Protocolos clínicos para restaurações diretas estéticas na Faculdade de Odontologia da Universidade Federal do Rio de Janeiro / Clinical protocols for esthetic direct restorations at the Faculty of Dentistry of the Federal University of Rio de Janeiro

Na Odontologia a realização de restaurações diretas estéticas tornou-se uma opção terapêutica cada vez mais frequente na rotina clínica, impulsionada pelas exigências de melhora na autoestima e qualidade de vida dos pacientes. Deste modo, com o desenvolvimento da Odontologia adesiva e o advento dos materiais estéticos cada vez mais eficazes se faz necessário a consolidação do conhecimento e domínio da técnica para realização de procedimentos duradouros. A fim de melhorar o diagnóstico, prognóstico e plano de tratamento dos pacientes atendidos na Faculdade de Odontologia da Universidade Federal do Rio de Janeiro (FO-UFRJ) e otimizar o tempo clínico disponível para realização de procedimentos este trabalho elaborou Protocolos clínicos para restaurações diretas estéticas, baseado em evidências científicas. Os protocolos foram encaminhados por e-mail para professores de Dentística lotados no Departamento de Clínica Odontológica por meio de um questionário eletrônico estruturado previamente validado. A amostra por conveniência foi composta por 15 participantes. O questionário foi dividido em característica sócio-demográficas dos participantes e dez questões no formato múltipla escolha para avaliar a opinião quanto a importância dos protocolos clínicos elaborados, conhecimento teórico e desempenho clínico dos alunos da FO-UFRJ. Para análise estatística todos os participantes elegíveis para a pesquisa foram entrevistados (N=15) o que denotada uma característica censitária à investigação e a descrição dos resultados foi efetuada com atenção a destacar diferenças substantivas que são privilegiadas ante análises inferenciais (que produzem um p-valor). Os resultados indicaram que 86,7% dos participantes julga ser fundamental a elaboração de protocolos clínicos na FO-UFRJ e espera-se com isso melhorar a prática clínica da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro e nortear a execução do plano de tratamento do paciente. (AU)

In Dentistry, performing direct aesthetic restorations has become an increasingly frequent therapeutic option in the clinical routine, driven by the demands for improvement in patients' self-esteem and quality of life. Thus, with the development of adhesive dentistry and the advent of increasingly effective aesthetic materials, it is necessary to consolidate knowledge and mastery of the technique to perform long-lasting procedures. In order to improve the diagnosis, prognosis and treatment plan of patients treated at the Dental School of the Federal University of Rio de Janeiro (FO-UFRJ) and to optimize the clinical time available for carrying out procedures, this study developed clinical protocols for direct aesthetic restorations, based on scientific evidence. The protocols were sent by e-mail to dentistry professors based in the Department of Dental Clinic through a structured electronic questionnaire. The convenience sample consisted of 15 participants. The questionnaire was divided into socio-demographic characteristics of the participants and ten questions in the multiple choice format to assess the opinion regarding the importance of the elaborated clinical protocols, theoretical knowledge and clinical performance of the students of FO-UFRJ. For statistical analysis, all participants eligible for the survey were interviewed (N = 15) which denoted a census characteristic to the investigation and the description of the results was carried out with attention to highlighting substantive differences that are privileged before inferential analyzes (which produce a p- value). The results indicated that 86.7% of the participants believe that the elaboration of clinical protocols at the FO-UFRJ is fundamental and that it is expected to improve the clinical practice of the Dental School of Federal University and guide the execution of the plan patient treatment. (AU)

Management of an extensive odontogenic keratocyst: A rare case report with 10-year follow-up.

INTRODUCTION: The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone. PATIENTS CONCERNS: The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant. DIAGNOSIS: This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature. INTERVENTION: As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower right anterior region, an aggressive approach was taken by curetting it out surgically along with associated teeth and cortical plate followed by application of Carnoy's solution. OUTCOME: Postsurgery uneventful healing of the lesion was noted on regular follow-up visits with complete resolution at 40 months. The case has been followed for 10 years with no sign of relapse and reoccurrence. CONCLUSIONS: Based on the expression of markers it can thus be concluded that Ki-67 and bcl-2 are site specific and bear strong relationship with the recurrence of OKCs.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Hypnosis, anesthesia, pain management, and preparation for medical procedures.

Hypnosis has a long history of use for anesthesia and pain management, as well as in assisting patient to prepare for medical procedures. This article reviews the history of hypnosis applications in clinical medicine and dentistry. Research on hypnotic susceptibility or hypnotic ability shows that the ability to respond effectively to hypnosis is a relatively stable trait, partially heritable, and measurable by means of several standard procedures. Persons low in hypnotic ability may benefit from alternative therapeutic interventions; however, the majority of medical patients will benefit from the integration of adjunctive hypnotic therapies into their medical and dental care. The article closes with a discussion of the stronger evidence-based applications of hypnosis in healthcare, and the need for well-trained certified hypnosis practitioners.

Acquisition of Skills in Operative Dentistry Following a Contemporary Technique Skills Course: A Retrospective Study.

The aim of this study was to evaluate the impact of a contemporary preclinical technique skills course on early dental student performance in a preclinical operative course. Ivorine teeth prepared for Class I resin restorations by the Classes of 2020 and 2021 in one U.S. dental school were evaluated in this study (N=184). Ivorine teeth were prepared during the first practical exam of the operative dentistry course. Students in the Class of 2021 had been enrolled in a contemporary technique skills course a semester prior to the operative dentistry course, while students in the Class of 2020 were not. The preparations were randomly evaluated by three calibrated and blinded faculty members using magnification loupes, an explorer, and a periodontal probe to evaluate external outline form, internal form, depth, and margin following an established rubric. The results showed that students in the Class of 2021 (who had taken the technique skills course) performed significantly better than students in the Class of 2020 for all criteria evaluated (p<0.05). In this study, incorporation of the preclinical technique skills course improved student performance in the subsequent operative dentistry course.

Has the implementation of the Minamata convention had an impact on the practice of operative dentistry in Jordan?

OBJECTIVE: To assess Jordanian dentists' current perception and attitudes towards amalgam and composite restorations four years after the Minamata treaty was endorsed and suggest decision making factors that may influence the type of restoration requested by patients. METHODS: The cross-sectional study was conducted through structured questionnaires distributed to dentists in Amman, Jordan from June 2017 to February 2018. RESULTS: Of the 1686 dentists who were contacted 758 dentists (response rate 45%) responded to the questionnaire either by email or via field visits. Jordanian dentists used more composite restorations than amalgam. Recurrent caries followed by fracture of the restoration were the main reasons for replacement of both fillings by dentists. However, dentists suggested that the main reason patients requested replacement of amalgam was for 'staining'. In addition, a large proportion of the dentists had experienced patients who had asked either for replacement of amalgam (77%) or refused an amalgam filling (99%) for aesthetic reasons. In the opinion of the dentists, only 20% patients requested replacement of amalgam because of the mercury content. CONCLUSION: The findings of this survey suggest that a 'phase-down' of dental amalgam is being implemented in Jordan's dental clinics but it is not associated with commitment to the Minamata Convention, rather to current dental practice trends and patients' aesthetic demands.

Dental Students' Factual and Procedural Knowledge Retention in Operative Dentistry in a Clinical Dental Curriculum.

The aim of this study was to evaluate dental students' retention of factual and procedural knowledge gained in a preclinical course in operative dentistry during a clinical dental curriculum. In 2017, all 157 seventh- to tenth-semester dental students at a dental school in Germany were asked to repeat the same written examination performed at the end of the preclinical course in the sixth semester. The examinations consisted of 30 multiple-choice questions covering factual and procedural knowledge. The percentage of correctly answered questions per exam and differences in correct answers between the original examination and the re-examination (per question) were analyzed. Students were also asked to self-rate their percentage of correctly answered questions and their knowledge in various disciplines of operative dentistry at the times of the original examination and the re-examination. After exclusions, data were analyzed for 129 students, for a participation rate of 82%. For the seventh- and tenth-semester students, the results on the original examination and the re-examination were not significantly different, while the eighth- and ninth-semester students performed significantly better on the original examination than the re-examination. In all semesters, procedural knowledge remained stable between the original examination and the re-examination, while factual knowledge decreased slightly. Their performance on the original examination was underestimated by the eighth- and ninth-semester students. All the students underestimated their performance on the re-examination. Students mostly rated their knowledge level significantly higher on the original examination than on the re-examination. Overall, this study found that factual and procedural knowledge gained in a preclinical course in operative dentistry was not increased during the clinical dental curriculum.

Regenerative Dentistry and Stem Cells: A Multilineage Differentiation as a Safe and Useful Alternative Way of Harvesting and Selection Adipose Derived Mesenchymal Stem Cells.

BACKGROUND: This review aims to address procedures and indications for the application of the adipose-derived stem cells (ADSCs) for regenerative dentistry. ADSCs have rarely been used in this particular field; conversely, experience from other clinical fields and basic research seems to recommend the suitability of this application. AIMS AND METHODS: We reviewed 32 out of 193 articles on Medline sorted by the relevance option. The main purpose of this paper is to perform a short review of the application of stem cells in regenerative dentistry, describing a multilineage differentiation as a safe and useful alternative way of harvesting and selection of ADSCs. RESULTS AND CONCLUSION: The most common derivation of stem cells for regenerative dentistry is from the adipose tissue. There are conditions in which the levy adipose cannot be easily achieved, or where large amount of grafting is not needed. For this purpose, the possibility of selecting stromal stem cells directly from the lax subcutaneous connective tissue, preferably of the head region, would allow a technical simplification.

Computer-Assisted Surgery: Applications in Dentistry and Oral and Maxillofacial Surgery.

Computer-assisted surgery (CAS) has evolved over time from its earliest introduction with utility in the Neurosurgical field. Within the past twenty years, optical navigation systems have emerged and developed into a great tool for the fields of dentistry and craniomaxillofacial surgery (CMF). Currently, CAS is useful for orthognathic and temporomandibular joint surgery, facial trauma, maxillomandibular reconstruction, implantology, and restorative dentistry. This article describes the indications of CAS in dentistry, with large emphasis on CMF. We will review the process, benefits as well as shortcomings, and end with a discussion on the future of CAS.

Stepwise Excavation.

The most recent inspiration for stepwise carious tissue removal in 2 stages originates from the knowhow on intralesion changes in deep carious lesions. The environmental change that takes place during the first stage of carious tissue removal is aiming for the arrest of the deep lesion, by placing a temporary restoration on top of the soft carious dentine. The cavity is optimised during the second stage for a final restoration, as potential shrinkage of the retained dentine may occur during the period of carious dentine arrestment. However, basic clinical limitations on the objective evaluation of pulp inflammation creates dilemmas in treating the deep lesions. Also, a global consensus is lacking for the definition of a so-called deep lesion. Finally, an optimal evidence goal for choosing the best approach for deep lesion treatment in adults has still not been fully defined. Taken together, it may not be a surprise that treatment variation is reported amongst general dental practitioners on deep caries treatment. Here, facts are presented supporting the treatment, including some drawbacks, as well as updated guidelines for the procedure. Recent clinical high evidence data from randomised clinical trials significantly favour the stepwise approach as a predictable and reliable treatment for well-defined deep carious lesions located in the pulpal quarter of the dentine in terms of avoiding pulp exposure, keeping the tooth vital and without the development of apical pathosis.

Removing or Controlling? How Caries Management Impacts on the Lifetime of Teeth.

Historically, traditional carious lesion management focused on the importance of removal of all carious tissue, with little thought to the lesion origins. The surgical removal of any sign of a carious lesion was prioritised with little, or no, consideration to pulp vitality, loss of tooth structure, or caries disease management. This symptomatic approach concentrating on lesions rather than on the cause of the disease, focused on preventing secondary carious lesion development. Early detection and improved understanding of the caries process - that lesion progress can be arrested or slowed - has led to preventive measures and less destructive management as a focus. The choice of lesion management depends on: whether a primary or permanent tooth is involved; which tooth surface(s) is/are involved; whether the lesion is confined to enamel or extends into dentine; the lesion depth, and lesion cleansability. Use of preventive and minimally invasive operative strategies is complicated by the lack of predictable ways of recording lesions' status to allow early detection of failed strategies and early intervention. Because re-restoration usually makes the cavity larger and, consequently, the tooth weaker, the clinician should be certain about initiating the repeat restoration cycle, delaying the first restoration as much as possible. The 3 main principles that support preventing or slowing the repeat restoration cycle are: (1) avoid restoration placement until there is no other option; (2) place them for maximum longevity; (3) if re-restoration is necessary, repair or refurbishment is preferable to replacement of a defective restoration.

Restoring the Carious Lesion.

Restoring carious lesions can be challenging, especially for deep lesions in proximity to the pulp. A number of factors can influence restoration longevity. This chapter will discuss aspects that should be considered when restoring carious lesions. In the first part, factors that might have an effect on the pulp such as preparation trauma, tooth hypersensitivity, and the use of liners will be described. In the second part, the challenges and limitations of adhesive bonding to (sound and carious) dentine will be discussed. Lastly, recommendations on the suitability of different bonding techniques and restorative materials in different situations will be given.

Clinical Recommendations on Carious Tissue Removal in Cavitated Lesions.

Non-cleansable carious lesions where sealing is no longer an option should be restored in the vast majority of cases. Prior to restoring the cavity, carious tissue removal is performed, mainly to increase the longevity of the restoration. Such removal, however, should not be conducted in a way that the vital pulp is harmed. This means that in teeth with shallow or moderately deep lesions, selective removal to firm dentine is recommended, while in deep lesions (radiographically extending into the pulpal third or quarter of the dentine) selective removal to soft dentine should be performed. In permanent teeth, stepwise removal is a possible alternative, while in primary teeth the Hall Technique can be considered too. To assess carious tissue removal, the hardness of the dentine should be the primary criterion. Moisture, colour, and additional parameters (like fluorescence of bacterial porphyrins, etc.) might be used, but should be critically evaluated towards their validity and patients' benefit. There is insufficient evidence to recommend a specific single carious tissue removal method. However, hand or chemomechanical excavation seem useful, as they reduce pain and discomfort during treatment. Current evidence also does not support any specific restoration material or (bonding) strategy for restoring cavities resulting from different carious tissue removal strategies. Prior to restoring the cavity, cavity disinfection is not recommended any longer.

Sealing Carious Tissue Using Resin and Glass-Ionomer Cements.

One of the most conservative ways to retain tooth structure, preserve pulpal health, and avoid invasive treatment is to simply completely seal established carious lesions. A tight seal to isolate the biofilm and arrest the lesion can be successfully achieved using a sealant material such as resin or glass-ionomer for non-cavitated lesions, a restorative material for cavitated lesions, or, for primary teeth, preformed stainless-steel crowns. This chapter focuses on sealants and restorative materials. Sealant materials are a viable treatment option for controlling non-cavitated lesions in occlusal and proximal surfaces where there is no significant breach in the surface integrity of the tooth, even if the lesion extends into dentine. Resin infiltration can also be used to manage proximal non-cavitated lesions. Even when the exact depth of lesion that can be sealed has not been established, evidence supports sealing shallow and moderate deep lesions into dentine. For cavitated lesions, sealing lesions without carious tissue removal might be an option when removal of tooth tissue is not required to provide a hard periphery around the lesion/cavity margin (to enhance bonding or to increase cavity depth for enough restorative material to be placed to last). There is little evidence for placing a restorative material over cavitated carious lesions without tissue removal or preparation. However, where there is a significant breach in the surface integrity of the tooth but there is still enough sound tooth tissue to provide bonding for an adhesive restoration, sealing in carious tissue might still be an option.

Removing Carious Tissue: Why and How?

Caries is no longer seen as an infectious disease, and the aim of treating carious lesions is to control their activity, not to remove the lesion itself. Such control can be implemented by sealing off the lesion from the environment, with sealed bacteria being deprived from carbohydrates and thus inactivated. For cavitated lesions, controlling them usually involves the placement of restorations to rebuild the cleansability of the surface. In this case, dental practitioners have traditionally removed carious tissues prior to the restoration. This has historically been for a number of reasons, while today the main reason for restoring a cavity is to maximise restoration longevity. In shallow lesions, dental practitioners should aim to remove as much carious tissue as possible (to allow adequate depth for the restorative material) without unnecessarily removing sound or remineralisable dentine. This means removal to hard dentine around the periphery, to firm dentine centrally for optimising restoration longevity and allowing a tight cavity seal. For deep lesions in teeth with vital pulps (without irreversible pulpitis), maintaining pulp vitality is critical. Dental practitioners should aim to avoid pulp exposure, leaving soft or leathery dentine in pulpoproximal areas. Peripherally, hard tissue is left, again to ensure a tight seal and sufficient mechanical support of the restoration. As an alternative to the selective removal to soft dentine, stepwise removal can be used. With this approach, the soft dentine is temporarily rather than permanently sealed in, and removed in a second step after 6-12 months. Strategies where carious tissue in cavitated lesions is not removed at all, but sealed or managed non-restoratively, are currently restricted to primary teeth.

Caries Excavation: Evidence Gaps.

Dental caries, the most common chronic disease in the world, affects over 3 billion people globally. Its management comprises a large proportion of dental care providers' clinical responsibility, yet despite the extensive evidence base for the management of cavitated carious lesions, gaps in the evidence persist. This promotes uncertainty and debate among providers. This chapter reiterates the 3 key components of evidence-based practice (EBP): clinical expertise, an awareness and appreciation of patient values, and use of best available evidence. Secondly, we give a brief summary of current best evidence pertaining to some key areas of caries excavation in the context of lesion management, and highlight respective gaps in the evidence. Consideration is given to the state of the evidence for: how carious-lesion excavation is best achieved, the extent to which excavation should occur, contemporaneous practice, the timing of dental intervention in relation to the extent of the disease, and some areas of contention. Finally, there is discussion around how dental care providers might proceed when high-quality evidence does not exist to inform that part of the EBP collective.

Sealing Carious Tissue in Primary Teeth Using Crowns: The Hall Technique.

In line with reducing the invasiveness of interventions in permanent teeth and changes towards more biological approaches, there have also been moves away from traditional restorative approaches to managing primary teeth where carious dentine/lesions were completely excised and a restoration placed. The Hall Technique is a method for managing carious primary molar teeth where a preformed stainless-steel crown, also known as a preformed metal crown, is seated over a tooth, sealing in, and not removing carious tissue. This chapter discusses the rationale behind the Hall Technique, an outline of the clinical procedure to carry it out, its indications and contraindications, together with the evidence supporting its use. The Hall Technique has been found to be acceptable to children and preferred to more invasive treatment options. Like all dental treatment options, it requires careful case selection, precise carious lesion and pulpal status diagnosis (clinically and radiographically), good patient management, and excellent parental cooperation. The Hall Technique has been shown to be a durable (being likely to last the lifespan of the primary molar) and economical management option for primary molars with carious lesions, which in addition offers the benefit of full coronal coverage, reducing the risk of future carious lesion development. As part of our everyday armamentarium in paediatric dentistry, the Hall Technique is an effective management option for controlling carious lesions in primary molars.

An Agreed Terminology for Carious Tissue Removal.

Understanding the carious process as a biofilm disease rather than an infectious disease has changed lesion management focus towards less invasive options. This has led to new and ongoing changes in recommendations for practitioners. However, the lack of clarity over what to do, and when, is complicated by different teaching, research, and policy documents containing different terms and definitions for carious lesions and management strategies. Lack of clear messages and communication over recommendations hampers moving evidence into practice. The International Caries Consensus Collaboration (ICCC) recommendations on terminology are one part of improving communication for discussing the diagnosis and management of dental caries and dental carious lesions. The term dental caries is the name of the disease, its use being limited to situations involving control of the disease using preventive and noninvasive measures at the patient level. Carious lesion management should be used where management is directly related to disease symptoms at the tooth level. As terminology cannot be used to directly relate the visual appearance of the carious lesion to the histopathology, the terms have been based around the clinical consequences of the disease: soft, leathery, firm and hard dentine. The 3 main carious tissue removal options are described as: (1) selective removal of carious tissue (to both soft and firm dentine), (2) stepwise removal, and (3) non-selective removal to hard dentine (previously known as complete removal and no longer recommended). Use of these terms across clinicians, researchers, dental educators, and even with patients, will help improve understanding and communication.

Selective Removal of Carious Tissue.

Describing and quantifying how much carious tissue should be removed prior to placing a restoration has been a long-debated issue stretching back as far as G.V. Black's "complete caries removal," now known as non-selective carious tissue removal. Originating in the 1960s and 1970s, from the differentiation between different layers of carious dentine, an outer contaminated ("infected") layer and an inner demineralised ("affected") layer, the former of which needed to be removed during cavity preparation and the latter not, selective carious tissue removal was born. Currently, it is termed selective removal to firm dentine. This chapter describes different selective carious tissue removal techniques (to firm, to leathery, to soft dentine) and how they can be achieved appropriately with conventional and novel techniques. Selective removal to firm dentine is recommended for shallow or moderately deep lesions, while for deep lesions (extending close to the pulp) in teeth with vital pulps, selective removal to soft dentine is recommended to avoid pulpal exposure and to preserve the health of the pulp. Leaving soft carious dentine beneath a restoration does, however, raise certain issues regarding how we truly assess pulpal health, what would other dental practitioners think if the patient moved practice, and how do we monitor such sealed residual caries in the future. These issues will all be discussed in this chapter but should at present not preclude dental practitioners from adopting such a minimally invasive evidence-based approach to carious tissue removal.

The Role of Digital 3D Scanned Models in Dental Students' Self-Assessments in Preclinical Operative Dentistry.

The aim of this study was to determine how dental student self-assessment and faculty assessment of operative preparations compared for conventional visual assessment versus assessment of scanned digital 3D models. In 2016, all third-year students in the Class of 2018 (N=35) at Harvard School of Dental Medicine performed preclinical exams of Class II amalgam preparations (C2AP) and Class III composite preparations (C3CP) and completed self-assessment forms; in 2017, all third-year students in the Class of 2019 (N=34) performed the same exams. Afterwards, the prepared typodont teeth were digitally scanned. Students self-assessed their preparations digitally, and four faculty members graded the preparations conventionally and digitally. The results showed that, overall, the students assessed their preparations higher than the faculty assessments. The mean student-faculty gaps for C2AP and C3CP in the conventional assessments were 11% and 5%, respectively. The mean digital student-faculty gap for C2AP and C3CP were 8% and 2%, respectively. In the conventional assessments, preclinical performance was negatively correlated with the student-faculty gap (r=-0.47, p<0.001). The correlations were not statistically significant with the digital assessments (p=0.39, p=0.26). Students in the bottom quartile significantly improved their self-assessment accuracy using digital self-assessments over conventional assessments (C2AP 10% vs. 17% and C3CP 3% vs. 10%, respectively). These results suggest that digital assessments offered a significant learning opportunity for students to critically self-assess themselves in operative preclinical dentistry. The lower performing students benefitted the most, improving their assessment ability to the level of the rest of the class.