Existence of concurrent luxation injury and complete root development are important risk factors of pulp necrosis in teeth with uncomplicated crown fractures in adolescent.

S elzer and Dunnington provide an interesting editorial discussing the tipping point in the value of surgical skills simulation as part of residency training. Surgical training has traditionally been focused on operating room experiences. However, intraoperative training for surgical residents has become increasingly more limited. Therefore, the authors hold that simulationbased training in laparoscopic surgery is inevitable, and they provide a framework for an effective integration of skills laboratory and laparoscopic skill acquisition into residency training programs. They address timing to initiate simulation-based training, coordination of the skills laboratories with clinical experience, which type of simulator to use, how to use skills laboratories to assess proficiency, and how to avoid deterioration of laparoscopic skills.A combination of factors in the recent past has left surgical residents with less autonomy in the operating room and less opportunity for independent learning. Attending surgeons are now mandated to be present for all operative procedures. In addition, there is increased legal action for morbidity associated with autonomous residents. The advent of specialty fellowships has reduced the opportunity for surgical residents to participate in new and innovative laparoscopic and endoscopic procedures. Moreover, attending surgeons are being forced to relearn new minimally invasive techniques they had previously mastered for open surgery. Furthermore, laparoscopic procedures are not conducive to an active teaching environment because attending surgeons are forced to control the camera and maintain adequate exposure, whereas residents are often left observing. The result is a shift of the primary responsibility of surgical performance, decision making, and overall patient care to senior residents, fellows, and faculty members, leaving residents with reduced opportunity to master laparoscopic techniques.The authors' editorial comes after a timely systematic review written by Zendejas et al 1 that looks into simulation-based training. Zendejas et al 1 draw 3 main conclusions. First, the surgical skills laboratory is the best environment for acquiring laparoscopic skills, even when compared with intraoperative experience. Second, less expensive box trainers with a Web camera or a mirror are as effective as virtual reality (VR) simulators for training. Third, immediate and ongoing feedback is more beneficial than summative feedback is at the conclusion of training sessions.Selzer and Dunnington build on the conclusion of Zendejas et al 1 and further provide several recommendations for effectively structuring simulation-based training within a surgical residency curriculum. First, they recommend that simulated training sessions begin as early as possible in the intern year. The benefit of early implementation is that it allows residents to have early and meaningful participation in the operating room, which builds further desire for skills laboratory work. Second, they recommend that training be dist...

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