IADR Abstract Archives
Protective Wedge for Prevention of Iatrogenic Damage During Tooth Preparation
Objectives: To determine student performance in proximal wall reduction during crown preparation using a protective wedge for preventing iatrogenic damage to adjacent teeth in a preclinical educational setting.
Methods: 60 undergraduate dental students, in their second-year, volunteered for this study as part of their formal learning to prepare the mandibular right first molar for a full metal crown restoration on a manikin-mounted typodont. The study was divided into three parts: Part I- students were randomly assigned into two groups to either undertake tooth preparation in a routine practice session according to a traditional crown preparation protocol, or tooth preparation using a protective wedge to help isolate the tooth during the crown preparation, followed by Part II- a crossover of the groups in the subsequent practice session. Part III - subsequent to the initial practice sessions, the students undertook a usual timed quiz, during which using the protective wedge was optional.
Damage to the adjacent teeth was evaluated blindly and independently by three calibrated faculty members extraorally using magnifying X 2.5 loupes. The depth and volumetric damage to adjacent teeth were also measured blindly and independently using a digital computer-aided design.
Results: Initial analysis demonstrated severe iatrogenic damage 38%, 39%, and 19% of the time without a protective wedge for the parts 1, 2, and 3 respectively, which was consistently less frequent, at 32%, 23%, and 5% respectively, when a protective wedge was used.
Conclusions: Use of a protective wedge reduced the frequency of severe iatrogenic damage to adjacent teeth during preclinical crown preparation. The results also stress the need to raise awareness of the potential for iatrogenic damage and to remind clinicians of its consequences.
Methods: 60 undergraduate dental students, in their second-year, volunteered for this study as part of their formal learning to prepare the mandibular right first molar for a full metal crown restoration on a manikin-mounted typodont. The study was divided into three parts: Part I- students were randomly assigned into two groups to either undertake tooth preparation in a routine practice session according to a traditional crown preparation protocol, or tooth preparation using a protective wedge to help isolate the tooth during the crown preparation, followed by Part II- a crossover of the groups in the subsequent practice session. Part III - subsequent to the initial practice sessions, the students undertook a usual timed quiz, during which using the protective wedge was optional.
Damage to the adjacent teeth was evaluated blindly and independently by three calibrated faculty members extraorally using magnifying X 2.5 loupes. The depth and volumetric damage to adjacent teeth were also measured blindly and independently using a digital computer-aided design.
Results: Initial analysis demonstrated severe iatrogenic damage 38%, 39%, and 19% of the time without a protective wedge for the parts 1, 2, and 3 respectively, which was consistently less frequent, at 32%, 23%, and 5% respectively, when a protective wedge was used.
Conclusions: Use of a protective wedge reduced the frequency of severe iatrogenic damage to adjacent teeth during preclinical crown preparation. The results also stress the need to raise awareness of the potential for iatrogenic damage and to remind clinicians of its consequences.