Conditioning factors for the learning and design of removable partial dentures at the UAC- Cusco* Factores condicionantes del aprendizaje y diseño de prótesis parcial removible en la UAC- Cusco

Background: The conditioning factors of learning, important in the level of teaching, training, evaluation of the removable partial prosthesis design (RPP) and in the methodology; reflect selfperceived difficulties in the level of knowledge of removable prosthesis design, impairing the skill and experience of the undergraduate student. Purpose: To determine the relationship between the conditioning factors of learning and the design of RPP. Method: It was a scientific, descriptive, comparative; sampling, not probabilistic, by quotas of voluntary subjects; with a 95 % confidence, of mixed students, a universe of 56 students, and a studied population of 24.35 %; the conditioning factors of learning and the ability to design a removable prosthesis were measured in data collection sheets, using a questionnaire, together with the knowledge test for Kennedy classification; an examiner was in charge of the evaluation; the qualifications of the designs were subject to the guide of qualification criteria of Loza; with ratings (adequate, fair and poor) for Classes I, II, III and IV and for the type of analysis, descriptive statistics were used. Results: For the variable factors conditioning learning; the level of education was 66.1 % deficient, 28.6 % regular and 5.4 % adequate; for the variable removable prosthesis design; 67.9 % were deficient, 25 % fair and 7.1 % adequate. Conclusion: There is a very high relationship between the conditioning factors of learning and the design of RPP.


INTRODUCTION
In Peruvian universities, the level of knowledge in the design of removable partial prostheses (RPP) is from fair to poor, in a study they evaluated whether clinical experience influenced the ability of students to correctly design the metal structures of said prostheses, showing that the students made fewer errors in the design after the clinical experience (539 errors in the first examination and 366 in the second), highlighting the clinical experience, and constant practice in novices (1)(2)(3)(4). The conditioning factors of learning, important in the level of teaching, training, evaluation of the design of (RPP) and in the methodology; reflect self-perceived difficulties in the level of knowledge of design, harming the ability and experience of the undergraduate student (5,6). Strengthening the conditioning factors of learning, through theory and the use of organized teaching materials; Furthermore, according to the opinion of experts, many dentists graduated from Peruvian universities ignore the correct design of a removable prosthesis, whose deficit in learning the design, generates serious problems in professional training and in the future patient with this attachment, without design. or adequate oral preparation (1,7).
Learning constitutes a stable change of behavior through practice, which involves specific stimuli and responses, improving behavior; in turn, there are two types of learning that alter behavior; the associative and the non-associative (8,9). Thus, within the conditioning factors of learning highlighted in this study, we have: The methodology in the design of prostheses; It is the stage of the project, which consists of directing specific techniques, in order to achieve a specific task, based on theoretical positions; frequently using the magisterial lesson, ineffective for the proposed goals, generating critical factors; in laboratory teaching, in the number of professors for practical training, in the theoretical and clinical teaching of removable prostheses. However, it has been shown that team-based learning (TBL) methodology, such as case-based learning (CBL), is preferable for mass teaching than traditional lecture-based instruction (LB), giving immediate results ; However, many universities agree to change and improve the syllabus, teaching the removable prosthodontics course, acquiring competencies, improving clinical practice, even recommending the use of clinical applicative manuals (9)(10)(11)(12)(13)(14)(15)(16)(17).
The level of training seeks to facilitate new knowledge and tools for the maximum development of abilities and skills based on the design of this prosthetic attachment; added to professional interest, scientific evidence, clinical experience, training, produces qualitative results; Thus, in a design workshop seminar for removable prostheses, better evaluative results were obtained; standardizing the group, where the majority of students learned, gained confidence in various treatments and improved the academic curriculum (1,(18)(19)(20)(21)(22).
The level of teaching in the design of RPP is the transmission of skills and experiences, making use of the clear and precise intellect of teachers and the discussion of clinical cases, a field in which insufficient treatments are carried out, to the detriment of the student (5.6). The level of evaluation, through the assessment of knowledge, skills, attitudes and student performance, valued in the design of prostheses; Together with the application or implementation of the indicated procedures, they achieve an adequate design, producing dialogue, understanding and improvements in the student; it is qualitative, because the processes are complex and reduces to numbers, simplifying its most substantive part (23)(24)(25). Consequently, the evaluation of the qualitative program called, study skills development program (P.D.H.E.) and its correlation with eight criteria; feasible, consistent, evaluable, congruent, convenient, contextualized, generalizable and flexible; improves learning needs (6).
Designing a RPP is to trace its shape and structure, on a diagnostic model, parallelized and without alteration of the mouth, a condition of clinical practice, and carried out in preclinical practice laboratories, to later be replicated in real definitive models in clinic; It is helpful to use teaching materials such as; videos, internet, computer aided learning (CAL) program for 3D models; benefiting their learning; following principles and sequences, designing the metallic structures in the artificial attachment, with a red pencil and the retentions with a blue pencil, like this; Occlusal rests, retainers, major connectors, minor connectors, proximal contact plates and base extensions (5,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).
These learning factors intervene when exercising memory (5); Through the memory of the set of images, defining forms and structural details recorded in the mind with the consequent knowledge and mastery of the design of the prosthetic device by the 9th Semester student in diagnostic models (37,38); and understanding in their ability to understand the indications in the design of removable prostheses, rescuing the most important ideas and the possibility of establishing links with previously acquired ideas, based on experience; prior to oral modification (6). Where the parallelization of the model is always carried out prior to the design of a RPP, offering greater retention, support and stability, important for quality standards, and for the benefit of designs; especially for the great casuistry of the lower arch, improving; supports, minor connectors and edentulous care protocols (1,26,39,40). It is an academic contribution, since university teaching must constantly be updated; Universities worldwide make changes in the teaching methodology for students and in the university curriculum; To achieve a goal, that its graduate students obtain optimal knowledge in the exercise of their professions and dentistry is part of it; It is beneficial, because the principles of the design of a RPP are something that every general dentist should know and it is the responsibility of every university to ensure that its students learn these concepts; it is novel, because it could manifest itself in the Colombian dental population; Various investigations carried out in different latitudes of the world, highlight that many dentists graduated from different universities do not know how to properly design said prosthetic attachment, and in this case in Peruvian universities (1,5).
Finding a reality in the undergraduate student, which is seen in Peru, corresponding to the lack of learning of the RPP design within the Peruvian university classrooms; the student or future dentist is the one who assumes or will assume the responsibility of making said abutment. Because it is the student who knows the oral status of the patient but not the dental technician; raising a question, in what way are the conditioning factors of learning related to the design of removable partial dentures at UAC-Cusco? (1). The present study presents as a hypothesis, the conditioning factors of learning are significantly related to the design of RPP; and the objective, to determine the relationship between the conditioning factors of learning and the design of RPP in students of the 9th semester of the UAC-Cusco (5,10,41,42).

MATERIALS AND METHODS
Type of study and design. The type of study is scientific, descriptive, quantitative, bivariate, analytical, comparative and cross-sectional; and its correlational design (43,44). The sample was obtained in a non-probabilistic way by quotas and from voluntary subjects at 95% confidence, consisting of a total of 56 students of both sexes from the 9th semester, representing 24.35% of the studied population (43).

Description of the inclusion and exclusion criteria of the sample.
Thus, considering the inclusion criteria: Students from the 9th semester of the stomatology professional career of the UAC faculty of health sciences who are enrolled in said academic semester; students who have taken the removable prosthesis course and have taken it with a passing grade; students who signed the commitment to participate in the project until its completion and voluntarily. Taking as Exclusion criteria: Students who have taken some additional external training to the removable prosthesis course; students who copied the design of their partner (s); students who obtained in their hands, data sheets and data collection sheets, without any code to guarantee their anonymity (5,43).

Ethical considerations of the study and approval by institutional ethics committees.
Participants collaborated by signing a commitment sheet, and anonymity to guarantee their evaluation, and based on similar studies of removable prosthesis design and methodology (22), found in search engines in PubMed ®, SciELO®, Google Scholar®. of national and international indexed journals, both in English and Spanish. The experts who validated the test were professors at the Universidad Nacional Mayor de San Marcos, Universidad Nacional San Antonio del Cusco, and Universidad Peruana Cayetano Heredia; According to the assessment of the five experts, regarding the validation of the instruments, an assessment resulted for the variable X = 76.6% and for the variable Y = 90.00%, which represented a high applicability in the studied sample; the research protocol received approval from Dr. Revoredo, for the use of Loza's qualification criteria (43).
Procedures. Using one envelope per participant duly coded for anonymity, which contained surveys and the removable prosthesis design on a sheet prepared with the four Kennedy classes for partial edentulous; the administrative procedure, by sending a request to the Academic Vice To assess the results, the surveys and the knowledge test were examined; the evaluation was carried out by a single examiner; Each case was assigned a numerical value from 0 to 12 for class I, from 0 to 13 for classes II and III and from 0 to 10 for class IV, according to the application of duly calibrated criteria and the use of a criteria guide for the RPP qualification, established by Loza (5).
The numerical data from the qualification of the surveys and knowledge tests were entered in a data table, adding columns interpreting the skill scores in the design of removable prostheses in the categories; adequate, fair and poor; the interpretation was made by the determination of ranges, where the cuts were established by the researcher and the gold standard in the study. The Technical characteristics of instruments and materials. The data collection instruments were formal and structured, informative and instructive, towards more objective and truthful data (43).
For variable X, a questionnaire was applied on a4 bond sheets; formal and structured instrument, Calibration to examiners. To calibrate the examiner who evaluated the questionnaire and the knowledge test, it happened at the beginning of the study with discussions of design criteria between the examiner and a professor of the specialty in oral rehabilitation of the Universidad Peruana Cayetano Heredia (UPCH), who served as baseline study. The intraclass correlation coefficient was used to determine the reliability of the calibration process (0.780), which would be at the level of good agreement (5,43,45).

Variables studied and their operationalization.
For the independent variable X conditioning factors of learning, were taken as dimensions; the methodology, the training level, the teaching level, and the evaluation level, and the following categories were taken: From 19-28 questions answered, 15-20 points (adequate); of 9-18 questions answered, 11-14 points (fair) and of 0-9 questions answered, 0-10 points (poor). While, for the dependent variable AND RPP design, they were taken as dimensions; the parallelization and quality standards, the following categories were Regarding the reliability of the instrument that was applied to the learning conditioning factors variable, Cronbach's alpha was .962 (96.25%), and for the variable Removable partial denture design, it can be seen that Cronbach's alpha was. 898 (98.8%); the instruments applied had a high trend, according to the sample response (6,43).

Data analysis.
The results obtained were recorded in files for this purpose, and were examined using the SPSS program, version 20, from IBM. The variables conditioning factors of learning and RPP design were examined, with their respective dimensions, the findings were expressed in percentages (43,44).

RESULTS
Having obtained the sample of 56 students, representing 24.35% of the studied population, a very high statistical correlation was obtained between both variables; The results identified in the conditioning factors for learning (Table 1) show that there were many difficulties in the teaching process of removable prosthesis design in preclinical studies, given by the methodology used, and those who managed to design adequately did so out of interest specific to prosthetic dentistry or acquired experience (25). adequate; valuing knowledge, individual work, and its implementation in the design sequence; The student concern may be, for having spent a long time from the moment they were given the theoretical classes, to the clinical practical moment, coinciding with in the third year, and a record, to perform 4 treatments of removable metal-based prostheses and 2 acrylic-based with adapted retainers (1).
For the variable RPP design ( Figure 1); In the case of the teaching of removable prosthesis design both in practice and in the clinic, many times the amount of removable prosthesis design exercises that one desires are not performed, which undermines student experience and skills; We have for

DISCUSSION
From the results obtained according to the initial approaches; the methodology is distributed heterogeneously among all teachers: both influences from external graduate schools, as well as non-academic schools (5,6). The problem is that in laboratory and clinical practice the instructions between teachers are not consistent, so that students do not have many options and alternatives, other than just obeying the teacher in charge of the clinic; Also, there are professors in removable prosthesis laboratory practice with different dental schools for 20 or 30 students per class, which limits giving directions, making explanations and corrections or carefully reviewing the practice; The procedures developed put a questionnaire and a knowledge test to the test to evaluate the variables under study, whose instrument described the purpose of the research; It was expected to find homogeneity in the type of methodology applied by the teacher, because this would have decreased the degree of difficulty and the insecurity of the student at the time of designing the removable prosthesis, finding that the level of education obtained a deficit of 84.3% and the methodology had a deficit of 66.1%, influencing the best removable prosthesis design over class III and that the design with the most deficit was for Kennedy class II. In what way are the conditioning factors for learning related to the design of a removable partial denture at UAC-Cusco? (1). The objective of this study was to determine the relationship between the conditioning factors of learning and the design of RPP (5,10,(41)(42)(43).
The instruments were applied for both variable X and variable Y, showing the percentages of the conditioning factors of learning (table 1), in high relation to the percentages of the removable partial prosthesis design (figure 1), therefore, These independent and dependent variables show a directly proportional relationship. It was expected to find a relationship between both study variables, and it was used to evaluate the existence of a high correlation between the conditioning factors of learning with the removable prosthesis design, because a large deficit is shown in the removable prosthesis design level.
Analyzing the method used, its strength was, in facing the reality of the student at the time of designing the removable prosthesis, so that from this message, the type of methodology taught is useful and applicative, however, the advantage lies that the learning problems of removable prosthesis design in Peruvian universities be taken into consideration, so that other countries can analyze whether or not they are in the same educational problem; while its weakness was the lack of evaluation of the students at different times, to evaluate their progress in the design of removable prostheses, after the training process given to the student during their undergraduate studies, in addition, the disadvantage points out that the results of this study are only for students in the 9th semester of the professional career of Stomatology at the UAC and cannot be generalized to the other classes of students (5.40).
It was applicable, because it helped to understand the learning weakness, related to the RPP design; contributing to this accessible and economical therapy for the edentulous population, being an adequate scientific type of evidence to recommend the technological adoption in the design of RPP. On the other hand, it responded to the hypotheses of the study, because there was a very high relationship, between the conditioning factors of learning and the design of RPP, with a methodologically heterogeneous student teaching motivation, a methodology, training, teaching level in prosthesis design removable and poor evaluation; few students designed removable prostheses correctly. Concluding that the student's interest in the prosthesis area generates improvements in the removable prosthesis design in the absence of a good methodology (6).
It remains to be answered: How could learning be improved at said university, avoiding the need to delegate responsibility for the design of removable prostheses to the dental technician? emerging new questions, such as: Are the proven methodologies for the design of removable prostheses such as CAL and the use of 3D technology used in the 21st century by Latin American Dental Schools?
Are the professors at the Peruvian Schools of Dentistry aware that the traditional methodology does not generate good results in the design of RPP? (1,6).
A high relationship was obtained between the conditioning factors of learning with the removable prosthesis design, because a small number of students who felt that a removable prosthesis was properly designed were wrong. They may not have been able to distinguish between a suitable and a poor design, due to a lack of theoretical or practical knowledge (22). Similar to that reported in At the training level, students are not able to learn to design simple edentulous models and / or with different dispositions of edentulous spaces and modifications for each classification (22).
Generating confusion among students when designing, especially Kennedy Class II, with a unilateral edentulous gap, which increased the complexity of the design and produced that the results of this class II had the lowest percentage of designs performed properly and the highest percentage of poorly executed designs.
The problem, the students will put into practice what they have learned in the theoretical classes and in the laboratory practices in the second semester of the fourth year, to simply make four removable prostheses according to the clinical case as a requirement; deducing that students will practice very little removable prosthesis design in that semester, and perhaps students who have a gap of 4 to 8 months since they finished practice, and a gap of 6, 10 and 14 months since they received their last class theoretical (5). At the training level, few students designed adequately,  (36).
The students noticed that this low level of learning in the design of removable prostheses could be due to several conditioning factors in their undergraduate learning, which according to the degree of importance were: The methodology, the level of training, the level of teaching of removable prosthesis and the level of evaluation. The concern of the students, for having spent a long time from the moment they were given the theoretical classes at the time of applying what they learned in clinical practice, which is precisely in the third year, where there is a record for performing 4 treatments with removable prosthesis with metal base and 2 with acrylic base with adapted retainers. According to the literature Lechner SK et al (1998), the computer-assisted learning program uses QuickTime® to simulate a three-dimensional perspective of diagnostic models; Animated diagrams can be added to illustrate various points. Students practice at their own pace, in several virtual cases, and thus learn to design removable prostheses; Lechner SK et al (1999) (33,34), determined that CAL is an easy-to-use program for students with little or no computer experience; considered a useful learning resource; Its interactive nature as a learning process and the ability to rotate diagnostic models, allows CAL programs to use the full potential of the computer's ability, generating students impressed by aspects of the program that could not be duplicated by a book (6).
In the case of clinical removable denture teaching, many times you do not perform the number of removable denture treatments that you want, which results in the student gaining less experience.
In the synthesis of the problem, a statistically significant correlation is observed between the undergraduate students in Dentistry" (16,22).

CONCLUSIONS
There is a very high relationship between the conditioning factors of learning and the design of RPP among students of the 9th semester of the professional career of Stomatology-UAC-Cusco.

RECOMMENDATIONS
Take advantage of the learning of the RPP design, with programs like CAL, and methodologies like TBL and CBL; also improving the level of teaching, training and evaluation.
Apply a similar study in other latitudes other than Peru, to evaluate the educational reality in the design of RPP.