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Effects of clinical experience and explorer type on judged crown margin acceptability
Casimir Leknius1, Lola Giusti, David Chambers
1Department of Restorative Dentistry, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA.
Summary
Operator experience significantly influences clinical decisions on crown marginal gaps, with experienced dentists rejecting smaller gaps. Internal standards, not just equipment, are key to dental decision-making.
Area of Science:
- Dental materials science
- Clinical dentistry
- Human factors in healthcare
Background:
- Assessing the clinical acceptability of dental crown marginal gaps is crucial for treatment success.
- Variability in judgment can arise from both the tools used and the operator's characteristics.
Purpose of the Study:
- To compare the impact of dental explorer type and operator experience on judgments of crown marginal gap acceptability.
- To identify sources of variation in the assessment of clinical acceptability for dental restorations.
Main Methods:
- A controlled laboratory setting was used to simulate marginal gaps in dental crowns, ranging from 0 to 250 micrometers.
- Forty-nine students and six faculty members evaluated gaps using five different explorer types via tactile examination.
- Generalizability analysis was employed to determine the contribution of different factors to judgment variation.
Main Results:
- No significant differences were found based on the type of explorer used.
- Operators with clinical experience rejected crowns with smaller marginal gaps compared to those without experience (p=0.007).
- Faculty members showed higher intra-operator consistency but lower inter-operator consistency than students.
Conclusions:
- Operator characteristics, particularly experience, accounted for a substantial portion (63%) of the variance in judging marginal gap acceptability.
- The type of explorer used contributed significantly less to the variance (approximately half that of operator differences).
- The study highlights the importance of individual dentists' internal standards in clinical decision-making, suggesting they may be more influential than instrumentation.
