The Effect of Enhanced Personal Protective Equipment on The Quality of Tooth Preparations Performed by Undergraduate Dental Students

Abstract

The COVID-19 pandemic has instigated significant changes in dental practice, especially the mandatory usage of Enhanced Personal Protective Equipment (EPPE) during aerosol-generating procedures (AGPs). This has implications for dental practitioners' safety and their work's effectiveness and efficiency. This study aimed to evaluate the effects of EPPE usage on the quality and time required for full ceramic metal crown preparations and the user's comfort during these intricate dental procedures. In addition to that, it aimed to develop a novel dental specific fine motor control test (3-slot test) and evaluate its ability to predict student performance during crown preparation by evaluating taper quality, amount of preparation depth and adjacent tooth damage. In this single-centre, crossover study, eighteen year 5 dental undergraduates were tasked with performing standard ceramo-metal tooth preparations on upper right canine tooth manikins. They conducted these procedures under two conditions: wearing Standard Personal Protective Equipment (SPPE) and Enhanced Personal Protective Equipment (EPPE). The order of PPE usage was randomly assigned. The 3-slot test is a novel dental-specific test that was designed and evaluated in terms of its predictive ability in determining clinical performance during a crown preparation. The duration of each preparation was recorded, and any damage to adjacent teeth was assessed. We collected subjective data on comfort levels with each type of PPE using questionnaires. We employed scanning, 3D analytical software (3dMDvultus, USA) and software Cloud (UCL, UK) to measure mean tooth reduction and the convergence angle of prepared teeth. A p-value of <0.05 was considered significant. The 3-slot test had good ability in identifying the students at risk of over-tapering the convergence angle of preparations, in contrast had a poor ability in identifying the students at risk of overpreparation and adjacent tooth damage during their crown preparations. The PPE level did not influence preparation time or induce any damage to adjacent teeth. Notably, the preparation convergence angle significantly increased in the EPPE group (P 0.001), while the amount of tooth prepared was consistent across both groups. Decreased comfort, vision, movement, and fine motor control were reported in the EPPE group (P = 0.001). Although EPPE does not affect the time or amount of tooth preparation, it can influence the preparation convergence angle and perceived comfort during dental procedures. The novel '3-slot test' provides a promising tool for predicting student performance and assessing their fine motor dental skills. Future research should address the limitations of this study.