system (student performance is compared to evidence-based clinical standards) was used and evaluated during the 2002-03 academic year and is now gradually replacing the traditional summative (numerical) grading system previously used at Baylor College of Dentistry. The methodology included: 1) consensus development of new clinical performance assessment forms over the summer of 2002; 2) concurrent fourth-year clinical faculty calibration to the new forms; 3) implementation at the beginning of the senior year for the Class of 2003; and 4) faculty and student evaluation surveys in May 2003. Every step of each clinical procedure was recorded, weekly performance summaries by both students and faculty were collected, and periodic workshops were held to refine the forms and further calibrate faculty. The results showed strong positive responses to the new system by graduates and faculty alike. We conclude that early results warrant broadened efforts toward a continuously improved schoolwide normative student clinical performance assessment system.