Skip to main content

An early microvascular training program of dental intern students and junior residents: a comparative prospective study

Abstract

Background

Clinical instructional strategies and the climate in which teaching and learning take place have a significant impact on the quality of dental education. Therefore, this study aimed to evaluate the impact of early microsurgery training on the skills of dental intern students who are planning to join an oral and maxillofacial surgical field (DIS) as compared with junior residents within an oral and maxillofacial surgery department who had no microsurgery experience (JR).

Methods

A total of 100 trainees, 70 were DIS, while the other 30 were JR. The average age was 23.87 ± 2.05 years for DIS group and 31.05 ± 3.06 for JR group. All trainees attended a microsurgical course (theoretical and practical parts) for seven days within a Microvascular Laboratory for Research and Education of a university-affiliated tertiary hospital. Two blinded examiners had assessed the performance of trainees independently using a specific scoring system. The independent sample t-test was used to compare the effect of microsurgery training between DIS and JR groups. The significance level was set at 0.05.

Results

The DIS group had showed higher attendance rate than JR group (p < 0.01), with a lower absence score in DIS than JR groups (0.33 ± 0.58 vs. 2.47 ± 1.36). The total score of the theoretical test was significantly different between both groups (p < 0.01). In this context, the DIS group had revealed higher total score than JR group (15.06 ± 1.92 vs. 12.73 ± 2.49). In term of tissue preservation, there was a significant difference between both groups, with the DIS had better performance score than JR (1.49 ± 0.51 vs. 0.93 ± 0.59). Further, the practical exam score was significantly higher in DIS group than JR group (p < 0.01).

Conclusion

Overall, the performance of dental intern students was favourably compared with junior residents in most aspects. Therefore, it is promising and essential for dental colleges to add a microsurgery course to the curriculum of dental intern students who plan to specialize in oral and maxillofacial surgery.

Peer Review reports

Background

Clinical instructional strategies and the climate in which teaching and learning take place have a significant impact on the quality of dental education. Therefore, attempts to improve clinical teaching should focus on both the instructor and the educational environment [1,2,3]. As a dental educator, one of your main responsibilities is to ensure that new graduates have the necessary skills and character attributes to begin their employment. It is theorized that the effectiveness of undergraduate training impacts students’ performance and their ability to complete tasks to a significant level [4]. Thus, the dentistry school curriculum is continuously modified to fit advancements in current dental practice, the demands on the new dentists, and the developing structure of the dental profession [5].

    One of the essential clinical innovations of the past decades is microsurgery [6, 7]. Microsurgical techniques are becoming more necessary for various surgical interventions. The process of gaining experience in microsurgery seems to differ widely amongst various specializations, partially due to the frequency of microsurgical approaches [8]. Microsurgical learning is a challenging process that needs a considerable amount of time, exceptional manual expertise, and patience, in addition to continual practicing and emotional balance [9,10,11,12]. Typically, classical microsurgery training programs usually begin after junior residents’ shifts. During this time, they are exposed to social pressure, high-intensity clinical tasks, and insufficient training and learning opportunities, while undergraduate internships lack surgical clinical skills, and the effect of microsurgery training is not clear.

    Medical students often feel inadequate for the obligations of a surgical internship because of a lack of exposure to resident tasks before beginning residency [13]. Early microsurgical training for young doctors may encourage them to practice and learn principles early in their clinical studies [14]. Typically, an intensive individual experiment is a starting point for acquiring experience in microsurgery [10]. Early undergraduate training could accelerate learning by enhancing excellent surgical skills and “habits” and avoiding self-taught training [8]. In this context, most relevant studies focused on medical students (undergraduate and internship students) [8, 12,13,14,15,16,17]. Meanwhile, they neglected the dental internship students who plan to enter a surgical field and junior residents within an oral and maxillofacial surgery department. Therefore, the design of microsurgery training content and timing become controversial among oral and maxillofacial surgeons and educators as well. Thus, this study aimed to evaluate and compare the impact of early microsurgery training on the skills of dental intern students who plan to join an oral and maxillofacial surgical field with junior residents within an oral and maxillofacial surgery department, who had no microsurgery experience.

Materials and methods

Trainees

A total of 100 trainees, 70 were dental intern students who are planning to join an oral and maxillofacial surgical field (DIS), while the other 30 were junior residents within an oral and maxillofacial surgery department who had no microsurgical experience (JR). The average age was 23.87 ± 2.05 years for DIS group and 31.05 ± 3.06 for JR group. Based on Helsinki principles, all trainees attended a microsurgical course (theoretical and practical parts) for seven days within a Microvascular Laboratory for Research and Education of a university-affiliated tertiary hospital. The trainees were randomly divided into 25 groups, with 4 trainees in each group. The trainee’s size was conducted based on previous comparable studies [8, 18, 19]. Based on ARRIVE guidelines, all rat experiments were carried out at the Advanced Science Research Center, Department of Animal Resources, with approval from Xian Jiaotong University, Animal Research Committee (ID: 2022 − 1522), and has been written informed consents were obtained from all trainees and instructors (two experienced microsurgeons) who followed the Helsinki principles. For the duration of this training course, all trainees were released from daily routine work.

Microsurgical equipment

Keoda ASOM-4B microscopes (China) were given extra tubes to observe and instruct the trainees during the microsurgical workouts.

Microsurgical training program

The training course is divided into two sections: theoretical and practical, with a particular emphasis on the practical section (Table 1). Each theoretical session was for 50 min [8], during which educators instructed the trainees on fundamental microsurgical approaches. This included details on handling the micro-instruments, suturing techniques for various minor vascular anastomosis, and their medical applications. Lectures on sterilization and cleaning micro-instruments were presented. Each practical session lasted for 120 min, and the program’s practical section consisted of a step-by-step training schedule using models and rats that have been previously reported and commonly used in practical training courses [9, 18, 20, 21]. Every trainee received equal opportunities from each instructional content session.

Table 1 Microvascular training program

Assessment of knowledge and skills

At the 7th day of the course, both practical and theoretical examinations were conducted, and the knowledge and skills acquired during this training course were evaluated using an objective grading system [8, 33]. The theoretical assessment consisted of twenty multiple-choice questions regarding basic knowledge in microsurgery, which were discussed in this course.

In the practical part, the trainees had to independently carry out end-to-end anastomosis of one another rat femoral vein and artery (Fig. 1).

Fig. 1
figure 1

A: Preparation of rat inguinal flap; B. End-to-end anastomosis of femoral artery and vein; C. Flap transplantation

While the trainees were directly instructed during the training by two experienced microsurgeons, the examinations were blindly assessed and scored by two other blinded microsurgeons, who had to judge the students separately and independently of each other to achieve greater reliability. A scoring system was used to assess the performance of trainees on the vascular anastomosis, which ranged from − 2 to + 2 scores, evaluated according to predefined objective criteria such as procedure time, handling of micro-instruments, proper needle handling, safe knot technique, proper thread cutting, distance of suture from vessel margins, proper vessel preparation, and tissue protection technique (Table 2).

Table 2 Evaluation criteria for the post-training microvascular program

Data analysis

SPSS v. 19.0 statistical software was used to conduct the statistical analysis of this study. Descriptive statistics are presented as the mean and standard deviation. The impact of microsurgery training between DIS and JR groups was compared using the independent sample t-test. The significance level was set at 0.05.

Results

A total of 100 trainees, 70 were dental intern students who are planning to join an oral and maxillofacial surgical field (DIS), while the other 30 were junior residents within an oral and maxillofacial surgery department who had no microsurgical experience (JR). The average age was 23.87 ± 2.05 years for DIS group and 31.05 ± 3.06 for JR group. Regarding the attendance rate of trainees, our findings showed a highly significant difference between both groups (p < 0.01), and the score of absence time for DIS was less than that of JR (0.33 ± 0.58 vs2.47 ± 1.36).

For theoretical section, a significant difference was reported between both groups (p < 0.01), and the scores of DIS were higher than those of JR (15.06 ± 1.92 vs12.73 ± 2.49).

In term of practical section, the criterion for tissue preservation showed a significant difference, with DIS group had better performance than JR group (1.49 ± 0.51 vs. 0.93 ± 0.59) (Table 3). The other objective criteria had shown non-significant higher scores in DIS group compared with JR group. On the other hand, the results of the practice exam showed a statistically significant difference between DIS and JR (p < 0.01), and the scores of DIS were higher than those of JR (Table 3).

Table 3 ; Assessment of DIS and JR results after the examination

Discussion

Since the world’s first severed hand reimplantation in 1963 was accomplished by Chen Zhongwei, the application of China’s microsurgery has progressed in orthopedics, burns, plastic surgery, and other surgical fields [34]. However, the microsurgery training in the field of oral and maxillofacial surgery still lacks systematic and scientific Instructional design, especially in developing countries. The present study amid to evaluate and compare the effect of early microsurgery training on the skills of dental intern students who plan to join an oral and maxillofacial surgical field with junior residents within an oral and maxillofacial surgery department who had no microsurgery experience. According to our knowledge, this is the first prospective study comparing the DIS and JR in term of microsurgical training.

According to the current findings, DIS presented greater enthusiasm, interest, and their attendance rate was significantly higher than that of JR. Further, DIS performed better on the theoretical test than did JR, demonstrating that DIS had a higher ability for theoretical learning and could more effectively assimilate new knowledge. These outcomes were consistent with Mücke et al. [8], who reported that the primary cause of medical residents’ absence was additional work interference, followed by interpersonal obligations. Similarly, Lascar et al. [11], Brown et al. [33], Mücke et al. [30], and Kelly et al. [35]concluded that there is little opportunity to learn microsurgery techniques during the residency program due to the demanding workload as well as restriction from devoting enough time to microsurgery training.

Contrary to our expectations, a significant difference in tissue preservation was noticed during the trainees’ skills’ blinded evaluation at the end of this course (DIS better than JR), which may showcase the significance of early microsurgical training in medical school. On the other hand, the overall scores for the practical part were higher in DIS than JR. Lindeman et al. [36] reported that early microsurgical training programs give senior medical students who want to specialize in surgery a chance to be more concerned about in-patient care. Cataldo et al. [37] reported that even if the students do not wish to specialize in microsurgery, an early microsurgery program has a beneficial impact on their ability to perform macroscopic surgery such as tissue handling and manipulation, becoming familiar with surgical instruments, performing the proper dissection of soft tissue, and obtaining more control over the placement of sutures. Our findings concluded that due to the surgical operation skills developed by the residents in the clinic for many years, they did not complete the practice exam in full accordance with the instructor’s requirements. Mücke et al.[8] reported that students with no previous experience with macroscopic surgery could learn quickly using model-based courses. On the other hand, it may be possible to minimize the potential for undesirable practices to be carried over from macroscopic to microscopic surgery by beginning microsurgical courses without any or little surgical experience [8]. Our conclusion was consistent with Klingensmith et al. [17], who concluded that the best way to promote skill progression during surgical residency is to build a strong base of skills early during the internship stage. The anastomoses are mainly depending on how the tissue is handled. A Failure in microsurgery may result in serious side effects such as flap necrosis, ischemia, or permanent failure.

The rate of learning in microsurgery is slow and greatly influenced by the quantity and quality of microsurgical training [38]. Based on the days absent rate (0.33 ± 0.58 vs. 2.47 ± 1.36), all trainees showed a strong desire to take maximum possible benefit from the training opportunity program. At the end of this microsurgery course, about 93% of the trainees believed the microsurgical training course was absolutely necessary. Thus, practical training courses become necessary for medical students, junior residents, and it may be helpful to practice their fundamental set of microsurgical skills early in their residency training program [15, 33, 35].

The current study still needs to be further adjusted and improved in the program content and the time required for this course. Thus, these limitations should be considered in further studies.

Conclusion

The main conclusions of this comparative study are as follows:

  1. 1.

    Dental intern students have higher attendance score owing to their time management flexibility, which allow them to attend microsurgical classes without feeling pressured or carrying an extra workload.

  2. 2.

    Dental intern students’ performance was higher on both portions of the test, highlighting their strong desire to acquire new knowledge and clinical approaches.

  3. 3.

    Early microsurgical training programs provide dental intern students who plan to specialize in oral and maxillofacial surgery the chance to become more concerned with clinical outcomes and get them ready for the subsequent level of responsibility.

Therefore, this study recommends that it is worthy and essential for dental colleges to add a microsurgery course to the curriculum of dental intern students who plan to specialize in oral and maxillofacial surgery.

Data Availability

The datasets used and/or analysed during the study are available from the corresponding author on reasonable request.

Abbreviations

DIS:

dental intern students who are planning to join an oral and maxillofacial surgical field.

JR:

junior residents within an oral and maxillofacial surgery department who had no microsurgery experience.

References

  1. Divaris K, Barlow P, Chendea S, Cheong W, Dounis A, Dragan I, Hamlin J, Hosseinzadeh L, Kuin D, Mitrirattanakul S. The academic environment: the students’ perspective. Eur J Dent Educ. 2008;12:120–30.

    Article  PubMed  Google Scholar 

  2. Hendricson WD, Anderson E, Andrieu SC, Chadwick DG, Cole JR, George MC, Glickman GN, Glover JF, Goldberg JS, Haden NK. Does faculty development enhance teaching effectiveness? J Dent Educ. 2007;71(12):1513–33.

    Article  PubMed  Google Scholar 

  3. Manogue M, McLoughlin J, Christersson C, Delap E, Lindh C, Schoonheim-Klein M, Plasschaert A. Curriculum structure, content, learning and assessment in european undergraduate dental education–update 2010. Eur J Dent Educ. 2011;15(3):133–41.

    Article  CAS  PubMed  Google Scholar 

  4. Hattar S, AlHadidi A, Altarawneh S, Hamdan AA, Shaini FJ, Wahab FK. Dental students’ experience and perceived confidence level in different restorative procedures. Eur J Dent Educ. 2021;25(1):207–14.

    Article  PubMed  Google Scholar 

  5. Honey J, Lynch CD, Burke F, Gilmour ASM. Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork. Eur J Dent Educ. 2011;15(2):98–103.

    Article  CAS  PubMed  Google Scholar 

  6. Buncke HJ, Buncke GM, Kind GM. The early history of microsurgery. Plast Reconstr Surg. 1996;98(6):1122–3.

    Article  CAS  PubMed  Google Scholar 

  7. Buncke HJ. Forty years of microsurgery: what’s next? J Hand Surg. 1995;20(3):34–S45.

    Article  Google Scholar 

  8. Mücke T, Borgmann A, Ritschl LM, Kesting MR, Loeffelbein DJ, Wolff K-D. Microvascular training of medical students and surgeons–A comparative prospective study. J Cranio-Maxillofacial Surg. 2013;41(8):e187–90.

    Article  Google Scholar 

  9. Thatte M. Acland′s Practice Manual for Microvascular Surgery - Third Edition 2008. Indian J Plast Surg 2008, 41.

  10. Vinagre G, Villa J, Amillo S. Microsurgery training: does it improve surgical skills? J Hand Microsurgery. 2017;9(01):047–8.

    Article  Google Scholar 

  11. Lascar I, Totir D, Cinca A, Cortan S, Stefanescu A, Bratianu R, Udrescu G, Calcaianu N, Zamfirescu DG. Training program and learning curve in experimental microsurgery during the residency in plastic surgery. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2007;27(4):263–7.

    Article  Google Scholar 

  12. Scholz M, Mücke T, Hölzle F, Schmieder K, Engelhardt M, Pechlivanis I, Harders AG. A program of microsurgical training for young medical students: are younger students better? Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2006;26(6):450–5.

    Article  Google Scholar 

  13. Lamb CR, Shaw RD, Hilty BK, Wong SL, Rosenkranz KM. A targeted needs Assessment for the development of a Surgical sub-internship curriculum. J Surg Educ. 2021;78(6):e121–8.

    Article  PubMed  Google Scholar 

  14. LaFemina J, Ahuja V, Alseidi A, Balters M, Brasel K, Clark C III, Delman KA, Farley D, Lindeman B, Relles D. APDS consensus statement: ideal senior medical student experiences for preparedness for general surgery internship. J Surg Educ. 2021;78(1):69–75.

    Article  PubMed  Google Scholar 

  15. Lin TS, Chiang YC. Correlation between microsurgical course performance and future surgical training selection by intern and junior residents. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2008;28(3):171–2.

    Article  Google Scholar 

  16. Satterwhite T, Son J, Carey J, Echo A, Spurling T, Paro J, Gurtner G, Chang J, Lee GK. The Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment. Ann Plast Surg. 2014;72:84–S88.

    Article  Google Scholar 

  17. Klingensmith ME, Brunt LM. Focused surgical skills training for senior medical students and interns. Surg Clin. 2010;90(3):505–18.

    Google Scholar 

  18. Nemeth N, Miko I, Furka I. Experiences with basic microsurgical training programs and skill assessment methods at the University of Debrecen, Hungary. Acta Cirúrgica Brasileira. 2018;33:842–52.

    Article  PubMed  Google Scholar 

  19. Trignano E, Fallico N, Zingone G, Dessy LA, Campus GV. Microsurgical training with the three-step approach. J Reconstr Microsurg. 2017;33(02):087–91.

    Article  Google Scholar 

  20. Komatsu S, Yamada K, Yamashita S, Sugiyama N, Tokuyama E, Matsumoto K, Takara A, Kimata Y. Evaluation of the microvascular research center training program for assessing microsurgical skills in trainee surgeons. Archives of plastic surgery. 2013;40(03):214–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. MacDonald JD. Learning to perform microvascular anastomosis. Skull Base. 2005;15(03):229–40.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hong JW, Kim YS, Lee WJ, Hong HJ, Roh TS, Song SY. Evaluation of the efficacy of microsurgical practice through time factor added protocol: microsurgical training using nonvital material. J Craniofac Surg. 2010;21(3):876–81.

    Article  PubMed  Google Scholar 

  23. Fanua SP, Kim J, Shaw Wilgis E. Alternative model for teaching microsurgery. Microsurgery. 2001;21(8):379–82.

    Article  CAS  PubMed  Google Scholar 

  24. Demirseren ME, Tosa Y, Hosaka Y. Microsurgical training with surgical gauze: the first step. J Reconstr Microsurg. 2003;19(06):385–6.

    Article  PubMed  Google Scholar 

  25. Miyamoto S, Okazaki M, Takushima A, Shiraishi T, Omori M, Harii K. Versatility of a posterior-wall‐first anastomotic technique using a short‐thread double‐needle microsuture for atherosclerotic arterial anastomosis. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2008;28(7):505–8.

    Article  Google Scholar 

  26. Sen C, Agir H, Iscen D. Simple and reliable procedure for end-to‐side microvascular anastomosis: the diamond technique. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2006;26(3):160–4.

    Article  Google Scholar 

  27. Sen C, Hasanov A. Comparative geometric analysis of diamond and hole techniques in end-to‐side microvascular anastomosis. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2008;28(4):262–4.

    Article  Google Scholar 

  28. Hölzle F, Loeffelbein DJ, Nolte D, Wolff K-D. Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J cranio-maxillofacial Surg. 2006;34(1):25–33.

    Article  Google Scholar 

  29. Knobloch K. Noninvasive microcirculatory flap monitoring or implantable doppler probes: only an adjunct to clinical assessment for reconstructive microsurgery? J Reconstr Microsurg. 2009;25(04):271–2.

    Article  PubMed  Google Scholar 

  30. Mücke T, Müller AA, Kansy K, Hallermann W, Kerkmann H, Schuck N, Zeilhofer H-F, Hoffmann J, Hölzle F. Reconstruction DcgfM: microsurgical reconstruction of the head and neck–current practice of maxillofacial units in Germany, Austria, and Switzerland. J cranio-maxillofacial Surg. 2011;39(6):449–52.

    Article  Google Scholar 

  31. Bourget A, Chang JT, Wu DB-S, Chang CJ, Wei FC. Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg. 2011;127(5):1901–8.

    Article  CAS  PubMed  Google Scholar 

  32. Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2009;29(1):1–7.

    Article  Google Scholar 

  33. Brown SA. Developing business opportunities from concept to end point for craniofacial surgeons. J Craniofac Surg. 2012;23(1):298–300.

    Article  PubMed  Google Scholar 

  34. Zhao D. Introduction: Microsurgery in China. Microsurgery. 2013;33(8):591–2.

    Article  PubMed  Google Scholar 

  35. Kelly K. The cutting edge of maxillofacial surgery in education and research. J Craniofac Surg. 2010;21(4):963–4.

    Article  PubMed  Google Scholar 

  36. Lindeman BM, Lipsett PA, Alseidi A, Lidor AO. Medical student subinternships in surgery: characterization and needs assessment. Am J Surg. 2013;205(2):175–81.

    Article  PubMed  Google Scholar 

  37. Di Cataldo A, Li Destri G, Trombatore G, Papillo B, Racalbuto A, Puleo S. Usefulness of microsurgery in the training of the general surgeon. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 1998;18(8):446–8.

    Article  Google Scholar 

  38. Martins PNA, Montero EFdS. Basic microsurgery training: comments and proposal. Acta Cirúrgica Brasileira. 2007;22:79–81.

    Article  PubMed  Google Scholar 

Download references

Funding

National Natural Science Foundation of China (Grant No. 81960194); Natural Science Foundation of Shaanxi Province, China (Grant No. 2020JQ563); Basic Scientific Research Business Expenses Project of Xi’an Jiaotong University, China (Grant No. xzy012020048).

Author information

Authors and Affiliations

Authors

Contributions

S.A.E; Conception and design of stud, Acquisition of data: laboratory, clinical/literature search, Analysis and interpretation of data collected, Drafting of article and critical revision and Final approval and guarantor of manuscript. X.L; Conception and design of study, Acquisition of data: laboratory or clinical/literature search, Analysis and interpretation of data collected, Drafting of article and critical revision and Final approval and guarantor of manuscript. K.A.S; Drafting of article and critical revision and Final approval and guarantor of manuscript. W.T; Acquisition of data: laboratory or clinical/literature search, Drafting of article and Final approval and guarantor of manuscript. M.A.A; Drafting of article and critical revision and Final approval and guarantor of manuscript. H.Y; Conception and design of study,Final approval and guarantor of manuscript. S.A.A; Drafting of article and Final approval and guarantor of manuscript. O.G; Acquisition of data: laboratory or clinical/literature search, and Final approval and guarantor of manuscript. C.H; Conception and design of study, Drafting of article and/or critical revision and Final approval and guarantor of manuscript. W.W; Conception and design of study, Acquisition of data: laboratory or clinical/literature search, Drafting of article and critical revision and Final approval and guarantor of manuscript. S.N; Conception and design of study, Acquisition of data: laboratory or clinical/literature search, Analysis and interpretation of data collected, Drafting of article and critical revision and Final approval and guarantor of manuscript.

Corresponding authors

Correspondence to Weiqi Wang or Sijia Na.

Ethics declarations

Ethics approval and consent to participate

Based on ARRIVE guidelines, all rat experiments were carried out at the Advanced Science Research Center, Department of Animal Resources, with approval from Xian Jiaotong University, Animal Research Committee (ID: 2022 − 1522), and has been written informed consents were obtained from all trainees and instructors who followed the Helsinki principles.

Consent for publication

‘Not applicable’.

Competing interests

There is no conflict of interest for submission of this manuscript, which is approved by all authors for publication. This manuscript is original research that has not been published previously, and not under consideration for publication elsewhere, in whole or in part. The manuscript does not contain any material from third parties.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elayah, S.A., Liang, X., Sakran, K.A. et al. An early microvascular training program of dental intern students and junior residents: a comparative prospective study. Head Face Med 19, 17 (2023). https://doi.org/10.1186/s13005-023-00360-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13005-023-00360-7

Keywords