Validation of a three-dimensional printed model for training of surgical extraction of supernumerary teeth

Does dynamic navigation assisted student training improve the accuracy of dental implant placement by postgraduate dental students: an in vitro study

OBJECTIVES

To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training.

METHODS

Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire.

RESULTS

A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training.

CONCLUSIONS

Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.

Preclinical teaching of periodontal surgical concepts using common instructional models: A comparative assessment

OBJECTIVES

Some commonly used models utilized for teaching periodontal surgical techniques to dental students include pig mandible and periodontal typodonts. Currently, no study compares the learning and teaching outcomes following the use of one model to the other. This study is aimed at evaluating the effectiveness of the preclinical laboratory component on student understanding of concepts taught in the periodontal surgical course and assessing students' and faculty members' satisfaction with the instructional models.

METHODS

As part of the surgical periodontics course, 98 students took the final exam, with eighty students participating in only the pig mandible session and twenty-three students participating in both the pig jaw mandible and an additional session utilizing periodontal typodonts under the supervision of ten periodontal faculty members. Examination scores of students attending or not attending the laboratory session were analyzed by a two-sample t-test. A questionnaire evaluating the effectiveness of both models was given to faculty members and students who participated in both laboratory sessions. These results were analyzed by paired t-test.

RESULTS

Participation in the laboratory sessions did not significantly impact the final exam scores (p = 0.722). Students who had better didactic performance in the course performed better in the final exam, irrespective of laboratory participation. Both students and faculty members preferred typodont to the pig mandibles in learning or teaching periodontal surgical concepts, but both felt gaining flap management and flap refection experience to be better with the pig mandible model without statistical significance (p = 0.119 and p = 0.070, respectively).

CONCLUSION

Within the limitations of this study, we can conclude that laboratory sessions did not significantly improve student performance on the exam. Students and faculty members generally gave positive feedback on both instructional models. Periodontal typodont could be an alternative model for teaching dental students, periodontal surgical concepts.

The Influence of Cone Beam Computed Tomography-Derived 3D-Printed Models on Endodontic Microsurgical Treatment Planning and Confidence of the Operator

INTRODUCTION

Currently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence.

MATERIALS

Endodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005.

RESULTS

The availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants' confidence in performing surgery was found to be significantly higher.

CONCLUSIONS

The availability of 3D printed models did not alter the participants' surgical approach but it significantly improved their confidence for endodontic microsurgery.

Technical Skills to Split Teeth During Extraction of Mesiodentes in High Site

PURPOSE

Extraction of mesiodens in high site is complicated. Here we introduce some technical skills to simply the process and achieve high success rate meanwhile.

METHODS

All patients should accept radiographic examination before surgery. According to the position of mesiodens based on cone-beam computed tomography, we choose the appropriate method and tool.

RESULTS

A series of cases have proved that these skills are applicable and convenient.

CONCLUSIONS

Dentists should analyze the inspection results seriously and select the optimal strategy to extract mesiodens in high site.

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.

Osteotomy training for dental students using three-dimensional simulation software and maxillofacial three-dimensional-printed models

PURPOSE/OBJECTIVES

Simulated educational models of teeth, bones, and gums have been used for a long time in procedural skills training in dentistry.  The advent of three-dimensional (3D) printing technologies and additive manufacturing has facilitated the production of more advanced 3D printed models that can be utilized for surgical and dental training together with other technologies (e.g., 3D scanners and image analysis software).

METHODS

We conducted training on osteotomy in the maxilla and mandible using maxillofacial simulation software (MSS) and a 3D-printed model for 5th-year undergraduate dental students (13 students in 2017 and 11 students in 2018 with more than half of their results). We compared the group (13 students) who performed osteotomy after participating in the simulation lecture with those (11 students) who performed osteotomy after performing self-simulation (they were instructed to bring their personal computers and install the MSS) using tests and questionnaires (pre- and post-curriculum).

RESULTS

The average test score was significantly higher in the group who performed osteotomy using the 3D-printed model after performing self-simulation; participants in this group had acquired a better understanding of the surgical procedure. Comparison using questionnaires showed a significant difference in the students' understanding of instruments and surgical techniques between both groups.

CONCLUSION

The MSS and 3D printed models are widely used clinically. Incorporating these in the curriculum will help accelerate student development. In addition, prompt education on the purpose and usefulness of these tools will not only facilitate simulation software and 3D-printed model-based treatment plan in the clinic but also promote further research.

Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report

Background: Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a prevalence of one per million births. The main causes of CCD are mutations in the core-binding factor alpha-1 (CBFA1) or runt-related transcription factor-2 (RUNX2), located at the 6p21 chromosomal region. RUNX2 plays important roles in osteoblast differentiation, chondrocyte proliferation and differentiation, and tooth formation. The disease is characterized by clavicular aplasia or hypoplasia, Wormian bones, delayed closure of cranial suture, brachycephalic head, maxillary deficiency, retention of primary teeth, inclusion of permanent teeth, and multiple supernumerary teeth. Materials and Methods: A 22-year-old girl suffering from cleidocranial dysplasia with short stature, narrow shoulders, craniofacial manifestations (short face, broad forehead, etc.) and dental anomalies (different lower dental elements under eruption, supernumerary and impacted multiple teeth, etc.) was examined at our service (Complex Operative Unit of Odontostomatology of Policlinico of Bari). RX Orthopantomography (OPG) and cone beam computed tomography (CBCT) were requested to better assess the position of the supernumerary teeth and their relationships with others and to evaluate the bone tissue. Results: Under eruption was probably caused by dental interferences with supernumerary teeth; hence, extractions of supernumerary upper canines and lower premolars were performed under general anaesthesia. Surgery outcome was excellent with good tissue healing and improvements in the therapeutic possibilities with future orthodontics. Conclusions: The objective of this article is to give an update about radiological, clinical, and molecular features of CCD and to alert the health team about the importance of establishing an early diagnosis and an appropriate treatment in these patients to prevent impacted teeth complications and to offer them a better quality of life.

Emerging simulation technologies in global craniofacial surgical training

The last few decades have seen an exponential growth in the development and adoption of novel technologies in medical and surgical training of residents globally. Simulation is an active and innovative teaching method, and can be achieved via physical or digital models. Simulation allows the learners to repeatedly practice without the risk of causing any error in an actual patient and enhance their surgical skills and efficiency. Simulation may also allow the clinical instructor to objectively test the ability of the trainee to carry out the clinical procedure competently and independently prior to trainee's completion of the program. This review aims to explore the role of emerging simulation technologies globally in craniofacial training of students and residents in improving their surgical knowledge and skills. These technologies include 3D printed biomodels, virtual and augmented reality, use of google glass, hololens and haptic feedback, surgical boot camps, serious games and escape games and how they can be implemented in low and middle income countries. Craniofacial surgical training methods will probably go through a sea change in the coming years, with the integration of these new technologies in the surgical curriculum, allowing learning in a safe environment with a virtual patient, through repeated exercise. In future, it may also be used as an assessment tool to perform any specific procedure, without putting the actual patient on risk. Although these new technologies are being enthusiastically welcomed by the young surgeons, they should only be used as an addition to the actual curriculum and not as a replacement to the conventional tools, as the mentor-mentee relationship can never be replaced by any technology.

Three-dimensional printed model of impacted third molar for surgical extraction training

OBJECTIVES

Extraction of impacted mandibular third molars is one of the most common surgical procedures performed at dental clinics; however effective training models for teaching oral surgery to dental students are limited. This study aimed to use three-dimension (3D) printing technology to develop an effective training model for impacted third molar extraction.

METHODS

The data for the 3D model were digitally processed using high-resolution computed tomography, and two common, but different patterns of impacted third molars were simulated using computer-aided design. Thereafter, the model was printed using the 3D-printing technology, and the efficiency of the 3D-printed model and an animal model (pig mandible) were compared using a five-point Likert scale by 35 oral surgeons in the oral surgery department and 208 students of stomatology in the internship stage.

RESULTS

The 3D-printed model consisted of three parts: a non-replaceable part (i.e., the body of the mandible and the teeth from the left first molar to the right first molar) and two replaceable parts (i.e., the part of the ascending ramus of the mandible, as well as the second and third molars). It was covered with a layer of rubber-like material to simulate the gingiva. For the comparison between the 3D-printed and animal models, a total of 205 questionnaires were collected. Both oral surgeons and students agreed that the 3D-printed model was better than the animal model in terms of total value and the anatomy of the bone and teeth, simulating the surgical procedure (p < 0.05), while the two models achieved similar results for haptic feedback of the soft tissue (p > 0.05).

CONCLUSIONS

The 3D-printed model is realistic and effective for learning impacted third molar extraction and received positive feedback from students and oral surgeons. This model can significantly improve the pre-clinical skill training of dental students.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

Surgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side. This first part therefore reviews, open field camera, telemedicine and 3D printing. This systematic review is registered on PROSPERO.