The effectiveness of a 3D virtual tooth identification test as an assessment tool for a dental anatomy course

The level of confidence of dentists in identifying intact and sectioned teeth

OBJECTIVE

This study aimed to assess the confidence levels of dentists in identifying intact and sectioned human teeth and to identify the factors contributing to variations in confidence levels.

DESIGN

An anonymous Jisc e-survey showing 14 questions was sent to dentists worldwide. Apart from acquiring demographic details of the participants, ten three-dimensional (3D) tooth models were presented for tooth identification including the opinion on the level of confidence in identifying. They included seven permanent and three deciduous teeth in intact or sectioned state. The tooth models were created and manipulated using ZBrush software (Maxon Industries, Inc.) and uploaded to the Sketchfab model hosting platform. The accuracy of results was quantitatively analysed in five categories, namely: (I) tooth type, (II) region, (III) tooth classification, (IV) tooth within the same class, and (V) FDI World Dental Federation notation.

RESULTS

Most participants received education in dental anatomy at the undergraduate level. No significant differences in accuracy were seen between intact and fractured tooth models. The highest accuracy was seen in Category I (Permanent or Deciduous, 0.74) and the lowest in Category V (FDI Notation, 0.26). The perceived confidence of each participant (total of 56) was seen to have the highest accuracy when the participant opined limited confidence, although with no significant differences for each category (P>0.05). Moreover, the most common error was found in the category II region, where participants could not correctly locate the tooth on the right or left side of the mouth in six 3D tooth models.

CONCLUSION

The assessment of intact and sectioned teeth has not presented differences in accuracy. High accuracy was seen when dentists categorised permanent and deciduous teeth. The highest accuracy in results was linked to the limited confidence of dentists but factors contributing to this level of confidence are not clear in this study. More attention should be paid to the dental features that distinguish location on the right or left side of the mouth.

Dental damage: Creating 3D anatomical models to illustrate destructive effects on human teeth

Forensic odontologists often must identify human remains with damaged teeth. This damage is due to high-impact accidents, violence, or disasters. This 2-part study aimed to create two 3D digital models. They should show the destructive effects of physical and chemical agents on human teeth and popular dental materials. Researchers created an e-survey to investigate how digital models are perceived as an educational tool for Forensic Odontology. Also, a systematic review assessed experimental studies on the effects of high temperature on various prosthodontic materials. According to the results of the survey, most participants (n=69; 79%) agreed that they would find a 3D model useful for training. Participants misidentify images of burned and broken teeth under Ellis and Davey system (1970). The systematic review identified dental implant and dental crown as the most studied prosthodontic materials exposed to heat. The researchers designed dental damage model 1 to represent restored and unrestored burnt teeth, postmortem pink teeth, and traumatic injuries. The dental damage model 2 was created to demonstrate the effects of various types of damage to different prosthetic and restorative dental materials, as well as the impact of acid, water, and burial on restorative materials as additional information. Both models were edited, sculpted and painted using 3D modelling software ZBrush (2020. 1.4) and Blender (version 3.6.2). The dental damage models were uploaded and labelled on Sketchfab (Cédric Pinson, Paris, France). The study's materials could transform the teaching of complex tooth changes.

Identifying teeth and tooth fragments from digital 3D models

Dental anatomy is an essential skill for human identification in forensic odontology. With the advent of technology enabling virtual autopsies, there is scope for virtual consultation by forensic odontologists especially when the expertise is unavailable but needed in zones of conflict or disasters. This study aimed to investigate potential benefits and challenges of identifying intact and damaged teeth from 3D scanned digital models. Ten 3D tooth models - nine permanent and deciduous human teeth and one animal tooth were uploaded on a hosting platform. A 3-part survey was circulated among 60 forensic odontologists with questions about demography (P1), tooth identification of the scanned 3D models (P2) and the perceived usefulness of 3D models for tooth identification (P3). This was the first time that a survey required the identification of individual human teeth (intact or not) and animal tooth combined. The response rate for study participation was 58%. Substantial agreement among participants was seen in the determination of tooth classification (i.e., molars, premolars) or non-human and tooth within the same tooth class (i.e., lateral incisors, second molar) (both k=0.61). The least agreement (k=0.21) was seen in identification of tooth according to the FDI notation with a mean accuracy of 0.34. While most responders correctly identified the animal tooth, most incorrect responses were seen in the identification of the intact third molar. While 3D-scanned teeth have the potential to be identified virtually, forensic odontologists should continuously test their skills in tooth morphology and dental anatomy of humans (damaged or not) and animals.

Different Methods of Teaching and Learning Dental Morphology

Dental anatomy education is traditionally structured into theoretical and practical modules to foster both cognitive and psychomotor development. The theoretical module typically involves didactic lectures where educators elucidate dental structures using visual aids. In contrast, practical modules utilize three-dimensional illustrations, extracted and plastic teeth, and tooth carving exercises on wax or soap blocks, chosen for their cost, ease of handling, and fidelity in replication. However, the efficacy of these traditional methods is increasingly questioned. The criticism in this concern is that oversized carving materials may distort students' understanding of anatomical proportions, potentially affecting the development of necessary skills for clinical practice. Lecture-driven instruction, on the other hand, is also criticized for its limitations in fostering interactive learning, resulting in a gap between pre-clinical instruction and practical patient care. In this study, we review the various educational strategies that have emerged to enhance traditional dental anatomy pedagogy by describing the effectiveness of conventional didactic lectures, wax carving exercises, the use of real and artificial teeth, the flipped classroom model, and e-learning tools. Our review aims to assess each method's contribution to improving clinical applicability and educational outcomes in dental anatomy, with a focus on developing pedagogical frameworks that align with contemporary educational needs and the evolving landscape of dental practice. We suggest that the optimal approach for teaching tooth morphology would be to integrate the digital benefits of the flipped classroom model with the practical, hands-on experience of using extracted human teeth. To address the challenges presented by this integration, the creation and standardization of three-dimensional tooth morphology educational tools, complemented with concise instructional videos for a flipped classroom setting, appears to be a highly effective strategy.

Innovations in assessment in health professions education during the COVID-19 pandemic: A scoping review

BACKGROUND

After an initial period of uncertainty during the COVID-19 pandemic, medical universities responded to the pandemic by innovating their methods of teaching-learning and assessment. This scoping review aimed to identify innovations in assessment in medical, dental and nursing education at the undergraduate and postgraduate levels during the pandemic.

METHODS

This review was conducted utilising Arksey and O'Malley's framework where three electronic databases-PubMed, Embase and Web of Science-were systematically searched in February 2022 for articles in English describing innovations in assessments published in or after January 2020.

RESULTS

A total of 70 articles were included in the review. Among the primary research articles, 82.1% reported online assessment, 76.1% were related to medical speciality, 74.6% described assessment at the undergraduate level, 68.7% described summative assessment and 58.2% reported assessment of practical skills. All assessments of theoretical knowledge were done virtually with MCQ being the most used assessment tool and virtual OSCE being the most popular assessment tool to assess practical skills; however, it was acknowledged that the assessment of procedural skills was its limitation. Although the studies described the newer forms of assessments as feasible and acceptable, few studies reported the reliability and validity of the assessments.

CONCLUSIONS

This scoping review identified several innovations in assessment during the COVID-19 pandemic with an overall shift towards virtual or hybrid forms of assessment. However, there was a dearth of evidence regarding the effectiveness of these assessment tools suggesting a need for more research before the tools can be implemented post-pandemic.

Visualizing Anatomy in Dental Morphology Education

Tooth morphology is a foundation course for all dental healthcare students including dentists, dental hygiene, dental therapy, and dental nursing students. This chapter explores the conventional and innovative teaching methods to deliver tooth morphology educational modules. The teaching tools are explored with a 2D and 3D lens, with a particular focus on visualization, student understanding, and engagement. Traditional methods of teaching tooth morphology must be complemented with innovative pedagogical approaches in order to maintain student's attention and accommodate their diverse learning methods. Teaching 3D anatomy enables students to visualize and spatially comprehend the link between various anatomical components. Online tests and quizzes motivate students and are also beneficial in preparing students for exams. Online self-examinations offering visualization with 3D teeth enable students to evaluate their knowledge and offers immediate feedback, which aids in the long-term retention of information. These tools can be as efficient as other teaching methods, allowing the students to study at their own pace and with repetition. The authors conclude that blended and innovative teaching methods should supplement student learning and not replace, traditional face-to-face educational methods.

Mobile virtual tooth morphology teaching environment for preclinical dental students

OBJECTIVES

Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies.

METHODS

Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively.

RESULTS

Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology.

CONCLUSIONS

The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Virtual dental teaching and its effect on test success - A cross-over study

OBJECTIVES

The aim of this cross-over investigation was to analyze the effect of virtual teaching using virtual reality (VR) within a dental learning environment by preclinical students with or without dental professional experience on test performance.

METHODS

Preclinical students (N = 82) were randomly divided into two groups for cross-over testing of tooth morphology knowledge: (a) anterior VR-group (group 1) using the VR-glasses as an additional learning tool for the anterior tooth morphologies and (b) posterior VR-group (group 2) using it for the posterior tooth morphologies also in addition to conventional learning. All students used the VR-glasses for 1 week independent of time and location depending on group. The students had to recognize teeth (anterior or posterior within two separate tests after three [anterior test] and 6 weeks [posterior test] of practical course) and note the tooth number and characteristics in written form. Former dental experience (dental technician/assistance) was noted. Test results were analyzed to quantify the effect of virtual teaching on test scores. Data were analyzed with the Kolmogorov-Smirnov and Mann-Whitney U test (p = 0.05).

RESULTS

By differentiating the two student groups (use of VR glasses for anterior/posterior teeth) within the dental experience group, significantly better test results (p = 0.040) were shown for group 1 in the total posterior teeth test score. Furthermore, no other significant differences, but a possible tendency, in the test results and thus no effect of the use of the VR glasses on both VR groups could be analyzed (p ≥ 0.051).

CONCLUSIONS

Using the VR tooth learning environment predominantly did not lead to a significant improvement of test results. Anterior teeth test scores predominantly showed significantly better results than posterior teeth test scores.