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Dummies make learning easier

Simulation laboratory provides dental students with authentic experience treating patients

March 19, 2018

By Jennifer Garvin

Photo of dental students viewing video screens
Screen time: First-year students look at the video screens to get a close-up look at a procedure during an operative dentistry lab on Feb. 9.
Editor's note: In November 2017, the ADA News launched Becoming a Dentist, a series of stories that follow three dental students at the University of Maryland School of Dentistry — Dan Yang, LaShonda Shepherd and Ben Horn — during their journey of becoming dentists. The first story, which introduced the students, ran in the Nov. 6 ADA News.

Image of Becoming A Dentist graphicBaltimore — "Did you get all your wax off?"

"What drill speed are you using?"

"How do the burs go? From white to red or red to white label?"

Welcome to eavesdropping during operative dentistry, the course that gets to the heart of dentistry: Improving someone's smile.

Today's assignment is to place a Class IV composite restoration on tooth No. 8. At the University of Maryland School of Dentistry, the operative dentistry program spans all four years of school. The first-year students receive hands-on experience in a simulation laboratory where they familiarize themselves with and learn to use typical dental materials on mannequins. Bit by bit the challenges they face and the knowledge they gain become increasingly complex, culminating in dental materials on mannequins. Bit by bit the challenges they face and the knowledge they gain become increasingly complex, culminating in their final two years when the students are tasked with developing treatment plans and treating their patients in the school's clinic.

According to Dr. Mary Anne Melo, an associate professor of operative dentistry leading today's class, the goal at this stage is to provide all the first years "an excellent foundation" that will inform them well beyond graduation.

"Anytime you can practice what you've learned in a pre-clinical setting, you're going to retain the information that much better," Ben said. "Working with composite and amalgam and learning to make ideal preparations with the drill definitely makes me feel like I really am becoming a dentist. This class, more than any thus far, makes me excited for what's to come as a D2 and especially once we make it to the clinic in our D3 year."
 
Photo of Dr. Melo demonstrating how to place a  composite
Watch me: Dr. Mary Anne Melo, an associate professor of operative dentistry at the University of Maryland School of Dentistry, demonstrates placing a composite.
Dr. Melo starts by demonstrating how to prepare a lingual matrix — a mold using an impression putty of the "patient's bite" — to guide the composite placement. As they do in all their simulation labs, the 65 students in this section of the class, watch Dr. Melo's movements up close on individual video screens that capture the professor's every motion from a camera focused exclusively on her hands as she demonstrates a clinical technique.

After the students let their impressions set for about five minutes, they begin to trim any excess material from the matrix's surface. As the assignment directs, their aim is to capture the "lingual and interproximal contours" and wrap the material around the "facial side of the incisal edge." In layman's terms, the sides of the tooth facing in towards the mouth, the area where two teeth touch and wrap along the biting edge of the tooth.

"Use the No. 20 blade, not the No. 12," Dr. Melo instructs from her perch at the teaching station in the room, as the students follow her lead and carefully remove the excess wax from their impressions. In addition to the camera, the professor's work station is equipped with a microphone to ensure that she can be heard even if the students are drilling or suctioning.

"She makes it look so easy," said Dan, watching Dr. Melo's hands move. "It's challenging getting all that wax off."

Ben agreed, saying, "I still have some wax on mine too."

Photo of dental students in a lab
Lab work: LaShonda and Dan take their time making sure their composites are placed just right in operative dentistry class.
During this portion of the lab, Dr. Melo walks about the classroom to see how her students are advancing with the etching and bonding portion of the assignment. She's joined by clinical instructors Drs. Elaine Miginsky and Michael Raderman, who meander through the classroom offering guidance where needed. After getting their matrixes in shape, the students move on to part two of the assignment: Placing the composite.

"Apply a generous amount of composite against your lingual matrix," Dr. Melo instructs.

"Use a plastic filling instrument for that. After the composite is loaded, apply light pressure to the matrix and tooth and push the composite into position."

"Can you see any gap between the composite and the lingual?" Dr. Melo asked.

"A little," said LaShonda.

"You can put a little more composite in there," Dr. Melo advised.

It's good practice, working on the mannequins.

Photo of a dental student showing off a mannequin's bite
The matrix: Dan shows off the mold of his mannequin's "bite."
"This lab has shown me just how far I am from becoming a real dentist," Dan said. "During simulation labs, I am constantly making mistakes but I also feel like I've definitely been improving. What I like most is the opportunity to familiarize myself with some of the instruments and techniques that I will be using in clinic. While I understand that everything is just a simulation and that in practice it will be much different, I believe that this is valuable exposure and time spent, even if it's just to learn how to hold or learn the names of some of these instruments."

"The lab gives us a glimpse of what's to come in our dental careers, and that aspect has been really cool," added LaShonda. "We're nearing the end of the course, so it's funny to look back on earlier assignments and see how much our hand skills have improved over these past few month."

After an hour of working on their matrixes and getting their composites ready, something magical happens: the students start to look more confident, as if filling teeth has been part of them all of their lives. LaShonda already has her "etch and bond" technique down, preferring to place a little of the composite on her table tray first and work on the lingual shelf "one layer at a time."

Ben, who recently watched his older brother, an orthodontist, take an impression, was pleased to have the opportunity now to use some of the same instruments and materials.

"I was like, I know how to use that," he said.

Photo of dental student curing a composite
The cure: Ben cures his composite for tooth No. 8.
As they move on to their final step — finishing and smoothing — the students have to figure the best way to smooth and shape the lingual surface. Out come the drills, but what speed? Everyone helps each other when possible.

"With so many minds in one room, you never run out of opinions on how to approach each restoration/preparation. Whether good or bad, I feel like it's always a positive to be able to bounce ideas off of so many different people," Dan said.

On cue, Ben asked fellow first-year, Bridget Nucum, "What drill speed are you using?"

"Fifteen," she replied, "Ten wasn't working for me."

"The anterior tooth has been fun for me because I've seen the dentist I shadowed restore a chipped tooth before," said LaShonda, adding that this assignment was one of her favorites since it "allowed us to tap into the more artistic side of dentistry."