Students' perception on flipped classroom with formative assessment: A focus group study.

OBJECTIVE: To explore students' perception on the implementation of flipped classroom (FC) combined with formative assessment during the undergraduate teaching of orthodontic wire-bending skills. METHODS: Third-year undergraduate dental students were taught wire-bending skills via FC teaching method using a series of pre-recorded online video demonstrations. As part of the formative assessment, the students were given the results and assessment rubrics of their prior wire-bending assessment before every subsequent session. Purposive sampling method for focus group discussion was used to recruit eight students comprising four high achievers and four low achievers. Strengths, weaknesses and suggestions for improvement of the FC with formative assessment were explored. Data were transcribed and thematically analysed. RESULTS: Students perceived that FC allowed for a more convenient and flexible learning experience with personalised learning and improved in-class teaching efficiency. The pre-recorded online videos were useful to aid in teaching wire-bending skills but lacked three-dimensional representation of the wire-bending process. Students suggested better standardisation of instructions and access to the marking rubric before and after assessment. CONCLUSIONS: FC teaching with continuous formative assessment and constructive feedback as a form of personalised learning was viewed favourably by students. The implementation of periodic individual feedback can further enhance their learning experience.

The effect of live demonstration and flipped classroom with continuous formative assessment on dental students' orthodontic wire-bending performance.

BACKGROUND: Wire-bending skills is commonly taught through live demonstrations (LD) though flipped classroom (FC) method has gained popularity. Continuous formative assessment promotes personalised learning via closely monitored progress, with the identification of students' strengths and weaknesses. This study aims to evaluate the effects of LD and FC teaching methods, supplemented with continuous formative assessment, on dental students' learning of wire-bending skills for six types of removable orthodontic appliance components. A deeper understanding of the relative effectiveness between LD and FC teaching methods can help identify the most appropriate method to achieve student learning objectives, which is especially important given the current Covid-19 pandemic. METHODS: Forty third-year undergraduate dental students were randomly assigned into FC (n = 20) or LD (n = 20) cohort. Each student attended six teaching sessions, each to teach students' competency in fabricating one type of wire component, for a total competency in fabricating six wire components over the course of six teaching sessions. Either LD or FC teaching methods were used. After each session, wire assignments had to be submitted. Wire assignments were then evaluated using a blinded wire-bending assessment protocol. As part of their formative assessment, the assessment results were distributed to students, lecturers, and technicians before the next session. After the first session (T0) and at the end of all six sessions (T1), students completed a self-reported questionnaire. RESULTS: The mean wire-bending scores for FC were significantly higher than LD for two of the six assignments, namely the Adams clasp (p < 0.01) and Z-spring (p = 0.03). Scores for both LD and FC increased significantly over time, which may be attributed to formative assessment. There was no statistically significant correlation between wire-bending scores and video usage. Students were satisfied with both teaching methods, according to T0 and T1 questionnaires. CONCLUSIONS: Both LD and FC are equally effective in transferring practical orthodontic wire-bending skills and well-received by students. Continuous formative assessment may have enhanced students' learning of orthodontic wire-bending skills. Further studies with control group are recommended to investigate the effect of formative assessment on teaching practical dental skills.

A multicenter study on the prevalence of adults and children seeking orthodontic treatment at high risk of obstructive sleep apnea.

OBJECTIVE: To investigate the prevalence of adults and children seeking orthodontic treatment at high risk of obstructive sleep apnea (OSA) and pediatric OSA (POSA) and its association with demographic variables. METHODS: One hundred-eleven adults and 105 children were consecutively recruited from three centers. The Epworth Sleepiness Scale (ESS) and ESS for Children and Adolescents were used for Risk stratifications for OSA and POSA. RESULTS: The prevalence of patients seeking orthodontic treatment at high risk of OSA/POSA was 27.8%, where 26.1% were adults, and 29.5% were children. High risk for OSA/POSA was not associated with gender, ethnicity, age, Body Mass Index, or neck circumference. CONCLUSION: Approximately 26% of adults and 30% of children seeking orthodontic care were at high risk for OSA and POSA. Screening for OSA and POSA among adults and children seeking orthodontic treatment is imperative.

Students' perception on flipped classroom in contrast to live demonstration for teaching orthodontic wire-bending skills: A focus group study.

OBJECTIVE: This study aimed to explore students' perceptions of flipped classroom (FC) compared to live demonstration (LD) in transferring skills of fabricating orthodontic wire components for orthodontic removable appliances. METHODS: Forty third-year undergraduate dental students were randomly assigned to two groups: FC (n = 20) and LD (n = 20). Students in group FC attended FC, while students in group LD attended LD. Both groups underwent a series of standardized teaching sessions to acquire skills in fabricating six types of orthodontic wire components. Eight students (four high achievers and four low achievers) from each group were randomly selected to attend separate focus group discussion (FGD) sessions. Students' perceptions on the strengths, weaknesses, and suggestions for improvement on each teaching method were explored. Audio and video recordings of FGD were transcribed and thematically analyzed using NVivo version 12 software. RESULTS: Promoting personalized learning, improvement in teaching efficacy, inaccuracy of three-dimensional demonstration from online video, and lack of standardization among instructors and video demonstration were among the themes identified. Similarly, lack of standardization among instructors was one of the themes identified for LD, in addition to other themes such as enabling immediate clarification and vantage point affected by seating arrangement and class size. CONCLUSIONS: In conclusion, FC outperformed LD in fostering personalized learning and improving the efficacy of physical class time. LD was more advantageous than FC in allowing immediate question and answer. However, seating arrangement and class size affected LD in contrast to FC.

A two-year comparative assessment of retention of arch width increases between modified vacuum-formed and Hawley retainers: a multi-center randomized clinical trial.

OBJECTIVES: To compare the clinical effectiveness of Hawley retainers (HRs) and modified vacuum-formed retainers (mVFRs) with palatal coverage in maintaining transverse expansion throughout a 24-month retention period and to assess the subjects' perception toward the retainers. MATERIALS AND METHODS: The trial accomplished blinding only by the outcome assessor and data analyst. Data were collected from post-orthodontic treatment patients who met the inclusion criteria. Thirty-five subjects were randomly allocated using a centralized randomization technique into either mVFR (n = 18) or HR group (n = 17). Dental casts of subjects were evaluated at debond (T0), 3-month (T1), 6-month (T2), 12-month (T3), and 24-month retention (T4). The intercanine width (ICW), interpremolar width (IPMW), interfirst molar mesiobuccal cusp width (IFMW1), and interfirst molar distobuccal cusp width (IFMW2) were compared between groups over time using Mixed ANOVA. A pilot-tested and validated questionnaire consisting of six items were given at T4. Subjects were instructed to rate their retainer in terms of fitting, speech, appearance, oral hygiene, durability, and comfort on a 100-mm Visual Analogue Scale (VAS). RESULTS: No statistically significant differences in arch width were found between the two groups at ICW (P = .83), IPMW (P = 0.63), IFMW1 (P = .22), and IFMW2 (P = .46) during the 24-month retention period. Also, no statistically significant differences were found between perception of both retainers in terms of fitting, speech, oral hygiene, durability, and comfort (P > .05) after 24-month wear. The appearance of mVFRs was rated significantly higher compared to HRs (P < .05). CONCLUSIONS: HR and mVFR have similar clinical effectiveness for retention of transverse expansion cases in a 24-month retention period. Both retainers were perceived to be equal in terms of fitting, speech, oral hygiene, durability, and comfort. Subjects in the mVFRs group found their retainers to be significantly more esthetic than those in HRs group.

A comparison study of dental pulp stem cells derived from healthy and orthodontically intruded human permanent teeth for mesenchymal stem cell characterisation.

The objective of this study was to compare the characteristics of Dental Pulp Stem Cells (DPSCs) derived from healthy human permanent teeth with those that were orthodontically-intruded to serve as potential Mesenchymal Stem Cells (MSC). Recruited subjects were treated with orthodontic intrusion on one side of the maxillary first premolar while the opposite side served as the control for a period of six weeks before the dental pulp was extracted. Isolated DPSCs from both the control and intruded samples were analyzed, looking at the morphology, growth kinetics, cell surface marker profile, and multilineage differentiation for MSC characterisation. Our study showed that cells isolated from both groups were able to attach to the cell culture flask, exhibited fibroblast-like morphology under light microscopy, able to differentiate into osteogenic, adipogenic and chondrogenic lineages as well as tested positive for MSCs cell surface markers CD90 and CD105 but negative for haematopoietic cell surface markers CD34 and HLA-DR. Both groups displayed a trend of gradually increasing population doubling time from passage 1 to passage 5. Viable DPSCs from both groups were successfully recovered from their cryopreserved state. In conclusion, DPSCs in the dental pulp of upper premolar not only remained viable after 6 weeks of orthodontic intrusion using fixed appliances but also able to develop into MSCs.

Synthetic Material for Bone, Periodontal, and Dental Tissue Regeneration: Where Are We Now, and Where Are We Heading Next?

Alloplasts are synthetic, inorganic, biocompatible bone substitutes that function as defect fillers to repair skeletal defects. The acceptance of these substitutes by host tissues is determined by the pore diameter and the porosity and inter-connectivity. This narrative review appraises recent developments, characterization, and biological performance of different synthetic materials for bone, periodontal, and dental tissue regeneration. They include calcium phosphate cements and their variants ß-tricalcium phosphate (ß-TCP) ceramics and biphasic calcium phosphates (hydroxyapatite (HA) and ß-TCP ceramics), calcium sulfate, bioactive glasses and polymer-based bone substitutes which include variants of polycaprolactone. In summary, the search for synthetic bone substitutes remains elusive with calcium compounds providing the best synthetic substitute. The combination of calcium sulphate and ß-TCP provides improved handling of the materials, dispensing with the need for a traditional membrane in guided bone regeneration. Evidence is supportive of improved angiogenesis at the recipient sites. One such product, (EthOss® Regeneration, Silesden, UK) has won numerous awards internationally as a commercial success. Bioglasses and polymers, which have been used as medical devices, are still in the experimental stage for dental application. Polycaprolactone-TCP, one of the products in this category is currently undergoing further randomized clinical trials as a 3D socket preservation filler. These aforementioned products may have vast potential for substituting human/animal-based bone grafts.

Comparing flipped classroom and conventional live demonstration for teaching orthodontic wire-bending skill.

Flipped classroom may overcome weaknesses of live demonstration in teaching orthodontic wire-bending. This study aims to compare the effectiveness between flipped classroom and live demonstration in transferring skills for fabricating Adams clasp. Forty third-year undergraduate dental students were assigned to two groups. The students in group LD (n = 20) attended a live demonstration while students in group FC (n = 20) attended a flipped classroom. Both groups were taught on skills to fabricate Adams clasp in a standardised way. Each student from both groups were asked to submit an Adams clasp for a blinded quality assessment by two trained and calibrated assessors using a 18-item rubric, followed by validated students' satisfaction questionnaires to evaluate their perceived satisfaction on the teaching method received. A crossover study was then conducted three weeks later where LD attended a flipped classroom while FC attended a live demonstration. Students' satisfaction questionnaires were again collected from each student for blinded analysis. Mean scores for the quality of Adams clasp were 9.775 and 9.125 for LD and FC, respectively. No significant difference was detected between the two groups. Statistically significant association was found for one statement on the questionnaire, "I found the classroom arrangements conducive for the wire-bending activity" (p = 0.010). No significant differences were found between the two groups for other statements (p > 0.05). In conclusion, within the limitations of the study, flipped classroom is equally effective as conventional live demonstration in transferring orthodontic wire-bending skills for fabrication of Adams clasp. However, students perceived the classroom arrangements during the flipped classroom significantly more conducive for teaching orthodontic wire-bending.