Combining virtual reality and 3D-printed models to simulate patient-specific dental operative procedures-A study exploring student perceptions.

INTRODUCTION: Students face a number of challenges in translating the skills acquired in pre-clinical simulation environments to the delivery of real patient care. These are particularly emphasised for complex operative procedures such as tooth preparations for indirect restorations. This paper reports student perceptions of a novel approach designed to improving student confidence when undertaking operative procedures on patients for the first time, by providing patient-specific simulation using virtual reality (VR) and 3D-printed models of the student's real clinical case. MATERIALS AND METHODS: Students practised on patient-specific models, in the presence of a clinical tutor, firstly using VR simulation then with 3D-printed models in a clinical skills laboratory. The students then carried out the operative procedure on their patients, on the third occasion of practice. After providing the treatment for their patients, students attended a semi-structured interview to discuss their experiences. The qualitative data were analysed using two forms of inductive analysis. RESULTS: Students most frequently cited: the value of the educator, increased confidence and efficiency during the clinical procedure, improved patient confidence and the complementary benefits of the two simulation modalities. Thematic analysis of participants' responses uncovered five key themes: The value of virtual reality dental simulators The value of clinical skills laboratory simulation with 3D-printed models The value of educator engagement The impact on the clinical procedure and the patient The VR and clinical skills laboratory balance CONCLUSION: This paper reports the early findings of an intervention that improves dental student confidence through the use of patient-specific VR exercises and 3D-printed models. These provided an incremental learning experience for an operative clinical procedure, prior to treatment of the live patient. Early results suggest this is a positive experience for the students, providing a valuable contribution to their confidence and preparedness.

Re-defining the virtual reality dental simulator: Demonstrating concurrent validity of clinically relevant assessment and feedback.

INTRODUCTION: Virtual reality (VR) dental simulators are gaining momentum as a useful tool to educate dental students. To date, no VR dental simulator exercise has been designed which is capable of reliably providing validated, meaningful clinical feedback to dental students. This study aims to measure the concurrent validity of the assessment and the provision of qualitative feedback, pertaining to cavity preparations by VR dental simulators. METHODS: A cavity preparation exercise was created on a VR dental simulator, and assessment criteria for cavity preparations were developed. The exercise was performed 10 times in order to demonstrate a range of performances, and for each, the simulator feedback was recorded. The exercises were subsequently three-dimensionally printed, and 12 clinical teachers were asked to assess the preparations according to the same criteria. Inter-rater reliability (IRR) between clinical teachers was measured using a free-marginal multirater kappa value. Clinical teacher assessment responses were compared with the VR simulator responses and percentage agreements calculated. RESULTS: IRR values for each exercise ranged from 0.39 to 0.77 (69.39%-88.48%). The assessment of smoothness (κfree 0.58, 78.79%) and ability to follow the outline (κfree 0.56, 77.88%) demonstrated highest agreement between clinical teachers, whilst the assessment of undercut (κfree 0.15, 57.58%) and depth (κfree 0.28, 64.09%) had the lowest agreement. The modal percentage agreement between clinical teachers and the VR simulator was, on average, 78% across all exercises. CONCLUSION: The results of this study demonstrate that it is possible to provide reliable and clinically relevant qualitative feedback via a VR dental simulator. Further research should look to employ this technique across a broader range of exercises that help to develop other complex operative dental skills.

Defining dental operative skills curricula: An ADEE consensus paper.

This paper reports on the recent activity of the pan-European consensus of the ADEE Special Interest Group for Pre-Clinical Operative Skills. Following the previous recommendations from the group, and in order to support teachers and to harmonise the delivery of skills training across Europe, a more formal curriculum relating to pre-clinical operative skills needs to be created. This paper reports European consensus surrounding the categorisation (level of importance, and difficulty) of basic operative dental clinical skills within the undergraduate curriculum and provides recommendations relating to session structure and timing of curricular elements for basic operative dental clinical skills teaching.

The value of stereoscopic three-dimensional vision on dental students' performance in a virtual reality simulator.

PURPOSE/OBJECTIVES: The aim of this study was to quantitatively investigate the impact of stereoscopic three-dimensional (3D) vision on students' performance when compared with that of two-dimensional (2D) vision in a 3D virtual reality (VR) simulator. METHODS: Twenty-four dental students (second- and fourth-year BDS) were assigned to perform three operative tasks under 3D and 2D viewing conditions on a Virteasy (HRV) simulator. Groups were crossed over and all students performed the same tasks under the alternate viewing conditions. The performance was evaluated by (1) accuracy, (2) outside target area removal, and (3) tooth cutting time, automatically using the generated feedback. RESULTS: Twenty-one participants completed all sessions. The results revealed a statistically significant effect of 3D vision over 2D vision on students' performance in terms of accuracy (p = 0.035). Stereoscopic 3D vision showed significant effect on outside target area removal in the first task (p = 0.035). Tooth cutting time was the same under both conditions (p = 0.766). The findings revealed improvement in accuracy score and reduction in outside target area removal over the course of the experiment under both conditions. Comparing the difference in 3D effect in the early and advanced learning groups revealed no significant difference among the groups (p > 0.05). CONCLUSION: Utilizing stereoscopic 3D vision in the training session improved students' perception of depth which led to more accurate tooth cutting within the target area, and less outside target area removal. However, 3D shows a limited impact on task completion time.

Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study.

BACKGROUND: Chest X-ray (CXR) has typically been the main investigation in children with suspected respiratory pathology. Recent advances in lung point-of-care ultrasound (POCUS) have shown the potential for it to be comparative, if not better, than CXR. The objective of this study was to compare CXR with lung POCUS in children with respiratory illness in a ward-based setting at a paediatric teaching hospital. METHODS: Any child <18 years of age presenting to Southampton Children's Hospital requiring a CXR for clinical reasons also had lung POCUS performed. CXR was reported by a consultant paediatric radiologist and lung POCUS was reviewed retrospectively by a blinded POCUS clinician, with only the clinical information provided on the CXR request. Comparisons were made between the CXR and lung POCUS findings. RESULTS: 100 paired lung POCUS and CXR were included in the study. 30% of lung POCUS were normal with 97% of these having a normal CXR. 70% of cases had POCUS abnormalities with 96% of POCUS cases identifying comparative lung pathology. Lung POCUS therefore had a sensitivity of 98.51% and a specificity of 87.9% with a diagnostic accuracy of 95% when compared with the CXR report. CONCLUSIONS: Lung POCUS has excellent diagnostic accuracy. The diagnosis of normal lung on POCUS when performed by a trained practitioner can reliably reduce the need for a CXR, thus reducing CXR use and radiation exposure in children. An abnormal lung POCUS could then either give the diagnosis or lead to a CXR with the expectation of clinically relevant findings.

Mobile apps for oral healthcare: recommendations for navigating uncharted terrain.

The past two years have prompted significant changes with regards to how healthcare is both taught and delivered. There has been a shift towards remote healthcare interventions where appropriate. As we return towards pre-pandemic practice, we must recognise that the healthcare environment has permanently changed. It is vital that safeguards and 'pandemic proofing' are built into healthcare provision.The prevalence of personal digital devices continues to increase, along with internet coverage. This technological revolution has also brought with it a plethora of free or cheap online platforms that allow individuals with limited IT skills to make mobile applications (apps). These factors create a perfect environment for considering mobile apps as viable, widespread healthcare interventions. There is also great potential for these to contribute to tackling inequality, reducing barriers and enhancing healthcare access. However, their use must be carefully considered.This article discusses the myriad of considerations pertaining to both developing and recommending mobile apps for healthcare. Examples of contemporaneous examples will be used, in conjunction with an app developed by the authors to demonstrate the process of creating bespoke resources.

Remote clinical consultations in restorative dentistry: a clinical service evaluation study.

Introduction Specialist consultant services in the UK NHS provide a decision-making support service to other health professionals. There is a drive to deliver this service in a more patient-centred, cost-effective and efficient manner. Remote clinical consultations (RCC), using secure, live, super-fast internet connectivity and high-resolution, multi-channel audio-visual streaming, has the potential for the delivery of this service.Aim To conduct a clinical service evaluation to assess the viability and efficiency of conducting a RCC for the management of primary care referrals in restorative dentistry, compared to an in-person consultation.Design A RCC was conducted for every participating patient and immediately followed with a 'verification' in-person consultation.Materials and method Twenty-three patients of even gender distribution participated in this study across the three specialisms of restorative dentistry. A thematic questionnaire was completed by each member of the study intervention team and the patient after each consultation.Results In all the cases, the consultant was able to conduct an effective and safe clinical consultation, not inferior to an in-person process, regardless of gender and age. The GDP, the nurse and the patient were able to participate effectively in the process and with each other.Conclusion This proof-of-concept study suggests that the RCC concept is a feasible way of delivering specialist consultations in restorative dentistry with high levels of patient acceptability and that it can be delivered in a practical and simple manner.

A scoping review of the use and application of virtual reality in pre-clinical dental education.

Introduction Virtual reality (VR) is gaining recognition as a valuable tool for training dental students and its use by dental schools around the world is growing. It is timely to review the literature relating to the use of VR in dental education, in order to ensure that educators are well-informed of current areas of inquiry, and those requiring further investigation, to enable appropriate decisions about whether to employ VR as a teaching tool. Method A scoping review using the method outlined by Arksey and O'Malley was conducted. Both Web of Science and ERIC databases were searched. Inclusion and exclusion criteria were established to filter results. The data were collected and categorised using a custom data collection spreadsheet. Results The review identified 68 relevant articles. Following review, four educational thematic areas relating to the 'simulation hardware', the 'realism of the simulation', 'scoring systems' and 'validation' of the systems emerged. Conclusion This paper summarises and draws out themes from the current areas of inquiry in the literature, uncovering a number of weaknesses and assumptions. It recommends areas where additional investigation is required in order to form a better evidence base for the utility of VR in dental education, as well as to inform its future development.

Impact of bladder volume on radiation dose to the rectum in the definitive treatment of prostate cancer.

BACKGROUND AND OBJECTIVE: Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship. METHODS: Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets. RESULTS: From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (𝑃 = .031). LIMITATIONS: Small sample size and small variations in bladder volumes. CONCLUSIONS: A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.