Relative contribution of haptic technology to assessment and training in implantology

Dental students' perceptions of the use of two-dimensional and three-dimensional vision in dental education using a three-dimensional haptic simulator: A qualitative study

OBJECTIVE

To assess the perceptions of novice and experienced undergraduate dental students of virtual learning with two-dimensional (2D) and three-dimensional (3D) vision.

MATERIALS AND METHODS

This qualitative study involved 21 students from the second and fourth years of a 5-year BDS program. They first performed three operative tasks in virtual reality (VR) training sessions using both 2D and 3D vision. Subsequently, they participated in one of four online focus group discussions (FGDs). The FGDs were recorded and transcribed, and the data obtained from the transcriptions were coded and thematically analyzed.

RESULTS

Three main themes emerged from the focus groups. With regard to their perceptions of 2D and 3D vision, most of the participants preferred 3D over 2D vision, mainly due to an improved ability to perceive depth. With regard to the theme of practicing 3D vision in the VR environment, some participants performed their tasks faster with 3D vision than with 2D vision, while others did not perceive any difference between them. Under the same main theme, some participants experienced headaches and eye fatigue with 3D vision. With regard to their perception of technical aspects, with 3D glasses, the participants experienced unpleasant sensations and saw darker images.

CONCLUSION

All the participants placed greater value on practicing with 3D than with 2D vision in the VR environment. They believed that VR training should be used in the early years of dental education as an adjunct to the phantom head as it helps students acquire the skills needed by dental professionals.

Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review

BACKGROUND

Virtual simulations (VSs) enhance clinical competencies and skills. However, a previous systematic review of 9 RCT studies highlighted a paucity of literature on the effects of haptic feedback in surgical VSs. An updated systematic and scoping review was conducted to encompass more studies and a broader range of study methodologies.

METHODS

A systematic literature search was conducted on July 31, 2023, in MEDLINE, Embase, and Cochrane. English language studies comparing haptic vs non-haptic conditions and using VSs were included. Studies were evaluated and reported using PRISMA-ScR guidelines.

RESULTS

Out of 2782 initial studies, 51 were included in the review. Most studies used RCT (21) or crossover (23) methodologies with medical residents, students, and attending physicians. Most used post-intervention metrics, while some used pre- and post-intervention metrics. Overall, 34 performance results from studies favored haptics, 3 favored non-haptics, and the rest showed mixed or equal results.

CONCLUSION

This updated review highlights the diverse application of haptic technology in surgical VSs. Haptics generally enhances performance, complements traditional teaching methods, and offers personalized learning with adequate simulator validation. However, a sparsity of orienting to the simulator, pre-/post-study designs, and small sample sizes poses concerns with the validity of the results. We underscore the urgent need for standardized protocols, large-scale studies, and nuanced understanding of haptic feedback integration. We also accentuate the significance of simulator validation, personalized learning potential, and the need for researcher, educator, and manufacturer collaboration. This review is a guidepost for navigating the complexities and advancements in haptic-enhanced surgical VSs.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Distinguishing skill levels with haptic simulation in restorative dentistry: Myth or reality?

INTRODUCTION

This study aims to validate that haptic simulator assistance could distinguish skill levels with haptic simulation in restorative dentistry.

MATERIALS AND METHODS

This work was carried out with 93 first-year, 87 third-year and 44 fifth-year dental students. The promotions of first- and fifth-year dental students made one session to represent the negative and the positive controls, respectively. The third-year dental students were the studied population. Whatever the group, the maximum time for each reparation was restricted to 3 min. All students have to perform the same three exercises. The third-year dental students performed four sessions spread over the whole university year. For each test, the total score provided by the simulator was recorded and analysed.

RESULTS

The exercises are not discriminating in direct vision while the exercise in indirect vision is very interesting to distinguish the levels of the learners.

CONCLUSION

The results underline that the exercises in indirect vision could distinguish different profiles of student having different preclinical and clinical levels, while making it possible to follow the acquisition of clinical competence.

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.

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.

Virtual aids and students' performance with haptic simulation in implantology

OBJETIVES

This study aims to validate that haptic simulator assistance could improve drilling ability in implantology and that the repetition of training session could highlight a learning curve.

METHODS

This work was carried out with 88 first-year dental students. After randomization, students were divided into two groups. Group 1 was assigned to prepare an implant site for a left first mandibular molar (36) on haptic simulator with assistance provided by simulator. Group 2 had to perform the same exercise without assistance. Whatever the group, the maximum time for each reparation was restricted to 5 min. An interval of 1 week was done between each session. For each test, different objective parameters provided by the simulator were recorded and analyzed.

RESULTS

This study showed that the presence of virtual aids led to quickly obtain better results, and the training led to gradually acquire sufficient competence to do without virtual aids.

CONCLUSION

By associating virtual assistance and repetition, the student will acquire more quickly the skills allowing to carry out his clinical gestures in real conditions.

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.

Impact of the Haptic Virtual Reality Simulator on Dental Students' Psychomotor Skills in Preclinical Operative Dentistry

One of the current trends in dental education is to empower dental students on a global platform using advanced technology. Haptic virtual reality simulation (HVRS) is a relatively new technology in the field of teaching and learning operative dentistry. This study aims to assess the impact of haptic virtual reality simulation (HVRS) on dental students’ psychomotor skills acquisition in preclinical operative dentistry. Class I cavity preparations (CP) were performed at baseline by 21 novice dental students on plastic teeth. Duration of CP was recorded and cavity features were evaluated and scored. Then, students were exposed to HVRS training on CP. Another Class I CP was performed by each student on plastic teeth after HVRS training, then evaluated, and the duration was recorded. There was a statistically significant decrease in CP performance time after HVRS training (p < 0.001) and an increase in the mean total marks of CP after HVRS training (p < 0.001). The change in the students’ performance in the CP displayed a statistically significant improvement after HVRS training in smoothness of the pulpal floor (p = 0.047), pulpal floor direction (p = 0.029), buccal, lingual, and mesial wall direction (p = 0.004, p = 0.025, p = 0.002), mesial and distal wall smoothness (p = 0.01, p = 0.001), internal line angle (p = 0.024), and internal point angle (p = 0.029). Overall improved performance in psychomotor skills was found after HVRS training. It could be beneficial to incorporate HVRS training early in pre-clinical operative dentistry courses as an adjunct to conventional phantom head training.

Significance of Haptic and Virtual Reality Simulation (VRS) in the Dental Education: A Review of Literature

The significance of haptic and virtual reality (VR) has been acknowledged by eminent dental professionals and has transformed dental teaching in the modern dental world. With this novel technological concept, students can interact with digital simulation on the screen and learn treatment skills before transferring them to real situations. This is helpful for gaining skills confidence, revising exercises again and again without the waste of materials, and for student assessment controlled by a teacher or tutor. It is a promising technology to enhance dental education for the new era of post COVID-19 practice due to noncontact patient training environments. It can create a safe learning environment for the teacher and learner or participant. The prospect of this literature review is to highlight the significance and clinical applications of virtual reality and simulations in undergraduate dental education.

The Current Situation and Future Prospects of Simulators in Dental Education

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

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.

Computer Simulation and Maxillary All-on-Four Surgery

Maxillary all-on-four implant reconstruction requires training beyond normal dental implant training. It conjoins technical surgical acumen, anatomic and complex spatial relationship understanding, thorough awareness of dental prosthodontic principles, and excellent patient management skills. Acquisition of appropriate training to the level of competence in an era of greater patient expectations and increased vigilance for patient safety and overall quality of care is limited. Repeated purposeful practice in performing complex psychomotor tasks is of paramount importance in achieving competence. Surgical simulation may assist surgical learners to acquire familiarity with relevant anatomic variations, instrumentation, surgical techniques, and management of intraoperative and postoperative complications.

A pilot study to assess the feasibility and accuracy of using haptic technology to occlude digital dental models

OBJECTIVES

The use of haptic technology as an adjunct to clinical teaching is well documented in medicine and dentistry. However its application in clinical patient care is less well documented. The aim of this pilot study was to determine the feasibility and accuracy of using a haptic device to determine the occlusion of virtual dental models.

METHODS

The non-occluded digital models of 20 pre-treatment individuals were chosen from the database of Faculty of Dentistry, The University of Hong Kong. Following minimal training with the haptic device (Geomagic(®) Touch™), the upper model was occluded with the lower model until a stable occlusion was achieved. Seven landmarks were placed on each of the corners of the original and haptically aligned upper model bases. The absolute distance between the landmarks was calculated. Intra- and inter-operator errors were assessed.

RESULTS

The absolute distance between the 7 landmarks for each original and corresponding haptically aligned model was 0.54 ± 0.40 mm in the x-direction (lateral), 0.73 ± 0.63 mm in the y-direction (anterior-posterior) and 0.55 ± 0.48 mm in the z-direction (inferior-superior).

CONCLUSION

Based on initial collision detection to prevent interpenetration of the upper and lower digital model surfaces, and contact form resistance during contact, it is possible to use a haptic device to occlude digital study models.

CLINICAL SIGNIFICANCE

The use of 3D digital study models is routine, but new problems arise, such as the lack of "touch" in a virtual environment. Occluding study models requires the sense of touch. For the first time, using haptic technology, it is possible to occlude digital study models in a virtual environment.