Cost analysis in dentistry: as applied to operative dentistry.
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A model for a clinical competency examination has been presented. Extensive efforts were exerted in standardizing the procedures, the criteria, and the examiners. In addition, the examination was designed to permit isolation and documentation of errors in various phases of a class II amalgam restoration.
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In comparing two methods of instruction, one must be cautious about forming conclusions because of certain variables which can influence results. Such variables are differences in populations, in instructor effectiveness, and in availability of instructional aids. The comparison does, however, demonstrate differences between the two groups. The fact that the entire class taught by the modified course passed the proficiency examination after nine trials, compared to 12 for those from the traditional course, is not in itself significant. The impressive fact is that in the early trials the rate of students who qualified for clinical practice was nearly doubled in the learning theory group. This might imply that the learning theory group demonstrated a greater degree of problem-solving ability because of opportunities for discovery learning within the course. Since both classes were given the proficiency examination approximately two-and-a-half months after they had completed the preclinical course, it would seem that the learning theory design resulted in retention of the objectives of the course by a significant number of students. Consequently, it is the authors' opinion that the learning theory design provided a more effective method of instruction. Clinical operative dentistry consists of highly intricate procedures which for their successful completion require complex psychomotor responses in the operator. Therefore a program of instruction in operative dentistry must be highly effective. When such a program is organized, utilization of learning theory principles, especially those of skill learning, may aid in achieving this goal.
The object of this study was to evaluate instructor reliabilities when using empirical or traditional and criterion-oriented grading methods. To do so, 52 sample preparations made in plastic teeth by freshman dental students in the preclinical operative dentistry laboratory course were graded by 12 instructors. The preparations included those for amalgam, inlay, and gold foil restorations. The instructors were divided into two groups according to their teaching experience. Intraclass correlation coefficients were calculated by using a one way analysis of variance technique. The criterion method, in general, yielded greater intraclass correlation coefficients. The increase in the intraclass correlation coefficient was found to be significant at the alpha = 0.10 error level for all restorations judged by experienced instructors. The different degrees of increase in correlation may be attributed to the vary ing clinical biases of the instructors and the differences in the types of preparations.
Periodontal and preventive considerations, other marginal fit and occlusion, are discussed as they relate to the fabrication of restorations in operative dentistry. The development of buccal, lingual, proximal, and transitional line contours is presented as related to maintenance of healthy periodontal tissues. Proximal contacts and marginal ridge relationships are related to food retention and arch integrity. The gingival attachment is described, as it determines certain techniques of tooth preparation and impression making.