A scoping review of the use and application of virtual reality in pre-clinical dental education

Endodontic education - present status and future directions

This paper explores the current landscape and future direction of endodontic education, highlighting the crucial role of individual self-efficacy in both teachers and learners. Endodontic education is influenced by a wide range of factors and frameworks that enable students to develop the scientific knowledge and procedural skills that support evidence-based practice. Educators in endodontics require appropriate training to support students through pre-clinical training and into clinical practice. This paper discusses innovative educational strategies, such as the use of additively manufactured typodonts for realistic practice and complexity progression, as well as the integration of augmented and virtual reality (AR/VR) to enhance experiential learning. Additionally, we discuss the implications of artificial intelligence (AI) in personalising learning experiences and improving diagnostic skills. Through these discussions, we identify promising directions for future research and pedagogical innovation in endodontics.

Development and user experience of a three-dimensional object-based virtual reality-simulation tool for dental radiography training: a randomized controlled trial

BACKGROUND

In dental radiography education, students typically observe instructor demonstrations and practice on mannequins or peers. However, owing to the large student-to-instructor ratio, providing individualized feedback is challenging. Repeated practice is also hindered by radiation exposure from dental radiography machines. Implementing three-dimensional (3D) object-based virtual reality (VR) simulations can address these concerns. We developed a 3D object-based VR-simulation tool for dental radiography learning (namely, 3DOVR-DR) and evaluated user experiences.

METHODS

For the development of 3DOVR-DR, a virtual dental radiography room was constructed using 3D objects. The intraoral radiography process was divided into 12 steps, and the Unity 3D engine was used to create an interactive VR environment for step-by-step learning. This study was a randomized controlled trial. To evaluate user experience, 79 participants were randomly assigned to a control group (n = 39), which used Google Cardboard for VR, or an experimental group (n = 40), which used 3DOVR-DR, to evaluate the user experience. A survey questionnaire of 22 items was administered to all participants. Statistical analyses included descriptive statistics and Mann-Whitney U test.

RESULTS

The 3DOVR-DR tool provided an immersive experience for simulating and learning the dental radiography process within a VR setting. Users performed step-by-step tasks related to dental radiography in the virtual space, adjusting and repeating the entire process or specific steps as needed for their learning. Users received guidance and practiced dental radiography using 3DOVR-DR. User-experience ratings were significantly higher in the experimental group (4.35±0.47) compared to the control group (3.63±0.66; P < 0.001).

CONCLUSIONS

The 3DOVR-DR tool shows potential as a learning medium for intraoral radiography education. Further analysis is needed to examine the impact and mediating effects of the 3D object-based VR experience on dental radiographic practice. Future research should include pedagogical analysis to evaluate the educational effectiveness of this learning tool.

Enhancing dental education with a 3D point cloud comparison and augmented reality for auto-evaluation of fixed prosthodontic practice: An in vitro study

OBJECTIVES

Traditional fixed prosthodontic training evaluations are time-consuming and subjective. This study aimed to introduce and evaluate a novel 3D auto-evaluate tooth preparation with an augmented reality (3DAR) visualization algorithm to enhance dental education for students and improve the efficiency of fixed prosthodontic training evaluations.

METHODS

Fifty maxillary central incisors and first molars prepared by 50 dental students on typodont models were scanned with a 3D scanner to capture STL files and evaluated using the 3DAR algorithm, which calculated Euclidean distances and root mean square error (RMSE) for accuracy assessment and assigned scores based on RMSE, using an augmented reality (AR) app for interactive evaluation and visualization. These scores were compared to manual scoring with computer assistance (MSCA method), which also used RMSE but required manual alignment and model scoring. Intrarater and interrater reliability of the 3DAR scoring method was assessed using intraclass correlation coefficients (ICC) and compared with the MSCA method. Additionally, the feasibility of 3DAR was evaluated based on evaluation time and user satisfaction.

RESULTS

The 3DAR method demonstrated good-to-excellent interrater agreement (ICC = 0.75-0.95) and perfect intrarater reliability (ICC = 1), while the MSCA method showed moderate-to-good reliability (ICC = 0.74-0.89). 3DAR significantly reduced evaluation time (10.514 s vs. 2 h required for MSCA) and received high user satisfaction ratings (average score = 4.66±0.24).

CONCLUSIONS

The 3DAR algorithm offers a reliable and efficient assessment method for prosthodontic training. It showed strong agreement with traditional methods, significantly reduced evaluation time, and achieved high user satisfaction.

CLINICAL SIGNIFICANCE

The integration of a 3D augmented reality-based auto-evaluation algorithm into tooth preparation training enhances reliability and provides interactive, real-time feedback on performance, highlighting its potential to advance dental education practices.

From Virtual Reality to Reality: Fine-Tuning the Taxonomy for Extended Reality Simulation in Dental Education

INTRODUCTION

Digital simulation in dental education has substantially evolved, addressing several educational challenges in dentistry. Following global lockdowns and sustainability concerns, dental educators are increasingly adopting digital simulation to enhance or replace traditional training methods. This review aimed to contribute to a uniform taxonomy for extended reality (XR) simulation within dental education.

METHODS

This scoping review followed the PRISMA and PRISMA-ScR guidelines. PubMed/MEDLINE, EMBASE, Web of Science and Google Scholar were searched. Eligible studies included English-written publications in indexed journals related to digital simulation in dental/maxillofacial education, providing theoretical descriptions of extended reality (XR) and/or immersive training tools (ITT). The outcomes of the scoping review were used as building blocks for a uniform of XR-simulation taxonomy.

RESULTS

A total of 141 articles from 2004 to 2024 were selected and categorised into Virtual Reality (VR), Mixed Reality (MR), Augmented Reality (AR), Augmented Virtuality (AV) and Computer Simulation (CS). Stereoscopic vision, immersion, interaction, modification and haptic feedback were identified as recurring features across XR-simulation in dentistry. These features formed the basis for a general XR-simulation taxonomy.

DISCUSSION

While XR-simulation features were consistent in the literature, the variety of definitions and classifications complicated the development of a taxonomy framework. VR was frequently used as an umbrella term. To address this, operational definitions were proposed for each category within the virtuality continuum, clarifying distinctions and commonalities.

CONCLUSION

This scoping review highlights the need for a uniform taxonomy in XR simulation within dental education. Establishing a consensus on XR-related terminology and definitions facilitates future research, allowing clear evidence reporting and analysis. The proposed taxonomy may also be of use for medical education, promoting alignment and the creation of a comprehensive body of evidence in XR technologies.

Potential applicability of virtual reality in implant dentistry: a narrative review

Dental implants have a high success rate but face challenges such as improper positioning, implant fracture, and tissue damage, often due to the lack of surgical proficiency. Virtual reality (VR) technology has emerged as a transformative solution in implant dentistry, offering a three-dimensional (3D), immersive environment for both educational and clinical applications. Initially used as a teaching aid, VR now facilitates comprehensive preoperative planning and precise implant placement, minimizing procedural errors. VR systems enhance student and novice surgeon training by providing a risk-free platform for skill development. Clinically, VR aids in accurate implant positioning through computer-guided surgical stents and simulation of surgical fields, improving patient outcomes by reducing complications. Furthermore, VR enhances patient education and communication, offering visual representations of treatment plans, thereby increasing patient satisfaction and understanding. Despite its benefits, VR integration faces challenges, including high costs, steep learning curves for experienced surgeons, and potential disruption of patient-clinician interactions. Developing affordable, compact VR systems and integrating VR early in dental curricula will facilitate widespread adoption and revolutionize implant dentistry by improving both surgical training and patient care. The review covers the historical development and current progress of VR with an overview of applications of VR in implant dentistry, its benefits in implant dentistry, challenges, and future perspectives.

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 impact of virtual reality haptic simulators in pre-clinical restorative dentistry: a qualitative enquiry into dental students' perceptions

PURPOSE

In the realm of restorative dentistry, the integration of virtual reality haptic simulation (VRHS) for learning operative skills has garnered varied perceptions among dental students. Therefore, the aim of this study was to delve deep into undergraduates dental students' perceptions related to the impact of VRHS in pre-clinical restorative dentistry.

METHODS

A homogeneous purposive sampling method was utilized to gather data from third-year undergraduate dental students (n = 23) at the College of Dental Medicine, Qatar University, to thoroughly investigate their views on the impact of VRHS on their learning experience in preparing a standard class I cavity. An explorative qualitative method using face-to-face focus group sessions were conducted in English during 2023. Focus group sessions were recorded and transcribed using Microsoft Teams. Two authors independently read the transcripts, coded the text, and manually analyzed text using an inductive thematic approach.

RESULTS

A total of 21 (91.3%) students participated in this study. Analysis of 3 focus group interviews revealed five primary themes summarized with the term "MASTR" (M = manual dexterity, A = assessment, S = sequence, T = training, and R = realism). Based on frequency of reported themes, students perceived realism/ lifelike nature of VRHS requiring further enhancement to achieve the desired learning objective.

CONCLUSION

Although, VRHS play a crucial role in modern dental education, offering innovative solutions for training, evaluation, and feedback, the need to enhance their ability to simulate real-life dental procedures and learning environment (realism), coupled with interactive and immersive learning experiences were the most frequently raised theme by students. In terms of curriculum design and learning pedagogies, dental educators should consider the appropriate sequence when integrating VRHS within the undergraduate curricula.

The application of a virtual rubber dam isolation training system in dental preclinical education

Objective

To assess the efficacy of a virtual rubber dam isolation training system in enhancing preclinical dental education.

Methods

A total of 28 Grade 4 undergraduate dental students were randomly divided into two groups: a virtual simulation priority group and a conventional phantom-head priority group. The virtual simulation priority group underwent virtual simulation training initially, followed by conventional phantom-head training. Conversely, the conventional phantom-head priority group received traditional training first, subsequently followed by virtual simulation training. Pre- and post-training theoretical knowledge examination were administered, and a practical ability assessment was conducted after the second theoretical examination. A questionnaire survey was also conducted to gauge students' attitudes and satisfaction towards the training process.

Results

After training, both groups exhibited significantly higher mean scores of theoretical knowledge examination compared to their baseline scores (P < 0.001). Notably, the virtual simulation priority group achieved significantly higher average scores than the conventional phantom-head priority group (P < 0.001,Cohen's d = 1.778). However, there was no significant difference in the mean time taken to complete the practical ability assessment between the two groups (P>0.05,Cohen's d = 0.19). Furthermore, the majority of students (96.4 %) strongly agreed that the virtual rubber dam isolation training enhanced their comprehension of the knowledge. 92.9 % of the students strongly agreed that the virtual training system improved their abilities of mastering the rubber dam isolation technique. Only two students (7.1 %) expressed neutrality regarding the virtual simulation effectiveness.

Conclusions

This study showed that the virtual rubber dam isolation training was useful in the preclinical skills training. The integration of virtual simulation into the curriculum, particularly when prioritized over conventional methods, has shown promising results in enhancing students' theoretical knowledge and technical skills related to rubber dam isolation.

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.

Self-perceived preparedness of new dental graduates from a Middle Eastern university

INTRODUCTION

Preparedness for independent clinical practice is a core goal of undergraduate dental education. The aim of this study was to evaluate the self-reported preparedness for the dental practice among new dental graduates from a University in the Middle East.

METHODS

Following ethics approval, a purposive sampling techniques were used to invite newly qualified dental graduates at a Middle Eastern University. A validated research instrument, namely the Dental Undergraduate Preparedness Assessment Scale (DU-PAS), was used to evaluate the self-perceived preparedness of the participants. Data collection was undertaken online using Google Forms and data were analysed to compute the descriptive statistics, reliability and demographic differences among the participants.

RESULTS

A total of 82 participants provided their response yielding a response rate of 68%. The participants included 49 males and 33 females. The overall reliability of DU-PAS was excellent. (α = 0.93). The participants included less than 40% of participants were able independently to prescribe medications, assess orthodontics needs and perform endodontic treatment on multirooted teeth. In addition, more than 65% indicated low confidence in evaluating new dental materials and products, interpreting new research findings and behavioural management of children.

CONCLUSION

The present findings identified strengths and weaknesses of new dental graduates from a Middle Eastern university. The participants were confident in basic clinical skills but lower confidence was reported for complex dental procedures. The findings highlight the learning needs of new dental graduates and can serve to inform the undergraduate curriculum to enhance the preparedness of future cohorts of dental graduates.

Effectiveness of virtual reality interactive simulation practice in prosthodontic education: A systematic review and meta-analysis

INTRODUCTION

Virtual reality-based interactive simulation (VRIS) provides a safe and controlled environment for dental students and professionals to develop skills and knowledge. This study aimed to investigate the effectiveness of using the VRIS for prosthodontic practice and to explore the trends, application areas, and users' attitudes towards VRIS.

MATERIALS AND METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for searching studies published until 21 March 2023 that reported quantitative or qualitative learning outcomes related to the use of VRIS for dental prosthodontic practice and clinical training. The quality of the included studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) tools. A random-effects meta-analysis was conducted to compare the intervention group (utilizing VRIS) and the control group (employing conventional prosthodontic training methods) based on performance skill scores and task completion time, with a significance level set at <.05.

RESULTS

The meta-analysis revealed that the utilization of VRIS generally improves students' performance scores (SMD = 1.04; 95% CI, -0.35 to 2.44; I2  > 50%; p = .13) and reduces task completion time (SMD = -0.03; 95% CI, 1.39-7.72; I2  > 50%; p = .93). Notably, using VRIS significantly enhanced the performance scores in implant surgery practice (SMD = 0.26; 95% CI, 0.09-0.42; p < .05). Additionally, the VRIS method significantly reduced task completion time in the cavity restorative preparation task (SMD = -1.19; 95% CI, -1.85 to -0.53; p < .05).

CONCLUSION

Engaging in practice with VRIS has the potential to enhance learning proficiency in prosthodontic education. The advantages associated with VRIS encompass the provision of immediate feedback, decreased task completion time, heightened confidence and motivation, accelerated skill acquisition, improved performance scores, and increased learning engagement.

Eye-Tracking Technology in Dentistry: A Review of Literature

This narrative review explores the integration of eye-tracking technology in dentistry, aiming to provide a comprehensive overview of its current applications and potential benefits. The review begins by elucidating the fundamental principles of eye tracking, encompassing the various eye-tracking methods and devices commonly used in dental research. It then delves into the role of eye tracking in dental education, where the technology offers a unique perspective on students' visual attention during training and skill acquisition. Moreover, the review examines how eye tracking can aid in assessing and improving dental practitioners' clinical performance, shedding light on areas of improvement and expertise. In patient care, the application of eye-tracking technology offers significant potential. By analyzing patients' gaze patterns and visual focus during dental procedures, clinicians can gain valuable insights into their experiences, identifying sources of anxiety and discomfort. This newfound understanding can pave the way for more patient-centric care and optimized treatment plans. The review also explores the application of eye-tracking technology in designing and evaluating dental interfaces and equipment. By assessing visual ergonomics and usability, researchers can develop user-friendly instruments that enhance dental professionals' workflow and efficiency. However, despite its promise, integrating eye tracking in dentistry is not without challenges. Technical limitations, data analysis complexities, and ethical considerations require careful attention to ensure this technology's ethical and responsible use. In conclusion, this narrative review highlights the growing significance of eye-tracking technology in dentistry. Its applications span dental education, clinical practice, and patient care, holding immense potential to revolutionize how dental procedures are conducted, evaluated, and experienced. Nevertheless, further research and collaboration between dental professionals and eye-tracking experts are necessary to unlock the technology's benefits and ensure its seamless integration into dental practices.

The importance of visual acuity screening in dental education amongst undergraduate dental students: a straightforward method

Background

Visual acuity plays a pivotal role in a dental professional's daily performance and screening the students' field of vision in their early formative years ensures successful undergraduate programmes.

Aims

To compare near and distance visual acuity and stereopsis in first-year and final-year dental students and investigate students' perception of their vision.

Method

This was a cross-sectional study involving 100 KCL first- and final-year dental students who underwent assessment of their vision and completed a self-perception questionnaire. Near visual acuity was assessed using a standardised near vision test chart, distance visual acuity using COMPlog (Clinical Vision Measurement Systems Ltd, London, UK) computerised software and stereopsis using the Frisby Stereotest. Based on the Mann-Whitney test, no statistical differences were found between the first-year and final-year students' near and distance visual acuity, nor in stereopsis difference at a significance level of α = 0.05. The null hypothesis was accepted.

Results

84% of first-year students and 94% of final-year students attained the highest binocular near visual acuity score of 0.50M. Distance visual acuity scores showed a median ETDRS (Early Treatment Diabetic Retinopathy Study) Letters score 94 in the first-year group and 95 in the final-year group. 8% of students were found to have correctable refractive errors in distance visual acuity. The majority of students across both year groups were able to discern 20 s arc of the smallest disparity. The final-year students reported worrying about their eyesight significantly more than the first-year students.

Conclusions

No statistically significant differences were found in near and distance visual acuity, and stereopsis, between first-year and final-year dental students. However, 8% of students were identified with undiagnosed, correctable refractive errors. The importance of students' vision in clinical dentistry is highlighted, and regular eye examination is recommended.

Developing an instructional module of 'digital dentistry' for undergraduate prosthodontics curriculum

Purpose

To prepare a module on 'Digital Dentistry", which can be used to sensitize dental undergraduate students during their final year Prosthodontics curriculum.

Methods

Ethical approval (167/Ethics/2022) was taken from the Institution before starting the study. Need assessment was achieved using focused group discussion (Online Zoom meeting) of various stakeholders of the Department of Prosthodontics of the institution. A preliminary module content was prepared in google questionnaire form after thorough literature review by the research team and final content was developed using modified Delphi technique in 3 questionnaire rounds with the help of 27 experts.

Result

Thematic analysis of Need Assessment focussed group discussion led to the emergence of both theoretical and practical aspect of learning in digital dentistry. The final module was developed with the process followed in modified Delphi technique.

Conclusion

Within the limitations of the study the module of Digital dentistry was developed which can be implemented in most of the dental institutes depending on the resources and available infrastructure.

Enhancing learning experiences in pre-clinical restorative dentistry: the impact of virtual reality haptic simulators

BACKGROUND

Utilization of Virtual Reality haptic simulation (VRHS) to aid in the training of various pre-clinical skills is of recent interest. The aim of this study was to evaluate the impact of VRHS in restorative dentistry on the learning experiences and perceptions of dental students.

METHODS

An interventional study design was utilized to recruit third year students. All participants provided informed consents and were randomly divided into two groups. Group 1: Initially performed a Class I cavity preparation with the VRHS, followed by the same exercise using the phantom head/ acrylic typodont teeth in a conventional simulation environment (CSE). Group 2: Initially performed Class I preparations in a CSE, followed by the same exercise using VRHS. Both groups performed the exercises on a lower right first molar. To understand students' perception, an online questionnaire was circulated. Data analysis involved Chi-square tests, independent t-tests and Mann-Whitney U-tests using the R statistical environment package.

RESULTS

A total of 23 dental students participated in this study. Although student's perceptions were similar in both groups, a strong agreement that VRHS training might be used to supplement standard pre-clinical training was noted. Advancements to the VRHS hardware and software are required to bridge the gap and provide a smooth transition to clinics.

CONCLUSION

Novice dental students generally perceived VRHS as a useful tool for enhancing their manual dexterity. Dental institutions should endorse virtual reality technology with caution, ensuring a planned integration into the curriculum to optimize benefit. Feedback is pivotal to effective learning in simulation-based education, and the triangulation of feedback could serve as a powerful aid to maximize the learning experience.

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.

The effect of 3D stereopsis and hand-tool alignment on learning effectiveness and skill transfer of a VR-based simulator for dental training

Recent years have seen the proliferation of VR-based dental simulators using a wide variety of different VR configurations with varying degrees of realism. Important aspects distinguishing VR hardware configurations are 3D stereoscopic rendering and visual alignment of the user's hands with the virtual tools. New dental simulators are often evaluated without analysing the impact of these simulation aspects. In this paper, we seek to determine the impact of 3D stereoscopic rendering and of hand-tool alignment on the teaching effectiveness and skill assessment accuracy of a VR dental simulator. We developed a bimanual simulator using an HMD and two haptic devices that provides an immersive environment with both 3D stereoscopic rendering and hand-tool alignment. We then independently controlled for each of the two aspects of the simulation. We trained four groups of students in root canal access opening using the simulator and measured the virtual and real learning gains. We quantified the real learning gains by pre- and post-testing using realistic plastic teeth and the virtual learning gains by scoring the training outcomes inside the simulator. We developed a scoring metric to automatically score the training outcomes that strongly correlates with experts' scoring of those outcomes. We found that hand-tool alignment has a positive impact on virtual and real learning gains, and improves the accuracy of skill assessment. We found that stereoscopic 3D had a negative impact on virtual and real learning gains, however it improves the accuracy of skill assessment. This finding is counter-intuitive, and we found eye-tooth distance to be a confounding variable of stereoscopic 3D, as it was significantly lower for the monoscopic 3D condition and negatively correlates with real learning gain. The results of our study provide valuable information for the future design of dental simulators, as well as simulators for other high-precision psycho-motor tasks.

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.

Barriers and Enablers to Implementing Teledentistry From the Perspective of Dental Health Care Professionals: Protocol for a Systematic Quantitative, Qualitative, and Mixed Studies Review

BACKGROUND

There is growing literature on the potential of digital technologies for improving access to, ensuring continuity and quality of health care, and to strengthen health systems. Some studies have reported the cost-effectiveness of teledentistry, its reliability for remote dental screening, diagnosis, consultation, and treatment planning. Nonetheless, current evidence suggests that teledentistry implementation faces many challenges and is not yet adopted by dental health care providers (DHCPs). Developing strategies to improve teledentistry adoption requires an understanding of the factors that promote or hinder its successful implementation.

OBJECTIVE

This systematic review aims to identify and synthetize barriers and enablers to implementing teledentistry as perceived by DHCPs in their clinical practices, using the Theoretical Domains Framework (TDF) and the Capacity, Opportunity, and Motivation Behavior (COM-B) model.

METHODS

This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols) checklist. Literature will be searched in the following databases: PubMed, Cochrane Library, Web of Science, CINAHL, Embase, and PsycINFO. We will perform additional searches on Google, Google Scholar, and ProQuest Dissertations & Theses Global, screen the references of the included studies to capture additional relevant studies, and contact the authors of studies if we need more details. We will consider studies using qualitative, quantitative, and mixed methods. There will be no restrictions on the publication date and dental setting. We will include studies published in French, English, and Portuguese. Two independent reviewers will select the study, extract data, and assess methodological quality using the Mixed Methods Appraisal Tool's checklist. Data analysis will include a descriptive and a thematic content analysis. We will synthetize and categorize the barriers and enablers using the TDF and COM-B model and present a narrative synthesis of our results using tables, figures, and quotes.

RESULTS

By March 2023, the literature search has retrieved 7355 publications. We will identify the range of barriers and enablers to implementing teledentistry through DHCPs' perspectives. Considering the critical need for theory-based implementation interventions to improve the use of evidence-informed practices, we will synthesize the factors influencing the adoption of teledentistry based on the TDF domains and the 3 essential conditions predicting behavior change in accordance with the COM-B model. As needed, we will include additional determinants if not included in the TDF. We will conduct some subgroups analyses if studies are sufficient. We expect to complete the review by July 2024.

CONCLUSIONS

This review will provide some insights on the determinants of teledentistry implementation as perceived by DHCPs in dental settings. These findings will cater to patients, families, DHCPs, researchers, academic and professional decision-makers, and policy makers. The results of the systematic review could be used to develop theory-led interventions in improving teledentistry implementation.

TRIAL REGISTRATION

PROSPERO CRD42021293376; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=293376.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44218.

Technology-enhanced simulation-based learning in orthodontic education: A scoping review

INTRODUCTION

Technology-enhanced simulations seem to be effective in dentistry, as they can support dental students to improve competencies in simulated environments. However, implementation of this technology in orthodontic education has not been reviewed.

OBJECTIVE

This scoping review aimed to comprehensively summarize the use of technology-enhanced simulations in orthodontic practice.

METHODS

A systematic search was conducted to identify literature on technology-enhanced simulation-based learning in orthodontic education published from 2000 to 2021. The search was conducted up to September 2021 to identify articles from Scopus, Embase, PubMed, ProQuest Dissertations & Theses Global, Google Scholar and the reference lists of identified articles.

RESULTS

The search identified 177 articles. Following the inclusion and exclusion criteria, 16 articles of 14 digital simulators were included in this review. The findings demonstrated an increasing use of technology-enhanced simulations in orthodontic education. They were designed in several formats, including three-dimensional virtual format, augmented reality, virtual reality, automaton, haptic, and scenario-based simulations. These simulations were implemented in varied areas of orthodontics including diagnosis and treatment planning, bracket positioning, orthodontic procedures, facial landmark, removable appliance and cephalometric tracing. Most included articles demonstrated the development process without outcome evaluation. Six studies provided outcome evaluations at reaction or learning levels. None of them provide the evaluation at behaviour and results levels.

CONCLUSION

Insufficient evidence has been generated to demonstrate the effectiveness of technology-enhanced simulations in orthodontic education. However, high-fidelity computer-based simulations together with robust design research should be required to confirm educational impact in orthodontic education.

Computer-aided design software-enabled preclinical prosthodontic training: A digital education technique

The prosthodontics preclinical training modules involve textbook-based two-dimensional (2D) ideal images and practicing on manikin models to emulate ideal tooth preparations and teeth arrangements. Relying solely on 2D images as objectives for preclinical exercises limits the trainee's creative skills to instructions of textbooks and clinical instructions received. With advancements in digital dentistry, dental trainees should have early exposure to the three-dimensional (3D) rendering of ideal preclinical objectives. A dental education technique using computer-aided design software and smartphones is described that will allow 3D rendering of ideal prosthodontic training assignments allowing early exposure to digital dentistry for dental training students.

Which digital learning strategies do undergraduate dentistry students favor? A questionnaire survey at a German university

Background

The development in teaching dental education toward ever greater digitization has gained enormous momentum in the last 2 years due to the pandemic. However, acceleration is not synonymous with improvement, especially from the learners' point of view. Therefore, the aim of this survey among students of dentistry was to determine which digital learning strategies and which media are preferred.

Method

Undergraduate students of clinical semesters (6th to 9th) in dental medicine during at the University of Freiburg participated in an online-survey. Questions were asked about personal learning strategies for and experience with using digital media for private and educational reasons. Furthermore, students were asked which digital learning formats they preferred for different learning phases.

Results

Students (N=148) are experienced in using digital media for learning. They prefer classical media (such as textbooks and lectures) for acquiring basic theoretical knowledge and mention digital teaching formats more in relation to practical training and complex treatment procedures. 67% prefer learning alone and 90% rate visualizations as helpful for learning. 78% report, that they feel well supported in the learning process by digital media and 83% agree that e-learning offerings are a quality factor for university teaching. 82% state e.g. that the growing range of online content allows a more flexible approach to face to face-teaching, enriches classroom teaching (78%) and helps organize one's own study (79%).

Conclusion

Students have a positive attitude towards the use of digital media, especially when it comes to having more time available for practical exercises. They also see an advantage in the fact that through the use of digital media, lectures can be organized more flexibly and also the organization of their studies can be optimized. New digital teaching media should be created based on these results. It is important to consider which digital formats seem suitable for which content during different semesters.

Developing and investigating an electronic performance support system for skill learning in the simulation environment

OBJECTIVE

Electronic performance support systems (EPSSs) developed in the literature generally use advanced programming. This situation may limit the use of the EPSSs. The purpose of this study was to develop an EPSS without any financial cost and using advanced programming to improve dental and medical students' knowledge and performance in the basic life support course in simulation environment.

MATERIALS AND METHODS

This study was planned and carried out as a developmental research. The participants of the study were composed of dental/medical students and experts. The academic achievement test, performance test, expert evaluation form and interview form were used as data collection tools. Data analyses were done by SPSS 21 package software.

RESULTS

Students taught using the EPSS have higher levels of academic achievement and performance compared with the students taught using the lecture format in a traditional way of teaching. Students stated that the system was useful and effective.

CONCLUSION

This web-based mid-level EPSS was developed without any financial cost and using advanced programming. EPSSs like present system can be used for supporting learning. The used framework in this study can provide guidance for future works.

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.

Modular Digital and 3D-Printed Dental Models with Applicability in Dental Education

Background and Objectives: The ever more complex modern dental education requires permanent adaptation to expanding medical knowledge and new advancements in digital technologies as well as intensification of interdisciplinary collaboration. Our study presents a newly developed computerized method allowing virtual case simulation on modular digital dental models and 3D-printing of the obtained digital models; additionally, undergraduate dental students' opinion on the advanced method is investigated in this paper. Materials and Methods: Based on the digitalization of didactic dental models, the proposed method generates modular digital dental models that can be easily converted into different types of partial edentulism scenarios, thus allowing the development of a digital library. Three-dimensionally printed simulated dental models can subsequently be manufactured based on the previously obtained digital models. The opinion of a group of undergraduate dental students (n = 205) on the proposed method was assessed via a questionnaire, administered as a Google form, sent via email. Results: The modular digital models allow students to perform repeated virtual simulations of any possible partial edentulism cases, to project 3D virtual treatment plans and to observe the subtle differences between diverse teeth preparations; the resulting 3D-printed models could be used in students' practical training. The proposed method received positive feedback from the undergraduate students. Conclusions: The advanced method is adequate for dental students' training, enabling the gradual design of modular digital dental models with partial edentulism, from simple to complex cases, and the hands-on training on corresponding 3D-printed dental models.

Obtaining human teeth for dental education: A cross-sectional study to create ethical and transparent processes

OBJECTIVES

This study explores the practices of obtaining human teeth for teaching and research in Paraguay. The goal of this research is to understand whether the data supports the need to improve ethical training within dental education, including the creation of a human tooth bank (HTB) METHODS: An observational cross-sectional study was conducted. Three semi-structured questionnaires were developed, one for each target population: dental students, dentists in practice, and the general population. The questionnaires were distributed between February and April 2021, using Google Forms RESULTS: The main places where human teeth were obtained by a student are dental clinics, followed by cemeteries. 94% of students and 91% of dentists paid for teeth on at least one occasion. There is a willingness on the part of students and dentists to donate collections of teeth, and among the general population to donate their teeth if they are extracted, for both teaching and research use. Note that, 31% of students and 6% of the population are aware of what an HTB is, at the same time only 16% of dentists know how it functions CONCLUSION: The number of respondents who obtain teeth from cemeteries and who pay for their acquisition is high. Both of these practices raise ethical concerns. The implementation of informed consent for the donation of extracted teeth is practically nil; although there is a positive attitude towards its implementation. Also, there is a lack of knowledge about the role of an HTB; although the population expressed a willingness to donate extracted teeth.

Dental education during the COVID-19 pandemic in Germany - cross-sectional lecturer-side evaluation for the application of digital teaching concepts

Background: The COVID-19 pandemic resulted in significant restrictions on dental teaching. The aim of this investigation was to evaluate the attitudes of faculty members towards digital teaching formats and the effort creating digital lectures. We hypothesized that on the lecturer side there is no difference between the various digital teaching concepts in terms of workload and effort and that there is no increase in workload and effort when switching to digital teaching concepts. Methods: All German dental faculties were invited to the online survey by an anonymous voluntary questionnaire from January to April 2021. The questionnaire consisted of 27 questions that could be answered with a visual analog scale, free text answers, or with fixed answer options. Data was analyzed using the Kolmogorov-Smirnov test and an exploratory data analysis (α=0.05). Results: Before the pandemic, 24.8% of the participating lecturers were using digital teaching and 64.4% had no previous experience. After the outbreak of the pandemic 100% of the dental teaching was initially held online. More than 80% of the lecturers stated that they offer online lectures (86.1%), online seminars (81.2%), and/or online bedside teaching (33.7%). 88.1% see face-to-face teaching as the preferred teaching format. The lecturers also see the greatest opportunities for interaction in the area of analog teaching and significantly worse in synchronous and asynchronous digital teaching. In the course of the pandemic, respondents' attitudes towards online teaching improved in the median of 24.0 to a median of 50.0. Conclusions: Faculty members have positively changed their attitudes towards online teaching formats over the course of the pandemic. Although they see the greatest learning success in conventional face-to-face teaching formats and the creation of digital lectures is associated with a higher effort, they want more online lessons in the future.

Influence of practical and clinical experience on dexterity performance measured using haptic virtual reality simulator

INTRODUCTION

Development of dexterity, hand-eye coordination and self-assessment are essential during the preclinical training of dental students. To meet this requirement, dental simulators have been developed combining virtual reality with a force feedback haptic interface. The aim of this study was to assess the capability of the VirTeaSy^© haptic simulator to discriminate between users with different levels of practical and clinical experience.

MATERIALS AND METHODS

Fifty-six volunteers divided into five groups (non-dentists, 1st/3rd/final-year dental students, recent graduates) had three attempts to prepare an occlusal amalgam cavity using the simulator. Percentages of volumes prepared inside (%IV) and outside (%OV) the required cavity, skill index and progression rate, referring to the evolution of skill index between trials 1 and 3, were assessed. The dental students and recent graduates completed a questionnaire to gather their opinions about their first hands-on experience with a haptic simulator.

RESULTS

The results showed no significant difference between the groups at the first attempt. Following the third attempt, the skill index was improved significantly. Analysis of progression rates, characterised by large standard deviations, did not reveal significant differences between groups. The third attempt showed significant differences in skill index and %IV between 1st-year undergraduate dental students and both non-dentists and recent dental graduates. The questionnaire indicated a tendency for dental operators to consider the simulator as a complement to their learning and not a substitute for traditional methods.

CONCLUSION

This study did not show the ability of a basic aptitude test on VirTeaSy^© haptic simulator to discriminate between users of different levels of expertise. Optimisations must be considered in order to make simulation-based assessment clinically relevant.

Evaluating the effectiveness of a virtual reality simulation for preclinical local anaesthesia dental education

INTRODUCTION

Traditional manikin training has limitations that virtual reality can address. This study investigated the effectiveness of two part-task training simulation methods, a virtual reality (VR Sim) vs a plastic manikin (PM Sim), on learning outcomes for local anaesthesia skills for second-year pre-clinical dental students.

METHODS

In an experimental study, 58 second-year students were randomly assigned to one of two groups, VR Sim or PM Sim. Both groups completed the same pre-post survey. The VR Sim group practiced with a VR simulation, completed a built-in treatment test and a transfer test with a live person, and was evaluated by an expert teaching assistant (TA) with a rubric. The PM Sim group practiced with a plastic manikin and completed a treatment test on the same manikin evaluated by a TA, followed by the same transfer test with a live person and evaluated by a TA with a rubric.

RESULTS

Covering knowledge and skills in the delivery of local anaesthesia, mean final transfer test scores were statistically significantly higher for the PM Sim compared to VR Sim, F(1, 57) = 9.719, p = .003 with effect size, η2 p  = 0.148. Scores on respective treatment tests were similar to final transfer test scores for each group suggesting differences were localised to the practice methods. Pre-survey results indicated participants had low prior experience with VR technology.

CONCLUSION

Whilst outcomes showed higher results for plastic manikin tutor training over the VR training method, they are complementary. As students practice more with the technology and the VR simulation they may improve further. Likewise, as the technology for haptics with VR improves beyond hand controllers so may the experience and learning of this skill for students.

Blended learning and simulation: the future of dental education in a post-COVID era

UK dental schools led in simulation and blended learning before the COVID-19 pandemic.

Simulation and blended learning are essential to dentistry, now more than ever, and are increasingly being introduced into dental education around the world.

UK dental schools need to work together to introduce educational standards on simulation in dentistry.

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.

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.

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.

Effectiveness of Virtual Reality-Based Training on Oral Healthcare for Disabled Elderly Persons: A Randomized Controlled Trial

(1) Background: Virtual reality (VR) technology is a widely used training tool in medical education. The present study aimed to evaluate the effectiveness of VR training of oral hygiene students on providing oral healthcare to disabled elderly persons. (2) Methods: A randomized controlled trial was conducted. In 2021, oral hygiene students were randomly assigned to a VR experimental group (EG; n = 11) and a control group (CG; n = 12). The EG received two-hour, thrice-repeated VR-based training interventions at 2-week, 4-week, and 6-week follow-ups. The CG received no VR-based interventions. Data were collected using a self-administered questionnaire before and immediately after each intervention. We performed generalized estimating equations to compare the responses. (3) Results: The EG exhibited a more significant improvement in oral care-related knowledge, attitude, self-efficacy, and intention at the 6-week follow-up than the CG. The students’ intention to assist the elderly in using interdental brushes (β = 0.91), with soft tissue cleaning (β = 0.53), and with oral desensitization (β = 0.53), and to have regular dental visits (β = 0.61) improved significantly at the 6-week follow-up. (4) Conclusions: VR training positively affected students’ knowledge, attitude, self-efficacy, and intentions on providing oral healthcare to disabled elderly persons.

Dental students' perceptions on a simulated practice using patient-based customised typodonts during the transition from preclinical to clinical education

PURPOSE/OBJECTIVES

Dental students experience difficulties during the transition from preclinical to clinical curriculum. In order to help the students to adapt to the clinical education programme, a simulated practice using patient-based customised models was introduced in this study to prepare for their first clinical practice.

METHODS

This study included 45 third-year predoctoral students (D3 students) who were about to perform the preparation of a single crown abutment on their first patient. After practicing abutment preparation using simulated models and providing the actual treatment to their own patient, the students were surveyed to investigate their perceptions on the simulated practice using the 3D-printed customised typodont model. The statistical analysis of the quantitative data and the thematic analysis of the qualitative data were conducted.

RESULTS

Regarding this simulation, more than 80% of the students gave positive feedback on their practice of (a) operative positions and postures, (b) finger rest, (c) occlusal reduction, (d) axial reduction and (e) proximal reduction. Student responses on the open-ended questions about how they perceived the usefulness of this simulation were categorised as "First clinical case," "Patient-based model" and "Realistic simulation environment." In addition, a number of improvements of the simulation were also suggested by the students including the typodont and the manikin.

CONCLUSIONS

This study gives insights into the significance of simulated practice using patient-based customised typodonts as a transitional education tool and its direction of development in the field of restorative treatments accompanied by irreversible tooth preparations.

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.

Development and assessment of an online virtual orthodontic curriculum

INTRODUCTION

Due to break space and time limits, an entirely new online curriculum of orthodontic education with online evaluation system has been structured and developed in the dental school, based on virtual reality simulation.

CURRICULUM

At Nanjing Medical University, a new online orthodontic curriculum with programmatic assessment process was constructed and implemented based on competency-based education (CBE). It was consisted of the online orthodontic theoretical lectures based on the National Open Online Course "Orthodontics," the online journal club via the online "flipped classroom," and the online orthodontic pre-clinical training via the virtual learning network platform. In order to evaluate this curriculum, 94 Year 4 dental students took part to complete the online orthodontic curriculum. The mean total score of all the students was 91.99, and the element scores of the online theoretical lectures, journal club, virtual pre-clinical training, and online final examination were respectively 96.83, 79.49, 96.00, and 87.02, which showed a good performance. According to the student feedback toward this curriculum via the online questionnaire, nearly 98% of the students showed agreement or strong agreement that the online orthodontic curriculum has enhanced their orthodontic theoretical understanding and orthodontic practical ability.

CONCLUSION

As a student-centered CBE, this online orthodontic curriculum with online evaluation system could provide both orthodontic theory and practice teaching for all the dental students at all times and places based on the online virtual mode, which enriched learners' critical thinking, problem solving, and assessment skills.

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.

Effect of online learning for dental education in asia during the pandemic of COVID-19

BACKGROUND/PURPOSE

Online learning has been utilized in the world to continue educational activities in dentistry, which was severely affected by the pandemic of coronavirus disease 2019 (COVID-19). The purpose of this study was aimed to evaluate the effect of online learning during the pandemic of COVID-19 in different dental schools of different countries in Asia by the questionnaire survey.

MATERIALS AND METHODS

Mantel-Haenszel chi-square tests were used to analyze the difference between dental schools with and without shutdown. A questionnaire-based online survey was used to evaluate the online learning effect on undergraduate students in 13 dental schools of 7 Asia countries and regions.

RESULTS

For the question that blended learning class has better learning efficiency, the agreement rate was significantly higher in the students (80.3%) from the dental schools that did not suspend face-to-face education activities than in the students (50.3%) from the dental school that was shut down.

CONCLUSION

Within the limitation of this study, it is concluded that a combination of physical and online classes in terms of blended learning courses will be the future trend for dental education.

The scope of dental education during COVID-19 pandemic: A systematic review

INTRODUCTION

COVID-19 forced e-learning processes to develop abruptly and posed challenges to the educational infrastructure. Emergency Remote Teaching was designated to distinguish the new educational scheme. This concept involves production of online activities that may return to face-to-face format as soon as the isolation period ends.

OBJECTIVE

From March through September of 2020, this systematic review attempted to elucidate experiences, benefits, and challenges enforced in dental education due to the pandemic, the learning technologies, and methods used to maintain education.

METHODS

A literature search was conducted on Cochrane, Embase, Lilacs, Livivo, PubMed, Scopus, and Web of Science databases. Gray literature was also contemplated. Studies in which online teaching methods were described and dental learners were the subjects during pandemic were included.

RESULTS

Learning technology, pedagogical model, knowledge gain, and dental learners' satisfaction and attitudes toward remote learning were assessed. The Joanna Briggs Institute JBI Critical Appraisal Checklist for Case Reports was applied as the methodological quality assessment to the 16 included studies. Assessments were related to demographic and historical characteristics of the participants, the intervention procedure, pre- and post-intervention descriptions, and identification of unanticipated events. All studies described the use of learning technology to ensure education continuity, and 15 studies highlighted the pedagogical model applied. Eight studies investigated knowledge gain while 12 searched the learners' satisfaction with online technologies.

CONCLUSION

The evidence suggests that learning technologies can support continuity in dental education. Reported problems include poor knowledge of faculty members on how to deal with technology, Internet connection, and content transition to online education.

Re-defining the virtual reality dental simulator: Demonstrating concurrent validity of clinically relevant assessment and feedback

INTRODUCTION

Virtual reality (VR) dental simulators are gaining momentum as a useful tool to educate dental students. To date, no VR dental simulator exercise has been designed which is capable of reliably providing validated, meaningful clinical feedback to dental students. This study aims to measure the concurrent validity of the assessment and the provision of qualitative feedback, pertaining to cavity preparations by VR dental simulators.

METHODS

A cavity preparation exercise was created on a VR dental simulator, and assessment criteria for cavity preparations were developed. The exercise was performed 10 times in order to demonstrate a range of performances, and for each, the simulator feedback was recorded. The exercises were subsequently three-dimensionally printed, and 12 clinical teachers were asked to assess the preparations according to the same criteria. Inter-rater reliability (IRR) between clinical teachers was measured using a free-marginal multirater kappa value. Clinical teacher assessment responses were compared with the VR simulator responses and percentage agreements calculated.

RESULTS

IRR values for each exercise ranged from 0.39 to 0.77 (69.39%-88.48%). The assessment of smoothness (κfree 0.58, 78.79%) and ability to follow the outline (κfree 0.56, 77.88%) demonstrated highest agreement between clinical teachers, whilst the assessment of undercut (κfree 0.15, 57.58%) and depth (κfree 0.28, 64.09%) had the lowest agreement. The modal percentage agreement between clinical teachers and the VR simulator was, on average, 78% across all exercises.

CONCLUSION

The results of this study demonstrate that it is possible to provide reliable and clinically relevant qualitative feedback via a VR dental simulator. Further research should look to employ this technique across a broader range of exercises that help to develop other complex operative dental skills.

The Modern and Digital Transformation of Oral Health Care: A Mini Review

Dentistry is a part of the field of medicine which is advocated in this digital revolution. The increasing trend in dentistry digitalization has led to the advancement in computer-derived data processing and manufacturing. This progress has been exponentially supported by the Internet of medical things (IoMT), big data and analytical algorithm, internet and communication technologies (ICT) including digital social media, augmented and virtual reality (AR and VR), and artificial intelligence (AI). The interplay between these sophisticated digital aspects has dramatically changed the healthcare and biomedical sectors, especially for dentistry. This myriad of applications of technologies will not only be able to streamline oral health care, facilitate workflow, increase oral health at a fraction of the current conventional cost, relieve dentist and dental auxiliary staff from routine and laborious tasks, but also ignite participatory in personalized oral health care. This narrative article review highlights recent dentistry digitalization encompassing technological advancement, limitations, challenges, and conceptual theoretical modern approaches in oral health prevention and care, particularly in ensuring the quality, efficiency, and strategic dental care in the modern era of dentistry.

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

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

Formative feedback generation in a VR-based dental surgical skill training simulator

Fine motor skill is indispensable for a dentist. As in many other medical fields of study, the traditional surgical master-apprentice model is widely adopted in dental education. Recently, virtual reality (VR) simulators have been employed as supplementary components to the traditional skill-training curriculum, and numerous dental VR systems have been developed academically and commercially. However, the full promise of such systems has yet to be realized due to the lack of sufficient support for formative feedback. Without such a mechanism, evaluation still demands dedicated time of experts in scarce supply. To fill the gap of formative assessment using VR simulators in skill training in dentistry, we present a framework to objectively assess the surgical skill and generate formative feedback automatically. VR simulators enable collecting detailed data on relevant metrics throughout a procedure. Our approach to formative feedback is to correlate procedure metrics with the procedure outcome to identify the portions of a procedure that need to be improved. Specifically, for the errors in the outcome, the responsible portions of the procedure are identified by using the location of the error. Tutoring formative feedback is provided using the video modality. The effectiveness of the feedback system is evaluated with dental students using randomized controlled trials. The findings show the feedback mechanisms to be effective and to have the potential to be used as valuable supplemental training resources.

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.

Psychometric analysis of a measure of acceptance of new technologies (UTAUT), applied to the use of haptic virtual simulators in dental students

BACKGROUND

The aims of this study are (a) to assess the psychometric quality of an instrument of acceptance of new technologies adapted from the UTAUT model, (b) to validate the UTAUT model as a valid measure to be applied in dental education, and (c) to determine which factors of the UTAUT model predict the behavioural intention of using a haptic virtual simulator (HVS).

METHODS

A cross-sectional design study with a sample of 265 dentistry students was carried out.

RESULTS

Using structural equation modelling, confirmatory factor analysis verified the adequacy of four-factor model, although the only factor that directly predicts behavioural intention is performance expectancy. Internal consistency coefficients of each factor ranged from 0.800 to 0.969.

DISCUSSION

These findings, as well as the predictive power of performance expectancy on behaviour intention, are in line with previous evidence found in the literature.

CONCLUSION

These findings suggest that the UTAUT scale has adequate reliability and construct factorial validity; therefore, UTAUT model could be a valuable approach to assess haptic virtual simulator acceptance in dental education.

3D Technology Development and Dental Education: What Topics Are Best Suited for 3D Learning Resources?

The aim of this study is to identify topics (knowledge and skills) from the dental curricula that would benefit from having a 3D learning resource using an exploratory sequential design method. The first phase targeted stakeholders from a Scottish dental school. Seven focus groups and three interviews disclosed 97 suitable topics for 3D technology development. These results were used to construct a survey that was sent to final year dental students, newly dental graduates and academics from three Scottish universities. The survey asked participants to rank each item based on the perceived benefit that a 3D learning resource would have for dental education. Results revealed that detailed anatomy of the temporomandibular joint, dental anaesthesiology, dental clinical skills techniques, dental occlusion and mandibular functioning were top priorities. Gender differences only appeared in relation to ‘Extraction techniques: movements and force’ (p < 0.05), this topic was considered to be more beneficial by females than by males. No statistical difference was found when comparing results of graduates with undergraduates. These results serve as a starting point when developing a new 3D technology tool for dental education, considering users demands and perceived needs has the potential to benefit dental students and dental education directly.

Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials

BACKGROUND

To investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods.

METHODS

A comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool.

RESULTS

A total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students' performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies.

CONCLUSIONS

Technology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students' performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.