Artificial Versus Natural Teeth for Preclinical Endodontic Training: A Randomized Controlled Trial

Introduction: The aim of this study was to compare preclinical endodontic training solely on artificial teeth (AT) versus training on natural teeth (NT) with regard to students' performance on NT in an objective structured practical examination (OSPE) in a randomized trial. Methods: Forty-three students were randomly allocated to training on AT (test, n = 20) or NT (control, n = 23). Practical training included intraoral root canal treatment of all tooth types on mannequin heads. Students' performance was assessed via an OSPE first on AT (TrueTooth Mandibular Molar; DELendo, Santa Barbara, CA) and then on a lower mandibular NT. Assessment was performed during the OSPE (13 items) and afterward on teeth and radiographs (22 items). The Mann-Whitney U and Wilcoxon tests compared performance between or within groups. Regression analysis and Bland-Altman plots were used to assess agreement between AT and NT performance. Results: The performance between training groups did not significantly differ on NT (P = .761/Mann-Whitney) or AT (P = .278). The performance on NT was significantly lower than that on AT in the test group (P < .05, Wilcoxon) but not the control group (P > .05). Performance on AT did not significantly predict performance in NT, with relative and proportional bias being present. Conclusions: Within the limitations of this study, training on AT seems suitable to prepare students for endodontic treatment on NT. Because performance on AT does not predict performance on NT, assessment using AT should be regarded with caution, and control of training success using NT might be more reliable.