Development and Assessment of a Three-Dimensional Tooth Morphology Quiz for Dental Students

Evaluating the effectiveness of a novel digital evaluation technology on dental preclinical crown preparation training

OBJECTIVES

To evaluate the assessment scores of a novel digital training program versus traditional training in dental preclinical crown preparation.

METHODS

Crown preparations in two consecutive preclinical training sessions were retrospectively collected and assigned to three groups: traditional group (TG), scanning group (SG), and digital evaluation group (DG). Students in the TG (n = 20) were taught by conventional visual grading, while students in the SG (n = 25) received three-dimensional feedback from digitally scanned preparations. All the SG students continued with supplementary digital evaluation and preparations were allocated into the DG (n = 25). Comparison of total scores between groups was investigated using independent samples t-test and paired samples t-test. Mann‒Whitney U-test and Wilcoxon signed-rank test were used to statistically analyze the differences in subdividing categories. The level of significance was p < 0.05. Questionnaires on the digital evaluation procedure were answered by students in DG.

RESULTS

The results showed a significant improvement (p < 0.01) in the total scores of DG than those of TG and SG, while there were no statistically significant differences between TG and SG. Scores of surface finish and undercut improved significantly in DG compared to TG and SG. The reduction scores of DG were significantly higher than those of SG. Students' feedback indicated a positive perspective on the implementation of the novel digital evaluation technology.

CONCLUSIONS

These findings suggest that digital evaluation technology is useful for preclinical crown preparation training. Attention should also be paid to studying the optimal integration of digital dentistry into traditional dental curricula and its effects on students' learning curves.

Application of deep learning in isolated tooth identification

BACKGROUND

Teeth identification has a pivotal role in the dental curriculum and provides one of the important foundations of clinical practice. Accurately identifying teeth is a vital aspect of dental education and clinical practice, but can be challenging due to the anatomical similarities between categories. In this study, we aim to explore the possibility of using a deep learning model to classify isolated tooth by a set of photographs.

METHODS

A collection of 5,100 photographs from 850 isolated human tooth specimens were assembled to serve as the dataset for this study. Each tooth was carefully labeled during the data collection phase through direct observation. We developed a deep learning model that incorporates the state-of-the-art feature extractor and attention mechanism to classify each tooth based on a set of 6 photographs captured from multiple angles. To increase the validity of model evaluation, a voting-based strategy was applied to refine the test set to generate a more reliable label, and the model was evaluated under different types of classification granularities.

RESULTS

This deep learning model achieved top-3 accuracies of over 90% in all classification types, with an average AUC of 0.95. The Cohen's Kappa demonstrated good agreement between model prediction and the test set.

CONCLUSIONS

This deep learning model can achieve performance comparable to that of human experts and has the potential to become a valuable tool for dental education and various applications in accurately identifying isolated tooth.

Identifying teeth and tooth fragments from digital 3D models

Dental anatomy is an essential skill for human identification in forensic odontology. With the advent of technology enabling virtual autopsies, there is scope for virtual consultation by forensic odontologists especially when the expertise is unavailable but needed in zones of conflict or disasters. This study aimed to investigate potential benefits and challenges of identifying intact and damaged teeth from 3D scanned digital models. Ten 3D tooth models - nine permanent and deciduous human teeth and one animal tooth were uploaded on a hosting platform. A 3-part survey was circulated among 60 forensic odontologists with questions about demography (P1), tooth identification of the scanned 3D models (P2) and the perceived usefulness of 3D models for tooth identification (P3). This was the first time that a survey required the identification of individual human teeth (intact or not) and animal tooth combined. The response rate for study participation was 58%. Substantial agreement among participants was seen in the determination of tooth classification (i.e., molars, premolars) or non-human and tooth within the same tooth class (i.e., lateral incisors, second molar) (both k=0.61). The least agreement (k=0.21) was seen in identification of tooth according to the FDI notation with a mean accuracy of 0.34. While most responders correctly identified the animal tooth, most incorrect responses were seen in the identification of the intact third molar. While 3D-scanned teeth have the potential to be identified virtually, forensic odontologists should continuously test their skills in tooth morphology and dental anatomy of humans (damaged or not) and animals.

Effect of teaching tools in spatial understanding in health science education: a systematic review

Background

The concept of spatial orientation is integral to health education. Students studying to be healthcare professionals use their visual intelligence to develop 3D mental models from 2D images, like X-rays, MRI, and CT scans, which exerts a heavy cognitive load on them. Innovative teaching tools and technologies are being developed to improve students' learning experiences. However, the impact of these teaching modalities on spatial understanding is not often evaluated. This systematic review aims to investigate current literature to identify which teaching tools and techniques are intended to improve the 3D sense of students and how these tools impact learners' spatial understanding.

Methods

The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed for the systematic review. Four databases were searched with multiple search terms. The articles were screened based on inclusion and exclusion criteria and assessed for quality.

Results

Nineteen articles were eligible for our systematic review. Teaching tools focused on improving spatial concepts can be grouped into five categories. The review findings reveal that the experimental groups have performed equally well or significantly better in tests and tasks with access to the teaching tool than the control groups.

Conclusion

Our review investigated the current literature to identify and categorize teaching tools shown to improve spatial understanding in healthcare professionals. The teaching tools identified in our review showed improvement in measured, and perceived spatial intelligence. However, a wide variation exists among the teaching tools and assessment techniques. We also identified knowledge gaps and future research opportunities.

Visualizing Anatomy in Dental Morphology Education

Tooth morphology is a foundation course for all dental healthcare students including dentists, dental hygiene, dental therapy, and dental nursing students. This chapter explores the conventional and innovative teaching methods to deliver tooth morphology educational modules. The teaching tools are explored with a 2D and 3D lens, with a particular focus on visualization, student understanding, and engagement. Traditional methods of teaching tooth morphology must be complemented with innovative pedagogical approaches in order to maintain student's attention and accommodate their diverse learning methods. Teaching 3D anatomy enables students to visualize and spatially comprehend the link between various anatomical components. Online tests and quizzes motivate students and are also beneficial in preparing students for exams. Online self-examinations offering visualization with 3D teeth enable students to evaluate their knowledge and offers immediate feedback, which aids in the long-term retention of information. These tools can be as efficient as other teaching methods, allowing the students to study at their own pace and with repetition. The authors conclude that blended and innovative teaching methods should supplement student learning and not replace, traditional face-to-face educational methods.

Application of HoloLens-based augmented reality and three-dimensional printed anatomical tooth reference models in dental education

Tooth anatomy is fundamental knowledge used in everyday dental practice to reconstruct the occlusal surface during cavity fillings. The main objective of this project was to evaluate the suitability of two types of anatomical tooth reference models used to support reconstruction of the occlusal anatomy of the teeth: (1) a three-dimensional (3D)-printed model and (2) a model displayed in augmented reality (AR) using Microsoft HoloLens. The secondary objective was to evaluate three aspects impacting the outcome: clinical experience, comfort of work, and other variables. The tertiary objective was to evaluate the usefulness of AR in dental education. Anatomical models of crowns of three different molars were made using cone beam computed tomography image segmentation, printed with a stereolithographic 3D-printer, and then displayed in the HoloLens. Each participant reconstructed the occlusal anatomy of three teeth. One without any reference materials and two with an anatomical reference model, either 3D-printed or holographic. The reconstruction work was followed by the completion of an evaluation questionnaire. The maximum Hausdorff distances (Hmax) between the superimposed images of the specimens after the procedures and the anatomical models were then calculated. The results showed that the most accurate but slowest reconstruction was achieved with the use of 3D-printed reference models and that the results were not affected by other aspects considered. For this method, the Hmax was observed to be 630 μm (p = 0.004). It was concluded that while AR models can be helpful in dental anatomy education, they are not suitable replacements for physical models.

Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review

BACKGROUND

Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users' needs. No previous reviews have investigated the usability of mobile apps developed for health care education.

OBJECTIVE

The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education.

METHODS

A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O'Malley framework for scoping reviews.

RESULTS

Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47%), control group design (12/98, 12%), randomized controlled trials (12/98, 12%), mixed methods (12/98, 12%), and qualitative methods (11/98, 11%). User testing methods applied were all think aloud (5/98, 5%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85%), but only 19% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method.

CONCLUSIONS

Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/19072.

The effectiveness of a 3D virtual tooth identification test as an assessment tool for a dental anatomy course

INTRODUCTION

There has been a recent demand in dental education for distance learning and the use of virtual assessment tools that can leverage technology to potentially replace physical testing facilities. However, virtual tools that evaluate student learning should be validated prior to adoption. The aim of this study was to investigate the effectiveness, efficiency and user satisfaction of a 3D tooth identification test for a dental anatomy course that can be given remotely.

MATERIALS AND METHODS

First-year dental students (n = 41) enrolled in a dental anatomy course took both traditional in-person practical and virtual 3D tooth identification tests consisting of 25 test items. The test scores, average test durations, faculty time commitment and user perception were collected and analysed. Pearson product-moment correlation coefficients (p < .05) were determined for the criterion measures including real tooth identification test scores, comprehensive written examination and overall grade for the course.

RESULTS

The average number of correct answers for the real and 3D virtual tooth identification examination was 21.3 ± 2.65 and 20.7 ± 2.56, respectively. The average test duration for the real and 3D virtual tooth identification test was 25:00 and 21:16 min, respectively. There was a positive correlation (p < .05) of the 3D virtual tooth identification test with the real tooth identification test (0.368), comprehensive written examination (0.334) and the overall course grade (0.646). The total faculty time commitment for the real and 3D virtual tooth identification test was 96 and 65 min, respectively. The students cited difficulty in manipulating the 3D models.

CONCLUSION

This study presents evidence that the 3D virtual tooth identification test can be used to assess dental students' understanding of dental anatomy effectively and efficiently.

Three-Dimensional Tooth Models with Pulp Cavity Enhance Dental Anatomy Education

Dental anatomy is an integrated, core fundamental dental course, which prepares students for all future clinical dental courses. This study aimed to build up an online dental learning platform of micro-computed tomography-based three-dimensional (3D) tooth models with pulp cavity, and to further evaluate its effectiveness for dental anatomy education using a cohort study. First, ninety-six extracted permanent teeth were scanned by micro-computed tomography and the enamel, dentine, and pulp cavity of each was distinguished by different grey-scale intensities using Mimics software. Three-dimensional images allowed further discrimination and insights into permanent three-rooted premolars, central tip, and dental diseases including deep caries and wedge-shaped defects. Furthermore, a second mesiobuccal canal (MB2) in maxillary permanent molar teeth and Vertucci type III root canal configuration in mandibular anterior teeth could be detected using the 3D analytical tool. A digitized 3D tooth model learning platform was implemented. Last, two groups of dental students were assessed to evaluate the effect of 3D models on dental anatomy education. Participants in the Digital group were allowed to use the online dental learning platform freely after class, while the participants in the Traditional group were not. Assessment quizzes showed that participants' scores improved in the Digital group with the use of the learning platform compared with scores in the Traditional group. A questionnaire survey indicated that the participants had a positive attitude toward the 3D models. Thus, adding digital 3D resources to a traditional curriculum may have a positive effect on academic achievements.

Implementation of an interactive virtual microscope laboratory system in teaching oral histopathology

Laboratory course acts as a key component of histopathology education. Recent trends of incorporating visual and interactive technology in active and inquiry-based learning pedagogical methods have led to significant improvement of histopathology laboratory courses. The present work aimed to describe interactive virtual microscope laboratory system (IVMLS) as a virtual platform for teaching histopathology in order to improve the quality and efficiency of teaching. The system is based on interactive technology and consists of interactive software, slide-reading software, teaching resources and integrated auxiliary equipment. It allows real-time interaction between teachers and students and provides students with a wealth of learning and review materials. In order to evaluate the effectiveness of the system, we conducted a comparative study with the use of light microscope (LM) as a method. Specifically, we compared the results of six assignments and one laboratory final exam between IVMLS group and LM group to analyse the impact of IVMLS on students' academic performance. A questionnaire survey was also conducted to obtain students' attitudes and views on this system. There was no overall difference in assignment performance between IVMLS group and LM group. But laboratory final test grades increased from a mean of 62% (43.8–80.0, 95% CI) before to 83% (71.0–94.2, 95% CI) after implement IVMLS, suggesting highly significant (p < 0.001) improvement on students' histopathology laboratory performance. Feedback of the questionnaire was positive, indicating that students were satisfied with the system, which they believed improved student communication and teacher-student interaction, increased learning resources, increased their focus on learning, and facilitated their independent thinking process. This study proves that IVMLS is an efficient and feasible teaching technology and improves students' academic performance.

Effect of Dental Course Cycle on Anatomical Knowledge and Dental Carving Ability of Dental Students

This study assessed the effect of the course cycle on theoretical knowledge of dental morphology and the dental carving ability of dental students. Thirty-two dental students from the third semester (initial cycle) and 30 students from the eighth and tenth semesters of the dental course (end cycle) had their theoretical knowledge on dental morphology assessed using a questionnaire with ten closed questions. Their dental carving ability was also assessed using wax carvings in macro models of plaster (for the third [S3] and eight [S8] semesters) and natural-sized artificial teeth (for the tenth [S10] semester). The teeth chosen for the dental carving activity were #16 and #47. The scores were statistically analyzed using the t-test, Kruskal-Wallis test, and Mann-Whitney test (α = 0.05). Students from the initial cycle presented better theoretical knowledge than the other groups did (P < 0.007). No significant differences in carving score were found between the initial and end cycles (P > 0.05), although S10 students obtained a higher score for teeth #16 and #47 (P < 0.05). Natural-sized artificial teeth received a higher evaluation score in dental carvings than the macro models (P < 0.001). Within the limits of this study, it was possible to conclude that students from the initial cycle (S3) presented higher theoretical knowledge, whereas no difference in carving ability was observed between the initial and end cycles. The tenth semester (S10) students performed dental carvings with better quality. Furthermore, carvings in natural-sized artificial teeth presented better quality compared with the macro models.

Correlating Spatial Ability With Anatomy Assessment Performance: A Meta-Analysis

Interest in spatial ability has grown over the past few decades following the emergence of correlational evidence associating spatial aptitude with educational performance in the fields of science, technology, engineering, and mathematics. The research field at large and the anatomy education literature on this topic are mixed. In an attempt to generate consensus, a meta-analysis was performed to objectively summarize the effects of spatial ability on anatomy assessment performance across multiple studies and populations. Relevant studies published within the past 50 years (1969-2019) were retrieved from eight databases. Study eligibility screening was followed by a full-text review and data extraction. Use of the Mental Rotations Test (MRT) was required for study inclusion. Out of 2,450 screened records, 15 studies were meta-analyzed. Seventy-three percent of studies (11 of 15) were from the United States and Canada, and the majority (9 of 15) studied professional students. Across 15 studies and 1,245 participants, spatial ability was weakly associated with anatomy performance (r_pooled  = 0.240; CI at 95% = 0.09, 0.38; P = 0.002). Performance on spatial and relationship-based assessments (i.e., practical assessments and drawing tasks) was correlated with spatial ability, while performance on assessments utilizing non-spatial multiple-choice items was not correlated with spatial ability. A significant sex difference was also observed, wherein males outperformed females on spatial ability tasks. Given the role of spatial reasoning in learning anatomy, educators are encouraged to consider curriculum delivery modifications and a comprehensive assessment strategy so as not to disadvantage individuals with low spatial ability.

Educational Interventions to Improve Dental Anatomy Carving Ability of Dental Students: A Systematic Review

This systematic review aimed to identify the level of impact of educational strategies for teaching tooth carving on the carving ability of undergraduate dental students. The PubMed-NCBI, Cochrane-CENTRAL, LILACS, Ibecs, BBO, Web of Science, and Scopus databases were searched in May 2019, for randomized controlled trials (RCTs) and two-arm non-randomized studies of interventions (NRSI) addressing educational interventions toward the dental carving of undergraduate students. Studies from the year 2000 until the search date, written in English, Portuguese, and Spanish were included. Study screening and data extraction were performed in duplicate and blinded. The data were presented narratively, considering the dental carving ability of students the primary outcome. The risk of bias was assessed using the RoB tool 2.0 and ROBINS-I, and the level of evidence was determined with GRADE. Of 3,574 studies, 6 were included, with 3 RCTs and 3 NRSIs. Very low level of evidence was provided from the NRSIs that flipped classroom (1 study; n = 140) and a student-driven revised module (1 study; n = 264) improved the carving ability of students. Additionally, there was moderate evidence of online complementary material (1 RCT; n = 30) and reinforcement class improving the carving ability of students (1 RCT; n = 29). The replacement of traditional classes by an instructional DVD (1 RCT; n = 73) and assessment of carving projects through digital systems (1 NRSI; n = 79) did not enhance the carving ability of students. Study design, risk of bias, and imprecision downgraded the level of evidence. There was a very low to moderate evidence on the effectiveness of student-driven educational approaches and complementary classes of dental anatomy in improving the dental carving ability of students.