Simplified ABO-OGS orientation improves training of orthodontic bracket positioning for undergraduate dental students | BMC Medical Education

Orthodontic bracket bonding is critical for achieving optimal results in orthodontic straight arch techniques. Mastery of this technique serves as a gateway for dental students to enter orthodontic clinical practice, making the orthodontic bracket bonding laboratory course a cornerstone of their education [1,2,3,4]. While the traditional plaster bracket bonding technique is economical and convenient for teaching, its effectiveness heavily relies on the clinical experience of the instructor [5, 6, 14]. As a result, students often lack clear, objective feedback on the correctness of their bracket positioning, especially regarding tooth root direction after bonding.

For undergraduate dental students, the major teaching objective is to help them get acquainted with the procedure and realize the importance of precise bracket positioning. To address these challenges, we employed the simplified ABO-OGS, a widely accepted index for achieving high standards in orthodontic treatment outcomes, as the benchmark for bracket bonding in this study. While the wax typodont articulator is widely used for preclinical hands-on training in orthodontics, its implementation is costly and time-consuming for undergraduates due to limited resources and class time. Consequently, we opted not to use the full typodont set in this study. Instead, we compared the effects of three different bracket bonding experimental sessions: traditional plaster model bonding (Control Group), online 2D digital bracket bonding (2D ABO-OGS Group), and artificial tooth bonding (ABO-OGS Group). Our findings indicate that all three types of experimental sessions effectively achieved the teaching objectives and produced satisfactory results.

Objective-oriented teaching facilitates effective educational outcomes [14,15,16]. The Objective Grading System (OGS), proposed by the American Board of Orthodontics in 1994, is now considered a standard tool for evaluating orthodontic treatment results [8, 9]. This study aimed to simplify the ABO-OGS by focusing on tooth alignment, marginal ridge heights, and root parallelism in orthodontic bracket bonding. Both teachers and students highly rated this methodology, with students in the ABO-OGS group appreciating the immediate visual feedback on how their bracket positioning influenced tooth root movement after full engagement and expression of bracket presetting. This approach incorporating similar procedure as clinic operation and objective parameterized evaluation system was perceived as an engaging and effective laboratory session that enhanced their technical proficiency.

Proper bracket positioning is crucial for effective orthodontic treatment. In orthodontics, indirect bonding technique offers numerous advantages over direct bonding, such as chair time saving, a more precise bracket placement and removal of flash to the bracket bases [19]. Additionally, the two techniques showed similar bonding failures [20]. Technological advancements in orthodontics, such as 3D digital indirect bonding, offer higher accuracy in bracket placement and are becoming increasingly popular [21,22,23,24,25]. However, due to time and financial constraints, this technique was not employed in our study. We recommend incorporating 3D digital methods into future laboratory sessions to improve the quality of orthodontic education. Besides, although promising, the scalability and cost-effectiveness of these 3D techniques remain a critical consideration for widespread adoption in educational settings. Further studies are needed to evaluate the practical challenges of implementing these technologies in resource-limited environments.

Particularly, our study found that both teachers and students provided less favorable feedback on the digital 2D bracket bonding sessions compared to traditional plaster model bonding and artificial tooth bonding with standard arch-wire verification. A significant factor influencing this feedback may be the abrupt shift to online classes during the pandemic, which hindered students’ ability to quickly adapt to and effectively master the online bracket bonding technique [26,27,28]. This underscores the hands-on nature of orthodontic training, where students can only achieve proficiency through direct practice.

Previous studies have highlighted several limitations of online teaching in medical and dental education, including the lack of immediate feedback and personalized guidance that in-person instruction offers [29,30,31,32]. The tactile and visual aspects of orthodontic procedures are challenging to convey through digital platforms, often leading to misunderstandings or improper technique application. Furthermore, the absence of physical models and realistic clinical simulations limits the online learning experience [33, 34]. Technical issues, such as internet connectivity problems, varying levels of access to necessary equipment, and the lack of a controlled learning environment, further hinder the effectiveness of online training [31, 33, 34]. As a result, students may feel isolated and disengaged, diminishing the overall learning experience.

Despite these limitations, digital learning offers notable advantages, such as convenience, repeatability and time efficiency [28, 35]. However, it is insufficient for developing the practical skills required in orthodontic training. One study demonstrated that blended online-offline teaching in medicinal chemistry significantly improved academic performance and student satisfaction [36]. Similarly, blended teaching in clinical skill training has been shown to achieve positive pedagogical outcomes in medical education [37,38,39]. Based on our findings, we recommend the integration of online and offline methodologies within the framework of simplified ABO-OGS-oriented bracket bonding lectures. Precisely, prior to their participation in the ABO-OGS laboratory course, students should be encouraged to engage with and familiarize themselves with the digital 2D ABO-OGS laboratory course materials at home. This preparatory step will serve to facilitate a more profound comprehension of the simplified ABO-OGS bracket bonding procedures, ultimately enhancing the overall educational experience. This blended learning approach may improve overall learning efficacy by providing students with fundamental theoretical knowledge through digital platforms, while concurrently reinforcing practical skills through hands-on training sessions.

Finally, while our study emphasizes the importance of hands-on practice, we must acknowledge its limitations. The study’s small sample size and the constraints imposed by the pandemic, such as the rapid shift to online learning, may have influenced the outcomes. Future research with larger sample sizes and more diverse instructional settings would provide more robust data on the effectiveness of different teaching methods. The limited time of the course and the confined objective for undergraduate students also hindered the full application of ABO-OGS in evaluation of orthodontic bonding outcomes. Further improvement of the ABO-OGS oriented orthodontic bracket bonding course in digital 3D simulation software and in full typodont training of orthodontic postgraduate and residency students is the direction of our future efforts.