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J Prosthodont. 2018 Aug;27(7):636-643. doi: 10.1111/jopr.12558. Epub 2016 Nov 3.

Effects of Evaluator's Fatigue and Level of Expertise on the Global and Analytical Evaluation of Preclinical Tooth Preparation.

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Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.



To investigate the effects of evaluator fatigue and level of expertise on the grading of preclinical tooth crown preparations, by global and analytical methods of evaluation.


The study had a double-blind design. Two faculty members, each with more than 10 years of clinical and teaching experience, and two demonstrators with no teaching experience evaluated tooth preparations on maxillary central incisors and mandibular first molars. As a test of the effect of fatigue, preparations were globally (subjective grading) and analytically (criteria-based grading) graded on day 1 (after evaluators had been on duty continuously for 8 hours) and day 2 (in the morning after evaluators had sufficient sleep). Evaluators worked under the same circumstances and did not communicate with each other. The assigned textbooks were used to develop the criteria for grading (rubric) and the predefined exclusion criteria. Grades were recorded and statistically analyzed using statistical software. The paired-sample t-test and Mann-Whitney U test were used for multiple comparisons. Level of significance was set at p ˂ 0.05.


An inconsistency in preclinical tooth preparation evaluation was found to exist by both global and analytical methods. Junior faculty tended to award higher grades than senior faculty did. Furthermore, higher grades were scored by the analytical method. More clinical and academic experience did not guarantee intra- and interexaminer reliability. Younger faculty appeared to tolerate fatigue better than older faculty. Likewise, global evaluation appeared to be more influenced by fatigue than was the analytical method.


There were variations in grading, with no consistently preferred grading method. Evaluator performance after continuous 8-hour duty had no significant effect on preclinical tooth preparation evaluation. Level of expertise did not affect preclinical evaluation regardless of the grading method used.


Evaluation; expertise; fatigue; grading; rubric; tooth preparation

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