Global Health Nexus, Winter 2004

A New Dimension in Dental Education: The Preclinical Course in Aesthetics

Denise J. Estafan, DDS, MS.
Associate Professor and Director of Aesthetics, Department of General Dentistry and Comprehensive Care

NYU Dentistry's new predoctoral curriculum recognizes that the process of training clinically competent, 21st century dentists, requires exposing students early in their professional education to how new knowledge in aesthetic dentistry is gained, how to evaluate new materials and new diagnostic techniques as they become available, and how to keep pace with the oral health needs and desires created by changing demographics and technologies.

Accordingly, students in their second year take a standardized, preclinical aesthetics course as a first step in preparing them to become knowledgeable in diagnosing and treating patients who require aesthetic procedures. The course, taught in our new, state-of-the-art simulation facility, begins with an introduction to aesthetic smile design and smile analysis, and includes a focus on the aesthetic principles and concepts to be followed in creating aesthetically pleasing smiles. Students also learn when to treat a patient, when to refer the patient to a specialist, and when multi-specialist treatment is indicated. They learn how to communicate with the laboratory technician, how to achieve color modifications and case evaluation as a therapeutic alternative, and the differences in aesthetic dentistry techniques for adult, geriatric, and pediatric patients.

But since the art of aesthetic dentistry is a lot more than simply knowing the techniques, students are also taught to be aware of and to manage patient expectations which may extend beyond the limits of appropriate dental care and the capabilities of available dental materials. For example, if a patient requests the removal of a gold or silver filling without a diagnosis of caries or fracture, it is the student’s responsibility to tell the patient that to do so would be unethical and unprofessional. In most cases, however, restorative aesthetic procedures are indeed indicated, and students learn how to sequence and carry out the treatment.

In addition to allowing students to learn the conventional methods of preparing and fabricating tooth-colored restorative materials, including inlays, onlays, and ceramic crowns, the preclinical course includes CAD/CAM (computer-aided design and computer-aided manufacture) technology, thereby providing students with hands-on training in fabricating a tooth restoration in a matter of minutes after an optical impression of the tooth has been made. Students practice designing these restorations on their own computers with the same ceramic restoration software, CEREC 3, which is used chairside in our clinics. In the coming year, an updated version of CEREC, CEREC 3D, will be included in the VitalBook™ Technology system — a completely digital curriculum, which all NYU Dentistry students now use. After each semester students trade in their old DVD for an updated version of the entire curriculum.

This leap in technology allows us to continually monitor and evaluate how information is transmitted to students and to ask what meaningful changes should be made in the course. For example, for the first time in the history of any of the predoctoral programs, we were able to produce digital recordings of the procedures the students performed in the course. These procedures will be included in next year’s DVD, so that students may own a reference copy of a variety of preclinical and clinical procedures that they will be able to preview before the course begins and to review before the exam. Prior to the introduction of the video DVD, preclinical demonstration videos were viewed only once by the students. The opportunity for repeated viewings will be especially valuable for third- and fourth-year students, who are preparing to perform these procedures on patients. In addition, video snippets of procedures are being converted to PDA (personal digital assistant or hand-held device) formats to further expand our students’ access to information and technology.

All of these innovations are adding a new dimension to preclinical aesthetic dentistry education for both students and faculty, who view them as enhancing dentistry’s ability to meet the ever-evolving needs of patients.

The author wishes to thank Dr. Elise Eisenberg, Director of Dental Informatics, and the NYU Dentistry Department of Audiovisual Services for their help in integrating computer-assisted learning technologies into the preclinical course in aesthetics.