Establishing CAD/CAM in Preclinical Dental Education: Evaluation of a Hands-On Module

Use of digital tools for preclinical training in complete denture: A pilot study

INTRODUCTION

Advances in CAD-CAM complete dentures open up opportunities in preclinical laboratory education. A cross-over study was conducted to assess the benefit of digital training in custom tray fabrication. Hypotheses were that digital training improved conceptual skill acquisition and that assessment of digital work helps in the discrimination of students' difficulty.

MATERIALS AND METHODS

Third-year students were allocated either into group A and took the manual practical classes before the digital ones, or into group B (N = 154). Prior to the sessions, a motor skill test was conducted. The influence on the learning process was evaluated by comparing the groups' results to the manual lab work with a Student's t-test. The effectiveness of the assessment in discriminating manual aptitude and conceptual skill was studied through Spearman's rank coefficient between digital and manual scores in conceptual skill and with a subgroup analysis according to the results of the motor skill test. The level of significance was set up at .05. Students' satisfaction was also assessed with a questionnaire.

RESULTS

Students in group B achieved better scores. Spearman's rank coefficient test showed a weak correlation, R = .16. For manual lab work, the most manually skilled students did significantly better. In contrast, for the digital session, the medium manually skilled students did better. More than half of the students (55%) found the manual and digital sessions complementary, without identifying any difference depending on the learning sequence.

CONCLUSION

Digital training improved the students' results in the conventional practical exercise. Assessments of the digital and conventional custom trays were complementary in order to distinguish conceptual and motor skills.

Computer aided design/computer aided manufacturing (CAD/CAM) technology in the undergraduate dental programs in the MENA region

INTRODUCTION

The aim of this study was to understand the trends of teaching Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) in the undergraduate dental curriculum in the MENA region by conducting an online survey among the undergraduate dental colleges in this region.

MATERIALS AND METHODS

An online survey was conducted using Google Forms consisting of 20 questions that could be answered by "yes" or "no" responses, multiple-choice answers or in a descriptive, "open" format. A total of 55 participants from the MENA region representing their dental college were requested to participate in this study.

RESULTS

The response rate of the survey was 85.5% following the twofold follow-up reminders method. Although the vast majority of professors demonstrated vital knowledge in the practical use of CAD/CAM, the majority of them did not provide theoretical and practical training on CAD/CAM in their institutions. Among the schools with established levels of teaching CAD/CAM, nearly 50% of them provide both pre-clinical and clinical training on CAD/CAM. Despite the availability of extra-curricular training courses on CAD/CAM outside the university setting, there is a lack of advocating for students to enrol in those courses by the institutions. More than 80% of the participants agreed that CAD/CAM has a strong future in chair-side dental clinics and CAD/CAM needs to be incorporated within undergraduate studies.

CONCLUSION

Based on the results of the current study, it is understandable that an intervention is required by the dental education providers to cope with the growing demand for CAD/CAM technology for the current and future dental practitioners of the MENA region.

Efficacy of CAD/CAM technology in dental procedures performed by students: A systematic scoping review of randomized clinical trials

To assess the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) in dental procedures performed by dental students.

METHODS

A systematic scoping review was performed. MeSH terms and keywords were specified to assess randomized clinical trials (RCTs) in all idioms.

RESULTS

Nine RCTs that include 520 students were selected. Two RCTs studied implant placement, and the rest of the trials explored implant impressions, intraoral scans, canal obturation, head positioning errors in panoramic images, deep caries and pulp exposure, diagnosis of temporomandibular disorders, and a tooth for restorations. Considering efficacy, variable results were found. The RCTs that explored implant impressions, deep caries and pulp exposure, and diagnosis of temporomandibular disorders showed better results when CAD/CAM technology was performed by students. Two RCTs that investigated implant placement presented contradictory outcomes; one showed better results when CAD/CAM systems were used while the other described similar results to conventional methods. The remaining RCTs did not find differences with conventional procedures. Considering the time spent during the procedures, two studies showed no differences between groups, while another indicated that the time spent was less for digital impressions (p < 0.001). A continuous decrease in scanning time was also perceived for all groups as skills in intraoral scanning augmented (p = 0.0005). Students indicated an interest in utilizing the CAD/CAM systems and recognized that their abilities were enhanced.

CONCLUSIONS

Considering the limitations of this review and the limited number of RCTs evaluated, students recognized that their skills improved using CAD/CAM systems; however, only in some specific procedures greater efficacy and less time spent were observed when this technology was used. Dental students also showed great interest in using these techniques.

Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials

To estimate the efficacy of three-dimensional (3D) models for medical education.

METHODS

A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted.

RESULTS

Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced.

CONCLUSIONS

Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Implementation of CAD/CAM program in a nonface-to-face classroom environment due to the COVID-19 pandemic

PURPOSE/OBJECTIVES

This study aimed to evaluate a nonface-to-face crown designing module in a preclinical dental course.

METHODS

Free dental planning software (Blue Sky Plan) was installed on the personal computers of dental college students, and a #46 full veneer crown designing practice was performed individually. An online survey was conducted on the computers' specification and main usage of the students, the practice process, and results. Statistical analysis was conducted to analyze the association between variables, such as "operating system," "central processing unit ," "number of cores," "random-access memory (RAM)," "graphic card," and task performance.

RESULTS

Of the D2 students, 75.4% (52 of 69) responded to the survey. Overall, 96% of the respondents used their computers, and all respondents had no problem running the program. Most of the students marked their level of computer literacy as intermediate and had purchased the computers for the purpose of performing light work. The most common specifications of the computer were Intel i5, quad core, 8 GB RAM, and Windows 10. Students had little experience with computer-aided design/computer-aided manufacturing before the class. The relationship between computer specifications and task performance was not statistically significant.

CONCLUSIONS

Overall, students with intermediate-level computer literacy used computers with less than the recommended specifications of the program; however, they were able to run the program and individually proceed with modules to submit results. Using an individually available crown designing program can provide an opportunity to diversify curricula and broaden students' perspectives even under circumstances like the COVID-19 pandemic that limits intimate face-to face classes.

Implementation of a Full Digital Workflow by 3D Printing Intraoral Splints Used in Dental Education: An Exploratory Observational Study with Respect to Students' Experiences

Fully digital workflows gained acceptance in dental practice and thereby are of interest for undergraduate education. An exploratory clinical observation was designed to track the implementation of such a workflow with novice digital users in order to describe its feasibility, time investment, and pitfalls.

METHODS

Students were invited to provide feedback for their experiences with a training module that consisted of the following: intraoral scanning, computer-aided design (CAD), manual finishing, and insertion of a 3D-printed bite splint for the lower jaw.

RESULTS

A total of 82 fourth-year students participated in the module. The average time required to perform an intraoral scan was 17 m 5 s, and all students were able to design a splint with an average time of 2 h 38 m. Students who indicated prior experience with CAD seem to outperform inexperienced students in both CAD task completion and intraoral scanning. The initial fit was reported as clinically acceptable by 68.5% of the participants, while 79% rated the workflow as very good to satisfactory and indicated that the training was helpful for dental practice.

CONCLUSIONS

The implementation of a digital workflow in undergraduate dental education is feasible and has acceptable clinical results. However, CAD is time-intensive, and the experience can be challenging.

Pre‐doctoral dental students’ computer‐aided design/computer‐aided manufacturing‐related education, knowledge, attitudes and behavior: A national survey

OBJECTIVES

Computer-aided design/computer-aided manufacturing (CAD/CAM) technology transformed the world of restorative dentistry. The objectives were to assess pre-doctoral dental students' CAD/CAM-related education, knowledge, attitudes, and professional behavior, and to explore the relationships between the year in dental school and these constructs.

METHODS

A total of 358 pre-doctoral dental students from 17 of the 68 US dental schools responded to a web-based anonymous survey.

RESULTS

CAD/CAM-related classroom-based education was likely to happen in lectures (87.2%) and simulated exercises as part of a class (86.9%). Faculty were most likely to provide CAD/CAM instruction (87.9%), with staff (44.8%) and dental technicians (20.2%) being engaged as well. Preclinical education included video demonstrations (81.8%), demonstrations during a lecture (76.4%) or for smaller groups of students (69.2%), hands-on workshops (65.6%), and individual instruction (50.4%). Considering the digital workflow in clinics, 45.2% reported using intraoral scans. The more advanced the students were in their program, the more CAD/CAM knowledge (r = 0.27; p < 0.001) and knowledge about what can be fabricated with CAD/CAM technology they had (r = 0.25; p < 0.001). However, the student's satisfaction with the education about CAD/CAM did not increase over the years (r = -0.04; n.s.) and remained neutral, while their attitudes became more positive the longer they were in dental school (r = 0.13; p < 0.05). Their attitudes were quite positive, with most students considering that CAD/CAM is the future of dentistry (5 = most positive: Mean = 4.34), agreeing that they enjoyed working with CAD/CAM (Mean = 4.11) and that CAD/CAM has the potential of making them a better dentist (Mean = 4.07).

CONCLUSIONS

The majority of students in the US dental schools appreciate CAD/CAM technology, consider it to be the future of dentistry, and believe it makes them better dentists. The fact that the majority is not satisfied with their classroom-based, preclinical and clinical CAD/CAM-related education should therefore be a call to action to rethink dental school curricula in this content area.

Rating criteria to evaluate student performance in digital wax-up training using multi-purpose software

PURPOSE

The aim of this study was to introduce rating criteria to evaluate student performance in a newly developed, digital wax-up preclinical program for computer-aided design (CAD) of full-coverage crowns and preliminarily investigate the reliability and internal consistency of the rating system.

MATERIALS AND METHODS

This study, conducted in 2017, enrolled 47 fifth-year dental students of Okayama University Dental School. Digital wax-up training included a fundamental practice using computer graphics (CG), multipurpose CAD software programs, and an advanced practice to execute a digital wax-up of the right mandibular second molar (#47). Each student’s digital wax-up work (stereolithography data) was evaluated by two instructors using seven qualitative criteria. The total qualitative score (0-90) of the criteria was calculated. The total volumetric discrepancy between each student’s digital wax-up work and a reference prepared by an instructor was automatically measured by the CAD software. The inter-rater reliability of each criterion was analyzed using a weighted kappa index. The relationship between the total volume discrepancy and the total qualitative score was analyzed using Spearman’s correlation.

RESULTS

The weighted kappa values for the seven qualitative criteria ranged from 0.62 - 0.93. The total qualitative score and the total volumetric discrepancy were negatively correlated (ρ = -0.27, P = .09, respectively); however, this was not statistically significant.

CONCLUSION

The established qualitative criteria to evaluate students’ work showed sufficiently high inter-rater reliability; however, the digitally measured volumetric discrepancy could not sufficiently predict the total qualitative score.

Effect of training on time efficiency and marginal adaptation of computer-aided design/computer-aided manufacturing crowns among dental students

INTRODUCTION

The computer-aided design/computer-aided manufacturing (CAD/CAM) technology has revolutionised dentistry at present. An operator's skills can affect the overall clinical duration and marginal accuracy of the prosthesis fabricated through this workflow. The aim of this study was to assess the effect of CAD/CAM hands-on training compared with that of a self-instructional video on the performance of dental students in digital impression and fabrication of a CAD/CAM crown.

METHODS

In this cross-sectional study, 30 undergraduate dental students were shown a CEREC demonstration video. Each operator then captured a digital impression using the intra-oral scanner, and a crown was subsequently milled. All participants underwent a training course before repeating the process. Marginal discrepancy for each crown on its abutment tooth was measured before and after training using a stereomicroscope and was evaluated using Wilcoxon signed rank test. The duration taken for the process was recorded before and after training and evaluated using paired t-test.

RESULTS

The overall mean ±standard deviation marginal adaptation for the CEREC crowns was 78.15 ± 42.83 μm before training and 52.41 ± 17.12 μm after training. The Wilcoxon signed rank test found significant difference (p < .05) in terms of marginal adaptation of crowns fabricated before and after training. Paired t-tests showed that the time efficiency after training significantly improved compared with that before training.

CONCLUSIONS

Training with guided feedback is crucial to improve the time efficiency of making a digital impression and marginal adaptation of fixed prosthesis using the CAD/CAM technology.

The soap carving versus the digital sculpting: Evaluation of students' preferences and performance in dental anatomy course: Pilot study

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 ≤ .05.

RESULTS

Forty 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 = .004) and the mean time of DS and SC methods for females (p = .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 = .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.

Immersive 3D Educational Contents: A Technical Note for Dental Educators

Three-dimensional files featuring patients’ geometry can be obtained through common tools in dental practice, such as an intraoral scanner (IOS) or Cone Beam Computed Tomography (CBCT). The use of 3D files in medical education is promoted, but only few methodologies were reported due to the lack of ease to use and accessible protocols for educators. The aim of this work was to present innovative and accessible methodologies to create 3D files in dental education. The first step requires the definition of the educational outcomes and the situations of interest. The second step relies on the use of IOS and CBCT to digitize the content. The last “post-treatment” steps involve free software for analysis of quality, re-meshing and simplifying the file in accordance with the desired educational activity. Several examples of educational activities using 3D files are illustrated in dental education and discussed. Three-dimensional files open up many accessible applications for a dental educator, but further investigations are required to develop collaborative tools and prevent educational inequalities between establishments.

Technology-dependent pedagogical process redesign: leveraging lean methods

Purpose

This research compared the efficacy of process outcomes leveraging lean methods versus traditional pedagogy applied to dental education dependent on emerging technology. The pedagogical objective was to improve system efficiency without compromising traditional outcomes of effectiveness (quality).

Design/methodology/approach

The research team tested the efficacy of a lean A3 framework to identify, remove waste and redesign a technology-dependent simulation laboratory course (CAD/CAM/IR Restorative Dentistry). Students were also sensitized to time-in-chair to introduce a stronger patient focus. Baseline data collected from a control group were statistically compared to the research group's data after the course redesign. In addition, course time allocations were measured and then compared.

Findings

The results showed the interventions significantly reduced procedure cycle times without compromising quality. Additionally, the course was more efficiently conducted as measured by course time allocations.

Practical implications

This research demonstrated that the use of the A3 framework enhanced learning through process documentation, reengineering and systems optimization resolving issues of inefficiency associated with the CAD/CAM/IR pedagogy. This work is significant because it demonstrates the practice of using lean interventions to redesign and improve a technology-based healthcare course to maximize benefits.

Originality/value

This research is the first to examine how to leverage lean methods in a healthcare simulation laboratory, dependent on innovative technology, to educate and train future practitioners. This research applied statistical rigor in a controlled experiment to maximize its applicability and generalizability.

Technical Protocol for Presenting Maxillofacial Prosthetics Concepts to Dental Students using Interactive 3D Virtual Models within a Portable Document Format

An appropriate presentation of maxillofacial defects and their prosthetic rehabilitation concepts using traditional two-dimensional educational materials is challenging for dental students and prosthodontics residents. This technique article introduces a simple approach to visualize and communicate three-dimensional (3D) virtual models embedded into a portable document format (PDF) file for presenting maxillofacial prosthetics concepts and enhancing students' spatial ability when learning maxillofacial prosthetics. MeVisLab software was used to combine various maxillofacial models and save them as a single 3D model. Adobe Acrobat Pro DC software was used to import the 3D model and create interactive visualization PDF documents. Adobe reader software was then used to visualize the content of the PDF documents. This approach allows educators to develop PDF files with multiple 3D models for teaching maxillofacial prosthetics concepts and communicate them with their students. Students can simply open the PDF file, activate the 3D mode, and interactively manipulate the 3D models to enhance their spatial ability for learning maxillofacial prosthetics.

Digital Undergraduate Education in Dentistry: A Systematic Review

The aim of this systematic review was to investigate current penetration and educational quality enhancements from digitalization in the dental curriculum. Using a modified PICO strategy, the literature was searched using PubMed supplemented with a manual search to identify English-language articles published between 1994 and 2020 that reported the use of digital techniques in dental education. A total of 211 articles were identified by electronic search, of which 55 articles were selected for inclusion and supplemented with 27 additional publications retrieved by manual search, resulting in 82 studies that were included in the review. Publications were categorized into five areas of digital dental education: Web-based knowledge transfer and e-learning, digital surface mapping, dental simulator motor skills (including intraoral optical scanning), digital radiography, and surveys related to the penetration and acceptance of digital education. This review demonstrates that digitalization offers great potential to revolutionize dental education to help prepare future dentists for their daily practice. More interactive and intuitive e-learning possibilities will arise to stimulate an enjoyable and meaningful educational experience with 24/7 facilities. Augmented and virtual reality technology will likely play a dominant role in the future of dental education.

Assessment of Digital Workflow in Predoctoral Education and Patient Care in North American Dental Schools

Technology has revolutionized the field of dentistry, and digital workflow has become commonplace in everyday dental practices. However, are future practitioners prepared to enter into an increasingly digitized world? The aim of this study was to determine the extent to which digital modalities were being taught to predoctoral dental students and used for patient care in dental schools throughout North America. A 35-question survey was sent in February 2019 to all 76 dental schools in the U.S. and Canada. After 90 days, 54 recorded responses were received, for a 71% response rate. Students were reported to be using CAD/CAM technology in 50 (93%) of the 54 responding schools. While almost all schools responding to the survey were using digital scanning, there was disparity among them in terms of the types and frequency of procedures for which digital impressions were utilized. This study found that the incorporation of CAD/CAM technology in predoctoral dental curricula varied widely. However, it was clear that the relative dearth of well-trained faculty members and the number of CAD/CAM units available to students limited its use. It is imperative that more emphasis is placed on the utilization of digital workflow in North American dental schools for future practitioners to practice contemporary restorative dentistry.

Lean Methods Applied to CAD/CAM Pedagogy in the Dental Simulation Laboratory

Dental education is incorporating computer-assisted design/computer-assisted manufacturing (CAD/CAM) into patient care delivery. The aim of this study was to determine if lean production methods applied to the preclinical phase of dental education would reduce the students' time (efficiency) to complete CAD/CAM indirect restorations (CAD/CAM IR) without compromising the desired quality of the CAD/CAM tooth preparations (effectiveness). In 2016, all third-year students at one U.S. dental school were randomly assigned to control and research groups (approximately 33 per group). The control group was taught using existing methods, while the course was redesigned to incorporate lean methods for the research group. Cycle times of the CAD/CAM IR process for both groups were collected and statistically analyzed to compare the effectiveness of the redesign. Standardized grading forms and tools were used to assess the quality of the CAD/CAM tooth preparations. The research group demonstrated significantly faster preparation times with both crowns and onlays (p<0.05) than the control group. The research group also produced CAD/CAM crown and onlay designs at a significantly faster pace than the control group (p<0.05). There was no significant difference between the control and research groups associated with the scanning process times (p>0.05) nor in the quality of the CAD/CAM tooth preparations (p>0.05). This study demonstrated that lean methods applied to pedagogy significantly decreased preparation and design times in a CAD/CAM restorative dentistry course without compromising the quality of the CAD/CAM tooth preparations.

Performance and perception of dental students using three intraoral CAD/CAM scanners for full-arch scanning

PURPOSE

To assess the average full-arch scanning time, perception and likelihood of future adoption of technology by final-year dental students using three different Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) intraoral scanning systems.

METHODS

Final-year undergraduate Dental Students (FDS), with no prior experience of intraoral scanning, full-arch scanned (IOS) a mannequin head-mounted model under supervision. Three scanning systems were used, TRIOS Colour (TRIOS); True Definition (TDef); and CEREC AC OmniCam (CEREC). Thereafter, FDS completed a questionnaire to assess their perception of IOS. Data were analysed by Generalized Estimating Equations, Fisher's exact tests and logistic regression.

RESULTS

Forty-nine FDS participated. Average full arch IOS time varied significantly (p<0.001) among the TRIOS, CEREC, and TDef, at 4min (n=48), 4min 42s (n=33), and 7min 32s (n=41) respectively. IOS using the TRIOS was significantly (p<0.001) the quickest, while TDef was the slowest (p<0.001). Seventy-one percent of FDS had positive overall IOS experience. FDS who reported intraoral scanning was timesaving compared with conventional impressions were more likely to adopt the technology after graduation (odds ratio (OR)=11.91, 95% confidence interval (CI)=2.56-55.45, p=0.002).

CONCLUSIONS

Intraoral scanning performance of novice users varied significantly and was dependent on the scanning system used. The questionnaire showed that the overall IOS experience was positive amongst FDS. The perception of time-saving, when using IOS versus conventional impression methods, determined the likelihood of future adoption of the technology.

Dental Students' Perceptions of Digital and Conventional Impression Techniques: A Randomized Controlled Trial

The aim of this randomized controlled trial was to analyze inexperienced dental students' perceptions of the difficulty and applicability of digital and conventional implant impressions and their preferences including performance. Fifty undergraduate dental students at a dental school in Switzerland were randomly divided into two groups (2×25). Group A first took digital impressions in a standardized phantom model and then conventional impressions, while the procedures were reversed for Group B. Participants were asked to complete a VAS questionnaire (0-100) on the level of difficulty and applicability (user/patient-friendliness) of both techniques. They were asked which technique they preferred and perceived to be more efficient. A quotient of "effective scan time per software-recorded time" (TRIOS) was calculated as an objective quality indicator for intraoral optical scanning (IOS). The majority of students perceived IOS as easier than the conventional technique. Most (72%) preferred the digital approach using IOS to take the implant impression to the conventional method (12%) or had no preference (12%). Although total work was similar for males and females, the TRIOS quotient indicated that male students tended to use their time more efficiently. In this study, dental students with no clinical experience were very capable of acquiring digital tools, indicating that digital impression techniques can be included early in the dental curriculum to help them catch up with ongoing development in computer-assisted technologies used in oral rehabilitation.