Problem Identification in In-Vitro Evaluation of Class II Amalgam Restoration Performed by Undergraduate Dental Students

Background: Preclinical dental education is fundamental to developing the psychomotor and cognitive skills required for restorative practice. Class II amalgam restoration remains a cornerstone of training due to its technical demands and clinical relevance, yet variability in student performance and subjectivity in assessment present ongoing challenges. Objective: This study aimed to evaluate the quality of Class II amalgam restorations performed by undergraduate dental students and to determine inter-examiner variability in grading outcomes. Methods: A cross-sectional observational study was conducted at the Department of Dental Materials, Fatima Jinnah Dental College, Karachi, from April to October 2023. One hundred Class II amalgam restorations on phantom teeth were performed by second-year students following standardized demonstrations. Restorations were independently graded by three examiners for surface, margin, and contour using a four-point scale. Data were analyzed using ANOVA with Tukey’s post hoc testing, and inter-rater reliability was assessed by Cohen’s kappa. Results: Examiner A assigned mean surface, margin, and contour scores of 3.29 ± 0.74, 0.66 ± 0.06, and 0.62 ± 0.06, respectively, examiner B scored 3.08 ± 0.84, 0.72 ± 0.07, and 0.80 ± 0.08, while examiner C scored 2.27 ± 0.52, 0.66 ± 0.06, and 0.39 ± 0.03. Statistically significant differences were observed across all parameters (p < 0.05), with weak inter-examiner agreement (κ range: -0.047 to 0.267). Conclusion: Considerable variability exists in student performance and examiner assessment of Class II amalgam restorations. Enhanced preclinical training, calibration exercises, and digital assessment tools are recommended to improve consistency and competency.