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Background: The objective of the present study was to evaluate the effect of 3D printed teeth and virtual simulation system on the pre-clinical access cavity preparation training of senior dental undergraduates. Methods: The 3D printed teeth were manufactured based on the micro-CT data of an extracted lower first molar. Ninety-eight senior dental undergraduate students were required to finish the access cavity preparation of lower first molar within 20 min on plastic and 3D printed teeth on the manikin system as well as on a virtual simulation machine respectively with randomly selected sequences. Expert dentists scored the operated teeth. The scores from the virtual simulation system were also recorded. All the scores were analyzed and compared. Following the procedure, two questionnaires were sent to students to further evaluate the feelings and optimal training sequence. Results: No significant differences were found between plastic and 3D printed teeth scores, while virtual simulation achieved a valid/invalid area removal ratio of 96.86% ± 5.08% and 3.97% ± 1.85%, respectively. Most students found plastic teeth training the easiest and favored the three-training combination (36.36%). 71.42% of the students thought the virtual simulation training should be put at the first place of the three trainings. Over 80% of students agreed with incorporating 3D printed teeth and virtual simulation into their routine training courses. In addition, the general advantages and disadvantages of the virtual simulation system and 3D printed teeth training received almost equal recognition by students. Conclusions: Virtual simulation system training + plastic teeth training + 3D printed teeth training might be the optimal training sequence. Virtual simulation system training could not completely replace the traditional training methods on the manikin system at the moment. With further modifications, 3D printed teeth could be expected to replace the plastic teeth for the pre-clinical access cavity preparation training. [ABSTRACT FROM AUTHOR]

To investigate the mechanism of Triton X-100 (TX-100) reducing the Ag+-resistance of Enterococcus faecalis (E. faecalis), and evaluate the antibacterial effect of TX-100 + Ag+ against the induced Ag+-resistant E. faecalis (AREf). The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of AgNO3 against E. faecalis with/without TX-100 were determined to verify the enhanced antibacterial activity. Transmission electron microscopy (TEM) was used to observe the morphological changes of E. faecalis after treatment. The intra- and extracellular concentration of Ag+ in treated E. faecalis was evaluated using inductively coupled plasma mass spectrometer (ICP-MS). The changes in cell membrane potential and integrity of treated E. faecalis were also observed using the flow cytometer. Moreover, AREf was induced through continuous exposure to sub-MIC of Ag+ and the antibacterial effect of TX-100 + Ag+ on AREf was further evaluated. The addition of 0.04% TX-100 showed maximal enhanced antibacterial effect of Ag+ against E. faecalis. The TEM and ICP-MS results demonstrated that TX-100 could facilitate Ag+ to enter E. faecalis through changing the membrane structure and integrity. Flow cytometry further showed the effect of TX-100 on membrane potential and permeability of E. faecalis. In addition, the enhanced antibacterial effect of TX-100 + Ag+ was also confirmed on induced AREf. TX-100 can facilitate Ag+ to enter E. faecalis through disrupting the membrane structure and changing the membrane potential and permeability, thus reducing the Ag+-resistance of E. faecalis and enhancing the antibacterial effect against either normal E. faecalis or induced AREf. [ABSTRACT FROM AUTHOR]