First experiences with patient-centered training in virtual reality

The impact of virtual reality simulation on dental education: A systematic review of learning outcomes and student engagement

PURPOSE

Virtual reality (VR) simulations have been increasingly employed to train dental students prior to clinical practice. According to the literature, blended learning designs in the form of VR simulations can be utilized by both dental students and instructors to provide quality education. They can also save time and improve motor skills before students enter clinical stages. Therefore, this study was designed to review the importance of available VR simulators and their impact on student learning and outcomes.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to review the literature systematically, and different databases such as PubMed, ScienceDirect, Cochrane Library, Scopus, and Google Scholar were searched (up to December 2023) for relevant articles using keywords: "virtual reality," "virtual reality simulators," "virtual reality simulation," and "dental education." The Mixed Methods Appraisal Tool was used to assess the study quality.

RESULTS

After a comprehensive literature search, 1477 research articles were identified, of which 16 were included in the present study. In terms of students' learning outcomes, engagement, and optimal approach, a significant improvement was observed compared to conventional training methods, specifically in their knowledge, performance, confidence, and psychomotor skills.

CONCLUSION

The findings suggest that VR simulators enhance the overall learning abilities of dental students and should be regarded as an integral component of the current curriculum. However, it is important to recognize that VR simulators cannot fully substitute traditional training methods; rather, they can effectively complement them.

The effect of virtual simulation technology applied to undergraduate teaching of periodontal probing

INTRODUCTION

The rise of virtual simulation technology and dental simulators has created a new pedagogical approach for undergraduate medical education. The purpose of this study is to evaluate the effect of virtual simulation (VS) technology on improving the students' comprehensive abilities in periodontal probing teaching in pre-practicum periodontology, such as increasing the accuracy of probing, tactile perception and performance on force control.

MATERIALS AND METHODS

Twenty students were randomly selected among the fourth-year students and equally divided into VS technology teaching group (VS group) and traditional teaching group (TT group) by drawing half lots. One day later, students were required to probe the periodontal pathology model. The consistency rate between PD measurements and PD reference values, time consumption and final exam scores were recorded and statistically analysed using an unpaired Student's t test and p < .05 was considered statistical significance. Finally, questionnaires relating to teaching methods evaluation and the fidelity of the digital VS training system were distributed to students and teachers.

RESULTS

VS group had a significantly higher consistency rate (72.976 ± 6.811%) than TT group (64.107 ± 4.988%, p = .004). To specify, the difference of consistency rates between the two groups in posterior teeth was larger than anterior teeth. Similarly, a larger difference was also found in proximal surfaces compared with buccal-lingual surfaces. As the pocket depth increased, the difference between the two groups increased too. These results indicated that VS is more efficient in complicated parts of periodontal probing teaching. In addition, students in VS group spent less time and gained a higher score than TT group (p < .05). The overall satisfaction rating in VS group was significantly higher than TT group. Lastly, teachers gave significant lower scores than students concerning the fidelity of VS system.

CONCLUSION

Although there are much to improve, VS technology has obvious advantages in periodontal probing teaching in pre-practicum periodontology.

O-Health-Edu: A viewpoint into the current state of oral health professional education in Europe: Part 2: Curriculum structure, facilities, staffing and quality assurance

INTRODUCTION

Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents.

METHODS

A total of 27 questions from a 91-item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi-step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data.

RESULTS

Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff-student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes.

CONCLUSION

To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

Impact of haptic simulators in preclinical dental education: A systematic review

BACKGROUND

Haptic technologies have opened a new avenue in preclinical dental education, with evidence that they can be used to improve student performance. The aim of this systematic review was to (1) determine the effect of haptic simulators on motor skill acquisition during preclinical dental training, (2) explore students' perception, and (3) explore the ability of haptic systems to distinguish users based on their initial level of manual dexterity.

METHODS

A comprehensive search of articles published up to February 2023 was performed using five databases (i.e., PubMed/Medline, ScienceDirect, Web of Sciences, Scopus, and Cochrane Library) and specialized journals. The Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines were followed, and the risk of bias was assessed. Only studies on the application of haptic simulators in dentistry preclinical training were included. Qualitative synthesis of data was performed, and the protocol was registered in PROSPERO (ID = CRD42022337177).

RESULTS

Twenty-three clinical studies, including 1303 participants, were included. The authors observed a statistically significant improvement in dental students' motor skills in various dental specialties, such as restorative dentistry, pediatric, prosthodontics, periodontics, implantology, and dental surgery, after haptic training. Haptic technologies were perceived well by all participants, with encouraging data regarding their ability to differentiate users according to their initial level of manual dexterity.

CONCLUSIONS

Our work suggests that haptic simulators can significantly improve motor skill acquisition in preclinical dental training. This new digital technology, which was well perceived by the participants, also showed encouraging results in discriminating users according to their level of experience.

Assessment of a virtual prosthetic case planning environment for dental education - A multicentric analysis

OBJECTIVES

The aim of the present study was the multicentric assessment of the virtual prosthetic case planning environment (VCPE), which relocates patient planning into the virtual space in dental education.

MATERIALS AND METHODS

The VCPE is separated into two rooms: a virtual entry area where the user can choose between 10 different prosthetic case plans of ascending complexity, and a virtual patient case planning room. In spring term 2022, the use of virtual case planning was voluntarily assessed in four different German dental schools (DSs) from the perspective of both lecturers and students. The assessment was performed afterwards using a questionnaire. Data were analysed using Kolmogorov-Smirnov test, exploratory data analysis, Fisher-Freeman-Halton test, and exact Fisher test. Reliability was assessed with Cronbach Alpha test (α < 0.05).

RESULTS

A total of 59 lecturers and 63 students were included. There were 38.5% male, 60.7% female, and 0.8% diverse participants. The mean age of the lecturers was 36.2 ± 9.0 years and of the students 24.3 ± 3.0 years. The VCPE was assessed as good, yet the evaluations between either the DSs or between the lecturers and students were significantly different.

CONCLUSIONS

Even though for some assessment criteria significantly different results between the four DS were observed, the majority of participants evaluated the VCPE positively and recommended them for teaching. The virtual reality as a teaching method for teaching prosthetic case planning for the further preparation of the students for the later professional life can be considered as helpful.

Comparison of the effectiveness of virtual reality-based education and conventional teaching methods in dental education: a systematic review

BACKGROUND AND OBJECTIVES

Virtual reality dental simulators as an educational tool may create specific training conditions for dental students, allowing them to practice dental skills in a safe and controlled condition. This study aimed to investigate the effectiveness of virtual reality-based education in dental education compared to traditional education approaches.

METHODS

In this systematic review, four databases (PubMed, Scopus, Web of Science, and Science Direct) were searched until 2023 following PRISMA guidelines. The Quality assessment and risk of bias were assessed by the Cochrane Collaboration Tool for RCTs and GRADE, respectively. Inclusion criteria were restricted to randomized or quasi-randomized trials about virtual reality efficacy in dental education. Two authors independently evaluated the data and reviewed the overall risk of bias for all selected studies. Study design, sample size, hardware, onset time of intervention, duration, and number of procedures performed were among the data extracted.

RESULTS

From the 703 titles, 48 full texts were chosen for review, yielding 14 articles for final inclusion. The review of these articles indicated the effective role of virtual reality dental simulators in improving students' knowledge and practical skills.

CONCLUSIONS

Based on our findings, adding haptic technology to virtual reality can improve students' practical skills, hand skills, theoretical knowledge, self-confidence, and learning environment. Although a fair amount of research needs to be done, notably on cost-effectiveness, student satisfaction, and other potentially adverse effects, virtual reality is a growing phenomenon with immense potential.

Simulator education in Japanese dental education

Advances in information and communication technology (ICT) and digital technology have contributed greatly to the development of educational methods, and new educational styles have been introduced over the past several years. In recent years, it has become possible to provide more realistic simulator training to prepare for patient care through the development of phantom heads with jaws and artificial teeth that reflect actual anatomical structures and composition. While these phantom head simulator resources are becoming more realistic, the development of digital devices utilizing virtual reality has enabled training that is even more realistic than the jaw models, such as scanning the teeth and transfer this scan into a VR model in the simulator which can be used to practice on prior to treating the patient. There was a basic research report on the development of VR haptics simulators in Japan about 20 years ago, but there have been no reports for some time since then, and there are several reports on VR haptics simulators published after 2018. Even now, in terms of utilization in dental education, it is difficult to say that VR haptics simulator has been widely introduced in Japan. The reasons for this may be related to the evaluation system for clinical dental skills in the Japanese dental education system, as well as issues with budgets and in current condition of dental clinical practice in dental schools. It must be that the VR haptics simulator will be utilized in terms of preparatory training for patient care as clinical dental practice participation is enhanced in the future.

Application of virtual reality and haptics system Simodont in Chinese dental education: A scoping review

INTRODUCTION

Virtual reality (VR) and haptic simulation technology have been increasingly implemented in dental training. Since the first haptic VR dental simulator (Simodont) was introduced 10 years ago, it has been applied in more than 40 universities in mainland China. This scoping review aimed to review literature, showcasing the teaching reform of dental virtual simulation in mainland China to global dental education peers.

METHODS

This scoping review was conducted using the PRISMA extension for scoping review guidelines. Seven electronic databases were searched, and two reviewers independently performed the selection and characterization of the studies.

RESULTS

The final scoping review included 12 studies. Four studies focused on the G. V. Black class II cavity, three on manual dexterity skills training, two on full metal crown preparation, one on pulpal access and coronal cavity preparation, one on flipped classroom teaching, and one on 'doctor-patient communication' skills.

DISCUSSION

The most critical scenarios, self-assessment, working posture, curriculum setting, training and cost are analysed and discussed.

CONCLUSION

Haptic simulation technology is a valuable complementary tool to the phantom head in dental education. The combined utilization of these two training devices has been superior to either in isolation. However, there is a lack of research on the sequencing of the two systems, as well as the appropriate distribution of curriculum between them. It is necessary for educators to organize or engage in experience sharing, collaboration and knowledge dissemination. These actions are essential for promoting effective teaching within dental educational institutions.

Impact of fully guided implant planning software training on the knowledge acquisition and satisfaction of dental undergraduate students

BACKGROUND

A majority of dental school students do not undergo hands-on clinical training in implantology in the undergraduate curriculum. Training is usually restricted to pre-implant evaluation and post-implant prostheses. Virtual implant planning software (VIPS) provides an alternative opportunity for undergraduate students to experience implant planning much before gaining hands-on experience. However, not many studies have the contribution of VIPS to the knowledge acquisition of students. We conducted a preliminary study to evaluate the knowledge acquisition of the students when exposed to a hands-on session of VIPS. We also evaluated students' satisfaction levels, when exposed to hands-on training in fully guided implant planning software.

METHODS

A two-part theory lecture on fully guided implant planning was delivered to 90, 5th (final)-year dental undergraduate students by the oral radiology faculty. The students were then randomly divided into three groups. Group A was exposed to didactic lectures only. Group B was shown a video for fully guided implant planning in addition to the didactic lecture. Group C was shown a video for fully guided implant planning in addition to a didactic lecture and then performed a hands-on session of virtual implant planning under faculty guidance. Students from all groups were given an MCQ-based test. After the completion of the test students from group A and B also received VIPS hands-on training. Students from all three groups answered and a feedback questionnaire regarding their satisfaction levels with VIPS.

RESULTS

The overall test score of students in Group C was higher than their colleagues in both Groups A and B and the differences were statistically significant (p = 0.01). More than 85% of the students were satisfied with the teaching approach.

CONCLUSIONS

The utilization of VIPS in the training of dental undergraduate students improves their performance confirming better knowledge acquisition and content mastery.

Virtual reality and haptics in dental education: Implementation progress and lessons learned after a decade

INTRODUCTION

The search for alternative training environments in dentistry responded mainly to scarcity and lack of standardisation of training material and non-availability of specific clinical procedures. The development of haptic virtual reality (VR) dental trainers provides a platform where irreversible procedures can be safely and unlimitedly practised. The aim of this study was to assess the educational implementation of these devices and evaluate schools' satisfaction.

METHODS

Dental schools that were using haptic VR dental trainers, were approached. The Dental Trainer User Inventory (DTUI), addressing the educational implementation and users' satisfaction, was developed and distributed.

RESULTS

Twenty-seven schools completed the DTUI. The total number of VR dental trainers available varied from one to 42 devices with a mean of 7 devices. The dental trainer was mostly made available from the first year (63.0%) of the undergraduate program, but it was mostly integrated into the curriculum by the third year (70.4%). Curricular integration was reported by 18 schools (66.7%), while nine schools (33.3%) indicated that they had not yet achieved integration. Twenty-one schools (69.4%) were 'satisfied' or 'very satisfied' with the devices, while two schools (7.4%) were dissatisfied and six schools (22.2%) were neither satisfied nor dissatisfied.

CONCLUSION

VR haptic dental trainers are implemented in multiple dental programs and are also being used for educational research and clinical training. Even though curricular changes and teachers' acceptance remain a challenge, most schools are satisfied with VR haptic dental trainers and would recommend the device to other schools.

A survey to assess perspectives of people with chronic stroke about customized safety harnesses for dance-based exergaming in home settings

BACKGROUND

Early dance-based exergaming (DBExG) trials in people with chronic stroke (PwCS) have shown promising results, but there remains a lack of knowledge if PwCS are interested in receiving such training in their homes and the applicability of a fall-protection safety harness in the home environment.

OBJECTIVE

To survey people with chronic stroke to understand the perspectives and preferences of various customized safety harnesses for home-based harness assisted dance-based exergaming rehabilitation.

METHODS

Participants were included in this survey study if they had a stroke, lived in the community, and understood English. Participants completed a study-specific safety harness survey via mail, in-person, or online. Descriptive statistics were used to characterize the sample and survey responses.

RESULTS

One hundred two survey responses were returned. The majority of participants voted for a door mountable harness (51%), side-release style buckle (58%), and preferred to receive a manual to explain how to use the harness (51%). Seventy-eight percent of the participants required permission to install or use a harness system in their homes. More than half of the participants preferred exhibiting independence by strapping the harness themselves (68%), along with choosing to live independently (the ability to live in one's own home and community safely, independently, comfortably, and able also perform their activities of daily living, regardless of physical ability level) (89%).

CONCLUSIONS

PwCS opted to use ShA-DBExG in their homes. The current survey serves as a guideline to develop, customize, and prescribe home-based ShA-DBExG rehabilitation.

Patient-specific virtual simulation in the clinical training for prosthetic dentistry

INTRODUCTION

Dental education always involves live patient treatment, and clinical training for each patient is different for students. Using an intraoral scanner and Simodont Dental Trainer, we can provide students with an opportunity to train on actual patient cases in a virtual environment before real preparation. This study aimed to develop, implement and test patient-specific virtual simulation training in prosthetic dentistry curriculum.

MATERIALS AND METHODS

Before the actual preparation, the students' patients were scanned using 3Shape intraoral scanner. Thereafter, the .stl file was uploaded to Simodont Dental Trainer (Nissin dental products) where all the scanned teeth were prepared virtually. The 'prepared' .stl file was downloaded and submitted to the teacher. Instruction manuals for virtual simulation patient-specific tasks were provided. The students were asked to voluntarily complete the survey, at the end of the course.

RESULTS

Forty-two 4th year students from the Faculty of Dentistry performed a patient-specific virtual simulation training task and completed a survey. The created training materials served as guidelines for students to perform all the steps on their own without teacher assistance, except in the final step, where the teacher evaluated the digital preparation. Students appreciated the amount of information provided regarding the technologies used and patient-specific tasks. Students admitted that the patient-specific task was more interesting than standard tasks. However, they were not satisfied with the technical performance of Simodont Dental Trainer or the reflection of reality.

CONCLUSION

Patient-specific virtual simulation can be accepted by students for training before actual teeth preparation in the clinic. However, technical improvements are required in this regard.

Haptic and Force Feedback Technology in Dental Education: A Bibliometric Analysis

The haptic and force feedback technology has received an increasing attention in dental schools due to its effectiveness in psychomotor skill training. However, the bibliometric analysis on haptic and force feedback technology in dental education is still scarce. Therefore, the aim of this study was to perform a bibliometric analysis of the development of haptic and force feedback technology and its changing trends in dental education. From 1 January 2001 to 30 November 2022, all papers published on haptic and force feedback technology were searched from the Web of Science Core Collection database. These data were then entered into Apple Numbers for descriptive bibliometric analysis and visualized using VOSviewer software. A total of 85 articles were retrieved following the inclusive and exclusive criteria. The results demonstrated that USA and China exhibited the most publications. The combination of correspondence author and author co-citation analysis identified the more prominent authors in this research field. The top-cited and the average citation count per year ranking led to different views of popularity. A significant increase in the number of haptic and force feedback technology publications were found in the last two years. Virtual reality is the main keyword that indicates more new integrative applications currently underway. Taken together, this study provides a detailed bibliographic analysis of haptic and force feedback technology in dental education to indicate representative authors, literatures, keywords, and trends. These detailed data will help researchers, teachers, and dental students as a very useful information when trying to make haptic and force feedback technology more prevalent in dental education in the near further.

Mobile virtual tooth morphology teaching environment for preclinical dental students

OBJECTIVES

Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies.

METHODS

Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively.

RESULTS

Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology.

CONCLUSIONS

The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Challenges and Opportunities for Dental Education from COVID-19

With the ongoing COVID-19 pandemic, dental education has been profoundly affected by this crisis. First of all, COVID-19 brought physical and psychological health problems to dental students and educators. In addition, both non-clinical teaching and clinical-based training experienced challenges, ranging from fully online educational content to limited dental training, students’ research was delayed in achieving project milestones and there was hesitancy in respect of the COVID-19 vaccine. On the other hand, the COVID-19 pandemic has increased the demand for teledentistry and dental emergency treatment, and brought awareness of the advantages and high-speed development of distance education. This review aims to present these challenges and opportunities for dental education, and suggest how dental institutions should prepare for the future demand for dental education.

Virtual 3D tooth creation for personized haptic simulation training in access cavity preparation

Personalized medicine is a new medical concept to achieve patient-centered care. In dentistry, it is recognized for the customization of operative strategies and managements for oral diseases. Access cavity preparation in endodontic treatment is an irreversible procedure. Endodontic training will be more realistic by the implementation of clinical relevant 3D virtual reality technology. In this article, the authors first presented a personized case from a real patient to provide assess cavity preparation in haptic virtual reality dental simulator Simodont® (Nissin Dental Products Inc., Nieuw-Vennep, Netherlands). The practical framework to generate STL from cone beam computed tomography was demonstrated. A case of virtual tooth #26 access cavity preparation in Simodont® was established for trainee unlimited practices before performing the clinical procedure on a real patient. Taken together, access cavity preparation in a virtual environment using a 3D personized tooth may minimize procedural errors and facilitate clinical treatment outcome.

Combining virtual reality and 3D-printed models to simulate patient-specific dental operative procedures-A study exploring student perceptions

INTRODUCTION

Students face a number of challenges in translating the skills acquired in pre-clinical simulation environments to the delivery of real patient care. These are particularly emphasised for complex operative procedures such as tooth preparations for indirect restorations. This paper reports student perceptions of a novel approach designed to improving student confidence when undertaking operative procedures on patients for the first time, by providing patient-specific simulation using virtual reality (VR) and 3D-printed models of the student's real clinical case.

MATERIALS AND METHODS

Students practised on patient-specific models, in the presence of a clinical tutor, firstly using VR simulation then with 3D-printed models in a clinical skills laboratory. The students then carried out the operative procedure on their patients, on the third occasion of practice. After providing the treatment for their patients, students attended a semi-structured interview to discuss their experiences. The qualitative data were analysed using two forms of inductive analysis.

RESULTS

Students most frequently cited: the value of the educator, increased confidence and efficiency during the clinical procedure, improved patient confidence and the complementary benefits of the two simulation modalities. Thematic analysis of participants' responses uncovered five key themes: The value of virtual reality dental simulators The value of clinical skills laboratory simulation with 3D-printed models The value of educator engagement The impact on the clinical procedure and the patient The VR and clinical skills laboratory balance CONCLUSION: This paper reports the early findings of an intervention that improves dental student confidence through the use of patient-specific VR exercises and 3D-printed models. These provided an incremental learning experience for an operative clinical procedure, prior to treatment of the live patient. Early results suggest this is a positive experience for the students, providing a valuable contribution to their confidence and preparedness.

Mixed Reality and Haptic-Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation

Background

Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR.

Objective

This study aimed to describe the research and development of a newly developed MR and haptic–based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity.

Methods

A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator.

Results

Of the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator’s ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD’s resolution (P=.03) and simulation of the preparation process (P=.001).

Conclusions

The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills.

Students' and tutors' perceptions of a deliberate simulated practice using patient-specific virtual and three-dimensional printed teeth models: A pilot study

OBJECTIVE

This pilot study aimed to investigate the perceptions of dental students and their tutors of a deliberate simulated practice using patient-specific virtual and three-dimensional (3D) printed teeth models. This is before they perform their first indirect posterior tooth restoration on their patients.

METHODS

Seventy-eight fourth-year dental students from the 2021 Comprehensive Clinic I course at the University of the Andes, Chile, were invited to participate in a deliberate practice protocol. This consisted of digitally scanning their patients' teeth, printing the files three-dimensionally, and loading them into a virtual reality (VR) dental simulator to create patient-specific models. Subsequently, they practiced the same indirect posterior restorations on these models before performing them on their actual patients. Perceptions about students' preparedness to perform tooth preparations before and after the protocol were collected from students and their tutors through surveys.

RESULTS

Sixty-three students (43 female) and six clinical tutors (all male) participated in the study. Before practicing with their patient-specific models, most students believed they had the knowledge, practical skills, and self-confidence to perform indirect restorations on their patients. However, after the protocol, most students thought their self-confidence increased and felt better prepared to treat their patients. Most students preferred the 3D-printed models over the VR models to practice but mentioned that it did not feel like drilling dental enamel. Tutors believed that participating students had higher self-confidence when treating their patients and were more autonomous.

CONCLUSIONS

This study demonstrated that students and clinical tutors had positive perceptions of practicing with patient-specific virtual and 3D-printed teeth models before students performed their first indirect restorations on their patients.

Clinical relevant haptic simulation learning and training in tooth preparation

Clinical dentistry is a complex activity which the procedure of most dental treatment are almost irreversible changes. Patient safety is a major challenge in clinical dental care. This is the reason why simulation-based learning and training is emphasized in dental education. In this article, the authors presented the clinical relevant haptic simulation learning and training in tooth preparation. The practical framework to set up the simulation environment from real patients in haptic 3D virtual reality dental training simulator Simodont® (Nissin Dental Products Inc., Nieuw-Vennep, Netherlands). Then, the trainee can repeatedly practice in Simodont® before performing the clinical procedure on real patient. Taken together, the implementation of this model in dental education may not only enhance trainees’ self-confidence and performance, but also facilitate patient safety during clinical dental care.

Scoping review of artificial intelligence and immersive digital tools in dental education

PURPOSE

The aim of this scoping review is to examine artificial intelligence (AI) and virtual teaching models within the context of dental education, establish methods to address the resources being investigated, and ultimately augment this approach for future scientific research.

METHODS

To evaluate the applications of AI and immersive technology, a scoping literature review was conducted using the Embase, PubMed, Web of Science, and Cochrane Library database from the years 2018 to May 19, 2021. Additionally, a manual search was completed. The search strategy was formulated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies that addressed the current uses of virtual devices and their revolutionary potential in dental education were categorized separately for further evaluation.

RESULTS

 Of the 2500 articles found in our initial search results, 31 articles met the inclusion criteria set for this review. The selected studies were directly related to AI and immersive tools in dental education.

CONCLUSION

To our knowledge, there are very few comprehensive literature reviews identifying the applications and efficacy of virtual and AI-driven tools in dental education. With limited verifiable evidence, an improved understanding of virtual and AI domains is needed to enable dental students to adapt to changes within and beyond their dental training education. To increase the scientific value of digital-related research, the scientific community must quickly define guidelines to enhance methodological approaches in order to effectively digitalize dentistry.

Virtual dental teaching and its effect on test success - A cross-over study

OBJECTIVES

The aim of this cross-over investigation was to analyze the effect of virtual teaching using virtual reality (VR) within a dental learning environment by preclinical students with or without dental professional experience on test performance.

METHODS

Preclinical students (N = 82) were randomly divided into two groups for cross-over testing of tooth morphology knowledge: (a) anterior VR-group (group 1) using the VR-glasses as an additional learning tool for the anterior tooth morphologies and (b) posterior VR-group (group 2) using it for the posterior tooth morphologies also in addition to conventional learning. All students used the VR-glasses for 1 week independent of time and location depending on group. The students had to recognize teeth (anterior or posterior within two separate tests after three [anterior test] and 6 weeks [posterior test] of practical course) and note the tooth number and characteristics in written form. Former dental experience (dental technician/assistance) was noted. Test results were analyzed to quantify the effect of virtual teaching on test scores. Data were analyzed with the Kolmogorov-Smirnov and Mann-Whitney U test (p = 0.05).

RESULTS

By differentiating the two student groups (use of VR glasses for anterior/posterior teeth) within the dental experience group, significantly better test results (p = 0.040) were shown for group 1 in the total posterior teeth test score. Furthermore, no other significant differences, but a possible tendency, in the test results and thus no effect of the use of the VR glasses on both VR groups could be analyzed (p ≥ 0.051).

CONCLUSIONS

Using the VR tooth learning environment predominantly did not lead to a significant improvement of test results. Anterior teeth test scores predominantly showed significantly better results than posterior teeth test scores.

Students' learning environment perception and the transition to clinical training in dentistry

INTRODUCTION

The learning environment (LE) influences students' behaviour, and predicts academic achievement, satisfaction and success. Measuring students' perception of the LE provides relevant information for curricular quality assurance. In this study, a LE assessment was used to observe variations in students' LE perception throughout the curriculum, to illustrate the possible influence that preclinical training (Pt) and clinical training (Ct) have on students' learning experience.

MATERIALS AND METHODS

All students in the six-year undergraduate dental programme (n = 849) at the Academic Centre for Dentistry Amsterdam (ACTA) were approached and divided into Pt and Ct groups according to their training phase in the curriculum. The LE was assessed using the Dundee Ready Educational Environment Measure (DREEM), and the results were evaluated using the Statistical Package for the Social Sciences (SPSS) software for distribution (Kolmogorov-Smirnov normality test), internal reliability (Cronbach's alpha) and comparative analysis (one-way ANOVA).

RESULTS

The questionnaire was completed by 216 (response rate=65%) Pt students and by 379 (response rate=75%) Ct students. With a general DREEM score of 124.3, significantly higher scores were found during Pt (DREEM=133.4) in comparison with the Ct phase of the curriculum (DREEM=119.2). DREEM scores steadily decreased throughout the 6-year curriculum, with the highest drops in LE perception observed in the second and third years of the programme. Significant differences in all DREEM domains were observed, with lower scores for Ct.

CONCLUSION

Students' LE perception deteriorates throughout the curriculum, especially within the Pt-Ct transition, during the second and third years of the programme. An inferior LE perception was observed in every domain of the LE questionnaire within this transition showing a learning experience, which requires an educational intervention. Further research is required to better understand the educational needs of the Pt-Ct transition at this school.

Technical skill training and assessment in dental education

Highly competent clinical practice requires cognitive, psychomotor and affective skills. Therefore, the ultimate goal of dental education is for practitioners to be competent in all of these domains. While many methods have been introduced to assess knowledge and non-technical skills, it is still very difficult for educators to assess technical skill. Assessment methods for technical skills are still not well established because it is very difficult to assure objectivity, validity and fairness. Nonetheless, technical skill is especially important in dental treatments, along with knowledge and attitude. The aim of this review was to summarize the methods of technical skill training in dental education and how they are assessed. This is a literature review. We searched PubMed MEDLINE using terms related to technical skill training and those assessment as of June 2020 and reviewed them. There have been many reports introducing methods of technical skill training and assessment, including the use of digital technology. However, no single assessment method had demonstrated validity of it. Technical skill training is very important in dental education and there are various ways of learning. The validity of current assessment methods is limited; therefore, a combination of several methods may achieve the best results.

Effectiveness of Virtual Reality and Interactive Simulators on Dental Education Outcomes: Systematic Review

In recent years, virtual reality and interactive digital simulations have been used in dental education to train dental students before interacting with real patients. Scientific evidence presented the application of virtual technology in dental education and some recent publications suggested that virtual and haptic technologies may have positive effects on dental education outcomes. The aim of this systematic review was to determine whether virtual technologies have positive effects on dental education outcomes and to explore the attitudes of dental students and educators toward these technologies. A thorough search was conducted in PubMed, Scopus, MEDLINE (via EBSCO), The Cochrane Library (via Wiley), Web of Science Core Collection (via Thomson Reuters), and Dentistry and Oral Science source (via EBSCO) using the keywords (student, dental) AND (education, dental) AND (virtual reality) OR (augmented reality) OR (haptics) OR (simulation) AND (dentistry) OR (dental medicine). The quality of the reported information was assessed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement for systematic reviews. A total of 73 publications were considered for this review. Fifty-two of the selected studies showed significant improvement in educational outcomes and virtual technologies were positively perceived by all the participants. Within the limitations of this review, virtual technology appears to improve education outcomes in dental students. Further studies with larger samples and longer term clinical trials are needed to substantiate this potential positive impact of various virtual technologies on dental education outcomes.

Listening to patients' voices: Applying the design-thinking method for teaching person-centered care to nursing students

BACKGROUND

Providing a person-centered care (PCC) education program to nursing students is necessary. This study aims to determine the impact of a design-thinking based education program on how nursing students perceive PCC.

METHODS

Five 2-h lessons were offered to 105 fourth-year nursing students in South Korea. Each randomly assigned group of eight or nine students was instructed to develop a plan to address the problems/dissatisfaction experienced by patients during hospitalization. The Individualized Care Scale-nurse's version was used to measure student's perception of PCC before and after the education program.

RESULTS

After the program the students exhibited significant improvements in how they viewed supporting patient individuality, with that score increasing by 0.44 (from 3.64 to 4.08; p < 0.0001), and maintaining patient individuality while providing care, with that score increasing by 0.34 (from 3.71 to 4.05; p < 0.0001). Among subdomains, the most notable change was in how the students viewed the personal life situation of patients, and its impact on patients' healthcare outcomes.

CONCLUSION

This education program, based on the design-thinking approach, was effective in improving the perceptions of nursing students about PCC. Expanding such PCC education programs for nursing school students should therefore be considered.

The Current Situation and Future Prospects of Simulators in Dental Education

The application of virtual reality has become increasingly extensive as this technology has developed. In dental education, virtual reality is mainly used to assist or replace traditional methods of teaching clinical skills in preclinical training for several subjects, such as endodontics, prosthodontics, periodontics, implantology, and dental surgery. The application of dental simulators in teaching can make up for the deficiency of traditional teaching methods and reduce the teaching burden, improving convenience for both teachers and students. However, because of the technology limitations of virtual reality and force feedback, dental simulators still have many hardware and software disadvantages that have prevented them from being an alternative to traditional dental simulators as a primary skill training method. In the future, when combined with big data, cloud computing, 5G, and deep learning technology, dental simulators will be able to give students individualized learning assistance, and their functions will be more diverse and suitable for preclinical training. The purpose of this review is to provide an overview of current dental simulators on related technologies, advantages and disadvantages, methods of evaluating effectiveness, and future directions for development.

The utility of haptic simulation in early restorative dental training: A scoping review

BACKGROUND

Haptic dental simulators are becoming increasingly available in dental schools around the world; however, there is a paucity of evidence on their pedagogical effectiveness particularly in early dental training for the acquisition of the highly specific fine motor dental skills.

METHODS

A scoping review was performed to broadly map the available evidence and to detect knowledge gaps on the utility of haptic dental simulation in early dental training. The review is reported using the PRISMA-ScR guidelines. Eight bibliographic databases were searched: Web of Science, Scopus, MEDLINE via PubMed, Cochrane library, CENTRAL, ERIC, IEEE Xplore, and TRIP. Charted data were reported by clustering results according to study characteristics, research themes, research purpose, and type of validity evidence identified.

RESULTS

The review process resulted in the inclusion of 36 studies published between 2009 and 2020. The majority of the studies were cross-sectional in design with short-term evaluation data. Of the studies included, 64% investigated commercially available haptic simulators, while 36% investigated experimental haptic simulators. The research themes identified were skill acquisition and transfer, task-specific haptic training, trainee level discrimination, feedback, subjective user evaluation, performance prediction, and human factors in haptic training.

CONCLUSION

Short-term evaluation evidence from reviewed studies indicates the usefulness of the haptic simulators in early dental training. They complement the existing phantom head simulators by offering qualitatively different features. Further empirical research is needed to investigate the long-term impact of training with haptic dental simulators, to improve the availability of validation evidence and to enhance the results generalizability.

Student performance comparisons for a critical thinking skill set (technology decision-making) for classroom and remote (Zoom) facilitation

A comparison of student learning in a critical thinking exercise for technology decision-making occurred with the onset of coronavirus and the switch from face-to-face to distance with Zoom. Literature on explicit critical thinking skill sets is scant in any format, including distance learning. While face-to-face and Zoom have similarities, seizing this opportunity for comparison can set the stage to determine soundness of distance learning in critical thinking on a preliminary basis. The learning outcome, learning guide and assessment instrument remained the same for the exercise in both formats; student teams presented analyses of different technologies with assessment by 2 faculty as before. Forty students had not completed the exercise when the coronavirus shut down occurred. Students performed at as high a level using virtual/Zoom as with face-to-face.

From Traditional to VR-Based Online Education Platforms: A Model of the Mechanism Influencing User Migration

VR technology can help create optimal virtual learning spaces. Such spaces offer new visual experiences that break through the limitations of time and space and greatly stimulate people’s imagination and creativity in learning. Currently, the bandwidth required for such spaces limits the large-scale application of virtual reality (VR) technology for this purpose. With the large-scale deployment and application of high-speed networks, however, online education platforms based on VR technology will be better able to meet the diversified and personalized learning needs of learners. To promote the development and popularization of new online education platforms based on VR, the factors influencing the migration of learners from traditional online education platforms to new platforms need to be understood more clearly. A model based on the theory of negative, positive, and anchoring effects can explain learners’ migration behavior in this connection. To this end, a structural equation model based on the PLS variance algorithm was used to analyze data obtained through offline and online questionnaires. It was found that in terms of “negative effects”, the afunction and loyalty associated with traditional online education platforms reduced learners’ willingness to migrate to new platforms based on VR technology. In terms of “positive effects”, the novel interactivity and personalization brought by the new platform increased the willingness of users of traditional platforms to migrate to new platforms. In terms of “anchoring effects”, the system quality and relationship quality of learners’ use of traditional online education platforms, as well as the transfer costs associated with the new platform, generated learners’ risk perception about platform migration. In addition, risk perception not only negatively affects learners’ migration to the new platforms, but also strengthens their cognition of the system quality and relationship quality of the traditional platforms, while reducing their interactive awareness of those platforms. Therefore, by adjusting the psychological component of virtual learning, the online education platforms based on VR technology can create high-quality platforms migrating from traditional platforms.

Disruptions during a pandemic: Gaps identified and lessons learned

Global disruptions caused by coronavirus disease 2019 (COVID‐19) affects all walks of life, and dentistry and dental education are no exceptions. Dental education uniquely blends didactic courses and hands‐on clinical training seamlessly to prepare oral healthcare providers of the future. Apart from economical and access to care implications, closure of all the dental institutions in the United States affects their educational mission greatly, equally disturbing pre‐doctoral and graduate training. Efforts are ongoing to continue the educational mission in dental institutions by delivering scheduled course content remotely using multiple online tools. In spite of those efforts, since clinical experiences cannot be completely replaced by any available alternative method of instruction that is delivered remotely, students are missing out on valuable patient‐based clinical experiences. In this perspective article, we briefly discuss the several implications of COVID‐19, in the context of dental education. We then highlight some of the lessons we can learn from this pandemic which we hope will have several positive implications, including curricular changes, increased public health awareness and preparedness for future public health emergencies.