Career of Constant Learning

Knowing you know nothing

By Emma J Guzman

As I complete my first semester of my second year of dental school, I feel accomplished but at the same moment I feel like I still know nothing. If I compare my knowledge from a year ago today I know so much more about dentistry and I feel that I am truly becoming familiar with this field. Taking classes such as direct, indirect and removable restorations, I know how to prep and restore plastic teeth beautifully. I look at my preps with close to perfect dimensions and my restorations with pride. But this is without a living person’s tongue, saliva and nerves in the way.

I can look at a radiograph and point out obvious defects and tell the difference in the type of caries a patient may have. I can look at a crown preparation and list the items wrong with it with confidence. But, a new method of testing is being implemented at my school and it is showing us students that we have so much more to learn.

We are now having interactive exams where we must treatment plan, list uses for instruments and list steps of a laboratory process. This style is referred to as the OSCE or An Objective Structured Clinical Examination. It is a modern type of examination often used in health sciences and it is designed to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures / prescription, exercise prescription, radiographic positioning, radiographic image evaluation and interpretation of results. This is a timed, rotation to various stations exam. This seems pretty simple; we get a lecture on these items in class so we should know it just like we know everything else we study. But, actually being able to look at a radiograph with no caries or fracture and be able to see the problem is that the tooth is tilted is not something I notice easily. Listing the exact steps of what occurs for a procedure clinically versus in the lab for pre-clinic is something I am not used to. I believe these OSCE style exams are super useful and help us prepare for clinic and boards but the first round was a bit rough. I think a little more than a 45-minute lecture is needed to get the treatment planning abilities flowing. At this point in our (myself & my classmates) careers we cannot recognize certain things but it is a learning process and I absolutely believe that this style of exams will make us better dentist.

It takes years of learning and experience to gain the knowledge of the great dentist who we meet and who teach us. Us students now know what we are expected to know and how we are expected to think and it gives me a greater appreciation for the field. We must obtain a wealth of knowledge to be competent dentist and this will only come with practice. So at this point I am content with the little I know and embrace this career of constant learning.

Have you ever had a patient that you did not know where to start or how to proceed? This blog is a step by step walkthrough of a complex case that was encountered at a dental school.

 This past month, I witnessed first-hand the dynamic field of computer aided design/computer aided manufacturing, also known as CAD/CAM. For the first time, second year dental students at the University of Maryland School of Dentistry were offered the opportunity to use this state of the art technology. Using omnicams and a lab grade milling unit, this technology will help dental students in self-assessing how to properly prepare teeth for inlays and onlays. In pre-clinic, our teeth preparations are evaluated on typodont manikins for criteria including tapered proximal walls, axial and occlusal reduction, rounded line angles, and precise margins. Improvement of our skills when prepping teeth will continue to increase as we become aware of our mistakes and are able to self-assess our own work using this technology. 

CAD/CAM technology allows for the capture of tooth preparations and the eventual manufacture of a crown, inlay, onlay, or other restorations. Capturing the tooth preparation allowed us, as students, to assess a digital, three-dimensional picture of our prepared tooth. When imaging my own tooth preparation, I noticed aspects and mistakes of the preparation that I would have otherwise overlooked. Obtaining a three-dimensional image of my tooth preparation was almost as if I was looking at my preparation through someone else’s eyes. After imaging, milling the ceramic crown was the next step in the process. It was really interesting to see the CAD/CAM machine at work and the step-by-step process that it followed to create the restoration. After 13 minutes, the milling component of my ceramic crown had finally finished. This hands-on experience was one that gave me an insight into the ever-changing field of dentistry. As a dentist, it is important to keep up with developing technology and learning this new technique now will allow us to be prepared to embrace technology when we leave dental school.  

Proficiency in CAD/CAM helps students practice restorative dentistry more efficiently and accurately. Students now progress through their education while learning digital imaging, restoration design on software, and milling of ceramic restorations. I was very impressed with the work of the CAD/CAM machine and my milled ceramic restoration. The measurement of marginal fit, axial contours, proximal contacts, and occlusal contacts were of superior clinical quality.   

The fact that this same system is used in the clinic at the school where students design and mill restorations in a single visit for a patient enhances this pre-clinical learning experience. This training is directly related to improving student performance in the clinic. The advancement of technology in dentistry will always shape our clinical education as well as our future practice. This technology allows for the creation of unique restorations as well as conservation of sound tooth structure, supporting the future of dentistry as it moves towards a philosophy emphasizing minimally invasive dentistry. As the first dental class to experience this technology hand-on, we are all very enthusiastic about this addition to the curriculum at the University of Maryland School of Dentistry. I hope that every dental student is given the opportunity to gain an experience and insight into this field just as we did.