Emerging simulation technologies in global craniofacial surgical training

Effectiveness of immersive technologies in oral health promotion and education: A systematic review

OBJECTIVE

To evaluate the effectiveness of immersive technologies in oral health promotion and education.

METHODS

An extensive literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. This study was systematically performed in six electronic databases (PubMed, Google Scholar, Web of Science, Cochrane, Scopus, and EBSCO). The risk of bias was assessed with the Cochrane tools using RoB 2.0 and ROBINS-I.

RESULTS

PICOS criteria were formulated for study inclusion. The bibliographical search identified 10,074 articles, which were filtered subsequently. Finally, the most pertinent nine articles were included and scrutinized for data synthesis and analysis. This includes five randomized controlled trials and four non-randomized controlled trials in different countries that focused on children (33.3%), adolescents (11.1%), and adults (55.6%). The interventions used virtual reality (VR) and augmented reality (AR) to promote knowledge and attitudes towards oral care, improve toothbrushing performance, and smoking cessation, and reduce anxiety levels in oral health education.

CONCLUSION

This systematic review demonstrates that immersive technologies, including VR and AR, significantly enhance oral health knowledge, attitudes, and self-efficacy, leading to improved health outcomes.

CLINICAL SIGNIFICANCE

Immersive technologies such as VR and AR have the potential to provide innovative and effective methods for enhancing oral health promotion and education, while promoting positive health behaviours, which are crucial for improving overall oral health outcomes.

The impact of the integration of digital platforms and active teaching strategies (Kahoot!) on the performance of Brazilian medical course students in the discipline of histology

Teaching human histology is part of understanding the tissues of the human body and, therefore, it is part of the training curriculum of all health courses. The increase in technologies and active teaching methodologies has a positive impact on student learning, as it reduces the challenges present in the subject. Therefore, this work aimed to compare the performance of students in the histology discipline, when compared to traditional teaching methodology and its association with game-based learning and a basic histology teaching platform. Three classes of the medical course were selected between the years 2022 and 2023, each of which was separated into a group. One group did not have access to any platform, being called the Traditional Group (TG), a group that used Kahoot!, being called the Kahoot Group (KG), and a group that used the teaching platform, being called the Histoatlas Group (HG). Both KG and HG groups showed greater effectiveness in learning and improved performance, when compared to TG. These improvements in KG and HG were also highlighted as learning aids and easy to use. KG students performed better in the practical test when comparing groups. However, this difference was not observed in the students' averages. However, students pointed out the relevance of trying to improve the traditional teaching methodology. Therefore, this study points out that, even though the traditional teaching methodology is efficient in the student's teaching and learning process, there is a need on the part of students to make the subject more dynamic.

Design and Validation of a 3D Printed Cranio-Facial Simulator: A Novel Tool for Surgical Education

OBJECTIVE

To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool.

DESIGN

Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration.

RESULTS

MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 (P = .02), OSATs score from 32.4/66 to 64.4/66 (P < .001) and GRS score from 13.9/35 to 27.5/35 (P < .001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) (P < .001), but lower than the post-lecture juniors (64.4/66) (P < .001).

CONCLUSION

We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties.

A Brief Review on Engaging and Interactive Learning for Children: Exploring the Potential of Metaverse-Based Oral Health Promotion

The importance of oral health for overall health makes it critical to establish proper oral hygiene practices in children early on. The traditional approaches to teaching children about dental health may not be successful since they may not be able to keep their interest. Metaverse technology offers a promising alternative, allowing for the design of engaging and immersive worlds that can effectively educate children about oral health. Despite the growing interest in the use of metaverse technology in healthcare, there is a lack of comprehensive reviews on its potential for oral health promotion in children. This review aims to fill this gap by providing an overview of the current state of metaverse-based oral health promotion for children, discussing its benefits and challenges, and highlighting its potential for improving children's oral health. By conducting this review, the authors hope to provide new information on the potential of metaverse-based oral health promotion for children and to contribute to the ongoing discussion on the use of metaverse technology in healthcare. This review may also provide valuable insights for dental organizations and practitioners interested in using metaverse technology to promote oral health and healthy living among children.

Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models

BACKGROUND

In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA.

METHODS

A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case.

RESULTS

Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = -0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = -0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = -0.4782, p = 0.2777).

CONCLUSIONS

Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.

Toward the validation of VR-HMDs for medical education: a systematic literature review

The latest technological advancements in the domain of virtual reality (VR) have created new opportunities to use VR as a training platform for medical students and practitioners more broadly. Despite the growing interest in the use of VR as a training tool, a commonly identified gap in VR-training for medical education is the confidence in the long-term validity of the applications. A systematic literature review was undertaken to explore the extent of VR (in particular head-mounted displays) applications for medical training with an additional focus on validation measures. The papers included in this review discussed empirical case studies of specific applications; however, these were mostly concerned with human-computer interaction and were polarized between demonstrating that a conceptual technology solution was feasible for simulation or looked at specific areas of VR usability with little discussion on validation measures for long-term training effectiveness and outcomes. The review uncovered a wide range of ad hoc applications and studies in terms of technology vendors, environments, tasks, envisaged users and effectiveness of learning outcomes. This presents decision-making challenges for those seeking to adopt, implement and embed such systems in teaching practice. The authors of this paper then take a wider socio-technical systems perspective to understand how the holistic training system can be engineered and validated effectively as fit for purpose, through distillation of a generic set of requirements from the literature review to aid design specification and implementation, and to drive more informed and traceable validation of these types of systems. In this review, we have identified 92 requirement statements in 11 key areas against which a VR-HMD training system could be validated; these were grouped into design considerations, learning mechanisms and implementation considerations.

Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education

Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates. Ten Otolaryngology residents each performed two ex vivo mandibular reconstructions, first using a PSRP followed by a manually contoured plate. Reconstruction time, CT scans, and accuracy measurements were collected. Paired Student’s t-test was performed. There was a significant difference between reconstructions with PSRP and manually contoured plates in: plate-mandible distance (0.39 ± 0.21 vs. 0.75 ± 0.31 mm, p = 0.0128), inter-fibular segment gap (0.90 ± 0.32 vs. 2.24 ± 1.03 mm, p = 0.0095), mandible-fibula gap (1.02 ± 0.39 vs. 2.87 ± 2.38 mm, p = 0.0260), average reconstruction deviation (1.11 ± 0.32 vs. 1.67 ± 0.47 mm, p = 0.0228), mandibular angle width difference (5.13 ± 4.32 vs. 11.79 ± 4.27 mm, p = 0.0221), and reconstruction time (16.67 ± 4.18 vs. 33.78 ± 8.45 min, p = 0.0006). Lower plate-mandible distance has been demonstrated to correlate with decreased plate extrusion rates. Similarly, improved bony apposition promotes bony union. PSRP appears to provide a more accurate scaffold to guide the surgeons in assembling donor bone segments, which could potentially improve patient outcome and reduce surgical time. Additionally, in-house PSRP can serve as a low-cost surgical simulation tool for resident education.

Cross-Sectional Study on the Comparative Assessment of Mandibular Anesthesia (Inferior Alveolar Nerve Blockage) Manual Skills Shaping among Dentists on Plastic and Biomaterial Models

Background: Providing regional anesthesia skills shaping remains relevant nowadays. A number of studies show that dentists have difficulties with these working independently. The study aim is the comparative analysis of the results of mandibular anesthesia (IANB) manual-skills shaping among dentists on plastic models and cadavers. Methods: In total, 999 participants were training in the skills of mandibular anesthesia from 2017 to 2021. The participants were divided in a random way into two groups: 700 participants were trained on plastic models, and 299 were trained on the cadaver material. After a lecture on the clinical and anatomical guidelines for IANB, a demonstration of the technique was provided, with subsequent testing of the injection technique. Satisfaction with the aspects of the training was assessed using the Likert scale. Results: the analysis of average values showed that participants from the group in which the manual skills were practiced on cadavers were more satisfied with the main aspects of the training, according to the sum of the main criteria of the modified scale. Conclusions: The important advantages of cadaver educational technology are that the sensations of tissue resistance are identical to natural ones, the individuality of each object, and the possibility of the visual study of the anesthesia technique, by dissection of the needle course and the location of the anesthetic depot.