Preclinical endodontic training using natural/simulative models: a cross-sectional study involved trainee and educator perspectives on clinical competence.

This study aimed to evaluate the influence of virtual reality (VR) haptic simulators on manual dexterity, self-confidence and stress levels of 3rd-semester dental students during preclinical endodontic training, as well as to determine the optimal timing for their introduction into the curriculum-before or after training with artificial teeth. Forty volunteered dental students enrolled in preclinical endodontic training were randomly divided into two groups. Group 1 (VR Haptic Simulator group, n = 20) completed four sessions with VR haptic simulators, including three training sessions followed by an evaluation session, before practicing on artificial teeth, whilst Group 2 (Control group, n = 20) performed a single attempt on artificial teeth first followed by the identical VR haptic simulator training period as Group 1. Prior to the training sessions, both groups received standardized lectures and demonstrations on access cavity preparation. Pre- and post-training evaluations included stress levels measured via a visual analog scale (VAS) at different phases, assessment of manual dexterity through preclinical training with artificial teeth performance scores, and self-confidence surveys. Statistical analyses were conducted with significance set at p < .05. Group 1 demonstrated significantly higher manual dexterity scores and self-assessed proficiency compared to Group 2 (p < .05). Stress levels, measured via VAS, were notably reduced following simulator practice in both groups, with Group 1 reporting lower anxiety levels during preclinical training with artificial teeth sessions (p < .05). Simulator-based performance metrics were comparable between the groups (p > .05). Self-confidence surveys indicated that Group 1 felt better prepared and more confident in performing access cavity preparations and managing procedural challenges. The integration of VR haptic simulators before preclinical training with artificial teeth has a positive effect on students' manual dexterity along with reduced stress and increased self-confidence in clinical skills. Further research is needed to explore long-term effects and optimal integration strategies for VR simulators in dental curricula.

To evaluate whether artificial resin teeth could replace extracted human teeth in pre-clinical endodontic training and if this teaching approach influences the outcome of root canal treatment on patients. In a pre-clinical training course, students of group 1 (n = 44) performed simulated endodontic exercises on four plastic blocks and three extracted human teeth. Students of group 2 (n = 45) performed their exercises on plastic blocks and artificial resin teeth (Real-T Endo, Acadental, Lenexa, KS, USA). Both groups performed their first root canal treatments on patients in the following term. Radiographs taken during root canal treatment were used for the evaluation of treatment outcome. Distances between the master cone or the root filling and the radiographic apex as well as iatrogenic errors were assessed, and comparisons were made using Fischer's exact test. In the pre-clinical course root canal treatments performed by students of group 2 were more often classified as acceptable and a higher number of iatrogenic errors were observed in group 1. When root canal treatments were performed on patients for the first time, no significant difference was observed between the groups in terms of radiographic technical quality of root fillings. The application of artificial teeth instead of extracted human teeth had no effect on the technical quality of root fillings in terms of position in relation to the root apex or the creation of aberrations.

Mastery Learning in Preclinical Endodontics Using Customized 3D-Printed Tooth Models for Deliberate Practice: An Application of Educational Design Research

To evaluate the current status of endodontic education and assessment at an undergraduate/predoctoral level in dental schools worldwide. The current survey comprised a 50-item online questionnaire related to undergraduate endodontic education. The project leaders emailed the survey's details to faculty members responsible for endodontic teaching at one dental school in every country to seek their willingness to participate in the survey. After the faculty members accepted, the survey details were sent to participants along with the survey link. Simple descriptive statistics were used to represent the data. Amongst the 44 faculty members from different countries who agreed to participate, 36 completed the survey. Endodontic training starts in 50% of dental schools from the third year of the curriculum. Each dental school employs a diverse range of educational methods. During pre-clinical training, 19.4% of the participating dental schools used only natural teeth. Stainless-steel hand instruments, syringe irrigation with a needle, resin-based sealer and the cold lateral compaction technique are the most frequently used in pre-clinical and clinical training. A significant percentage of dental institutions necessitate that students treat a predetermined quantity of canals or teeth throughout their pre-clinical and clinical education. Dental institutions conduct formative, summative or a combination of the formative and summative throughout the clinical and pre-clinical phases of endodontic training. According to the data collected from this survey, there are considerable variations in the curriculum for undergraduate/predoctoral endodontic programmes amongst the surveyed dental schools. Pre-clinical and clinical education should integrate a larger array of modern tools and procedures.

This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P<0.001). The inter- and intra-examiner strength of agreement were 0.78 and 0.86, respectively. More than 50% of the teeth were categorised as moderate complexity. Almost one-quarter of the total sample, in particular molars, was classified as high complexity, thus unsuitable for undergraduate pre-clinical training.

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

Objectives The aim of this study was to investigate the influence of exposure to additional preclinical endodontic training on undergraduate students' technical quality of root canal treatment and overall confidence levels in endodontics. Methods Technical quality of root canal treatment performed clinically by fifth-year undergraduate students was evaluated and divided into two groups: Group 1, teeth treated by students who had attended both a preclinical endodontic block course and an elective preclinical course. Group 2: teeth treated by students who had not attended the elective preclinical course. All students were also invited to participate in a survey to rate their undergraduate endodontic training and confidence levels performing endodontic treatment. Statistical analysis of data was performed using Person chi-square test, Fisher Freeman Halton exact test, and t-test. A p-value <0.05 was considered statistically significant. Results There was no significant difference between the two groups in overall obturation quality (p=0.619). However, more teeth treated by attendees were of adequate obturation length (p=0.015) and lacked procedural errors (p=0.004). Significantly more elective course attendees rated their undergraduate endodontic training as adequate (p=0.002), but there was no significant difference in the level of confidence between the attendees and the non-attendees. Conclusion Within the limitations of this study, additional preclinical training showed minimal effect on overall quality of root canal treatment performed clinically by undergraduate students and did not enhance their confidence levels; however, it was associated with more satisfaction with their undergraduate endodontic education.

This study aimed to compare the effects of two different curriculum sequencing models-holistic and step-by-step-on the technical competency and self-confidence of undergraduate dental students in preclinical endodontic education. A total of 120 second-year dental students in the 2023-2024 academic year were divided into two groups for the preclinical endodontic course. Group A followed a holistic curriculum, completing all stages of root canal treatment on each tooth group before moving to the next. Group B followed a step-by-step curriculum, performing each treatment stage sequentially across all tooth groups. At the end of the preclinical training, self-confidence was assessed using a five-point Likert scale questionnaire, and technical competency was evaluated through standardized rubrics applied to endodontic treatments on single- and multi-rooted extracted teeth. Statistical analyses included the Pearson chi-square, Fisher's exact, Mann-Whitney U, and Kendall's Tau correlation tests, with significance set at p<0.05. The only significant difference in self-confidence between groups was found in posterior rubber dam application, with Group B reporting higher confidence (p<0.05). Also, Group B achieved significantly higher scores in cavity preparation for multi-rooted teeth and root canal obturation for both single- and multi-rooted teeth (p<0.05). A low but significant positive correlation was found between self-confidence and performance in multi-rooted cavity preparation (p = 0.049). The step-by-step curriculum led to superior technical competency in complex procedures, while self-confidence levels remained similar between the two groups. These findings suggest that the step-by-step curriculum may better support early skill acquisition in preclinical endodontics, while perceived confidence does not necessarily reflect actual competence.

Models of artificial root canals are used in several fields of endodontic investigations and pre-clinical endodontic training. They allow the physical testing of dental treatments, the operating of instruments used and the interaction between these instruments and the tissues. Currently, a large number of different artificial root canal models exist whose geometry is created either on the basis of selected natural root canal systems or to represent individual geometrical properties. Currently, only a few geometric properties such as the root canal curvature or the endodontic working width are taken into consideration when generating these models. To improve the representational capability of the artificial root canal models, the aim of the current study is therefore to generate an artificial root canal based on the statistical evaluation of selected natural root canals. Here, the approach introduced by Kucher for determining the geometry of a root canal model is used, which is based on the measurement and statistical evaluation of the root canal center line's curvatures and their cross-sectional dimensions. Using the example of unbranched distal root canals of mandibular molars (n = 29), an artificial root canal model representing the mean length, curvature, torsion and cross-sectional dimensions of these teeth could be derived.

Introduction The reorganization of the healthcare system prompted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has posed unique challenges for Residency Training Programs worldwide. To mitigate its potential negative effects, it is crucial to assess how the pandemic influenced the activity and quality of life of residents. The purpose of this study was to assess the impact of the pandemic on residents’ competencies, satisfaction, working load, training patterns and occupational exposure in the clinical, surgical, research and didactic fields and to quantify its effects on quality of life and risk perception. Methods An online cross-sectional survey was distributed between 1 June 2020 and 31 July 2020 to 1645 residents enrolled in all Residency Programs of four Universities in northern Italy. The survey included questions about clinical, surgical, and research competencies, educational activity, and quality of life pre- and post-pandemic, and on policies and workplace interventions to reduce exposure to SARS-CoV-2. The main outcome measure was the variation in self-perceived clinical, surgical and research competencies and in specialistic training. Data were analysed using the statistical package R Core Team 4.0.0, estimating mean and standard deviation or median and interquartile range for continuous variables. Variables were compared using chi-square test, Fisher exact tests or McNemar test, as appropriate. A multivariate binary logistic regression analysis was performed to test the effect of different factors on the impact of coronavirus disease-2019 (COVID-19) on self-perceived clinical and research competencies and on didactic training. Results A total of 498 residents completed the survey (response rate 30.3%). The mean age of respondents was 28.9 years, 62.9% were women, and 52.4% were enrolled in the first two years of Training Programs. On the first pandemic wave, over 60% of residents reported a negative impact of the pandemic on their specialistic training. In contrast, 40% of residents involved in clinical duties perceived an improvement in their clinical competences, especially those involved in COVID-19 care, and 34.5% perceived an improvement in their research competences, particularly junior residents, while only 3.5% reported an improvement in surgical skills. Most surgical residents (88.5%) reported a decrease in surgical activities, mainly due to reduced hospital bed capacity and reduction of elective surgery. Almost 90% of all residents experienced a reduction in their didactic activities, but 80% stated their Residency Program adopted virtual training methods. A statistically significant reduction in all examined quality of life items post-pandemic vs. pre-pandemic was found. Even though most survey participants reported the availability of personal protective equipment for residents, 44% considered themselves to be at higher risk of exposure compared to senior staff. Conclusion COVID-19 pandemic caused a significant disruption in surgical training, but it had a positive impact on clinical competencies among residents involved in COVID-19 and urgent care. The pandemic had a detrimental effect on all quality of life aspects, and most residents considered themselves at higher risk of SARS-CoV-2 infection compared to other healthcare professionals. Key Messages Coronavirus disease-2019 (COVID-19) pandemic caused a significant disruption in surgical training, but it had a positive impact on clinical competencies among residents involved in COVID-19 and urgent care. Most residents experienced a reduction of didactic activities. Although the majority of training programs implemented virtual training methods to counteract the restrictions imposed by the pandemic, only half of the residents were satisfied of them. A vast proportion of residents had a high occupational exposure to SARS-CoV-2 and considered themselves at higher risk of COVID-19 infection compared to senior staff. The survey highlighted a statistically significant reduction in five key quality of life measures (i.e. sleep, mood, familiar relationships and social relationships quality and employment satisfaction) during the first wave, with mood and social relationships being the most affected. Notably, employment satisfaction was significantly higher in medical compared to surgical residents.

To assess a modified use of Compare software as a resource to (1) improve students' ability to self-assess their endodontic access preparations (EAPs) and (2) students' opinions of this adjunct. Sixty second-year dental students were randomly assigned to two groups (n=30). A questionnaire was developed and validated. Both groups performed two accesses on #14 acrylic teeth, one at the course's outset and another at its conclusion, and evaluated them using a traditional method of assessment, completed the self-assessment form, and answered items 1‒4 of the questionnaire. The experimental group (G2) received training and were asked to evaluate their EAPs three-dimensionally (3D), complete the self-assessment form a second time, and answer items 5‒14 of the questionnaire. Data were analyzed statistically (significance set at 5%). Using the traditional method, G1 (control group) showed improvement in "size-shape," G2 in "encroachment," and both increased their "overall rate" (p<0.05). Using the 3D method, G2 showed improvement in the "mesial extent" (p<0.05). No difference was found between groups for self-assessment or opinions (items 1‒4) (p>0.05). However, both had an increase in confidence from the first access to the second, and G1 participants believed they improved their ability to perform and assess EAPs (p<0.05). No difference was observed between the two groups when relying upon the traditional method alone. Both groups experienced an increase in confidence but only G1 believed that their ability to perform and assess EAPs improved. Notably, 96.7% of G2 believed that the 3D method should be incorporated into preclinical endodontic training.

Introduction: Students' attitude toward choosing a specialty subject for post graduate studies is of great importance for the education system.Aim: To evaluate the dental students' perception and attitude toward learning, in rendering treatment, choosing endodontics as a specialty for post-graduation. Materials and Methods: A semi structured questionnaire study survey consisting of 10 multiple-choice questions was compiled and distributed among 400 undergraduate dental clinical students. The main domains appraised were preclinical and clinical training in endodontics, their opinion and interest in endodontics as post-graduate specialty. One sample chi-square test was done to see the association of subject response toward endodontic as a specialty response to each question. Results: The response rate was 74.5%, the results showed 72% of the students preferred preclinical training on extracted human teeth. 71% of the students believed that intense preclinical training will help them to manage patients confidently. Conclusion: The principal conclusion of the study revealed that majority of the students find endodontics an interesting subject to study and they would opt for endodontics as a postgraduate specialty subject.

Aim: To evaluate electrical conductivity of the medium provided with ModuPRO endodontic modules, and compare it with those of alginate and vinyl polysiloxane impression materials over varying time intervals. Materials and Methods: A 24 Real Endo-t teeth were mounted in the ModuPRO Endo™ modules using three different mounting media [Groups A (Apex Putty), B (alginate), C (extra-light body vinyl polysiloxane)]. The working lengths were predetermined by microscopy, and the root canals were prepared with ProFile rotary instruments before mounting. Working lengths were checked with an electronic apex locator at 24 and 48 hours; 1, 4, and 6 weeks; and 6 months. Data were analyzed using one-way analysis of variance (ANOVA), the Tukey-Kramer multiple comparison tests, and the Wilcoxon Signed Rank Sum test, with significance set at P < 0.05. Results: Group C showed higher measurements and significant differences from groups A and B for up to 6 weeks (P < 0.05). There was no difference between groups A and B (P > 0.05). After 6 months, all groups showed significantly higher working lengths from those predetermined, but no statistically significant differences were observed among them (P > 0.05). For all groups, differences from predetermined working lengths were lowest at the 1-week interval. Conclusions: Both alginate and the Apex Putty can be used for determining the working lengths using an apex locator over a longer time period. Our study has shown that ModuPRO Endo™ modules, along with the Apex Putty, are effective tools for teaching working length determination with apex locators in preclinical endodontic training.

Background:The quality of academic training can best be analyzed by including the student’s perceptions. The aim of this study is to evaluate the short comings in preclinical endodontic training and also to find out key areas to stress upon for better student understanding and treatment outcome.Materials and Methods:A total of 72 structured questionnaires were distributed to the dental students who have already entered or finished clinical endodontic training in 4th year after successfully completing the preclinical endodontic course in 3rd year. The questions were focused on the list of difficulties encountered during each step of endodontics including patient consideration, access related difficulties, difficulties during working length determination, cleaning and shaping and obturation. The difficulty level for each of the questions was also rated on a scale of 1-3. About 88% of the questionnaires were returned for evaluation. The obtained answers were analyzed generating a data showing the type and level of difficulty.Results:Locating the apical constriction and controlling the length of the master cone has the highest percentage of difficulty among all the groups.Conclusions:This study helped in highlighting key areas of difficulties faced by the students. The training for students in future needs to be amended so that they are better able to manage such difficulties.

Evaluation of students' self-assessment performance in preclinical endodontic training by means of rubrics and a 3D printed model