Clinical relevant haptic simulation learning and training in tooth preparation

Application Study of Virtual Simulation System for Preclinical Cavity Preparation Training

OBJECTIVES

The virtual simulation system (VSS) is a new type of preclinical trainer that has unique advantages compared with traditional manikin system (TMS). The objective of this study was to compare the impact of the order of VSS and TMS training and to evaluate the potential of VSS in preclinical cavity preparation training for undergraduates.

METHODS

The participants (n = 97) were randomly assigned to two groups and subjected to VSS and TMS in different sequences for G. V. Black Class I, II and V cavity preparations; one group was first prepared with VSS followed by TMS (VM group), while the other group was prepared with TMS followed by VSS (MV group). The scores of the two groups were compared based on the different training orders and cavity types. Subsequently, two questionnaires were sent to all participants to further assess their views on the usage of VSS and their efficacy in preclinical training.

RESULT

The training results of the VSS showed that the MV group had a higher average score than the VM group, but had no significant difference except for the Class II cavity preparation. Moreover, for the TMS training results, although the VM group generally scored higher than the MV group did, there was no significant difference between the two groups. In addition, the majority of participants agreed that the VSS was more difficult to operate than the TMS and that the VSS should be arranged before the TMS, and nearly 90% of participants were willing to use VSS for preclinical training in future experimental courses.

CONCLUSIONS

Introducing VSS in preclinical dental training is promising as it overcomes some of the drawbacks of TMS. It allows for repeated practice while avoiding accidental injuries, contamination, evaluation bias and material waste, and can also enhance the proficiency and operation accuracy of students. Moreover, VSS training was favoured to be arranged before the TMS training. A thorough VR simulation curriculum design is necessary to help dental students better adapt to virtual simulation systems.

Predicting novice dental students' performances in conventional simulation: A prospective pilot study using haptic exercises

Background/purpose

While haptic simulators in preclinical dentistry show promise, few studies predict novice dental students' performance in conventional simulations using haptic exercises. This study aimed to explore associations between (i) the number of failures in haptic exercises, (ii) the haptic performance index, and (iii) the quality of prosthetic preparation for cast crowns. Additionally, the students' perceptions regarding the use of the VirTeaSy Dental® haptic simulator was analyzed.

Materials and methods

Forty novice students were randomly selected from the Dental Faculty of Nantes University in September 2022 (mean age: 19.7 ± 1.8 years). They completed four haptic exercises using the VirTeaSy Dental® simulator and prepared cast crowns on pedagogical phantom-mounted models. Data on haptic variables, prosthetic preparation quality scores, and the number of failed/successful haptic exercises were collected. Correlation analyses were conducted, and the mean preparation quality score was compared between students who failed and those who passed the haptic exercises. A questionnaire assessing the students' perceptions when using VirTeaSy Dental® was completed.

Results

A correlation was found between the number of haptic exercise failures and the prosthetic preparation quality score, with students who failed showing lower scores (10.66 ± 3.69) compared to those who passed (13.72 ± 4.76) (P < 0.05). No correlation was observed for the haptic performance index. Students reported that the VirTeaSy simulator positively impacted their learning of milling gestures.

Conclusion

The number of haptic exercise failures can predict performance in conventional simulations and help identify students with manual dexterity issues, guiding personalized preclinical training adjustments.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

The impact of virtual reality simulation on dental education: A systematic review of learning outcomes and student engagement

PURPOSE

Virtual reality (VR) simulations have been increasingly employed to train dental students prior to clinical practice. According to the literature, blended learning designs in the form of VR simulations can be utilized by both dental students and instructors to provide quality education. They can also save time and improve motor skills before students enter clinical stages. Therefore, this study was designed to review the importance of available VR simulators and their impact on student learning and outcomes.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to review the literature systematically, and different databases such as PubMed, ScienceDirect, Cochrane Library, Scopus, and Google Scholar were searched (up to December 2023) for relevant articles using keywords: "virtual reality," "virtual reality simulators," "virtual reality simulation," and "dental education." The Mixed Methods Appraisal Tool was used to assess the study quality.

RESULTS

After a comprehensive literature search, 1477 research articles were identified, of which 16 were included in the present study. In terms of students' learning outcomes, engagement, and optimal approach, a significant improvement was observed compared to conventional training methods, specifically in their knowledge, performance, confidence, and psychomotor skills.

CONCLUSION

The findings suggest that VR simulators enhance the overall learning abilities of dental students and should be regarded as an integral component of the current curriculum. However, it is important to recognize that VR simulators cannot fully substitute traditional training methods; rather, they can effectively complement them.

Evaluating the effectiveness of a novel digital evaluation technology on dental preclinical crown preparation training

OBJECTIVES

To evaluate the assessment scores of a novel digital training program versus traditional training in dental preclinical crown preparation.

METHODS

Crown preparations in two consecutive preclinical training sessions were retrospectively collected and assigned to three groups: traditional group (TG), scanning group (SG), and digital evaluation group (DG). Students in the TG (n = 20) were taught by conventional visual grading, while students in the SG (n = 25) received three-dimensional feedback from digitally scanned preparations. All the SG students continued with supplementary digital evaluation and preparations were allocated into the DG (n = 25). Comparison of total scores between groups was investigated using independent samples t-test and paired samples t-test. Mann‒Whitney U-test and Wilcoxon signed-rank test were used to statistically analyze the differences in subdividing categories. The level of significance was p < 0.05. Questionnaires on the digital evaluation procedure were answered by students in DG.

RESULTS

The results showed a significant improvement (p < 0.01) in the total scores of DG than those of TG and SG, while there were no statistically significant differences between TG and SG. Scores of surface finish and undercut improved significantly in DG compared to TG and SG. The reduction scores of DG were significantly higher than those of SG. Students' feedback indicated a positive perspective on the implementation of the novel digital evaluation technology.

CONCLUSIONS

These findings suggest that digital evaluation technology is useful for preclinical crown preparation training. Attention should also be paid to studying the optimal integration of digital dentistry into traditional dental curricula and its effects on students' learning curves.

Simulator education in Japanese dental education

Advances in information and communication technology (ICT) and digital technology have contributed greatly to the development of educational methods, and new educational styles have been introduced over the past several years. In recent years, it has become possible to provide more realistic simulator training to prepare for patient care through the development of phantom heads with jaws and artificial teeth that reflect actual anatomical structures and composition. While these phantom head simulator resources are becoming more realistic, the development of digital devices utilizing virtual reality has enabled training that is even more realistic than the jaw models, such as scanning the teeth and transfer this scan into a VR model in the simulator which can be used to practice on prior to treating the patient. There was a basic research report on the development of VR haptics simulators in Japan about 20 years ago, but there have been no reports for some time since then, and there are several reports on VR haptics simulators published after 2018. Even now, in terms of utilization in dental education, it is difficult to say that VR haptics simulator has been widely introduced in Japan. The reasons for this may be related to the evaluation system for clinical dental skills in the Japanese dental education system, as well as issues with budgets and in current condition of dental clinical practice in dental schools. It must be that the VR haptics simulator will be utilized in terms of preparatory training for patient care as clinical dental practice participation is enhanced in the future.

Application of virtual reality and haptics system Simodont in Chinese dental education: A scoping review

INTRODUCTION

Virtual reality (VR) and haptic simulation technology have been increasingly implemented in dental training. Since the first haptic VR dental simulator (Simodont) was introduced 10 years ago, it has been applied in more than 40 universities in mainland China. This scoping review aimed to review literature, showcasing the teaching reform of dental virtual simulation in mainland China to global dental education peers.

METHODS

This scoping review was conducted using the PRISMA extension for scoping review guidelines. Seven electronic databases were searched, and two reviewers independently performed the selection and characterization of the studies.

RESULTS

The final scoping review included 12 studies. Four studies focused on the G. V. Black class II cavity, three on manual dexterity skills training, two on full metal crown preparation, one on pulpal access and coronal cavity preparation, one on flipped classroom teaching, and one on 'doctor-patient communication' skills.

DISCUSSION

The most critical scenarios, self-assessment, working posture, curriculum setting, training and cost are analysed and discussed.

CONCLUSION

Haptic simulation technology is a valuable complementary tool to the phantom head in dental education. The combined utilization of these two training devices has been superior to either in isolation. However, there is a lack of research on the sequencing of the two systems, as well as the appropriate distribution of curriculum between them. It is necessary for educators to organize or engage in experience sharing, collaboration and knowledge dissemination. These actions are essential for promoting effective teaching within dental educational institutions.

Effectiveness of haptic feedback devices in preclinical training of dental students-a systematic review

BACKGROUND

Acquisition of psychomotor skills is of utmost importance for competent preclinical restorative dentistry. Recent advancements in haptic feedback technology have been incorporated into preclinical dental education to augment the conventional phantom head-based training.

OBJECTIVE

This systematic review aims to assess the effectiveness of haptic feedback device, Simodont, in improving the skill development and learning outcomes of dental students during their preclinical training.

MATERIALS AND METHODS

Electronic databases Web of Science, Scopus, PubMed were searched for relevant studies since inception up until March, 2023. Only English language studies that assessed the effectiveness of haptic feedback devices in preclinical dental education were included. We excluded studies that did not use Simodont as the haptic feedback device or did not involve preclinical restorative work. Study quality was assessed using the revised Cochrane risk of bias tool and ROBINS-I. The primary goal of the study is to evaluate the efficacy of Simodont as a complementary training modality for dentistry students.

RESULTS

Results from 9 high-quality studies were analyzed and synthesized to evaluate the overall impact of haptic feedback devices on various aspects of preclinical training. The studies were conducted on 826 undergraduate dental students enrolled in various years of their training across dental colleges and universities in different parts of the world. A majority of studies showed some concerns regarding risk of bias. Haptic feedback devices added a new layer to Virtual Reality (VR) through the perception of touch and force feedback. It assisted junior dental students improve their psychomotor skills and movement skills. Instantaneous feedback on the students' performance helped enhance their self-assessment and correction, and also eliminated the subjectivity of evaluation. Data derived from virtual simulators helped stratify dental students and predict their clinical performance, providing an opportunity to tailor the learning process to meet individual diversity in students' expertise.

CONCLUSION

Based on the limited evidence available, Simodont was effective in preclinical training of dental students, offering advantages such as unlimited reproducibility, objective evaluation of preparation by computer assessment, and cost reduction. And further studies are warranted to explore the incorporation of patient's oral environment simulation for better skill training.

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.

The analysis and feedback from the performance of pre-clinical operation skills tests for clerkship in School of Dentistry, National Taiwan University in 2022

Background/purpose

The simulated pre-clinical operation skill test (PCOST) is part of the objective structured clinical examination (OSCE) and designed for clinical practice using manikins, physical typodonts, and instruments in the laboratory. This study tried to evaluate the influencing factors of the PCOST results for dental students.

Materials and methods

The 32 5th-year dental students of the dental school of National Taiwan University (NTU) joined the PCOST. The contents of PCOST included two specialties: operative dentistry (OD) and prosthodontics (PS). The examination content of OD was tooth 36 mesio-occluso-distal (MOD) cavity preparation, and that of PS was crown preparation and temporary crown fabrication of tooth 11. Several factors including the gender, age, and dental student admission ways (with or without the skill tests) were evaluated. Each scoring item was calculated. The students also filled the feedback questionnaire about the examination questions and suggestions for the PCOST.

Results

For both OD and PS, there were no significant differences in the mean PCOST scores between male and female dental students, between two groups of dental students with or without the skill tests in the admission process, and among three different age groups of dental students. According to the feedback questionnaire from the participated dental students, they were satisfied with the PCOST.

Conclusion

The PCOST is a good simulated examination in clinical practice. However, we still need to collect more PCOST data and feedback to revise the guideline of the PCOST, and to promote the performance of clinical works of dental students.

Virtual 3D tooth creation for personized haptic simulation training in access cavity preparation

Personalized medicine is a new medical concept to achieve patient-centered care. In dentistry, it is recognized for the customization of operative strategies and managements for oral diseases. Access cavity preparation in endodontic treatment is an irreversible procedure. Endodontic training will be more realistic by the implementation of clinical relevant 3D virtual reality technology. In this article, the authors first presented a personized case from a real patient to provide assess cavity preparation in haptic virtual reality dental simulator Simodont® (Nissin Dental Products Inc., Nieuw-Vennep, Netherlands). The practical framework to generate STL from cone beam computed tomography was demonstrated. A case of virtual tooth #26 access cavity preparation in Simodont® was established for trainee unlimited practices before performing the clinical procedure on a real patient. Taken together, access cavity preparation in a virtual environment using a 3D personized tooth may minimize procedural errors and facilitate clinical treatment outcome.