Virtual reality and haptics in dental education: Implementation progress and lessons learned after a decade.

INTRODUCTION: The search for alternative training environments in dentistry responded mainly to scarcity and lack of standardisation of training material and non-availability of specific clinical procedures. The development of haptic virtual reality (VR) dental trainers provides a platform where irreversible procedures can be safely and unlimitedly practised. The aim of this study was to assess the educational implementation of these devices and evaluate schools' satisfaction. METHODS: Dental schools that were using haptic VR dental trainers, were approached. The Dental Trainer User Inventory (DTUI), addressing the educational implementation and users' satisfaction, was developed and distributed. RESULTS: Twenty-seven schools completed the DTUI. The total number of VR dental trainers available varied from one to 42 devices with a mean of 7 devices. The dental trainer was mostly made available from the first year (63.0%) of the undergraduate program, but it was mostly integrated into the curriculum by the third year (70.4%). Curricular integration was reported by 18 schools (66.7%), while nine schools (33.3%) indicated that they had not yet achieved integration. Twenty-one schools (69.4%) were 'satisfied' or 'very satisfied' with the devices, while two schools (7.4%) were dissatisfied and six schools (22.2%) were neither satisfied nor dissatisfied. CONCLUSION: VR haptic dental trainers are implemented in multiple dental programs and are also being used for educational research and clinical training. Even though curricular changes and teachers' acceptance remain a challenge, most schools are satisfied with VR haptic dental trainers and would recommend the device to other schools.

Students' learning environment perception and the transition to clinical training in dentistry.

INTRODUCTION: The learning environment (LE) influences students' behaviour, and predicts academic achievement, satisfaction and success. Measuring students' perception of the LE provides relevant information for curricular quality assurance. In this study, a LE assessment was used to observe variations in students' LE perception throughout the curriculum, to illustrate the possible influence that preclinical training (Pt) and clinical training (Ct) have on students' learning experience. MATERIALS AND METHODS: All students in the six-year undergraduate dental programme (n = 849) at the Academic Centre for Dentistry Amsterdam (ACTA) were approached and divided into Pt and Ct groups according to their training phase in the curriculum. The LE was assessed using the Dundee Ready Educational Environment Measure (DREEM), and the results were evaluated using the Statistical Package for the Social Sciences (SPSS) software for distribution (Kolmogorov-Smirnov normality test), internal reliability (Cronbach's alpha) and comparative analysis (one-way ANOVA). RESULTS: The questionnaire was completed by 216 (response rate=65%) Pt students and by 379 (response rate=75%) Ct students. With a general DREEM score of 124.3, significantly higher scores were found during Pt (DREEM=133.4) in comparison with the Ct phase of the curriculum (DREEM=119.2). DREEM scores steadily decreased throughout the 6-year curriculum, with the highest drops in LE perception observed in the second and third years of the programme. Significant differences in all DREEM domains were observed, with lower scores for Ct. CONCLUSION: Students' LE perception deteriorates throughout the curriculum, especially within the Pt-Ct transition, during the second and third years of the programme. An inferior LE perception was observed in every domain of the LE questionnaire within this transition showing a learning experience, which requires an educational intervention. Further research is required to better understand the educational needs of the Pt-Ct transition at this school.

First experiences with patient-centered training in virtual reality.

CONTEXT: In preclinical dental education, plastic and extracted teeth have been broadly used for skills training without specific focus on the patient behind the procedure. A patient-centered approach remains challenging in traditional simulation, which does not resemble realistic clinical situations. OBJECTIVE: This article describes the development and first experiences with a patient-centered virtual reality training module (PC-VR) that allows dental care providers to prepare, beforehand and in virtual reality (VR), specific procedures required by their patients. Experiences with this patient-centered practice are described to reflect on its value for clinical training in dentistry. DESIGN: Using an intraoral scanner, digital impressions of 10 patients were made; these served as stereolithography (STL) digital files, which were converted into volumetric haptic models for display in a VR dental simulator. In this study, students' experiences were investigated through a short open-answer survey in 2018. Atlas.ti was used for qualitative analysis of the answers through the inductive methodology of the grounded theory approach. RESULTS: Drillable virtual models of real patients were made available for training using VR. Inductive analysis of the experiences identified 5 dimensions describing the main features of PC-VR: added value, competence development, self-efficacy, outcomes, and room for development. CONCLUSION: This article provides a general overview of the possibilities and challenges of the implementation PC-VR in dental education. Although concrete effects on trainees' self-confidence and performance are yet to be determined, all participants appreciated the opportunity to explore clinical situations before experiencing them in the context of a real patient.

The Effect of Variations in Force Feedback in a Virtual Reality Environment on the Performance and Satisfaction of Dental Students.

INTRODUCTION: The aim of this study was to investigate the transfer of skills between various levels of force feedback (FFB) using the Simodont dental trainer (Moog, Nieuw-Vennep, the Netherlands). Students practiced a manual dexterity exercise in a virtual reality environment at a standard level of FFB and then were tested at the standard and an altered level of FFB. In addition, the students' satisfaction with the training exercise was evaluated. METHODS: One hundred twenty-six first-year dental students were randomly distributed into four groups and underwent a manual dexterity test in the virtual reality environment with automatic assessment after a 3-month period of practicing with standard FFB. The test consisted of drilling with the standard FFB and an altered level of FFB to evaluate the effect on performance. After the test, the participants completed a questionnaire. RESULTS: The results showed that 74% of the students who passed completed between one of three and three of three successful attempts at FFB levels at which they had not previously practiced. CONCLUSIONS: The results of this study imply that if students practice a sufficient amount of time at one level of FFB, a skill is transferable from one level of FFB to another.

The Effect of Force Feedback in a Virtual Learning Environment on the Performance and Satisfaction of Dental Students.

INTRODUCTION: This study investigated the effect of force feedback (FFB) on student performance in a virtual learning environment (VLE) using the Simodont dental trainer (Moog, Nieuw-Vennep, the Netherlands) and evaluated the students' satisfaction with and without FFB. METHODS: The Simodont dental trainer, which was used as a VLE, was randomly assigned to 101 first-year dental students with no previous experience in cutting a tooth or working in a VLE with FFB. This study was designed as a crossover study. One half of the students practiced without FFB, whereas one half practiced with FFB. Both groups practiced four sessions lasting 45 minutes on a cross preparation. In the fifth session, test 1 was scheduled. After test 1, the same practicing and testing protocol was followed, although the environment was switched. After test 2, participants filled out a questionnaire. For the statistical analysis, only the questionnaires of the students who participated in both tests were processed. RESULTS: The results of test 1 and test 2 revealed that only students who used FFB were able to pass the tests. The questionnaire outcomes supported the results of both tests; 100% of the students preferred working with FFB. CONCLUSIONS: The results suggest that FFB is important for performance in a VLE and essential for satisfaction.