In August 2022 I fell off my roof at home and ruined a perfectly good body. You would have thought that many months of paralysis from the waist down would be a time for deep inner reflection and a chance to emerge reborn as a wonderful human being. Sadly, that was not the case. I got better and I am still a cynical, miserable bastard.
Here is a less than glowing review of a recent article in the International Endodontic Journal.
Endodontic access cavity training using artificial teeth and Simodont® dental trainer: A comparison of student performance and acceptance
Damian M Slaczka, Rishma Shah, Chuning Liu, Fei Zou, Glen A Karunanayake
https://doi.org/10.1111/iej.14171
This week I supervised some of our fellowship students carrying out endodontic treatment on our patients. We do this via a state-of-the-art camera system in which I have control of two cameras watching what they are doing through the microscope, with the ability to advise them through an earpiece without the patients realising their deficiencies.
It is a system that can work well but on this morning the camera in the microscope was not focused and I had only the blurriest of images. The tooth was an upper central incisor and I did not think it was going to be a problem.
Cutting an access cavity is a skill we spend quite a bit of time demonstrating and teaching due to its importance in achieving our endodontic aims and objectives. Competency requires key motor skills, good conceptual understanding, and an appreciation of three-dimensional pulp chamber anatomy.
Unfortunately, the patient I blurringly observed returned two days after treatment as the access cavity seal over the non-vital bleach had broken and I had to replace it. I was horrified by the shape of the cavity. Instead of an inverted triangular shape it was a pomegranate (see previous edition) with its stalk cut into the incisal edge.
I was rather interested, therefore, to find this article given how our own attempts at endodontic access cavity training seem to have failed. Admittedly, cutting an access cavity using a microscope requires extra levels of skill, but we do all our training in microscopes. This study evaluated the evolution in the performance of dentists trained to prepare access cavities either using artificial teeth mounted within a phantom head or a new haptic virtual reality simulator (Simodont).
The shape of a perfect access cavity is to some degree rather subjective, and it must have taken some amount of training to synchronise the evaluators, but the inter and intra observer Cohen kappa variations were 0.73 and 1 respectively, which is surprisingly good.
The results after 60 minutes of training with instructor feedback were that the evolution of skills in dentists trained using the haptic device was comparable to those trained using artificial teeth.
It amused me to read the continuation of the conclusion that it was therefore reasonable to use the haptic device as an adjunct to artificial teeth for endodontic access cavity training. I think we knew where these Indiana University researchers’ hearts lay.
From my point of view it confirmed that we didn’t need to go out and spend £80,000 on a haptic trainer for our fellowship students. Phew!
Written by Dr Richard Kahan
