PURPOSE:The purpose of this study was to test whether critical thinking changes over the course of dental education by assessing dental students at the beginning and toward the end of their training.METHODS:Dental student participants completed a survey at the beginning of their first year (August 2019) and at the start of their last year of dental school (August 2022). The survey consisted of two instruments designed to measure the disposition and metacognition components of critical thinking. The study used a pretest-posttest design. Paired t tests were used to determine whether critical thinking scores changed over the 3-year period.RESULTS:Surveys were completed by 85 of 94 students (90%) on the pretest and 63 of 93 students (68%) on the posttest. Of the 92 students who were members of the class at both testing periods, data were available for 59 students (64%). There were significant mean decreases in disposition and its tolerance for cognitive complexity subscale, as well as in metacognition and its metacognitive strategies subscale (p < .05). There was no significant mean change in either open-mindedness or metacognitive thinking.CONCLUSION:Results of this study suggest that some aspects of critical thinking (metacognition and disposition) decrease over the course of dental education. Future research should investigate why this is the case, and explore different instructional methods designed to improve critical thinking.

OBJECTIVE:The purpose of this study was to determine the psychometric properties of instruments designed to assess the critical thinking domains of disposition and metacognition in a dental student population.METHODS:Two instruments originally developed to assess disposition and metacognition domains in undergraduate student populations were administered to dental students from 3 classes in the Spring of 2019. The overall response rate was 73%. Sampling adequacy was established for both domains. Exploratory factor analysis was used to determine underlying dimensions. Criterion validity was established by correlation with traditional measures of academic achievement.RESULTS:Kaiser-Meyer-Olkin index (>0.80) and Bartlett's test of sphericity (P < 0.005) indicated sampling adequacy for both domains. Factor analysis supported a 2-factor solution for Disposition (Level of Open Mindedness and Tolerance for Cognitive Complexity) and a 2-factor solution for Metacognition (Metacognitive Thinking and Metacognitive Strategies). Items loading at 0.4 or higher were retained. Cronbach's alpha was above 0.8 for all but the Metacognitive Thinking subscale, which nonetheless showed adequate reliability (0.65). Reliability for Disposition and Metacognition scales was also above 0.8.CONCLUSION:These results indicate that the instrument has sufficient validity and reliability to support further use in dental education.

This study evaluated the effectiveness of diode laser irradiation combined with topical fluoride application for increasing the hardness of demineralized bovine enamel and esthetically improving white-spot lesions (WSLs). In addition, the study evaluated intrapulpal temperature changes during laser irradiation. One hundred twenty bovine incisors with 4 × 4-mm artificial WSLs were randomly assigned to 8 groups (n = 15): untreated control; fluoride only; LF1, LF2, and LF3, fluoride plus 2-W laser for 15, 30, and 60 seconds, respectively; and LF4, LF5, and LF6, fluoride plus 5-W laser for 15, 30, and 60 seconds, respectively. The Vickers hardness number, CIE L*a*b color space values, and visual analog scale ratings for color improvement were recorded at baseline, after demineralization to create the WSLs, and after treatment. The intrapulpal temperature changes were recorded at completion of irradiation for 30 bovine teeth that were assigned to 6 groups (n = 5) to receive doses of irradiation equivalent to the treatment of the corresponding laser groups described previously. Statistical analysis included 1-way analysis of variance and Tukey multiple comparison tests (α = 0.05) The mean Vickers hardness numbers were significantly greater for the laser groups, and mean visual analog scale scores were significantly greater for all the treatment groups (P < 0.05). The fluoride group had a significantly lower mean color change (ΔE*) value (P < 0.05). The mean intrapulpal temperature changes in the 5-W laser groups were significantly greater than those in the 2-W groups (P < 0.05). Diode laser irradiation combined with topical fluoride application significantly increased the hardness and improved the esthetic appearance of WSLs compared to no treatment (control) and fluoride treatment alone. Intrapulpal temperature changes indicated that diode laser irradiation is safer at a 2-W setting than a 5-W setting.

Critical thinking is widely recognized as an essential competency in dental education, but there is little agreement on how it should be assessed. The aim of this systematic review was to determine the availability of instruments that could be used to measure critical thinking in dental students and to evaluate psychometric evidence to support their use. In January 2017, an electronic search of both the medical and education literature was performed on nine databases. The search included both keyword and Medical Subject Heading terms for critical thinking, higher education/health sciences education, measurement/assessment, and reproducibility of results. The grey literature was included in the search. The search produced 2,977 unique records. From the title and abstract review, 183 articles were selected for further review, which resulted in 36 articles for data extraction. Ten of these studies sought to evaluate psychometric properties of the instruments used and were subjected to quality assessment. Seven assessment instruments were identified. Of these, three instruments that have not been widely used nor tested in health professions students showed evidence of psychometric strength and appeared to have potential for use in dental education. Further research should focus on the three critical thinking instruments with strong psychometric evidence, with the aim of establishing validity and reliability in the context of dental education.

The purpose of this study was to evaluate interrater agreement between faculty and virtual assessments of preparations for complete coverage restorations in preclinical fixed prosthodontics. Teeth prepared during preclinical fixed prosthodontics practical exams at the University at Buffalo School of Dental Medicine were used in this study. Teeth were prepared for fabrication of complete cast, metal ceramic, and all ceramic crowns. The specimens were digitized using an intraoral scanner. Then, they were virtually superimposed on the corresponding standard preparations using Compare software. The software was used to quantify comparison percentages, average finish line widths, and average axial wall heights. Two calibrated faculty members assessed preparations for occlusal/incisal reduction, finish line location, axial wall height, and finish line width using traditional assessment forms. Cohen's kappa coefficient was used to measure interrater agreement between faculty and virtual assessments. Kappa interrater agreement scores ranged between 0.83 and 0.88 for virtually assessed comparison percentages and sums of faculty-assessed occlusal/incisal reduction and finish line location. Kappa interrater agreement score ranges were 0.64-0.94 and 0.74-0.89 for comparisons of virtual and faculty assessments for axial wall height and finish line width, respectively. Virtual assessments are similar to faculty assessments for occlusal/incisal reduction, finish line location, axial wall height, and finish line width in fixed prosthodontics and can be used as equivalent evaluations of student performance for these criteria.

Statement of problem. Different techniques are used to fabricate complete coverage restorations. Each fabrication technique requires a specific preparation design that may violate a principle of tooth preparation, that is, conservation of tooth structure. Purpose. The purpose of this in vitro study was to compare the volume of loss of mandibular first molar structure associated with a preparation for computer-aided design and computer-aided manufacturing (CAD-CAM) versus conventionally fabricated complete coverage restorations. Materials and methods. Fifty artificial mandibular right first molars were weighed before and after preparation for complete coverage restorations of the following types: complete cast, monolithic zirconia, monolithic pressed lithium disilicate, monolithic milled lithium disilicate, and metal-ceramic crowns (n=10 per method). Tooth mass loss was measured by subtracting the mass after preparation from the mass before the preparation, and tooth volume loss was calculated by dividing the mass by the density of the material. A robust analysis of variance (ANOVA), followed by a post hoc test, was used to compare the volume of tooth loss (alpha=.01). Results. Mean tooth volume losses were 255.6 mm(3), 270.0 mm(3), 312.7 mm(3), 331.7 mm(3), and 309.9 mm(3) for complete cast, monolithic zirconia, monolithic pressed lithium disilicate, monolithic milled lithium disilicate, and metal-ceramic crowns, respectively. Teeth prepared for monolithic CAD-CAM zirconia and lithium disilicate crowns did not exhibit a significantly lower (P>.01) decrease in volume loss than with complete cast and monolithic pressed lithium crowns. Conclusions. Preparation of teeth for monolithic CAD-CAM complete coverage restorations is not associated with a significantly higher volume of tooth loss than their conventionally fabricated counterpart preparations.

OBJECTIVE:The objective of this study was to determine student adherence to infection control policies at 1 dental school. A secondary objective was to determine the influence of Ebola virus disease (EVD)-related training on student infection control behaviors.METHODS:An instrument to assess and record infection control behaviors was developed to reflect Centers for Disease Control and Prevention guidelines as well as current teaching. Third- and fourth-year dental students were observed during patient-care appointments and behaviors were recorded and analyzed. Behaviors observed before the EVD outbreak and subsequent mandatory in-service training were compared with behaviors observed after completion of the training.RESULTS:Use of personal protective equipment was nearly universal. Overall compliance with infection control parameters was 88%. However, only a minority of students demonstrated no breaches of protocol. Most violations involved improper mask use and improper glove use during the intraoperative phase of an appointment and failure to wash hands after removing gloves. There were no significant overall differences in observed behavior pre- and post-EVD training.CONCLUSION:Overall compliance with recommendations was high but some areas showed room for improvement. Future training in infection control should focus on these areas. Training related to EVD had no influence on student behavior.

The development of empathy and positive attitudes are essential elements of professional education. This study explored the nature of empathy and its association with attitudes about, and exposure to older patients in a sample of dental students. Students completed an adapted version of the Jefferson Scale of Physician Empathy (JSPE), the Aging Semantic Differential (ASD) and answered questions about their exposure to older people. Factor analysis was used to identify four factors: (1) Empathy is Valuable, (2) Empathy is Demonstrated, (3) Empathy is not Influential, and (4) Empathy is Difficult to Accomplish. Higher empathy scores were related to the ASD subscale attitude of acceptability of aging and to greater exposure to older adults outside of clinical practice. There were no demographic predictors of higher empathy scores.

The objectives of this study were to compare glucometer experience and attitudes toward counseling, monitoring, and screening for diabetes between two classes of graduating students at one dental school to determine if there were differences by experience and year of graduation. Dental students graduating in 2010 and 2013 completed a survey about their experience with use of a glucometer as well as their attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling. Response rates for the two classes were 100 percent and 95.7 percent, respectively. Students in the two classes were in general agreement that activities related to glucose monitoring and counseling of patients with diabetes are within the scope and responsibility of the dental profession. Examination of their attitudes toward diabetes monitoring and counseling activities by level of glucometer experience indicated that students with more experience using a glucometer were more likely to consider these activities to be within the scope of dental practice and less likely to perceive barriers to such activities compared to those with little or no experience. In addition, regardless of experience, there was significantly higher endorsement for monitoring of patients who had already been diagnosed than for screening of patients who had not been diagnosed. This study suggests that any strategy to encourage dental students' and dentists' involvement in nontraditional health promotion activities should include ample direct clinical experience with these activities.

The main objective of this study was to determine if level of education, gender, and tobacco history affected attitudes of dental students toward tobacco cessation counseling. A secondary objective was to examine the psychometric properties of the survey instrument. First- and fourth-year dental students at one school of dental medicine completed a survey examining attitudes toward tobacco cessation and perceived barriers to performing tobacco cessation counseling in a dental setting. Analyses were conducted to determine whether there were differences in attitudes by gender, level of education, or personal and family tobacco use. A main effect for education level was discovered. Fourth-year students were more likely than first-year students to consider the prescription of nicotine gum and transdermal patches to be within the scope and responsibility of the dental profession. No significant differences were seen with regard to gender or students' personal and family tobacco histories. Dental students were in general agreement that tobacco cessation counseling is within the responsibility of the dental profession, is within the scope of dental practice, and can be effective. Psychometric analysis revealed reliability of the survey instrument.

PURPOSE:This study compares implant primary stability achieved in cancellous bone after placement in piezoelectric prepared sites versus conventionally drilled sites.MATERIALS AND METHODS:Four bovine ribs were randomly assigned and placed in a water bath at 36.5 °C. Five sites per rib (total n = 20 sites) were prepared using piezoelectric system (test) or conventional drills (control) with twenty 10 × 3.6-mm Implantium implants placed. Using Osstell Mentor quantitative analysis, 5 resonance frequency analysis [implant stability quotient {ISQ}] values per implant were recorded at 5 locations for a total of 100 measurements.RESULTS:Independent t test analysis indicated significant difference in primary stabilities between groups: t (17) = 2.637, P = 0.17, with equal variance assumption satisfied (P = 0.196). Examination of means indicated a higher mean ISQ for piezoelectric than for conventional: 58.9 (+8.55) versus 49.2 (+7.33), respectively. Analysis of variance indicated a significant difference in mean ISQ value by rib. Tukey test indicated significantly higher ISQ values for rib A (test) than ribs B, C (control), and D (test).CONCLUSION:Implant site preparation using the piezoelectric system gives higher implant primary stability in cancellous bone. However, variations in quality across bones may have affected the results.

The main objective of this study was to examine attitudes of dental students toward chairside counseling and monitoring of and screening for diabetes. A secondary objective was to examine the psychometric properties of the survey instrument. First- and fourth-year students at one dental school completed a survey examining attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling in a dental setting. Surveys were completed by seventy-one of ninety first-year dental students (79 percent) and eighty-six fourth-year students (100 percent) for a total of 157 responses. Factor analysis of the survey instrument resulted in a three-factor solution: scope and responsibility, barriers, and glucometer use. In analyses to determine whether there were differences in attitudes by gender, level of education, or family history of diabetes, no statistically significant effects were seen. The dental students were in general agreement that glucose monitoring of patients diagnosed with diabetes is within the scope and responsibility of the dental profession; however, only a minority endorsed screening of patients who have not been diagnosed with diabetes. Psychometric analysis revealed internal reliability of the survey instrument.

PURPOSE This study evaluated the effect of denture base acrylic, denture tooth composition, and ridge-lap surface treatment on the microtensile bond strength (μTBS) of three commercially available denture teeth and two injection denture processing systems. MATERIALS AND METHODS Sixteen experimental groups were formed (n = 3), according to denture tooth surface treatment (no treatment or surface treatment recommended by the manufacturer), denture base processing technique and acrylic (SR-Ivocap-Ivocap Plus or Success-Lucitone 199), and tooth type-composition at bonding interface (BlueLine DCL-PMMA, Portrait IPN-PMMA, Phonares II-PMMA, Phonares II-NHC). Rectangular bar specimens with a 1 mm(2) cross sectional area were fabricated and subsequently thermocycled at 10,000 cycles between 5°C and 55°C with a 15-second dwell time. Select specimens underwent μTBS testing in a universal testing machine with a 1 kN load cell at 0.5 mm/min crosshead speed. Data were analyzed statistically by two and three-way ANOVA and Tukey post hoc test (α = 0.05). RESULTS Mean μTBS ranged between 56.2 ± 5.6 and 60.8 ± 5.0 N/mm(2) for the Ivocap Plus specimens and 13.3 ± 5.12 to 60.1 ± 6.0 N/mm(2) for the Lucitone 199 specimens. Among the Ivocap specimens, BlueLine DCL and Phonares II NHC had significantly higher μTBS than Portrait IPN to Ivocap Plus acrylic. There were no statistically significant differences among Blueline, Phonares II PMMA, and Phonares II NHC, or between Phonares II PMMA and Portrait IPN. Within the Luctione 199 specimens, there was a significantly higher μTBS for BlueLine DCL and Phonares II NHC denture teeth with the manufacturer-recommended surface treatment when compared to control surface. BlueLine, Portrait, and Phonares II PMMA groups achieved significantly higher mean μTBS than the Phonares II NHC group. There were no statistically significant differences among BlueLine, Portrait, and Phonares II PMMA groups. CONCLUSION When evaluating the μTBS of PMMA and NHC denture teeth to base resins, a stronger bond was achieved using materials produced by the same manufacturer. Within the Luctione 199 specimens, the Phonares II NHC group demonstrated significantly lower bond strength than other specimens, suggesting that gross ridge-lap reduction of NHC denture teeth is not recommended if a base acrylic by a different manufacturer from the tooth is going to be used.

STATEMENT OF PROBLEM:The predictable nature of the hot pressing ceramic technique has several applications, but no study was identified that evaluated its application to the fabrication of custom implant abutments. PURPOSE:The purpose of this study was to compare the fracture resistance of an experimentally designed pressable metal ceramic custom implant abutment (PR) with that of a duplicate zirconia abutment (ZR). MATERIALS AND METHODS:Two groups of narrow platform (NP) (Nobel Replace) implant abutment specimens were fabricated (n=10). The experimental abutment (PR) had a metal substructure cast with ceramic alloy (Lodestar) and veneered with leucite pressable glass ceramic (InLine PoM). Each PR abutment was individually scanned and 10 duplicate CAD/CAM ZR abutments were fabricated for the control group. Ceramic crowns (n=20) with the average dimensions of a human lateral incisor were pressed with lithium disilicate glass ceramic (IPS e.max Press) and bonded on the abutments with a resin luting agent (Multilink Automix). The specimens were subjected to thermocycling, cyclic loading, and finally static loading to failure with a computer-controlled Universal Testing Machine. An independent t test (1 sided) determined whether the mean values of the fracture load differed significantly (α=.05) between the 2 groups. RESULTS:No specimen failed during cyclic loading. Upon static loading, the mean (SD) load to failure was significantly higher for the PR group (525.89 [143.547] N) than for the ZR group (413.70 [35.515] N) for internal connection narrow platform bone-level implants (P=.025). Failure was initiated at the screw and internal connection level for both groups. CONCLUSIONS:It is possible to fabricate PR abutments that are stronger than ZR abutments for Nobel Biocare internal connection NP bone-level implants. The screw and the internal connection are the weak links for both groups.

A mechanically retentive structure and meticulous surface cleanliness are critical factors in providing fracture resistance and clinical success of metal ceramic restorations. This investigation compared the porcelain/metal interfaces of deliberate compressive fractures of ceramic crowns between conventional preparation and application of the Radio Frequency Glow Discharge Treatment (RFGDT) before each bonding step. It evaluated RFGDT’s capacity to improve wetting effectiveness and minimize porosity. Twelve metal ceramic crowns were fabricated identically. RFGDT was applied to the metal substructures of half the specimens before the ceramic layering process. All specimens were fractured in the same manner by an applied compressive force to simulate dental occlusive failure. Fracture surfaces were inspected by light and scanning electron microscopy. Quantitative analyses of images were performed to identify numbers, locations of cracks, porosity patterns, and other morphological correlates of the fracture zones. There were significantly fewer voids per millimeter at the interfaces in the RFGDT group than in the non-RFGDT group (t = 2.377, df = 9, p = 0.021). There was a significant difference in the number of horizontal cracks per millimeter between the groups (t = 2.132, df = 7, p = 0.035), with more cracks occurring in the non-RFGDT group. RFGDT can improve the integrity of metal ceramic crowns by increasing the substratum surface energy, improving porcelain wetting and spreading and thereby diminishing the numbers of interfacial voids available for initiation of fracture. Routine application of RFGDT should result in fewer cracks along metal/ceramic interfaces in all restorative preparations.

Objective: To compare dentin shear bond strength (SBS) of four combinations of light-activated one-bottle adhesives and composites to determine if cross-compatibility exists, and to determine if the use of the same manufacturer's adhesive and composite results in higher SBS than systems that combine different manufacturers' products.Methods: One hundred sixty human third molars were used for bonding (n=10). Specimens were treated with 37% phosphoric acid and one of four etch-and-rinse adhesives. Specimens were placed in a bonding jig, which was filled with one of four composites. Adhesives PQ1 (Ultradent), Excite (Ivoclar-Vivadent), Optibond Solo Plus (Kerr), and Single Bond (3M-ESPE) and composites Vit-l-Escence (Ultradent), Four Seasons (Ivoclar-Vivadent), Premise (Kerr), and Filtek Supreme Plus (3M-ESPE) were tested. SBS was measured at 24 hours and three months with a testing machine at a speed of 1 mm/min and expressed in MPa. A three-way analysis of variance and Tukey tests were used for data analysis.Results: Significant differences were evidenced among composites for each adhesive system (p<0.001) and among adhesives for each composite system (p<0.001). Optibond Solo Plus and PQ1 yielded significantly higher bond strengths than Single Bond and Excite for all composite systems (p<0.05). All combinations, with the exception of two, demonstrated a decrease in bond strength values after aging.Conclusions: Cross-compatibility was demonstrated, indicating that etch-and-rinse one-bottle adhesive systems can be safely used with composites from different manufacturers without a compromise to the bond strength. Moreover, even higher mean SBS values were demonstrated for selective combinations of different manufacturers' products.

This study was an extension of a previous study that considered dental student attitudes about older adults. In the current study, the association of student interactions with older adults, in both the dental school clinic and daily life, with their attitudes about this group was evaluated using the Aging Semantic Differential. A total of 311 dental students across all four years of academic standing were included in the study. The results showed that students' interactions with older adults outside the clinic did not relate to positive attitudes; however, even after controlling for the age of the student and the frequency, type of individual, and context of interactions with older adults outside the dental clinic, the number of older adult patients seen in the clinic showed a significant positive relationship with attitudes towards older adults. These results reinforce the conclusions drawn in a previous study that dental students' general attitudes about older adults may be changed, but that it is the exposure to older adults in a clinical setting that seems to be more critical in shaping these attitudes.

OBJECTIVES:This study aims to determine differences in primary stability between implants placed in cortical bone following Piezoelectric or conventional site preparation, as assessed by resonance frequency analysis (RFA) and reverse torque testing (RTT).MATERIAL AND METHODS:Four fresh bovine ribs were acquired and surgical guides fabricated with five sites per rib (n = 20), for proper site preparation. Implant sites were prepared via conventional drilling technique as per manufacturer's instruction (Implantium) or via Piezoelectric (Mectron) implant site preparation using the Implant Prep kit. Twenty 10 mm long, 3.6 mm diameter Implantium implants were placed with 35 Ncm torque; 10 implants per preparation method. RFA was assessed via the Osstell Mentor. Five values were taken per implant. All implants where subjected to a reverse torque in increasing increments of 5 until 50 Ncm force was reached.RESULTS:The five RFA values per site were averaged and plotted by placement technique. A paired t-test statistical analysis was run. The average RFA values showed no statistical significance between the 10 test (RFA = 69.04 ± 5.11) and 10 control (RFA = 70.94 ± 6.41) sites (P > 0.05). All implants in both groups withstood RTT up to 50 Ncm force without movement and thus showed no statistical differences.CONCLUSION:Results of this ex vivo study imply that the Piezoelectric implant site preparation affords similar primary implant stability in comparison to conventional rotary instrumentation in cortical bone.

A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.

This study examined the relationship between didactic instruction related to special needs patients and dental students' expectations of and reported comfort levels in treating those with intellectual disabilities. The relationship between students' experience with individuals with intellectual disabilities and their expectations and comfort levels was also assessed. Third-year students were surveyed immediately before and one week, six months, and one year after a lecture on management of patients with developmental disabilities. Students indicated their previous experience with individuals with intellectual disabilities, assessment of their general capabilities (i.e., life function skills) and dental capabilities, and current and anticipated comfort levels related to their treatment. Repeated measures ANOVA indicated significantly higher expectations of general and dental capabilities after instruction (p<0.05), but no change in comfort levels. At one-year follow-up, students' expectations were still significantly higher than at baseline. Regression analyses indicated significant positive relationships between experience and baseline comfort levels (p<0.05), but no significant relationship between experience and expectations of general or dental capabilities. Based on these findings and review of the literature, it is recommended that curricula include experiential learning with reflective components in order to develop students' comfort level in treating special needs populations.