Training on the haptic VR simulator and conventional phantom head had equivalent effects on minimizing procedural errors in endodontic access cavity preparation.

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We have developed a haptic virtual reality system for dental skill training. In this study we examined several kinds of kinematic information about the movement provided by the system supplement knowledge of results (KR) in dental skill acquisition. The kinematic variables examined involved force utilization (F) and mirror view (M). This created three experimental conditions that received augmented kinematic feedback (F, M, FM) and one control condition that did not (KR-only). Thirty-two dental students were randomly assigned to four groups. Their task was to perform access opening on the upper irst molar with the haptic virtual reality system. An acquisition session consisted of two days of ten trials of practice in which augmented kinematic feedback was provided for the appropriate experimental conditions after each trial. One week after, a retention test consisting of two trials without augmented feedback was completed. The results showed that the augmented kinematic feedback groups had larger mean performance scores than the KR-only group in Day 1 of the acquisition and retention sessions (ANOVA, p<0.05). The apparent differences among feedback groups were not signiicant in Day 2 of the acquisition session (ANOVA, p>0.05). The trends in acquisition and retention sessions suggest that the augmented kinematic feedback can enhance the performance earlier in the skill acquisition and retention sessions.

The aim of this study was to demonstrate construct validation of the haptic virtual reality (VR) dental simulator and to deine expert benchmarking criteria for skills assessment. Thirty-four self-selected participants (fourteen novices, fourteen intermediates, and six experts in endodontics) at one dental school performed ten repetitions of three mode tasks of endodontic cavity preparation: easy (mandibular premolar with one canal), medium (maxillary premolar with two canals), and hard (mandibular molar with three canals). The virtual instrument's path length was registered by the simulator. The outcomes were assessed by an expert. The error scores in easy and medium modes accurately distinguished the experts from novices and intermediates at the onset of training, when there was a signiicant difference between groups (ANOVA, p<0.05). The trend was consistent until trial 5. From trial 6 on, the three groups achieved similar scores. No signiicant difference was found between groups at the end of training. Error score analysis was not able to distinguish any group at the hard level of training. Instrument path length showed a difference in performance according to groups at the onset of training (ANOVA, p<0.05). This study established construct validity for the haptic VR dental simulator by demonstrating its discriminant capabilities between that of experts and non-experts. The experts' error scores and path length were used to deine benchmarking criteria for optimal performance.

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This work presents the multilayered caries model with a visuo-tactile virtual reality simulator and a randomized controlled trial protocol to determine the effectiveness of the simulator in training for minimally invasive caries removal. A three-dimensional, multilayered caries model was reconstructed from 10 micro-computed tomography (CT) images of deeply carious extracted human teeth before and after caries removal. The full grey scale 0-255 yielded a median grey scale value of 0-9, 10-18, 19-25, 26-52, and 53-80 regarding dental pulp, infected carious dentin, affected carious dentin, normal dentin, and normal enamel, respectively. The simulator was connected to two haptic devices for a handpiece and mouth mirror. The visuo-tactile feedback during the operation varied depending on the grey scale. Sixth-year dental students underwent a pretraining assessment of caries removal on extracted teeth. The students were then randomly assigned to train on either the simulator (n=16) or conventional extracted teeth (n=16) for 3 days, after which the assessment was repeated. The posttraining performance of caries removal improved compared with pretraining in both groups (Wilcoxon, p<0.05). The equivalence test for proportional differences (two 1-sided t-tests) with a 0.2 margin confirmed that the participants in both groups had identical posttraining performance scores (95% CI=0.92, 1; p=0.00). In conclusion, training on the micro-CT multilayered caries model with the visuo-tactile virtual reality simulator and conventional extracted tooth had equivalent effects on improving performance of minimally invasive caries removal.

Pre-surgical practice in a virtual environment using the 3D computerized model generated from the original CBCT image data improved endodontic microsurgery performance.