Is Prophylactic Antibiotic Use Necessary Before Dental Procedures in Primary and Revision TKA? A Propensity Score-matched, Large-database Study.

BACKGROUND: The question of whether dental procedures increase the risk of periprosthetic joint infection (PJI) in patients who have undergone total joint arthroplasty (TJA) remains controversial. QUESTIONS/PURPOSES: (1) Are dental procedures associated with an increased incidence of PJI in the setting of either primary or revision TKA after controlling for relevant potentially confounding variables? (2) Is the administration of prophylactic antibiotics before dental procedures associated with any differences in this risk? (3) Which factors are associated with increased incidence of PJI after dental procedures? METHODS: This nationwide, retrospective, comparative, large-database study evaluated 591,602 patients who underwent unilateral primary or revision TKA between 2009 and 2019 using the Health Insurance Review and Assessment Service data in South Korea, in which all people in South Korea were registered and to which all medical institutions must charge any procedures they performed. The study population was divided into 530,156 patients with dental procedures and 61,446 patients without dental procedures based on whether the patients underwent a dental procedure at least 1 year after the index surgery. After propensity score matching, patients were classified into a dental (n = 182,052) and a nondental cohort (n = 61,422). The dental cohort was then divided into two groups: 66,303 patients with prophylactic antibiotics and 115,749 patients without prophylactic antibiotics based on prophylactic antibiotic use. After propensity score matching, patients were categorized into prophylactic (n = 66,277) and nonprophylactic (n = 66,277) cohorts. Propensity score matching was used to control for covariates including posttraumatic arthritis associated with PJI risk according to the dental procedure and prophylactic antibiotic use among the cohorts. After propensity score matching, the standardized mean difference was confirmed to be less than 0.1 for all variables. Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards regression analysis was performed. RESULTS: Dental procedures were not associated with an increase in PJI risk after primary (adjusted HR 1.56 [95% CI 0.30 to 8.15]; p = 0.60) or revision TKA (adjusted HR 1.74 [95% CI 0.90 to 3.34]; p = 0.10). Additionally, use of prophylactic antibiotics was not associated with a reduced PJI risk after the index surgery, either for primary (adjusted HR 1.28 [95% CI 0.30 to 5.42]; p = 0.74) or revision TKA (adjusted HR 0.74 [95% CI 0.45 to 1.23]; p = 0.25). Although surgery type and prophylactic antibiotic use exhibited no influence on PJI occurrence after dental procedures, posttraumatic arthritis was associated with PJI. The adjusted HR for posttraumatic arthritis was 4.54 (p = 0.046). CONCLUSION: Our findings suggest that dental procedures were not associated with an increased risk of PJI for up to 2 years after the dental procedure in patients who underwent either primary or revision TKA. Based on these findings, there is insufficient rationale for the use of prophylactic antibiotics before dental procedures in patients who have undergone primary or revision TKA. LEVEL OF EVIDENCE: Level III, therapeutic study.

Effectiveness of blended pedagogy for radiographic interpretation skills in operative dentistry - a comparison of test scores and student experiences at an undergraduate dental school in Pakistan.

BACKGROUND: Utilizing Blended pedagogy (BP) in radiographic skills may prove to be an effective teaching strategy. However, studies on the use of BP in dentistry are quite limited in Pakistan, where teaching has mostly been via traditional Didactic Lectures (DL); and radiographic interpretation skills of undergraduate dental students are suboptimal. Therefore, this study aims to assess whether utilizing BP to teach radiographic interpretation skills is an effective teaching methodology in Pakistan. METHODS: This mixed-method study was conducted on final year dental students at Jinnah Medical and Dental College (JMDC). Two groups of students were utilized for this study, one taught by traditional DL and the other taught by BP for the same module. BP was conducted over six weeks. A post-module test was conducted in both groups. Additionally, the BP group completed a modified Community of Inquiry (CoI) survey tool and volunteered to discuss their experiences through a focused group discussion (FGD). Descriptive statistics were computed and independent sample t-test was used to analyse the difference between the scores of the two groups. Thematic analysis was performed for the qualitative data. RESULTS: The mean post-test scores were found to be significantly higher in the BP group (61.0 ± 10.2) compared to the DL group (44.4 ± 12.3) (p = < 0.001, CI = 95%, Cronbach Alpha > 0.8). The mean scores for the modified CoI instrument were 4.0 ± 0.29 for the whole instrument; 4.25 ± 0.22 for Teaching Presence, 3.71 ± 0.23 for Social Presence and 3.97 ± 0.16 Cognitive Presence, with all three having a Cronbach's alpha > 0.75. Thematic analysis revealed that BP students mutually agreed that BP method was beneficial with the appreciation of strong support from the facilitator. However, challenges like interrupted power supply and increased effort requirement from students were pointed out. CONCLUSION: Students taught radiographic interpretation skills with BP in comparison to DL had higher test scores and expressed a positive experience demonstrated via a modified CoI survey and FGD. Considering the encouraging results found, dental schools should incorporate BP in their teaching methodology and follow-up studies are needed to further support the use of BP as an effective teaching methodology in Dentistry.

Setting the boundaries and scope of practice for the two sister specialities of dentistry: Operative dentistry-endodontics and prosthodontics.

Dental academia in Pakistan has recently achieved an important milestone. The name of Operative Dentistry speciality has been changed to Operative Dentistry & Endodontics (ODE). It was a much-needed change that was first felt about two decades ago. However, with the correction of name, there are certain challenges that this speciality has to manage now. These include improving the curriculum, setting up standards, and lastly, setting up its boundaries and scope of practice as some of its scope overlaps with a sister speciality called Prosthodontics. This overlapping of the boundaries of dental disciplines is a problem that is unique to Pakistan, India, and some East Asian countries where Operative Dentistry or Conservative Dentistry is combined with Endodontics. This paper aims to discuss the objective delineation of dental procedures and suggest a model of peaceful co-existence of sister dental specialities.

An evaluation of the relationship between clinical requirements and tests of competence in a competency-based curriculum in dentistry.

BACKGROUND: The development of competencies in dentistry is a complicated process that calls for the development of not just cognitive and psychomotor abilities but also behaviors and attitudes that change as technical proficiency increases and meaningful patient encounters occur. This study examined the relationship between the number of clinical requirements completed by dental students and subsequent performance on tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence. METHODS: Retrospective assessment data for 81 students were used in this analysis. Data included the amounts of clinical requirements completed for operative dentistry, endodontics, periodontics, and fixed prosthodontics together with data on the respective performance in tests of competence. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements using a non-parametric Spearman's Rho test at an alpha level of 0.05. RESULTS: Fixed prosthodontics and posterior endodontics were the least common procedures completed by dental students. Statistically significant weak correlations were found between the amounts of clinical requirements performed for posterior endodontic(p = 0.005) and operative procedures (p = 0.006) and associated performance in tests of competence. A moderate correlation was found between the number of fixed prosthodontic procedures completed and associated performance in tests of competence. This latter correlation, however, was not statistically significant (p = 0.654). A significant weak correlation was found between requirements completed for periodontics and the associated test of competence (p = 0.04). A highly statistically significant moderate correlation was found between clinical requirements for anterior endodontics and the associated performance in the tests of competence (p < 0.001). CONCLUSION: The null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform.

Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment.

BACKGROUND: Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees' self-assessment of operative procedures. METHODS: A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%. RESULTS: Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants' self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants' attitudes towards the assessment method were positive. CONCLUSIONS: The findings suggest that the self DOPS method was effective in developing participants' ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.

Study protocol: understanding pain after dental procedures, an observational study within the National Dental PBRN.

BACKGROUND: Patient-reported outcome measures provide an essential perspective on the quality of health care provided. However, how data are collected, how providers value and make sense of the data, and, ultimately, use the data to create meaningful impact all influence the success of using patient-reported outcomes. OBJECTIVES: The primary objective is to assess post-operative pain experiences by dental procedure type through 21 days post-procedure as reported by patients following dental procedures and assess patients' satisfaction with pain management following dental surgical procedures. Secondary objectives are to: 1) assess post-operative pain management strategies 1 week following dental surgical procedures, as recommended by practitioners and reported by patients, and 2) evaluate practitioner and patient acceptance of the FollowApp.Care post visit patient monitoring technology (FollowApp.Care). We will evaluate FollowApp.Care usage, perceived usefulness, ease of use, and impact on clinical workload. DESIGN AND METHODS: We describe the protocol for an observational study involving the use of the FollowApp.Care platform, an innovative mobile application that collects dental patients' assessments of their post-operative symptoms (e.g., pain). The study will be conducted in collaboration with the National Dental Practice-based Research Network, a collective Network of dental practices that include private and group practices, public health clinics, community health centers and Federal Qualified Health Centers, academic institutional settings, and special patient populations. We will recruit a minimum of 150 and up to 215 dental providers and up to 3147 patients who will receive push notifications through text messages FollowApp.Care on their mobile phones at designated time intervals following dental procedures. This innovative approach of implementing an existing and tested mobile health system technology into the real-world dental office setting will actively track pain and other complications following dental procedures. Through patients' use of their mobile phones, we expect to promptly and precisely identify specific pain levels and other issues after surgical dental procedures. The study's primary outcome will be the patients' reported pain experiences. Secondary outcomes include pain management strategies and medications implemented by the patient and provider and perceptions of usefulness and ease of use by patients and providers.

Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists.

BACKGROUND: The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry. MATERIALS AND METHODS: This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05. RESULTS: 4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement. CONCLUSION: In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

3D Digital technology as an alternative educational tool in preclinical dentistry.

INTRODUCTION: The advancement of 3D digital scanners has allowed educators to uphold the quality of education whilst implementing novel methods of assessment. OBJECTIVE: The purpose of this study was to compare two evaluation methods, conventional and digital scanned assessments, on student cavity preparations and students and faculty's perceptions of these assessment methods. METHODS: Predoctoral students performed Class II amalgam and Class III resin composite preparations on simulated teeth for their preclinical competency examinations. Two calibrated faculty evaluated the students' preparations using dental instruments for conventional assessments and 3D scanned images for digital assessments. Faculty scores from both assessment methods were compared and statistically analysed (p < .05). Students also self-assessed their performance using the digital scanned images and filled out a perception survey. RESULTS: There was no statistically significant difference between the conventional (Class II; 73.3 ± 12.2 and Class III; 82.5 ± 8.9) and the digital assessment with scanned images (Class II; 71.3 ± 11.0 and Class III; 82.2 ± 8.2). Faculty scores from both methods have shown a trend of comparability. Most students agreed that digital ideal preparation models were useful (84.2%) and almost all students agreed that digital technology helped them learn operative dentistry (91.1%). In contrast, most students agreed that conventional assessment should be the main self-evaluation system (82.2%) and disagreed that digital assessment is more effective than conventional self-assessment (68.3%). CONCLUSION: Our study demonstrated that 3D digital technology could be an alternative and/or supplementary educational tool to aid in upholding the quality of dental education.

The impact of COVID-19 pandemic on student performance and self-evaluation in preclinical operative dentistry.

INTRODUCTION: During the COVID-19 pandemic, dental schools were required to reformat their curricula to accommodate regulations mandated to protect the health of students and faculty. For students enrolled in the Operative Dentistry preclinical courses at the Harvard School of Dental Medicine (HSDM), this modified curriculum included frontloading the course with lectures delivered remotely, followed by in-person laboratory exercises of learned concepts. The aim of this article was to determine the impact that the modifications had on student performance and student self-evaluation capabilities. MATERIALS AND METHODS: Thirty-eight students were introduced to this restructured course. Their performance in a final multiple-choice (MC) examination, four preclinical laboratory competency assessments (class II amalgam preparation and restoration, class III composite preparation and restoration) and their self-assessment of these preclinical competency assessments were then compared with the pre-COVID pandemic (P-CP) classes from years 2014 to 2019 (n = 216 students). Linear regressions were performed to determine differences in mean faculty scores, self-assessment scores, student-faculty score gaps (S-F gaps) and absolute S-F gaps seen between the class impacted by the pandemic and the P-CP classes. RESULTS: The results demonstrated that students during the COVID-19 pandemic (D-CP) had a higher average faculty score in all four preclinical laboratory competency assessments and in the final MC examination. In addition, the S-F gap was smaller in this cohort as compared with the P-CP classes. CONCLUSION: Despite the challenges of restructuring the preclinical curricula, D-CP students performed better than their P-CP predecessors in multiple facets of this Operative Dentistry course including self-assessment accuracy.

Navigating through our history in research: An altmetric analysis for publications by the full-time operative dentistry faculty at the Aga Khan University Hospital in the past decade.

OBJECTIVE: To analyse the social dissemination of publications by fulltime faculty at a tertiary care facility. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised publication records of the fulltime Operative Dentistry faculty members between July 2011 till July 2021. The search was done on Google Scholar, Altmetric Explorer and PubMed electronic databases. After final screening, all the publications in PubMed-indexed journals, including in vitro studies, randomised controlled trials, original research articles, case reports and letters to the editor, for which the Altmetric Attention Score was available were included. RESULTS: Of the 225 publications identified, 34 (15%) formed the final sample. The cumulative citation count for the publications was 617 and Altmetric Attention Score was 158. There were 16 Facebook mentions and 163 tweets. CONCLUSION: The social impact of publications by the Operative Dentistry faculty over a decade was not convincing in terms of Altmetric Attention Score.

Dental students' experience and perceived confidence level in different restorative procedures.

PURPOSE: Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate self-perceived level of confidence of fifth-year dental students in different restorative-related tasks and the relationship between their clinical training and its corresponding confidence. METHODS: Fifth-year graduate dental students (n = 202) were asked to fill a questionnaire that rated their level of confidence in different clinical restorative dentistry tasks. Additionally, they were asked about the number of times they performed tasks prior to attempting the equivalent competency and in which sub-specialty they felt the most confident. RESULTS: Completed responses were received from 120 students giving a response rate of 59%. Students felt the most prepared and confident in direct restorations and simple endodontic treatment, and they seemed less confident in indirect restorations and complex endodontic treatment. Regarding the steps of indirect restorations, students expressed least confidence in crown preparation compared to impression making and try-in procedures (P < .05). Students rated their confidence highest in operative dentistry, followed by endodontics and lastly fixed prosthodontics. CONCLUSION: The results highlight the areas in which students exhibit the least confidence. Enhancement of student clinical skills and directed exposure is necessary to raise the level of perceived confidence which will reflect positively on their current and future professional performance.

Personality, learning styles and handedness: The use of the non-dominant hand in pre-clinical operative dentistry training.

AIM: This research was undertaken with the aim of using personality traits, learning styles and handedness to develop and evaluate a scale to measure a new concept in operative dentistry, symmetrisation. An initial hypothesis was proposed, stating that handedness, personality trait and learning style could be used to predict symmetrisation potential in the domain of operative dentistry. METHODS: Participants completed three questionnaires: the Edinburgh handedness inventory assessment; the Keirsey Temperament Sorter-II (KTS-II); and the learning style assessment (VARK). Then, participants prepared a cavity on an artificial third molar tooth in the traditional phantom head using their non-dominant hand. For evaluation and comparison purposes, Standard Tessellation Language images were obtained from prepared teeth using a CAD/CAM scanner and then aligned against a reference "unprepared" tooth image using a custom software developed by the authors based on the Iterative Closest Point algorithm. RESULTS: Extroverts, intuitive and participants characterised as relying on their feelings were more accurate compared to introverts, sensory and toughminded participants, respectively. Extroverts were faster to complete the task compared to introverts. Participants with a preference for read/writing learning style produced more errors than any of the other groups. Handedness, however, did not show any significant association with performance. CONCLUSIONS: It was concluded that both the KTS-II and the learning style assessment (VARK) questionnaires possess potential as useful measures of symmetrisation potential and the ability to use the non-dominant hand in operative dentistry, as well as platform for continuing research.

Can an interactive case-based activity help bridge the theory-practice gap in operative dentistry?

INTRODUCTION: A theory-practice gap in pre-doctoral dental education is a common source of stress for dental students. An interactive, small-group, case-based activity was designed to bridge the gap between pre-clinical and clinical experiences. The aim of our study was to assess the effectiveness of the case-based activity by evaluating students' comfort level in operative procedures. MATERIALS AND METHODS: Over 5 years, a total of 172 second-year students from the classes of 2017 through 2021 participated in the case-based activity delivered after the completion of the core operative dentistry course. The exercise included a pre-activity online quiz, an in-class case-based session and a laboratory exercise. Students' self-reported comfort levels in performing operative procedures were collected by surveys at three different times. They included the post-course survey distributed after the completion of the core operative dentistry course, the post-activity survey distributed after the completion of the case-based activity, and the follow-up survey distributed after students completed their first operative procedures in clinic. RESULTS: There was a 93% response rate. The average rating of all eight statements revealed statistically significant increase in students' comfort level after completing the case-based activity and after performing their first operative procedures in the teaching practice. CONCLUSION: This observation suggests that the case-based activity was effective in raising students' comfort levels. The activity may serve as an important tool in bridging the theory-practice gap between pre-clinical and clinical operative experiences.

Inculcating research curriculum in Operative Dentistry - Endodontics residency programme: Experience and outcomes.

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Evaluation of magnetic resonance imaging for diagnostic purposes in operative dentistry-a systematic review.

OBJECTIVES: Magnetic resonance imaging (MRI) is a well-established diagnostic tool in various areas of medicine. The technique provides radiographic images in the absence of ionizing radiation. The aim of the present analysis was to evaluate the best available current external evidence for application of MRI in operative dentistry. MATERIAL AND METHODS: A systematic literature search was performed for studies published by August 2019 in three electronic databases (MEDLINE, Embase via Ovid, Cochrane Library) supplemented by a hand search. The PRISMA criteria were applied to a PICO question. Data were extracted and summarized in data extraction files, and a quality assessment of the included studies was performed. RESULTS: From 287 titles identified, 12 case series with two studies on caries detection, six studies on endodontic, and four studies on anatomical aspects were eligible for inclusion. The studies included showed a high level of heterogeneity and summarized data from 343 subjects. The data available indicate potential of certain MRI settings for diagnostic of caries lesions, presentation of pulp tissues and periapical lesions, and the localization of impacted teeth. CONCLUSIONS: The limited currently available evidence shows potential of certain MRI settings for the use in operative dentistry. Further research needs to assess the applicability and accuracy for dental hard tissues as well as cost-benefit aspects of the MRI technique. CLINICAL RELEVANCE: Certain MRI settings may have the potential as diagnostic tool in operative dentistry.

Determining defensible cut-off scores for dental courses.

PURPOSE: Many countries and institutions have a fixed passing score of 60%. For example, this is a national policy in all Saudi universities where students at all levels must score 60% or higher to pass courses. The purpose of this study is to broaden the scope of standard-setting applications, using data from five major dental courses (Endodontics, Operative, Removable and Fixed Prosthodontics, and Pedodontics) in the 5th dental academic year for two consecutive years to determine the cut-off scores. METHODOLOGY: Four expert raters conducted Angoff's method on final examinations of five dental courses to determine the cut-off scores for the two academic years (2015, and 2016). Cohort size of 2015 was 120 students, whilst that of 2016 was 142 students. The study was conducted at the faculty of Dentistry, at King Abdulaziz University (KAU) from December 2017 to June 2018. RESULTS: All five dental courses yielded different cut-off scores than the fixed 60%. The cut-off scores for 2015 and 2016 examinations were 59.15%, 63.75% for Removable Prosthodontics, 51.86%, 53.75% for Fixed Prosthodontics, 47.42%, 50.5% for Pedodontics, 74.22%, 74.31% for Endodontics and 58%, 55.55% for Operative Dentistry. CONCLUSION: Angoff method yielded different cut-off scores than the fixed 60% passing score currently used by the dental school, yielding a difference in pass-fail rates by as much as a staggering 41%. This finding provides support to use evidence-based standard-setting methods to determine the cut-off score for the courses in Dentistry programme.

'Evaluation of the introduction of a dental virtual simulator on the performance of undergraduate dental students in the pre-clinical operative dentistry course'.

INTRODUCTION: Virtual reality-based platforms are becoming increasingly popular in education. The aim of this study was to evaluate the performance of undergraduate dental students with the introduction of the Moog Simodont dental trainer (VR) within the pre-clinical curriculum in the direct restoration module of the operative dentistry course using manual and digital methods. METHODS: Thirty-two randomly selected year 2 undergraduate students were divided into two groups: group 1, exposed to the Moog Simodont dental trainer (VR) and group 2, no exposure to VR. All students were then evaluated in carrying out a Class I preparation in a single-blinded fashion. All preparations were evaluated by three assessors using a traditional manual approach and a digital software. Statistical analysis of the data was performed using chi-square test (alpha = 0.05). RESULTS: The number of students who performed satisfactory preparations was more in group 1 (12/16), compared to group 2 (7/16). The percentage of satisfactory domains was significantly higher in group 1, compared to group 2, both in the manual evaluation (83.9% (94/112) and 59.8% (67/112) in groups 1 and 2, respectively) and in the digital evaluation (85.7% (96/112) and 55.4% (62/112) in groups 1 and 2, respectively) (P < .05). There was no significant difference between the manual and digital methods of evaluation with regard to the percentage of satisfactory or unsatisfactory preparations (P > .05). CONCLUSIONS: The use of the Moog Simodont dental trainer (VR) significantly improved the satisfactory performance of students. The virtual reality simulator may be a valuable adjunct in the undergraduate direct restorations course and for remedial student.

Similarities and differences in specialty training of conservative dentistry and endodontics (India), operative dentistry (Pakistan) and restorative dentistry-endodontics (United Kingdom).

Dental education and training in Pakistan and India are largely influenced by the British system of education. However, there are some differences in the mode of postgraduate training in these countries. In Pakistan, hospital-based residency training is the mainstay, culminating in a fellowship diploma awarded by the College of Physicians and Surgeons of Pakistan. Whereas, in Indian students of dentistry pursue university-based MDS programme as the primary pathway to specialist training. From the beginning the Indian dental academia has remained vigilant in adopting a correct nomenclature for the specialty concerned with the dental conservation. They named it Conservative Dentistry & Endodontics while in Pakistan the same specialty termed Operative Dentistry has become an obsolete term and does not represent the scope of work practiced by specialists in this discipline. A simple addition of the term "Endodontics" to the present nomenclature of "Operative Dentistry" will resolve the matter of a missing identity in a clinical specialty in Pakistan. The present paper suggests the need for advocacy to change the term used for this particular dental specialty.

Reconstructive Options for Inferior Alveolar and Lingual Nerve Injuries After Dental and Oral Surgery: An Evidence-Based Review.

PURPOSE: The investigators wanted to evaluate, analyze, and compare the current microsurgical repair modalities (primary repair, autograft, tube conduit, and allograft reconstruction) in achieving functional sensory recovery in inferior alveolar and lingual nerve reconstructions due to injury. METHODS: A literature review was undertaken to identify studies focusing on microsurgical repair of inferior alveolar and lingual nerve injuries. Included studies provided a defined sample size, the reconstruction modality, and functional sensory recovery rates. A Fischer exact test analysis was performed with groups based on the nerve and repair type, which included subgroups of specific nerve gap reconstruction modalities. RESULTS: Twelve studies were analyzed resulting in a sample consisting of 122 lingual nerve and 137 inferior alveolar nerve reconstructions. Among the nerve gap reconstructions for the lingual nerve, processed nerve allografts and autografts were found to be superior in achieving functional sensory recovery over the conduits with P values of 0.0001 and 0.0003, respectively. Among the nerve gap reconstructions for the inferior alveolar nerve, processed nerve allografts and autografts were also found to be superior in achieving functional sensory recovery over the conduits with P values of 0.027 and 0.026, respectively. Overall, nerve gap reconstructions with allografts and autografts for inferior alveolar and lingual nerve reconstruction were superior in achieving functional sensory recovery with a P value of <0.0001. CONCLUSIONS: The data analyzed in this study suggest that primary tension-free repair should be performed in inferior alveolar and lingual nerve reconstructions when possible. If a bridging material is to be used, then processed nerve allografts and autografts are both superior to conduits and noninferior to each other. In addition, allografts do not have the complications related to autograft harvesting such as permanent donor site morbidity. Based on the conclusions drawn from these data, we provide a reproducible operative technique for inferior alveolar and lingual nerve reconstruction.

Sialocele Following Traumatic Dental Procedure: A Case Report and Review of Dental Complications.

We present a case of a 17-year-old girl with sialadenitis and sialocele due to trauma sustained from a dental procedure. Our objectives are to review relevant literature and anatomy of the floor of the mouth and salivary glands and discuss potential complications of dental procedures.