ArticlePDF Available

A preliminary study using virtual reality to train dental students

Authors:

Abstract and Figures

This study compared virtual reality simulator-enhanced training with laboratory-only practice on the development of dental technical skills. Sixty-eight students were randomly assigned to practice their skills in either a traditional preclinical dentistry laboratory or in combination with a virtual reality simulator. The results indicate that students who trained with the virtual reality simulator between six and ten hours improved significantly more than did the students in the control group from the first examination of the year to the final examination of the year. These results indicate that the use of virtual reality simulators holds promise for the training of future dentists. Additional research is necessary to determine the ideal implementation of virtual reality simulators into traditional dentistry curricula.
Content may be subject to copyright.
378 Journal of Dental Education Volume 68, Number 3
A Preliminary Study in Using Virtual Reality to
Train Dental Students
Vicki R. LeBlanc, Ph.D.; Alice Urbankova, M.L.L.Dr.; Farhad Hadavi, D.M.D., M.Sc.;
Richard M. Lichtenthal, D.D.S.
Abstract: This study compared virtual reality simulator-enhanced training with laboratory-only practice on the development of
dental technical skills. Sixty-eight students were randomly assigned to practice their skills in either a traditional preclinical
dentistry laboratory or in combination with a virtual reality simulator. The results indicate that students who trained with the
virtual reality simulator between six and ten hours improved significantly more than did the students in the control group from
the first examination of the year to the final examination of the year. These results indicate that the use of virtual reality simula-
tors holds promise for the training of future dentists. Additional research is necessary to determine the ideal implementation of
virtual reality simulators into traditional dentistry curricula.
Dr. LeBlanc is Assistant Professor, University of Toronto, Faculty of Medicine; Dr. Urbankova is Assistant Clinical Professor,
Columbia University School of Oral and Dental Surgery; Dr. Hadavi is Professor, Clinical Dentistry, Columbia University School
of Oral and Dental Surgery; and Dr. Lichtenthal is Benfield Associate Professor and Chair of the Division of Operative Dentistry
and Endodontics, Department of Restorative Dentistry, Columbia University School of Oral and Dental Surgery. Direct corre-
spondence and requests for reprints to Dr. Vicki LeBlanc, University of Toronto Faculty of Medicine, Centre for Research in
Education, 200 Elizabeth Street, 1 Eaton South 565, Toronto, ON M5G 2C4; 416-340-3054 phone; 416-340-3792 fax;
vicki.leblanc@utoronto.ca.
Key words: education, preclinical dentistry, virtual reality simulation
Submitted for publication 2/11/03; accepted 11/24/03
O
ne of the most important skills for any den-
tist is the ability to prepare and restore dam-
aged tissue resulting from carious lesions.
The development of this skill requires mastery of two
components: knowledge of the concepts of the pro-
cedure and the dexterity to perform it. Instruction
regarding the concepts of cavity preparation and dem-
onstrations of techniques can be offered by faculty
in large group sessions. However, the performance
component requires a situation in which students can
repeatedly practice the application of the knowledge
imparted by the instructor. In the past decades, edu-
cators have come to the realization that the clinical
arena may not be an optimal environment for dental
education. There are a number of reasons for this.
Technical skills are increasingly complex due to ad-
vances in knowledge, materials, and technology. In
parallel with the technological advances, financial
restraints have increased the pressure for high pa-
tient turnover at dental school clinics, leaving less
teaching time available to instructors and students.
Finally, concerns over patient safety have led to a
decrease in the acceptance of having students prac-
tice new skills on patients.
1,2
The realization that the clinical setting is not
an ideal environment for skills training, coupled with
recent technological advances, is leading to an in-
creased use of computer applications in health care
education. Growth in computer-aided instruction has
been fueled by increases in computer capacities, soft-
ware applicability and accessibility, and decreased
costs, as well as student demands for the most up-to-
date training possible.
3,4
Computer-aided instruction
can range from computer or web-based tutorials, dis-
cussion groups, and courses to more sophisticated
virtual reality-based, computerized patient simula-
tors and virtual reality-based simulations.
5
Simula-
tors are useful learning tools because they allow for
practice in controlled environments and are adapt-
able to flexible scheduling for students as well as
instructors.
6
They offer an arena for students to test
and observe the results of dental procedures without
any patient morbidity.
7
They also facilitate repeti-
tion of the skill to be learned, offer controlled train-
ing variations, and provide opportunities to quanti-
tatively assess student performance. Students can
thus learn how to deal with the outcomes of their
actions in safe environments.
8
To date, most developments in virtual reality
patient simulation have occurred in the field of sur-
gery, where it is essential for surgeons to master com-
plex procedures prior to performing them on pa-
tients.
6
However, dentistry has recently witnessed the
introduction of simulated environments for the de-
March 2004 Journal of Dental Education 379
velopment of dental skills. Most dental schools have
developed preclinical laboratories where students
practice skills on typodont teeth with articulating
mandibles in life-sized mannequin torsos. While such
a method of practice does provide students with a
means to practice the skills of preparing and restor-
ing teeth, it has limits in the realism provided to the
students and in the quantity and quality of feedback.
The field of dentistry has also seen an increase in the
use of computer-assisted simulation for the training
and assessment of haptic (or tactile-based) skills, such
as the ability to detect carious lesions.
9
Simulators
are also used in preclinical training of dental students,
as a tool to provide a smoother transition to clinic by
broadening students’ preclinical experiences.
5,10
Kaufmann proposes that natural progression of this
technology will be for virtual reality simulators to
be used for education, certification, and recertifica-
tion in all health care fields.
1
Dental operatory and virtual reality patient
simulators (such as the DentSim developed by DenX)
offer the promise of providing practice in a realistic
environment filled with detailed, frequent, and ob-
jective feedback.
11
However, it is unknown if these
characteristics will lead to better or accelerated de-
velopment of skills. The purpose of this study was
to evaluate the effect of training through virtual re-
ality simulation on student performance during pre-
clinical laboratory work, based on standard grading
evaluation procedures at Columbia’s School of Den-
tal and Oral Surgery (SDOS). In this study, we in-
vestigated whether training with a computerized
simulator was comparable to or better than traditional
training in developing the skills necessary for per-
forming operative dentistry procedures.
Methods
Sixty-eight students (forty-four males/twenty-
four females) were enrolled in the second-year course
of preclinical operative dentistry course at
Columbia’s SDOS. The study was introduced to the
students during a large-group session, and all stu-
dents initially volunteered to participate. Based on
space limitations, simulator unit availability, and time
restrictions, twenty of these students were randomly
selected to engage in computerized simulation train-
ing (simulator group: twelve males/eight females)
in addition to the standard 110 hours of traditional
laboratory-based instruction in operative dentistry
alongside the control students. One student (female)
eventually dropped out of the study after the intro-
ductory session, but prior to any individualized train-
ing, due to a lack of interest in completing the com-
puterized simulation training. Her results were not
included in the data analysis. The remaining forty-
eight students (control group: thirty-two males/six-
teen females) continued to receive only the traditional
laboratory-based instruction. In addition to the course
time, all sixty-eight students were free to engage in
extracurricular practice in the traditional preclinical
laboratory on their own time. This research project
received approval from Columbia University’s In-
ternal Review Board, and the students gave signed
consent for their performance to be used as research
data.
Simulator
The DentSim® computer-assisted simulator,
manufactured by DenX Ltd. of Israel,
12
is a clinical
simulator providing real-time tactile feedback with
use of 3D graphics and real time image processing.
The DentSim® unit combines a patient mannequin,
the typodont with a set of teeth, and rotary dental
instruments. In addition, it is equipped with infrared
light emitting diodes and an overhead infrared cam-
era feeding to two computers and a monitor to inter-
pret the spatial orientation of the mannequin and to
produce a three-dimensional image of the patient’s
mouth. The operator can view any cut made in a tooth
from any angle on the monitor.
The software provides detailed feedback com-
paring the operators performance with a pre-
programmed acceptable “ideal” cavity preparation
in its database at any point of the procedure. Feed-
back consists of detailed diagrams with quantitative
analysis in various cross sections. Using the feed-
back during the procedure serves as a guidance tool,
while using it strictly at the end simulates an exami-
nation. The entire procedure is saved and stored in
individual student files that can be reviewed later in
movie format with a final evaluation and a list of
error messages, allowing students to actually watch
how each mistake was made. Errors are also audio
signaled in real time while students are working and
can be viewed immediately. This allows students to
know the results of their errors when they are made,
rather than after the preparation has been completed
(as in traditional preclinical instruction). They can
thus develop the skill to make mid-course adjust-
ments that increase both the quality of the final prod-
uct and the efficiency of the skill development it-
self.
13
The virtual environment is enhanced with
380 Journal of Dental Education Volume 68, Number 3
complete patient records including medical and den-
tal history, X-rays, examination notes, diagnosis, and
treatment plan.
The computerized simulation module at Co-
lumbia University’s SDOS has been in use for three
years. To date, students involved in training and par-
ticipating in study have been first- and second-year
students. There is no designated class time for com-
puterized training in the students’ class schedule due
to an already densely filled curriculum. Students
worked during their free time. Time spent in the simu-
lation laboratory was monitored by upperclass stu-
dent teaching assistants and a sign-up sheet.
Procedure
All sixty-eight students received the conven-
tional instruction and training in operative dentistry.
This consisted of in-class faculty lectures and dem-
onstrations, as well as scheduled laboratory practice
in the preparation and restoration of carious lesions.
All students participated in the traditional education
together, with the same faculty instructors. Seven
faculty members provided instruction throughout the
academic year to all sixty-eight students, and the in-
structor-student ratio in the class was, on average,
1:10. All students could also engage in individual
practice outside of regular class hours, and this prac-
tice time was not monitored.
Students who were assigned to the simulator
group received an additional six to ten hours of train-
ing on the computerized simulator in three blocks
over a period of eight months. During Block 1 (De-
cember-April), students received one to two hours
of training with the computerized simulator. This
training consisted of a one-hour introduction and a
hands-on demonstration on interacting with the simu-
lator. During Block 2 (April-May), students in the
simulator group received two to three hours of inde-
pendent practice with the simulator. In Block 3 (May–
July), the students in the simulator group received
an additional three to five hours of training with the
computerized simulator. Each student in this study
group was required to perform two cavity prepara-
tions that were deemed acceptable based on the
DentSim unit’s computerized grading system in each
two-hour session, for a total of four cavity prepara-
tions. Students who fulfilled this requirement in less
than the allotted time were not required to stay for
the remainder of the session. Instructors were not
present to evaluate or aid the students during these
final two training sessions, and an upper-class stu-
dent teaching assistant was present to monitor atten-
dance and provide assistance for any technical diffi-
culties. Students in the simulator group were also
free to engage in individual practice in the traditional
operative dentistry laboratory, as were the control
group students.
Measures
Performance on the practical exams in the pre-
clinical course in Operative Dentistry was used as
an assessment of the effects of the additional six to
ten hours of training with the DentSim. The practi-
cal exams in the course take place in December, April,
May, and July. During these exams that last five to
eight hours each, students perform a variety of cav-
ity preparations and restorations. Two instructors
independently rate the quality of the cavity prepara-
tions and restorations on a scale of 0-100, in inter-
vals of five points, with the lowest grade awarded
being a 60 up to a high of 95. The average of the two
ratings determines the score for a particular prepara-
tion or restoration, and the scores for each item are
averaged to provide the student with an overall score
on the practical component of the exam. Typically,
students complete between three and six procedures
for each exam, with a preparation and restoration of
the same tooth counting as two procedures. All in-
structors grading student performance on the practi-
cal exams, including two investigators in this study,
were blinded as to which students were in the study
or the control groups.
As the year progressed, the procedures included
in the practical exams increased in complexity and
skill required to achieve a passing grade. For ex-
ample, Exam 1 consisted of only class I and II amal-
gam cavity preparations. Exam 4 required compe-
tence in preparing and restoring class II, class IV,
and a gold onlay with retentive boxes and bevels. In
this manner, each exam was considered a cumula-
tive test of skills, with the final examination being
used as a capstone to evaluate competence in the
entire years worth of procedures.
Scores for the cavity preparations on each of
the four practical exams in the operative dentistry
course were compared between students in the simu-
lator group and those in the control group. Scores on
the exams were submitted to a 2 x 4 mixed-design
analysis of variance, with group (simulator vs. con-
trol) as a between-subject variable and test (Test 1,
Test 2, Test 3, and Test 4) as a repeated measure.
March 2004 Journal of Dental Education 381
Results
Overall, the average scores on the exams in-
creased throughout the year, F(3, 177)=12.59, MSE
=9.3, p<.01. This result indicates that the students’
ability to prepare cavities improved throughout the
course. Students in the two groups did not differ on
their overall performance scores during the year, F(1,
59)=.352, MSE=23.12, p=.56. However, we observed
a significant group by test interaction, F(3, 177)=
4.15, p<.05. On the early exams, the students in the
control group obtained higher scores than did the stu-
dents in the simulator group. However, by the final
exam, the students in the simulator group showed a
trend towards obtaining higher scores than did the
students in the control group (78.4 vs. 76.6, p=.07).
An independent t-test indicated that the exam scores
of the students in the simulator group improved sig-
nificantly more from the first to the fourth exam than
did the exam scores of the students in the control
group (improvement of 4.8 pts vs. 1.4 pts, p=.01). In
a few short hours of training, the DentSim group
improved significantly more than the control stu-
dents. See Table 1 for the scores on each of the ex-
ams.
Discussion
The results of this study suggest that virtual
reality simulation provides an effective training
method for the development of operative dentistry
skills in students. Students assigned to the simulator
group demonstrated better improvements in exam
scores throughout the year than did students in the
control group. These findings are very positive, given
that the individual practice time never exceeded eight
hours throughout the academic year.
Our results are in line with other research on
the effect of computer simulation in the training of
dentistry skills. Buchanan has published some of the
few studies investigating the effectiveness of com-
puter simulation instruction. Her findings show that
students learn procedures faster with computerized
simulation training than students who train in tradi-
tional laboratories.
5
She hypothesized that the rea-
son for this acceleration of learning is that the stu-
dents are able to complete more preparations per hour
(up to twice as many) than students in the traditional
laboratory.
We believe that the advantage of computerized
simulation training comes from a variety of factors.
In traditional operative dentistry instruction, preclini-
cal students practice on mannequins in large groups.
There are limits in the objectivity and the frequency
of the feedback provided by the instructors in tradi-
tional training. The laboratories are typically large
ones, and the ratio of instructor to student is low.
Thus, students often have to wait extended periods
of time before receiving any feedback. Research has
shown that, for the most effective instruction, some
external feedback should be offered when students
are practicing.
14
While this study does provide evidence in sup-
port of technology in the training of dental students,
further research needs to be conducted to determine
the optimal coordination of the traditional didactic
instruction with emerging technology-based instruc-
tion. First, it is unknown what is the optimal amount
of training required on the computerized simulator
to lead to improvements in the acquisition of skills.
Anecdotal evidence from the University of Pennsyl-
vania showed that postgraduate dentists required, on
average, five hours of training on a computerized
simulator before realizing significant benefit based
on the computerized grading system. In this study,
students just barely crossed the five-hour plateau.
This finding suggests that more extensive training
time would lead to more profound improvements in
skill. Second, it is unknown when is the best time to
schedule computerized simulation training during the
acquisition phase of operative skills. It may be hy-
pothesized that the earlier the training, the better,
while others have argued that a tactile skill cannot
be fully optimized without the didactic knowledge
base in place.
15,16
We are currently investigating the
benefits of computerized simulation training incor-
porated early versus later in the skills acquisition.
Table 1. Performance on practical exams
Exam Exam 1 Exam 2 Exam 3 Exam 4
Simulator Group 73.6 73.9 76.9 78.4
n=19 (.84)* (.83) (.80) (.81)
Control Group 75.3 75.8 76.7 76.6
n=48 (.57) (.56) (.54) (.54)
Average 74.4 74.9 76.8 77.5
(.51) (.50) (.48) (.49)
*Numbers in parentheses are standard errors of the mean.
382 Journal of Dental Education Volume 68, Number 3
We are aware of limitations in the design of
the study, most notably that we were not able to con-
trol the amount of time students practiced the skill
on their own time. Thus, we are not in a position to
determine whether the increased performance of the
simulator group results from training specifically
with the virtual reality simulator or whether it sim-
ply results from them having more practice time over-
all than the students in the control group. Our belief
is that the six to ten hours of actual individualized
training was insignificant compared to the 110 hours
of in-class laboratory time as well as any additional
hours of self-practice. An informal survey of the stu-
dents revealed that they spent, on average, approxi-
mately eighty-three hours practicing outside of class
throughout the year. We believe those six to ten hours
had a greater impact due to the individualized atten-
tion and evaluation each student in the DentSim
group received, rather than due to significantly extra
time spent on practice. We are currently designing
studies investigating this question.
While this study indicates that students who
trained on the computerized simulator showed im-
provements on exams of operative dentistry, we wish
to stress that the training on the simulators was not a
stand-alone activity. Rather, training with the simu-
lator was placed within the context of initial class-
based instruction so that the trainees would learn the
relevant principles of the skills of operative dentistry.
Research in skill acquisition has shown that knowl-
edge of performance (error information related to the
characteristics of the performance) and knowledge
of results (comparison between actual outcome and
desired outcome) are required for acquisition and
improvement of motor skills.
15,16
Such knowledge can
be acquired during class-based instruction where the
students learn demonstration through lectures and,
by asking questions, how to discriminate between
the desired performances and outcomes and ones that
contain errors. Thus, it is our belief that the coordi-
nation of training on simulators with class-based in-
struction is necessary to ensure that the skills per-
fected on the simulator are the correct ones.
Conclusion
This study is one of the first investigating the
effects of computerized simulation on the develop-
ment of operative dentistry skills. The results indi-
cate that students in the DentSim simulator group
improved their scores significantly more from the
first to the fourth examination of the year than did
students in a control group who did not receive aug-
mented instruction by the simulator. The simulation
group improved from a mean score of 73.6 percent
on the first exam of the year to 78.4 percent on the
fourth exam, which served as a cumulative capstone
assessment of the students’ operative skills. The con-
trol group (traditional training only) improved from
75.3 percent on the first exam to 76.6 percent on the
fourth exam. However, while the use of simulators
for the training of dental holds promise, their inte-
gration into the curriculum should not go unchecked.
Rather, the implementation of simulators should be
guided by theory and by relevant research regarding
how individuals obtain and process information. For
this last purpose, simulators can serve the additional
function of aiding researchers in determining areas
of clinical practice that need enhancement and of
guiding faculty in modifying curricula.
REFERENCES
1. Kaufmann CR. Computers in surgical education and the
operating room. Ann Chir Gynaecol 2001;90:141-5.
2. Wanzel KR, Ward M, Reznick RK. Teaching the surgical
craft: from selection to certification. Curr Probl Surg
2002;39(6):573-660.
3. Keane DR, Norman GR, Vickers J. The inadequacy of
recent research on computer-assisted instruction. Acad
Med 1991;66(8):444-8.
4. Larbuisson R, Pendeville P, Nyssen AS, Janssens M,
Mayne A. Use of anaesthesia simulator: initial impres-
sions of its use in two Belgian university centers. Acta
Anaesthesiol Belg 1999;50:87-93.
5. Buchanan JA. Use of dental simulation technology in den-
tal education. J Dent Educ 2001;65(11):1225-31.
6. Derossis AM, Fried GM, Abrahamowicz M, Sigman HH,
Barkun JS, Meakins JL. Development of a model for train-
ing and evaluation of laparoscopic skills. Am J Surg
1998;175:482-7.
7. Kokoska MS, Citardi MJ. Computer-aided surgical re-
duction of facial fractures. Facial Plast Surg Clin North
Am 2000;16(2):169-79.
8. Miller MD. Education, training, and proficiency of pro-
cedural skills. Prim Care 1997;24(2):231-40.
9. Thomas G, Johnson L, Dow S, Stanford C. The design
and testing of a force feedback dental simulator. Comput
Methods Programs Biomed 2001;64:53-64.
10. Suvinen TI, Messer LB, Franco E. Clinical simulation in
teaching preclinical dentistry. Eur J Dent Educ
1998;2(1):25-32.
11. Carr MM, Reznick RK, Brown DH. Comparison of com-
puter-assisted instruction and seminar instruction to ac-
quire psychomotor ad cognitive knowledge of epistaxi
management. Otolaryngol Head Neck Surg 1999;121(4):
430-4.
12. DenX Ltd., DenX Advanced Dental Systems. At:
denx.com. Accessed: January 18, 2003.
March 2004 Journal of Dental Education 383
13. Newell KM, Morris LR, Scully DM. Augmented infor-
mation and the acquisition of skill in physical activity.
Exerc Sports Sci Rev 1985;13:235-61.
14. Rogers DA, Regehr G, Yeh KA, Howdieshell TR. Com-
puter-assisted learning versus a lecture and feedback semi-
nar for teaching a basic surgical technical skill. Am J Surg
1998;175:508-10.
15. Feil P. An assessment of the application of psychomotor
learning theory constructs in preclinical laboratory instruc-
tion. J Dent Educ 1992;56(3):176-82.
16. Kovacs G. Procedural skills in medicine: linking theory
to practice. J Emerg Med 1997;15(3):387-91.
... Our results are in line with other research on the acceptance of computer-based education in the field of dentistry. 13 However, this research study failed to prove that a complete replacement of the traditional teaching methods would be appreciated by the students. One of the limitations was the fact that students' technical orthodontic skills, as they entered the technical course, had not been developed. ...
... 10 While this study does provide evidence in using the technology in the educating process of dental students, further research needs to be conducted, to determine the optimal coordination of the traditional didactic methods with emerging technology-based guidance. 13 It is incomprehensible that many dental schools are still hesitant to take action considering the high cost of establishing a digital simulation laboratory. 15 The authors want to continue to encourage institutions that have established simulation dental courses to conduct additional studies that evaluate students' ability to use digital technology, to individually review each step of a specific practical learning procedure, and to measure students' skills on a specific set experience. ...
Article
Full-text available
Purpose/objectives More and more creative applications are used in the field of dentistry for clinical practice, patient orientation, teaching, and learning, in order to awake the students’ interest and to enable a deep learning and its retention. The aim of this study was to demonstrate the impact and the effectiveness of the current simulation laboratories on the practical dental education. For this purpose, a survey on a new developed “AR-Demonstrator-App” was conducted during the orthodontic technical courses in 2017, 2018, and 2020 in the Department of Orthodontics (C.G. Carus, TU Dresden, Germany). Methods With this application, the students had the opportunity to see every single step with instructions on how to manufacture a removable orthodontic device in a compulsory technical course. At the end of these courses, the students were asked to anonymously fill out a printed questionnaire with 12 questions regarding the learning progress related to the app. Results The yearly mean Likert scores and their bootstrapped 95% confidence intervals as well as the yearly median Likert scores suggest a very positive feedback about the use of the new application as an educational instrument. Despite the recognized predominant benefits of this app, the students concluded that they do not prefer the total replacement of the physical plaster casts and that a combination of conventional and computer-based education provided the optimum approach to acquisition of dental practical skills. Conclusions This survey indicates a generally positive attitude toward computer-assisted simulation systems, providing the facility for acquisition of knowledge and practical skills in a multimedia environment.
... The extensive use of VR technology and simulators in dental education is owing to their significant benefits. The possibility of self-assessment, rapid acquisition of knowledge and skills by students, reducing the risks that negatively affect the patients' health, and increasing the level of safety of students facing patients [20] are among the most important benefits of using a VR system, which has led to high satisfaction among students [21]. ...
Article
Full-text available
Background Today, the use of virtual reality (VR) technology as an educational tool in dental education has expanded considerably. This study was aimed to evaluate the effectiveness of using VR technology in teaching neutral zone and teeth arrangement. Methods This randomized trial was conducted at Kermanshah University of Medical Sciences, Iran in 2019. The study sample consisted of 50 six-year dental students who were randomly divided into experimental (n = 25) and control (n = 25) groups. Students’ performance in both groups was assessed using tests. A questionnaire was used to assess the usability of VR technology and students’ satisfaction with it. Results All faculty members confirmed the usability of VR technology in dental education. The majority of students (76%) were highly satisfied with the use of this technology in their learning process. The mean score of students was significantly higher in the experimental group (16.92 ± 1.12) than in the control group (16.14 ± 1.18). Conclusion In general, it can be argued that VR technology is useful and effective in the teaching–learning process. Therefore, its use in medical and dental schools can play an effective role in creating a dynamic, attractive, and successful learning environment.
... VR simulators with direct feedback and an objective evaluation function may become an important tool in the future of dental objective structured clinical examination (OSCE) [7,12]. Therefore, many studies have indicated that VR simulation has the potential to be an alternative to conventional dental training methods [13][14][15]. ...
Article
Full-text available
(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.
... VR training aims to create realistic and safe workplace experiences that allow users to learn how to avoid risks and apply ergonomics while working in demanding environments [5][6][7]. VR simulation and training have become a popular pre-clinical training tool in dentistry schools worldwide, and the results have been promising [8,9]. Such training helps students develop their technical skills without the expenses and risks associated with dental models or patients. ...
Chapter
Lower back and neck pain are common musculoskeletal disorders (MSDs) among dentists and dentistry students. Increased awareness of ergonomics during job tasks could help to reduce MSDs. Virtual reality (VR) enhanced dentistry training programs are gaining popularity in academia. Quantifying inverse kinematics (IK) using VR manikins that mimic a user’s body can inform ergonomic risk evaluations. We calibrated and investigated one of the IK manikins' accuracy compared to motion capture (MoCap) using a novel method. We show that posture estimation using VR is accurate to less than 10° in 81% of the seated pick and place tasks for the neck and trunk angles. These results suggest that an accurate estimation of posture in VR is achievable to inform real-time postural feedback. This postural feedback can be integrated into VR enhanced training for dental students to help reinforce ergonomic posture and safer movements.
... List of equipment for dental health sciences education. Simodont ® (Nissin Dental Products Inc., Kyoto, Japan)30 DentSim (Image Navigation Ltd., New York U.S.A.)31 VRDTS (Virtual reality dental training system) (Novint Technologies, Delaware, U.S.A.) IDSS (Iowa dental surgical simulator) (from Dentistry College of University of Iowa, U.S.A) Dentaroid (Nissin Dental Products, Kyoto, Japan) ...
Article
The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new …
Article
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 trial 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, characterized 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. Optimizations must be considered in order to make simulation-based assessment clinically relevant.
Article
Purpose/Objectives The aim of this study was to evaluate the change in students' preferences between soap carving (SC) and digital sculpting (DS) methods after obtaining tooth with both methods, their opinions about the methods and their performance in the dental anatomy course. Materials and Methods The SC and DS methods were demonstrated. Students were asked to obtain a maxillary central incisor by both methods and to record time. Students' preferences were asked both before and after applying both methods. The level of significance for statistical analysis was set at P≤ 0.05. Results 40 first year preclinical students (24 female, 16 male) participated in this study. Their mean age was 19.38 years ±1.00 year. There was a statistically significant difference between the mean time of the DS method according to gender (P = 0.004) and the mean time of DS and SC methods for females (P = 0.015). There was also a statistically significant difference between preferences of students for “In the future while treating the patient in the clinic, I learned with ………… method in the preclinic will be more useful for me.” statement, before and after applying both methods (P=0.034). Conclusions The obtaining the tooth of the students with DS method were longer than with SC method (especially in the females). After applying both methods, the students changed their minds that learning the information about the SC and DS methods would have a similar effect when treating patients in the clinic.
Article
Hoy en día, una nueva pandemia conocida como la COVID-19 ha venido a alterar la vida normal de todas las personas. Esta situación no evita paralizar el dictado de clases en diferentes universidades del mundo, incluidos los países en vías de desarrollo. Por ello, el presente artículo tiene como objetivo determinar la importancia del uso de la simulación háptica como herramienta didáctica en el logro de competencias en estudiantes y docentes universitarios de pregrado a nivel mundial. La metodología empleada fue Preferred Reporting Items for Systematic Reviews (PRISMA). Al respecto, se realizó una cadena de búsqueda: “haptic, AND simulator, AND education, AND teaching, AND dental” en bases de datos como Scopus y Google Académico. De un total de 41 artículos identificados, llegaron 18 a la fase final de PRISMA, considerando por ello que es una investigación exploratoria en el área de la odontología.
Article
The purpose of this study was to develop prototype of virtual reality(VR) simulation with malocclusion models and evaluate its applicability. Task abilities, task completion time, and a satisfaction survey were compared between dentist trainees and dental students. Participants were instructed to observe virtual malocclusion models and then performed three tasks to diagnose the type of malocclusion, determine clinical findings and develop treatment plans. Their satisfaction with the simulation experience were evaluated using a questionnaire containing five questions. Task abilities of trainees related to clinical features and treatment plans were significantly higher than that of students(p < 0.01). In both groups, the task completion time for the second case was significantly reduced compared to that for the first case(p < 0.01). The satisfaction survey showed high scores and positive responses for this simulation in both groups. If the prototype of VR simulation is continuously advanced, it will be applicable for orthodontic education in pediatric dentistry.
Article
Full-text available
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.
Article
Full-text available
459 trainees in Anesthesia and Intensive Care Medicine, accompanied by fully certified specialists from several Belgian University Hospital Centers, spend at least a 3 hour session at the Anaesthesia Simulator. Each session comprises three segments: the briefing, the simulation session and the debriefing. The use of simulations allows significant individualization of the learning experience. The simulator helps to develop the capacity to understand, explain a phenomenon and to resolve problems. Another important aspect of the use of the simulator involves the trainee's "right to make mistakes". This allows to widen the spectrum of executional situations, and decreases the number of dangerous situations. Two University Centers (ULg and UCL) have each organized simulator sessions despite some differences in their approaches. The simulator is a teaching tool worthy of an obligatory role in the most up-to-date training possible of modern anesthesiologist. This is all the more important given that the current practice of anesthesiology is so complex that any error could cost a human life.
Article
The purpose of this paper is to report the results of a survey assessing the application of constructs related to the acquisition of psychomotor skills in the preclinic curriculum. Questionnaires were mailed to all departments of operative dentistry, fixed prosthodontics, removable prosthodontics, pediatric dentistry, and periodontics. Personal and institutional anonymity were maintained. Approximately 70 percent of all surveys were returned. Results suggest that there are insufficient opportunities for students to define desired outcomes and performances. Students usually are not required to generate knowledge of results or knowledge of performance, both of which appear to be closely related to the acquisition of motor skill. Finally, the conditions under which dental motor skills are acquired do not simulate those characteristic of clinical practice, and adequate simulations of actual dental conditions often are not utilized. Significant improvement in preclinical instruction can be attained through application of findings in the motor skill literature.
Article
Clinical competence exists when a practitioner has sufficient knowledge and skill such that a procedure can be performed to obtain intended outcomes without harm to the patient. Practitioners who want to be competent in performing clinical procedures should examine how the procedures are relevant to their practice, place the procedures in a familiar context, learn what outcomes are expected, and practice self-evaluation. Competence has several components, including knowledge, clinical decision making, judgment, technical skills, attitudes, professional habits, and interpersonal skills. Each of these must be mastered using a variety of sources of information and skill acquisition.
Article
Emergency departments offer a unique educational setting where housestaff can be exposed to and learn a variety of procedural skills. However, procedural skills are often overlooked as an assumed activity without a formal educational context. The clinical educator's understanding of the educational principals of teaching and learning procedural skills is minimal. This review offers further insight. The "psychomotor domain," which represents a hierarchy of learning motor skills, and relevant motor learning theory extracted from the educational psychology literature are reviewed. These theoretical considerations can be adapted to and provide useful information relevant to procedural medicine. Issues of curriculum content, methods of teaching and learning, and issues of competence relevant to the creation of a procedural skill program are reviewed and discussed.
Article
Current and projected approaches to dental education have created a wide interest in clinical simulation, and recently there has been a considerable expansion in the availability of experiential learning tools which imitate "real life" clinical conditions in dentistry. These include patient simulation devices such as heads, jaws, teeth and clinical environments, standardized patients, interactive video-discs and computer-based instruction. This paper reviews some of the equipment currently available for simulation of clinical procedures, and assesses the initial experiences and responses of 2nd, 3rd and 4th year undergraduate dental students at The University of Melbourne to case-based simulations in a patient simulator in comparison with preclinical exercises in a traditional bench and manikin laboratory. Student response to teaching and learning in the simulator over a 3-year evaluation period, collected via a student questionnaire was uniformly positive. Students were very enthusiastic about the learning environment and educational approach, preferring it to traditional preclinical laboratory instruction.
Article
Rapid improvements in computer technology allow us to consider the use of computer-assisted learning (CAL) for teaching technical skills in surgical training. The objective of this study was to compare in a prospective, randomized fashion, CAL with a lecture and feedback seminar (LFS) for the purpose of teaching a basic surgical skill. Freshman medical students were randomly assigned to spend 1 hour in either a CAL or LFS session. Both sessions were designed to teach them to tie a two-handed square knot. Students in both groups were given knot tying boards and those in the CAL group were asked to interact with the CAL program. Students in the LFS group were given a slide presentation and were given individualized feedback as they practiced this skill. At the end of the session the students were videotaped tying two complete knots. The tapes were independently analyzed, in a blinded fashion, by three surgeons. The total time for the task was recorded, the knots were evaluated for squareness, and each subject was scored for the quality of performance. Data from 82 subjects were available for the final analysis. Comparison of the two groups demonstrated no significant difference between the proportion of subjects who were able to tie a square knot. There was no difference between the average time required to perform the task. The CAL group had significantly lower quality of performance (t = 5.37, P <0.0001). CAL and LFS were equally effective in conveying the cognitive information associated with this skill. However, the significantly lower performance score demonstrates that the students in the CAL group did not attain a proficiency in this skill equal to the students in the LFS group. Comments by the students suggest that the lack of feedback in this model of CAL was the significant difference between these two educational methods.
Article
Interest in the training and evaluation of laparoscopic skills is extending beyond the realm of the operating room to the use of laparoscopic simulators. The purpose of this study was to develop a series of structured tasks to objectively measure laparoscopic skills. This model was then used to test for the effects of level of training and practice on performance. Forty-two subjects (6 each of surgical residents PGY1 to PGY5, 6 surgeons who practice laparoscopy and 6 who do not) were evaluated. Each subject viewed a 20-minute introductory video, then was tested performing 7 laparoscopic tasks (peg transfers, pattern cutting, clip and divide, endolooping, mesh placement and fixation, suturing with intracorporeal or extracorporeal knots). Performance was measured using a scoring system rewarding precision and speed. Each candidate repeated all 7 tasks and was rescored. Data were analyzed by linear regression to assess the relationship of performance with level of residency training for each task, and by ANOVA with repeated measures to test for effects of level of training, of repetition, and of the interaction between level of training and repetition on overall performance. Student's t test was used to evaluate differences between laparoscopic and nonlaparoscopic surgeons and between each of these groups and the PGY 5 level of surgical residents. Significant predictors of overall performance were (a) level of training (P = 0.002), (b) repetition (P < 0.0001), and (c) interaction between level of training and practice (P = 0.001). There was also a significant interaction between level of training and the specific task on performance scores (P = 0.006). When each task was evaluated individually for the 30 residents, 4 of the 7 tasks (tasks 1, 2, 6, 7) showed significant correlation between PGY level and score. A significant difference in performance scores between laparoscopic and nonlaparoscopic surgeons was seen for tasks 1, 2, and 6. A model was developed to evaluate laparoscopic skills. Construct validity was demonstrated by measuring significant improvement in performance with increasing residency training, and with practice. Further validation will require correlation of performance in the model with skill in vivo.
Article
Epistaxis is a common problem faced by primary care physicians. Typically, first-hand experience with this problem is not obtained in medical school. A computer learning module was developed to address practical management of epistaxis. It was evaluated by use of third-year clerks and compared with an interactive seminar based on the same material. Fifty-eight students doing their required otolaryngology rotations were randomly separated into 3 groups: (1) doing a preinstruction test, (2) using the computer module, and (3) participating in a small-group seminar. All participants were tested with a short written test and a practical test that involved performing anterior nasal pack placement in a model patient. Percentage scores for the 2 groups were compared by use of t tests, and there was no significant difference between the written, practical, or combined scores at a level where P = 0.05. This study shows that basic patient management and a simple procedure can be taught as effectively with a computer module as with a small-group interactive seminar.