A patient-specific haptic drilling simulator based on virtual reality for dental implant surgery

Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery

STATEMENT OF PROBLEM

A model offering anatomic replication and haptic feedback similar to that of real bone is essential for hands-on surgical dental implant training. Patient-specific skeletal models can be produced with 3-dimensional (3D) printing, but whether these models can offer optimal haptic feedback for simulating implant surgery is unknown.

PURPOSE

The purpose of this trial was to compare the haptic feedback of different 3D printed models for simulating dental implant surgery.

MATERIAL AND METHODS

A cone beam computed tomography image of a 60-year-old man with a partially edentulous mandible was manipulated to segment the mandible and isolated from the rest of the scan. Three-dimensional models were printed with 6 different printers and materials: material jetting-based printer (MJ, acrylic-based resin); digital light processing-based printer (DLP, acrylic-based resin); fused filament fabrication-based printer (FFF1, polycarbonate filament; FFF2, polylactic acid filament); stereolithography-based printer (SLA, acrylic-based resin); and selective laser sintering-based printer (SLS, polyamide filament). Five experienced maxillofacial surgeons performed a simulated implant surgery on the models. A 5-point Likert scale questionnaire was established to assess the haptic feedback. The Friedman test and cumulative logit models were applied to evaluate differences among the models (α=.05).

RESULTS

The median score for drilling perception and implant insertion was highest for the MJ-based model and lowest for the SLS-based model. In relation to the drill chips, a median score of ≥3 was observed for all models. The score for corticotrabecular transition was highest for the MJ-based model and lowest for the FFF2-based model. Overall, the MJ-based model offered the highest score compared with the other models.

CONCLUSIONS

The 3D printed model with MJ technology and acrylic-based resin provided the best haptic feedback for performing implant surgery. However, none of the models were able to completely replicate the haptic perception of real bone.

Haptic devices as an educational approach for oral and maxillofacial surgical procedures

OBJECTIVE

Developing the skills of a proficient surgeon with a deep understanding of force requires extensive training and repetitive practice. Traditionally, dental students and surgical trainees observed and participated in procedures using models, animals, or cadavers under expert supervision before performing the procedures independently. To address these challenges, interactive simulators with visuo-haptic features have been introduced in surgical training, providing visual and tactile feedback that replicates the sense of touch through applied forces, vibrations, or motions.

STUDY DESIGN

Two independent reviewers employed a specific search strategy to explore online databases such as PubMed, Scopus, and Web of Science (WoS). This strategy included keywords such as "haptic device," "education," "oral surgery," "surgery," and "maxillofacial surgery." All types of studies related to maxillofacial surgery, except for case reports, reviews, and eBooks, were considered for inclusion.

RESULTS

A total of 22 articles meeting the screening criteria were identified. The use of haptic devices for training dental students in oral surgery, anesthesia, as well as oral and maxillofacial trainees and surgeons in various surgical procedures, was evaluated.

CONCLUSION

Incorporating tactile devices into the training of residents and maxillofacial surgeons offers numerous advantages, including improved technical skills and enhanced patient safety.

Development of a virtual reality-based zygomatic implant surgery training system with global collision detection and optimized finite element method model

BACKGROUND AND OBJECTIVE

Zygomatic implant surgery is challenging due to the complex structure of the zygomatic bone, limited visual range during surgery, and lengthy implant path. Moreover, traditional training methods are costly, and experimental subjects are scarce.

METHODS

To overcome these challenges, we propose a novel training system that integrates visual, haptic, and auditory feedback to create a more immersive surgical experience. The system uses dynamic bounding volume hierarchy (BVH) and Symplectic Euler to detect global collisions between surgical tools and models, while an optimized finite element method (FEM) model simulates soft tissue and detects collisions. Compared to previous works, our system achieves global rigid-body collisions between surgical tools and patient models, while also providing stable and realistic simulation and collisions of soft tissues. This advancement offers a more realistic simulation for zygomatic implant surgery.

RESULTS

We conducted three experiments and evaluations. The first experiment measured the axial force generated during the zygomatic implant simulation process and compared it with actual surgery, demonstrating the realistic force rendering feedback of our system. The second evaluation involved 15 novice surgeons who experienced the system and completed a questionnaire survey focusing on five aspects. The results showed satisfactory evaluations. The third experiment involved six surgeons who underwent in-depth training for two hours daily and were tested on the first, third, and fifth days. We collected data and combined it with the doctors' feedback to prove that our system can improve surgeons' proficiency in zygomatic implant surgery and provide a novel training solution for this procedure.

CONCLUSION

We have innovatively integrated global collision detection and optimized soft tissue simulation into our system. Furthermore, we have conducted experimental validation to demonstrate the effectiveness of this implementation. We present a novel solution for zygomatic implant surgery training.

Smoothed particle hydrodynamics method applied to oral region: A narrative review

Traditionally, simulation studies in dentistry have relied on the finite element method (FEM). However, the smoothed particle hydrodynamics (SPH) method, which represents objects as particle collections without the use of meshes, has gained recent attention. Despite its application in dentistry, there is currently a lack of comprehensive literature summarizing the specific applications of the SPH method in the oral region. This review aims to provide a summary of studies that have utilized the SPH method in dentistry, focusing on its applications in analyzing large deformations, such as dental ceramic collisions, soft material analysis (e.g., denture adhesive), and virtual training simulations for dental treatments. By combining the advantages of the SPH and FEM methods, more accurate simulations can be achieved, and further applications of the SPH method in dentistry are anticipated.

Application of virtual reality in dental implants: a systematic review

BACKGROUND AND OBJECTIVE

A treatment approach that is widely used as a permanent and natural replacement for missing or extracted teeth is dental implants .VR is a computer-generated simulation that creates a three-dimensional (3D) image or environment. Advances in VR -based learning allow learners and students to practice and also help professionals plan a wide variety of surgical procedures, including the correct placement of dental implants. Therefore, in this systematic review, our aim was to investigate and evaluate the available virtual reality tools for dental implants and their effectiveness.

MATERIALS AND METHODS

Studies published up to 01/30/2023 which report the applications of using virtual reality technology in dental implants, were reviewed in three databases, including PubMed, Web of Science, and Scopus. All studies with evidence reporting the role of virtual reality technology in the field of dental implants were included in our analyses, written in English and published in peer-reviewed form, are included. Theoretical articles, and letters that did not provide original data, as well as studies that reported incomplete information, were excluded. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies, and decisive agreement was reached by discussion and consultation with the third researcher. Narrative synthesis was undertaken to summarize and report the findings.

RESULTS

Out of 1633 initial search results, nine were included in the present study based on the inclusion criteria. The focus of seven studies was on teaching and learning, and two studies have examined the implant planning procedure. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. In almost all studies, the results showed that the use of virtual reality-based systems improves and enhances the skills of users, including dental students and specialists.

CONCLUSIONS

Our findings showed that VR is an effective method for teaching and planning the implant process. Although the use of VR technology is limited for various reasons such as cost, it can increase the skills of dental professionals in performing dental implants.

The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview

BACKGROUND

This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue.

METHODS

Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022.

RESULTS

After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics.

DISCUSSION

Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community.

Validation of a surgical drill with a haptic interface in spine surgery

Real haptics is a technology that reproduces the sense of force and touch by transmitting contact information with real objects by converting human movements and the feel of the objects into data. In recent years, real haptics technology has been installed in several surgical devices. A custom-made surgical drill was used to drill into the posterior lamina to verify the time required for penetration detection and the distance the drill advanced after penetration. A surgeon operated with the drill and the same aspects were measured and verified. All experiments were performed on female miniature pigs at 9 months of age with a mean body weight of 23.6 kg (range 9-10 months and 22.5-25.8 kg, n = 12). There were statistically significant differences in the average reaction time and the distance travelled after penetration between a handheld drill and the drill with the penetration detection function (p < 0.001). The reaction time to detect penetration and the distance after penetration were both significantly improved when compared with those of the handheld surgical drill without the penetration detection function, with mean differences of 0.049 ± 0.019 s [95% CI 0.012, 0.086 s] and 2.511 ± 0.537 mm [95% CI 1.505, 3.516 mm]. In this study, we successfully conducted a performance evaluation test of a custom-made haptic interface surgical drill. A prototype high-speed drill with a haptic interface accurately detected the penetration of the porcine posterior lamina.

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.

Instantaneous Reaction and Vibration Suppression Using Two-Degree-of-Freedom Admittance Control with H∞ Feedback Controller in Surgical Training Simulator with Chiseling Operation

Surgical training simulators with virtual reality have been developed to enable surgeons to efficiently acquire and improve their surgical skills. In hard tissue surgery, the surgeon uses a chisel and mallet to cut a bone or tooth with large and instantaneous forces. In the previous study by present authors, to represent the force sensation of the cutting operation in the virtual training simulator, we constructed the force display device using the ball-screw mechanism to obtain high stiffness and display the large force. Additionally, we applied the two-degrees-of-freedom (2DOF) admittance control to react instantaneously to the impact force by pounding with the mallet. The feedback controller of the 2DOF admittance control is required to increase the high-frequency gain for improving the responsiveness of the force display device. However, the vibrational mode of the force display device can be excited by increasing the controller gain. Therefore, this study develops the design approach of the feedback controller using the H∞ control in the 2DOF admittance control system, which can be systematically constructed to reduce the vibrational mode and react instantaneously in the force display device. The efficacy of the proposed force display control system is verified through the virtual experience of the free movement and the hard contact operations.

Practice makes perfect? Association between students' performance measures in an advanced dental simulation course

PURPOSE

This study examines the relationship between student performance measures during practice and exams using advanced dental simulation.

METHODS

Data from 11 classes of first-year dental students were extracted from Advanced Simulation software (DentSim™) related to Class I and Class II preparations including: total number of practice sessions, average practice score, exam scores, average time preparing teeth during practice/exam, and average time self-evaluating preparations during practice/exam. Comparisons of average practice and exam scores were examined using paired t-test. Relationships between practice/exam measures and exam scores were determined with multiple linear regression.

RESULTS

Practice mean and exam scores were significantly associated; exam scores were significantly higher in both procedures. Class I: a significant positive relationship exists between both practice and exam measures: The average practice score was significantly associated with exam score (p < 0.001); time spent preparing the exam tooth was negatively associated with the exam score (p < 0.001); conversely, time spent self-evaluating the exam tooth was significantly associated with an increase in exam score (p = 0.0135). Class II: exam score was significantly associated with two practice measures but neither of the exam measures: exam score for Class II mesioocclusal preparation was significantly associated with average practice score (p < 0.001) and the number of practice attempts (p = 0.025).

CONCLUSION

This study emphasizes the predictive value of novice learners' deliberate, repetitive practice using advanced dental simulation, which enhances self-assessment in early stages of psychomotor skill development. Future studies are needed to demonstrate the translation of these skills into a patient care setting.

Development of a maxillofacial virtual surgical system based on biomechanical parameters of facial soft tissue

Purpose

Lack of biomechanical force model of soft tissue hinders the development of virtual surgical simulation in maxillofacial surgery. In this study, a physical model of facial soft tissue based on real biomechanical parameters was constructed, and a haptics-enabled virtual surgical system was developed to simulate incision-making process on facial soft tissue and to help maxillofacial surgery training.

Methods

CT data of a 25-year-old female patient were imported into Mimics software to reconstruct 3D models of maxillofacial soft and skeletal tissues. 3dMD stereo-photo of the patient was fused on facial surface to include texture information. Insertion and cutting parameters of facial soft tissue measured on fresh cadavers were integrated, and a maxillofacial biomechanical force model was established. Rapid deformation and force feedback were realized through localized deformation algorithm and axis aligned bounding box (AABB)-based collision detection. The virtual model was validated quantitatively and qualitatively.

Results

A patient-specific physical model composed of skeletal and facial soft tissue was constructed and embedded in the virtual surgical system. Insertion and cutting in different regions of facial soft tissue were simulated using omega 6, and real-time feedback force was recorded. The feedback force was consistent with acquired force data of experiments conducted on tissue specimen. Real-time graphic and haptic feedback were realized. The mean score of the system performance was 3.71 given by surgeons in evaluation questionnaires.

Conclusion

The maxillofacial physical model enabled operators to simulate insertion and cutting on facial soft tissue with realization of realistic deformation and haptic feedback. The combination of localized deformation algorithm and AABB-based collision detection improved computational efficiency. The proposed virtual surgical system demonstrated excellent performance in simulation and training of incision-making process.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11548-022-02657-5.

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.

Dental Robotics: A Disruptive Technology

Robotics is a disruptive technology that will change diagnostics and treatment protocols in dental medicine. Robots can perform repeated workflows for an indefinite length of time while enhancing the overall quality and quantity of patient care. Early robots required a human operator, but robotic systems have advanced significantly over the past decade, and the latest medical robots can perform patient intervention or remote monitoring autonomously. However, little research data on the therapeutic reliability and precision of autonomous robots are available. The present paper reviews the promise and practice of robots in dentistry by evaluating published work on commercial robot systems in dental implantology, oral and maxillofacial surgery, prosthetic and restorative dentistry, endodontics, orthodontics, oral radiology as well as dental education. In conclusion, this review critically addresses the current limitations of dental robotics and anticipates the potential future impact on oral healthcare and the dental profession.

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 Challenge of Dental Education After COVID-19 Pandemic - Present and Future Innovation Study Design

The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new technology devices, instrumentations systems, haptic systems, simulation based training, 3D printer machines, to permit validation and calibration of the technical skills of dental students.

A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery

Background: Research proves that the apprenticeship model, which is the gold standard for training surgical residents, is obsolete. For that reason, there is a continuing effort toward the development of high-fidelity surgical simulators to replace the apprenticeship model. Applying Virtual Reality Augmented Reality (AR) and Mixed Reality (MR) in surgical simulators increases the fidelity, level of immersion and overall experience of these simulators.Areas covered: The objective of this review is to provide a comprehensive overview of the application of VR, AR and MR for distinct surgical disciplines, including maxillofacial surgery and neurosurgery. The current developments in these areas, as well as potential future directions, are discussed.Expert opinion: The key components for incorporating VR into surgical simulators are visual and haptic rendering. These components ensure that the user is completely immersed in the virtual environment and can interact in the same way as in the physical world. The key components for the application of AR and MR into surgical simulators include the tracking system as well as the visual rendering. The advantages of these surgical simulators are the ability to perform user evaluations and increase the training frequency of surgical residents.

Surgical Training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery - Part II

PURPOSE

Many technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols.

METHODS

This article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice.

RESULTS

The results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias.

CONCLUSION

Surgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side. This second part therefore reviews, social networks, serious games and virtual reality. This Systematic review is registered on PROSPERO (CRD42020181376).

Immersion and haptic feedback impacts on dental anesthesia technical skills virtual reality training

OBJECTIVES

Administering anesthesia to the inferior alveolar nerve is 1 of the most stressful processes in dental training. Most studies using virtual reality (VR) for dental training have used non-immersive technologies. The purpose of this work is to assess the impact of immersive technologies on skills training.

METHODS

On May 2019, an experimental study was conducted with 163 clinical dental students, divided into 4 groups across 2 phases (preceptorship and training) with haptic feedback either On or Off. The participants trained on the inferior alveolar dental anesthesia procedure in a haptic VR simulator. Their technical skills were evaluated in terms of needle insertion features which were computed from a haptic device providing kinematic data. Also, the participants reported their subjective experience with syringe handling and simulator sickness. A machine learning method was implemented to automatically evaluate the needle insertion point performance of the student.

RESULTS

Groups receiving immersive preceptorship and/or immersive training showed more accuracy and confidence in administering the anesthesia. Participants perceived a high sense of realism with the haptic feedback when handling the syringe. The machine learning method was validated, with an accuracy of 84%, as a good classifier to assess a student's needle insertion point performance.

CONCLUSIONS

The immersive VR simulator allows the practice of the inferior alveolar nerve block under near real conditions and with immediate feedback to the dental student with respect to the needle insertion point. This machine learning based automatic evaluation provides a method to improve technical skills, contributing to dental training.

Dentronics: Towards robotics and artificial intelligence in dentistry

OBJECTIVES

This paper provides an overview of existing applications and concepts of robotic systems and artificial intelligence in dentistry. This review aims to provide the community with novel inputs and argues for an increased utilization of these recent technological developments, referred to as Dentronics, in order to advance dentistry.

METHODS

First, background on developments in robotics, artificial intelligence (AI) and machine learning (ML) are reviewed that may enable novel assistive applications in dentistry (Sec A). Second, a systematic technology review that evaluates existing state-of-the-art applications in AI, ML and robotics in the context of dentistry is presented (Sec B).

RESULTS

A systematic literature research in pubmed yielded in a total of 558 results. 41 studies related to ML, 53 studies related to AI and 49 original research papers on robotics application in dentistry were included. ML and AI have been applied in dental research to analyze large amounts of data to eventually support dental decision making, diagnosis, prognosis and treatment planning with the help of data-driven analysis algorithms based on machine learning. So far, only few robotic applications have made it to reality, mostly restricted to pilot use cases.

SIGNIFICANCE

The authors believe that dentistry can greatly benefit from the current rise of digital human-centered automation and be transformed towards a new robotic, ML and AI-enabled era. In the future, Dentronics will enhance reliability, reproducibility, accuracy and efficiency in dentistry through the democratized use of modern dental technologies, such as medical robot systems and specialized artificial intelligence. Dentronics will increase our understanding of disease pathogenesis, improve risk-assessment-strategies, diagnosis, disease prediction and finally lead to better treatment outcomes.

Digital dentistry: The new state of the art - Is it disruptive or destructive?

OBJECTIVE

Summarizing the new state of the art of digital dentistry, opens exploration of the type and extent of innovations and technological advances that have impacted - and improved - dentistry. The objective is to describe advances and innovations, the breadth of their impact, disruptions and advantages they produce, and opportunities created for material scientists.

METHODS

On-line data bases, web searches, and discussions with industry experts, clinicians, and dental researchers informed the content. Emphasis for inclusion was on most recent publications along with innovations presented at trade shows, in press releases, and discovered through discussions leading to web searches for new products.

RESULTS

Digital dentistry has caused disruption on many fronts, bringing new techniques, systems, and interactions that have improved dentistry. Innovation has spurred opportunities for material scientists' future research.

SIGNIFICANCE

With disruptions intrinsic in digital dentistry's new state of the art, patient experience has improved. More restoration options are available delivering longer lifetimes, and better esthetics. Fresh approaches are bringing greater efficiency and accuracy, capitalizing on the interest, capabilities, and skills of those involved. New ways for effective and efficient inter-professional and clinician-patient interactions have evolved. Data can be more efficiently mined for forensic and epidemiological uses. Students have fresh ways of learning. New, often unexpected, partnerships have formed bringing further disruption - and novel advantages. Yes, digital dentistry has been disruptive, but the abundance of positive outcomes argues strongly that it has not been destructive.

Advances in Surgical Training Using Simulation

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.