Faculty and student perceptions of the success of a hybrid-PBL dental curriculum in achieving curriculum reform benchmarks.

The dental education literature identifies eleven benchmark reform agenda curriculum qualities. The purpose of this study was to determine the extent to which the University of British Columbia D.M.D. curriculum was perceived by students and faculty as achieving these benchmarks and to note any differences in perceptions within and between the student and faculty groups. A WebEval survey consisting of twenty-one questions was delivered online in November 2007 to faculty members and D.M.D. students. The response rate was similar (~60 percent) for both students and faculty members. Comparisons were made between faculty members and students as well as within each group. For the faculty, we looked at the influence of appointment, focus, and teaching experience. For students, we looked at the influence of the year in the program, gender, and program track. Some differences (p<0.05) were identified within the faculty and student groups; however, there were many more differences between the faculty and the students, especially in areas related to curriculum redesign, collaborations with other health professions, preparation for independent practice, and creating a trust-based clinic environment. Faculty members were more optimistic about curriculum progress than were students. Improved communication of curriculum goals and explicit efforts at creating a safe and supportive learning environment could diminish these differences over time.

A randomized clinical trial comparing patient satisfaction and prosthetic outcomes with mandibular overdentures retained by one or two implants.

PURPOSE: This randomized clinical trial tested hypotheses that there are no differences in patient satisfaction, component costs, or treatment and maintenance times when mandibular overdentures are retained by one or two implants. MATERIALS AND METHODS: Subjects wearing conventional complete dentures were randomized to receive either one midline or two bilateral mandibular implants followed by a mandibular denture reline to incorporate implant retention. They indicated on a visual analog scale satisfaction with their dentures before implants and at 2 months and 1 year after implant retention. Satisfaction outcomes between the two groups were compared using the Wilcoxon/Mann-Whitney nonparametric rank test, while changes within each group were analyzed using signed-rank tests. Component costs and times for surgery, prosthodontic treatment, and maintenance were compared using nonparametric and t tests. RESULTS: Eighty-six subjects enrolled in this study and 85 completed the 1-year follow-up, at which median satisfaction was 93 (maximum 100) in the single-implant group and 94 in the two-implant group (P > .5). Within each group, median improvement in satisfaction was similarly dramatic (approximately 44) and significant (P < .001). Prosthodontic maintenance time was similar for both groups (P > .37), but the single-implant group had significantly lower component costs (P < .001) and lower times for surgery (P = .002), postsurgical denture maintenance (P = .021), and denture reline (P < .001). Five implants failed in four subjects, all in the two-implant group and all before denture reline. CONCLUSION: Lower component costs and treatment times, with comparable satisfaction and maintenance time over the first year, indicate that a mandibular overdenture retained by a single midline implant may be an alternative to the customary two-implant overdenture for maladaptive denture patients.

Screening and enrolling subjects in a randomized clinical trial involving implant dentures.

PURPOSE: When planning and budgeting for a clinical trial, researchers have few references to help them estimate how many volunteers will need to be screened, how long the screening process may take, and how much it may cost to enroll sufficient qualified subjects. The purpose of this study was to analyze the time and costs involved in recruiting, screening, and enrolling subjects for a randomized clinical trial examining patient satisfaction with mandibular dentures retained by 1 or 2 implants. MATERIALS AND METHODS: Data collected included age and sex of volunteers, recruiting sources, length of time and costs of recruiting and screening volunteers, and reasons for inclusion or exclusion. Results were analyzed using Pearson chi-square tests. RESULTS: We estimated that we would need to screen 180 volunteers over a period of 4 years at an estimated total cost of CAN$47,664.00 to enroll 86 subjects. Instead, we had to screen 220 volunteers at a direct cost of $63,324.81. We excluded 28% of volunteers, while 32% declined participation and 40% agreed to participate in the study. Volunteers were most commonly excluded because of technical problems with their existing dentures, while they were most likely to decline participation because of perceived surgical risks with implants. Those who agreed to participate most commonly cited anticipation of a more secure mandibular denture as their reason for enrolling. CONCLUSION: We had to screen more volunteers at a higher cost than anticipated, with only 40% of those screened meeting inclusion criteria and agreeing to participate in the trial.

The burden of debt for Canadian dental students: part 4. The influence of debt on program and career decisions.

In the 3 previous papers of this 4-part series, we explored the issue of debt among dental students in Canada to analyze the factors influencing levels of debt. The information was obtained from a national survey of all dental students enrolled in Canadian dental schools during the 2003-2004 academic year. The aims of this fourth paper were to investigate the influence of debt upon career decisions after graduation and to comment on future directions for research into the impact of the rising costs of dental education and dental students' increasing debt levels. The results show that almost half of respondents found the costs of dental programs significantly higher than they anticipated. One-third of the respondents indicated that their anticipated debt level upon graduation had influenced their choice of career path within dentistry. Although this study provides baseline information about the degree of and influences on the indebtedness of students currently enrolled in dental programs across Canada, much remains to be learned about the impact of the higher costs of dental education on potential applicants to dental school and the effect of increased educational debt on practising dentists.

The burden of debt for Canadian dental students: part 3. Student indebtedness, sources of funding and the influence of socioeconomic status on debt.

In recent years, tuition fees at most universities across Canada have increased substantially, particularly in professional programs such as dentistry. Anecdotal evidence suggests that these increases have a significant adverse impact on the educational experience of dental students. In January 2004, students at Canada's 10 dental schools were invited to participate in a survey on costs, debt and other factors related to attending dental school in Canada. This third article in a series of 4 examines the effects of funding sources and socioeconomic status (SES) on dental students' debt. The survey provided key information about the costs of attending dental school and the levels of debt among dental students across Canada. Choice of school and year of study had a significant effect on the overall costs of attending dental school, and dental students' costs were largely financed by private loans or other forms of debt. Canadian dental students' average debt varied between 24,000 to 26,000 dollars per annum, depending on their year of study. Key determinants of borrowing included type of residence, SES, total costs, and number of dependents. Students who lived at home or with relatives borrowed significantly less than those who were renting. Parents' SES was related to students' access to forms of educational funding that result in no debt burden. SES also played a role in determining the likelihood of a student pursuing further professional education.

The burden of debt for Canadian dental students: part 2. A report on survey participants and an analysis of dental education costs.

There are many anecdotes, but few facts about the issue of dental students' debt in Canada. This second of a 4-part series about dental students' debt attempts to remedy this situation. In January 2004, students at Canada's 10 dental schools were invited to participate in a survey on costs, debt and other factors related to attending dental school in Canada. The survey provided previously inaccessible demographic information about levels of debt amongst dental students. A typical dental student respondent had completed 4 years of post-secondary education, was in first year of dental school, was single with no dependents, did not work outside of classes, lived in rented accommodation and walked to school. Reported costs to attend dental school varied widely among Canadian dental schools. Choice of school and year of study had a significant effect on overall costs of attending dental school.

The burden of debt for Canadian dental students: part 1. Review of the literature.

Debt among Canadian university graduates is increasing, while money apportioned to federal and provincial needs-based student assistance programs has been decreasing since the 1990s. Dental students have had to absorb increased tuition fees at both the undergraduate and post-baccalaureate levels. Existing debt and high tuition fees may adversely influence a potential candidate"s decision to enroll in dental school. Likewise, debt incurred during the minimum 2 years of pre-dental education adds to the future debt load of dental graduates. It seems that few dental students can remain debt-free during their dental education, although data are lacking about the extent of debt among dental students and its impact on their career decisions. Government statistics focus primarily on tuition costs for baccalaureate-degree students. Tuition and clinic-related fees constitute a significant proportion of costs for dental students; moreover, university administrations perceive dentistry as an expensive curriculum. This first article of a 4-part series examines debt among dental students, both nationally and internationally.

A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for implant-retained complete overdentures: three-year results.

STATEMENT OF PROBLEM: Few prospective trials of implant-retained mandibular dentures have evaluated the increase and duration of patient satisfaction, costs of denture maintenance in relation to different methods of attaching overdentures to implants, or the use of a reinforced framework. PURPOSE: This report evaluates subjects' satisfaction and prosthodontic maintenance during a 3-year randomized clinical trial of implant-retained mandibular complete dentures, whether reinforced or not with a cast framework, and attached by bar-clip or 2.25-mm ball-spring matrices to endosteal dental implants. MATERIALS AND METHODS: One hundred edentulous subjects, each having at least 1 year's experience with conventional complete dentures, were selected from respondents to a university dental clinic's request for volunteers. Candidates were examined to verify adequate mandibular bone and medical suitability for implants. Subjects then received 2 implants in the anterior mandible before being stratified by mandibular bone height and gender and assigned randomly to 1 of 4 treatment groups. Every subject received a new maxillary complete denture in addition to an implant-supported mandibular complete denture, with or without a reinforcing framework, connected to implants by either a bar-clip or a ball-spring patrix and matrix. The dentures were adjusted and repaired as needed. Subjects indicated on a visual analogue scale (VAS) satisfaction with conventional dentures prior to the study and then with new dentures at 1 month, 1 year, and 2 years. The results reported here are from the first 68 subjects observed for 3 years after receiving new dentures (19 subjects received new dentures less than 3 years before this analysis, and another 13 subjects were lost to follow-up). VAS scores are presented in simple tables and graphs, and results for different groups were compared using 2-sided nonparametric rank tests and repeated measures ANOVA. With respect to costs and maintenance, t tests were used to compare group means. Sample size and other design considerations used a .05 significance level. RESULTS: After receiving new dentures with mandibular implant supports, improved satisfaction "within subject" was prompt, durable, substantial, and statistically significant, regardless of the attachment mechanism, and with or without a reinforcing framework. In contrast, there were no notable satisfaction differences between the 2 attachment mechanisms, or with the presence or absence of a reinforcing framework, either at specific intervals after receiving the new dentures, or in repeated measures ANOVA. For both attachment groups, most denture adjustments occurred during the first year. This accounted for 81% of total adjustments during 3 years, when the 34 subjects in the ball-spring group and the 34 in the bar-clip group were combined. The mean numbers of adjustments per subject and associated clinical times did not differ significantly between the 2 groups. Conversely, denture repairs declined more slowly than adjustments. Almost all repairs (90%) occurred in the ball-spring group to correct problems with the attachments, 39% in the first year, and tapering off only slightly in the following 2 years. Over 3 years of follow-up, mean numbers of repairs per subject differed significantly between groups: 6.7 repairs per person in the ball-spring group, compared to 0.8 in the bar-clip group ( P<.001), and mean time per appointment was greater for repairs in the ball-spring group: 18.9 minutes compared to 16.9 ( P<.01). The cast framework had no influence on the satisfaction expressed or on adjustments and repairs. CONCLUSION: Subjects were very satisfied with the new dentures, although the ball-spring attachment tested in this trial required substantially more repairs.

One-year prosthetic outcomes with implant overdentures: a randomized clinical trial.

PURPOSE: This randomized clinical trial examined implant overdenture (IOD) fabrication and maintenance time and costs, adjustment and repair incidence, and patient satisfaction after 1 year. MATERIALS AND METHODS: Sixty-four patients received 2 mandibular implants and an IOD with either a bar with 2 clips or 2 ball attachments for denture retention. RESULTS: Fabrication time, number of appointments, and chair time for adjustments were similar for the 2 denture designs. The most common adjustments for both types were to the IOD contours. Ball-attachment dentures required about 8 times longer for repairs than bar-clip prostheses. Approximately 84% of patients with ball-attachment dentures needed at least 1 repair, versus 20% of those with a bar-clip mechanism. The most common repairs were replacement of the cap spring or cap for the ball-attachment IOD and replacement of a lost or loose clip for bar-clip dentures. DISCUSSION: Patients were equally and highly satisfied with the improvements in function, comfort, and appearance with both types of IOD compared to their original conventional dentures. CONCLUSIONS: Given equivalent levels of patient satisfaction with either method of retention and a much higher repair rate for the ball attachment, it is suggested that a bar-clip design be used rather than the particular ball attachment utilized in this study.