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Handpiece and bur skills evaluation during an introductory clinical skills programme in a graduate-entry dental school: a pilot study.


The development of a new Dental School in the Grampian Region of Scotland, (UK) was a manifesto commitment of the Scottish Government to assist in the provision of a suitably-qualified dental workforce for the country's needs. The School opened in September 2008 offering a graduate-entry four-year program. Within the UK, there are currently 18 Dental Schools, six of which including the one in the current study are graduate-entry offering a four-year accelerated program for graduates who hold a biomedical science-type degree. The new custom-built Dental School building was completed in Autumn 2009 and clinical and academic teaching activities have been taking place there since November 2009.

The course has been designed following the recommendations of both the General Dental Council (GDC) within the UK and also the Association for Dental Education in Europe regarding the content and competencies for the dental undergraduate curriculum [Allen, 2005; Plasschaert et al., 2007; General Dental Council, 2008]. Students' initial exposure to hands-on clinical dentistry begins in the first semester of their first academic year with an introductory Clinical Skills Program. During this phase, students are introduced to rotary instruments and asked to perform simple treatments on patient simulators. The course concludes with a Clinical Skills Examination of two hours duration in which students are asked to complete two separate techniques. Each student has to demonstrate competence in a number of cavity preparation techniques prior to clinical access.

Within the UK, not all Dental Schools incorporate Clinical Skills teaching within their degree course [unpublished data]. To date, a number of reports in the literature have indicated that simulation clinics improve student performance in practical skills, although the majority of these have investigated the Class I cavity [Wanzel et al., 2003; de Andres et al., 2004; Gansky et al., 2004; Wierinck et al., 2005, 2006; Giuliani et al., 2007]. As such, the aim of the current pilot study was to determine the effect of an introductory Clinical Skills Program on the development of two tasks aimed at teaching a Class II cavity preparation technique.

Materials and Methods

The study was undertaken during the introductory Clinical Skills Program within the University of Aberdeen Dental School between November 2010 and March 2011. Ethics approval was obtained from the College Ethics Research Board prior to study commencement. All 23 first year students (F: 19; M: 4) participated in the study. Students attended the Skills Laboratory one day/week over the duration of the course. Students were introduced to cavity preparation techniques using rotary instruments in January 2011. Prior to each session, a demonstration of the technique was provided and in addition a Microsoft[R] Powerpoint was placed on the virtual learning environment (VLE) 48h prior to the session.

Students were asked to complete two tasks using a Frasaco[R] 46 tooth and a FG 565 pear-shaped diamond bur as follows:

* Task One: Cut a groove from the central fissure area to within 1mm of the marginal ridge which was 5mm in length, 2mm in width and 2mm in depth.

* Task Two: As for Task One and in addition, cut a slot vertically downward at the marginal ridge to create a box 2mm in length, 2mm in width and 3mm in depth.

Both tasks were undertaken during the initial operative phase of the Clinical Skills Program and two months later after further clinical skills practice. Cavity dimensions were measured using a Digital Caliper with a depth gauge. Duplicate measurements for each cavity dimension were taken and the mean calculated for each. Measurements were undertaken by two examiners and the mean of each of the measurements was analysed using a two-sample t-test (MINITAB[R] 15.1).


Regarding Task One, there was a statistically-significant improvement in mean groove width from 1.09 mm (S.E.M [+ or -] 0.13) to 1.73 mm (S.E.M [+ or -] 0.10) (t = -3.80, p = 0.01). There was also an improvement in the mean groove distance to the marginal ridge between the initial and final skills practice, although this did not reach statistical significance (Table 1). Concerning Task Two, both the mean groove width and the mean box width improved and both were statistically significant (t = -2.48, p = 0.02 and t = -2.19, p = 0.05, respectively). There were also improvements in all other mean groove and box dimensions, although none reached statistical significance (Table 2).


The overall aim of the accelerated graduate-entry Bachelor of Dental Surgery program in Aberdeen is to provide the skills and knowledge to become a competent and independent practitioner as defined by the GDC in the "The First Five Years" [General Dental Council, 2008]. The course has been designed around six themes which run with both horizontal (between themes within the same year) and vertical (in subsequent years within each theme) integration throughout the program. Emphasis has been placed on early clinical contact and the curriculum has a number of integrated Clinical Skills Programs. These encompass the introductory operative course reviewed in this study, one in Paediatric Dentistry and further programs in Prosthodontics and Endodontics.

The present study investigated the Class II cavity given the more difficult nature of its preparation compared with the Class I cavity which has been reviewed by a number of other authors [Wierinck et al., 2005; 2006]. The technique is taught in two phases, firstly as Task One which leaves a small amount of plastic tooth material as a marginal ridge and moving on to Task Two with box creation. The rationale for this is to emphasise the importance of preventing iatrogenic damage to the adjacent tooth which has been a significant finding with conventional rotary instrument preparation techniques [Medeiros and Seddon, 2000; Lussi et al., 2003; Lenters et al., 2006].

Within the current pilot study, the objective was to assess the development of two cavity techniques with both tasks designed to teach a Class II cavity preparation. Results from this study demonstrated significant improvement in the performance of students after conventional skills training which is in agreement with a number of other studies [Wanzel et al., 2003; de Andres et al., 2004; Gansky et al., 2004; Giuliani et al., 2007]. Indeed, others have confirmed in a longitudinal study that manual dexterity skills are improved in those studying dentistry compared to those studying medicine which involves limited dexterity training [Luck et al., 2000].

One recent study examined the effectiveness of a conventional pre-clinical operative skills program within a group of second year dental students who were required to prepare a Class I cavity on a mandibular molar tooth. The procedure was undertaken at the start of the course after a demonstration and introductory lecture and subsequently, again at the end of the training. Cavities were coded according to outline form, retention form, smoothness, cavity depth and cavity margin angulations. The authors determined a significant improvement in clinical skills performance on course completion [Polyzois et al., 2011].

Recently, there have been a number of reports investigating the use of virtual reality simulation systems in teaching and evaluating manual dexterity which appear to produce valid and reliable results [Buchanan, 2004; Wierinck et al., 2007; Urbankova, 2010; Gal et al., 2011]. Haptic systems allow for objective assessment of tool or bur position, orientation and the degree of applied force, allowing feedback on the user's performance during each stage of a procedure. Skills assessment using haptic models have been researched in for example, crown preparation, endodontic access and oral implant surgery [Kusumoto et al., 2006; Rhienmora et al., 2011; Suebnukarn et al., 2011].


The current study would suggest that an introductory operative skills program is beneficial in teaching a Class II cavity preparation technique.


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J.I. Foley, J. Drummie

Dept Paediatric Dentistry, The University of Aberdeen Dental School and Hospital, United Kingdom

Postal address: J.I. Foley. The University of Aberdeen Dental School and Hospital, Foresterhill, Aberdeen, AB25 2ZR

Table 1. Mean (S.E.M.) cavity dimensions (mm) for Task One at baseline
and two months after clinical skills practice (n-=23).

Cavity Dimension   Initial Skills   Final Skills   Two-sample   p-value
                      Practice        Practice       t-test

Groove length       4.50 (0.61)     5.73 (0.33)       -1.77     0.096
Groove Width        1.09 (0.13)     1.73 (0.10)       -3.80     0.001 *
Groove Depth        2.05 (0.31)     1.96 (0.16)       0.26      0.799
Groove Margin       1.86 (0.28)     1.46 (0.22)       1.16      0.263

Key: statistically significant at p < 0.05

Table 2. Mean (S.E.M.) Cavity dimensions (mm) for Task Two at
baseline and two months after clinical skills practice (n=23).

Cavity            Initial        Final        Two-    p-Value
Dimension         Skills         Skills      sample
                  Practice      Practice     t-test

Groove Lenqth   3.32 (0.78)    4.36 (0.36)   -1.22     0.242
Groove Width    1.14 ( 0.15)   1.73 (0.18)   -2.48    0.023*
Groove Depth    1.64 (0.33)    2.09 (0.11)   -1.30     0.218
Box Lenqth      1.32 (0.31)    1.46 (0.11)   -0.42     0.685
Box Width       1.18 (0.24)    1.73 (0.79)   -2.19    0.049*
Box Depth       2.23 (0.44)    3.09 (0.09)   -1.91     0.086

Key: statistically significant at p < 0.05
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Author:Foley, J.I.; Drummie, J.
Publication:European Archives of Paediatric Dentistry
Article Type:Report
Geographic Code:4EUUK
Date:Jun 1, 2012
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