The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review.

Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored "good" in the overall quality and the remaining 5 (71%) scored "fair." VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students' skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education.

An Audit of the Technical Quality and Iatrogenic Errors of Root Canal Treatment by Undergraduate Dental Students at the University of Sharjah.

OBJECTIVES: The aim of this study was to determine the technical quality of root canal fillings and the presence of iatrogenic errors in the cases treated by undergraduate dental students using radiographic images. MATERIALS AND METHODS: This study included 480 root-filled teeth, which were evaluated using intraoral periapical radiographic images. The technical quality of obturation was assessed by observing the length, density, and taperness of the root filling. Ledges, apical transportation, fractured instruments, zipping, and root perforation were recorded as iatrogenic errors. Teeth were classified as acceptable if the technical parameters were adequate and there were no iatrogenic errors. STATISTICAL ANALYSIS: Data were statistically analyzed using Pearson's chi-squared test. RESULTS: The quality of root filling was acceptable in 183 of the 480 teeth. The rate of acceptable quality was higher for the teeth treated by 4th-year students (41.9%) than for those treated by 5th-year students (27.4%; p = 0.004). Length and taperness were adequate in more of the patients treated by the 4th-year students (p<0.05). There was a significant difference in the incidence of ledge formation and apical transportation in relation to the student's level (p<0.05). CONCLUSIONS: The technical quality of root fillings performed without iatrogenic errors by undergraduate dental students was declared acceptable in 38.1% of the assessed teeth. There was a noticeable difference in the quality of root canal treatment between the 4th- and 5th-year students. CLINICAL RELEVANCE: The findings demonstrate that periodic assessment of the technical quality of root filling performed by undergraduate dental students provides feedback on curriculum standards.

Impact of Guidance and Multitasking on Manual Dexterity Skills in Dentistry.

OBJECTIVES: This study investigated the effect of learning by observation on the development of fine motor skills related to endodontic manual instrumentation. We evaluated if learning by observation with guidance had any influence upon operator performance under tense or taxing conditions. MATERIALS AND METHODS: Dental students prepared standardized simulated root canals of varying morphology. Learning involved silent video with hand guidance (n = 23), audiovisual combined with oral instructions (n = 23), or silent video (n = 13). Undergraduates who previously completed conventional preclinical endodontics provided comparative data as a control group (n = 16). During investigations, a root canal of a lower molar plastic tooth was shaped, beginning with a primary task, and followed by multitasking conditions. The performance of the students was assessed by evaluating the accuracy of dental canal shaping and time taken to complete the task. STATISTICAL ANALYSIS: Differences were analyzed using ANOVA (p < 0.05). RESULTS: Performance was similar during learning between the three experimental groups. Accuracy of the performance did not differ within each group for the two tests nor between the groups at each test (p > 0.05). CONCLUSIONS: These findings demonstrated that performance subsequent to learning by observation without instructions was comparable to learning with instructed observation. The results also identified that the performance of the experimental group (1.5- to 2-hour practice) was comparable with the conventional control group (15- to 20-hour practice). Alternative approaches to learning dexterity skills in dentistry may provide improved outcomes, especially in demanding situations.

Exploring Professionalism among Final Year Dental Students and New Graduates: Translating Knowledge to Practice.

OBJECTIVES: The aim of this study was to evaluate senior students' and dental graduates' perception of professionalism as defined by international regulatory bodies and to assess students' ability to apply such knowledge in clinical-based scenarios. MATERIALS AND METHODS: Knowledge of professional competencies was conducted using a survey based on domains of professionalism for a newly qualified general dental practitioner as defined by international regulatory bodies. This survey consists of 32 items addressing participants' perception of three domains of professionalism. Application of the perceived professional competencies was tested by asking participants to answer questions following the observation of a clinical-based scenario video where participants needed to identify issues related to professional, ethical, and communication skills, which were embedded in the scenarios. STATISTICAL ANALYSIS: Differences were analyzed using ANOVA and t-tests (p<0.05). RESULTS: Data from 146 participants showed no significant differences in the survey scores between the participants' professional levels, place of practice, age groups, and genders. Analyses of correlation between the different domains of professionalism showed significant relationships between pair-wise comparisons of the total domain scores. Paired t-tests revealed that the mean score percentage for each of the three domains of professionalism was significantly higher than the responses reported in the relevant clinical-based scenario questions. CONCLUSIONS: This indicates that all domains of professionalism contributed in a similar way to their overall assessment. Furthermore, our findings show that dental practitioners may not be able to apply their knowledge of professionalism in real-life scenarios. This suggests that teaching professionalism at the early stages of the dental curriculum should incorporate innovative approaches to mimic real-life scenarios.

Clinical effectiveness of space maintainers and space regainers in the mixed dentition: A systematic review.

BACKGROUND: The aim of this systematic review was to address the clinical effectiveness of space maintainers and space regainers in the prevention and correction of dental arch decreases in mixed dentition. METHODS: An electronic search was conducted using five databases: the Cochrane Database for Systematic Reviews, EBSCO Host, ScienceDirect, PubMed, and Scopus (until February 2021) and 6 relevant journals. Inclusion criteria were: Randomized Controlled Clinical Trials (RCTs), Controlled Clinical Trials (CCTs), cohort studies and case-control studies of children in the mixed dentition requiring a space maintainer or a space regainer, children with mild to moderate crowding, and with Class I and mild Class II or Class III skeletal pattern. All articles included in this review were examined independently by three teams of investigators to assess the level of bias using the Cochrane risk of bias tools RoB 2.0 (for RCTs) and ROBINS-I (for non-RCTs). RESULTS: Following the three phases of a systematic search, 11 studies were included for the final analysis, of which nine used space maintainers (a lower lingual arch) and two used space regainers (one lip bumper and one transpalatal arch) with contradicting results. Four of the former and one of the latter devices showed a significant increase in arch length. Out of the 11 articles, one was found to be of critical risk, two of serious risk and eight of moderate risk of bias. CONCLUSIONS: There is very low evidence to suggest that space maintainers and regainers are effective in preserving arch length and preventing mild to moderate crowding in children during the mixed dentition stage at the expense of lower incisor proclination. However, considering the low evidence provided by this systematic review, high-quality studies are needed.

Determining the impact of stressors on students' clinical performance in endodontics.

OBJECTIVES: This study aims to evaluate the impact of stress on the clinical performance of endodontics dental students. METHOD: The study sample consists of 16 randomly selected fourth-year dental students who had completed pre-clinical activities stipulated in their curriculum. The distal canal of a plastic mandibular first molar is prepared on two separate occasions, first under normal conditions and then under stressful conditions. The preparation accuracy of the root canal and the time taken to complete the task area measured. Stress is assessed using subjective (State-Trait Anxiety Inventory and Perceived Stress Scale) and objective (heart rate) measures. RESULTS: While the accuracy of the root canal preparation did not differ significantly between the normal and stressful conditions (p > 0.05, paired t-test), the completion time for the root canal preparation decreased significantly under stressful conditions (p < 0.05, paired t-test). CONCLUSION: The findings of this study suggest that there is no association between the high levels of stress and the performance breakdown of root canal hand instrumentation skills. Students develop an adaptive response to stress, enabling them to improve their completion times and maintain their performance under stressful conditions. Future research should focus on learning methods that can contribute toward better outcomes, especially in stressful environments.

Understanding Motor Skill Learning as Related to Dentistry.

Learning dental procedures is a complex task involving the development of fine motor skills. The reported use of theories and/or evidence for designing learning activities to develop the fine motor skills needed for dental practice is limited. The aim of this review is to explore the available body of knowledge related to learning motor skills relevant to dentistry. Evidence from studies investigating motor skill learning highlights the negative impact of self-focus and self-regulation on learning outcomes, particularly during the early stages of learning. The development of activities and schedules that enable novices to demonstrate characteristics similar to experts, without the reported long period of 'deliberate practice', is clearly of value. Outcomes of learning implicitly are important in dentistry because working under stressful conditions is common, either during undergraduate study or in practice. It is suggested that learning implicitly in the simulation stage can reduce disrupted performance when transitioning to clinical settings. Therefore, further investigation of effective methods for learning dental fine motor skills is indicated, using approaches that result in robust performance, even under stressful conditions.

The role of prosthetic, orthodontic and implant-supported rehabilitation in the management of secondary malocclusion to maxillofacial trauma- A systematic review.

PURPOSE: Different approaches have been proposed to treat malocclusion secondary to the treatment of maxillofacial trauma. This study aimed to investigate the efficacy of prosthodontic treatment, orthodontic treatment, and implant-supported rehabilitation for the management of secondary malocclusion after maxillofacial trauma. STUDY SELECTION: We searched five electronic databases and hand searched eight journals. The types of studies included were randomized controlled trials, cohorts, case-controls, and case series with at least eight patients with maxillofacial trauma and postoperative malocclusion. These studies used prosthetic treatment and implant-supported rehabilitation for secondary malocclusion after maxillofacial trauma. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using a tool for methodological quality assessment and synthesis of case series and case reports. RESULTS: After initial screening and identification of titles and abstracts, full text of 44 articles were found and evaluated against inclusion criteria. Of these 42 articles were excluded and remaining two were included in the review. Both the studies were case series with moderate to high risk of bias. CONCLUSIONS: Both prosthetic treatment and implant-supported rehabilitation have the potential to restore secondary malocclusion after maxillofacial trauma. However, because less number of well-designed studies with high risk of bias were included in this systematic review, the findings should be interpreted with caution. Well-designed high-quality studies are required to draw definitive conclusions.

Evaluation of Conscious Monitoring and Movement Control Efforts Among Dental Students.

Prior research has demonstrated that motor skill learning is often disrupted by self-focus and attempts to control movement. The propensity for reinvestment (i.e., self-focus and movement control) has been associated with poor motor skill learning in sport and surgery, but it has not yet been examined in dental education. Therefore, the aim of this study was to evaluate the propensity for disruptive reinvestment among dental students so as to optimize their learning needs. Volunteer dental students (210) completed three reinvestment surveys to investigate their self-reported propensity to engage in conscious self-monitoring and control of their movements and decisions. We used analysis of variance (ANOVA), with post-hoc analyses as appropriate, to assess the effect of various participant demographics on their reinvestment scores. Male participants had a lower mean reinvestment scale score than females (p < .05). Older participants were found to have a lower mean movement reinvestment score, compared to younger reinvesters (p < .05). On the other hand, younger reinvesters had a lower mean decision reinvestment score compared to the older age group (p < .05). When compared with participants in previous studies our participants obtained a significantly higher reinvestment score (p < .05). In conclusion, gender and age may be related to dental students' self-reported propensity to reinvest. Moreover, dental students were found to be more self-conscious when compared with individuals who perform gross motor skill tasks. These results provide insight into the acquisition of dental skills that may assist in designing pre-clinical training curriculum in dental education.

How to Improve Fine Motor Skill Learning in Dentistry.

INTRODUCTION: Restorative dental treatment is a complex task involving various procedures which require the development and integration of both theoretical knowledge and fine motor skills. It aims to provide the theoretical background and role of key factors in learning these skills. MATERIALS AND METHODS: The following electronic databases were searched to identify relevant articles to our topic: PubMed, Medline, Google Scholar, and Scopus. Generic keywords, that is, factors, fine, performance, and dentistry, and MeSH terms, that is, "learning," "instruction," "patient simulation," "motor skills," "perception," "tactile," "neurophysiology," and "working memory" were used to conduct our comprehensive search. Results and Conclusions. Several techniques are used in performing different restorative procedures in dentistry, that is, root canal preparation, root planning, and minor oral surgery procedures. Mastering these techniques requires a good understanding of the underpinning cognitive, sensory, and neuromuscular processes. Factors including the amount and timing of instructions provided, cognitive abilities, and practice schedule of learning trials may have significant implications on the design of fine motor skill learning exercises.

Effect of errorless learning on the acquisition of fine motor skills in pre-clinical endodontics.

This study aimed to evaluate the impact of errorless and errorful learning, on acquisition of root canal hand-instrumentation skills. Dental students prepared standardised canals of different diameters and curvatures. Learning involved minimising (errorless: n = 21) or maximising errors (errorful: n = 21). Students who had completed accredited pre-clinical activities provided comparative data (n = 17). During testing, the distal canal of a plastic mandibular molar was prepared, first as a single task and then under multi-tasking conditions. Performance was assessed by preparation accuracy and time. Differences were assessed using anova (P < 0.05). Performance in the experimental groups was similar during learning. When multi-tasking, errorful learners showed a deterioration in preparation accuracy (P < 0.05). In contrast, preparation accuracy and completion times for the errorless and comparative groups remained stable when multi-tasking. Errorless learning resulted in stable performance under multi-tasking conditions. Investigation of alternative approaches to learning motor skills in dentistry is warranted as such approaches may provide better outcomes, especially under demanding conditions.

Application of a Cone-Beam Computed Tomography-Based Index for Evaluating Surgical Sites Prior to Sinus Lift Procedures-A Pilot Study.

OBJECTIVES: Radiography-based indices can help surgeons perform detailed examinations of the surgical site and predict the surgical difficulty of cases. We aimed to develop and validate a novel CBCT-based index that can predict the surgical difficulty of sinus-augmentation procedures. MATERIALS AND METHODS: In the first stage, five experienced dental specialists performed a review of the literature and closed group discussions and designed the novel index. In the next stage, the index was validated. CBCT scans of 30 patients scheduled for sinus-augmentation procedures were evaluated and assigned presurgical CBCT evaluation scores (PSCESs) by five examiners. Subsequently, one oral surgeon performed sinus augmentation using the lateral antrostomy technique and assigned surgical difficulty scores (SDSs) to each of the 30 cases along with 2 observers. The PSCESs and SDSs were statistically analysed to determine the interrater reliability and validity of the index. RESULTS: The interrater agreement of the PSCES among the five presurgical evaluators was 0.85. The PSCES of the five evaluators had highly significant correlation (P < 0.001, r = 0.68 to 0.76) with the SDS. Regression analysis revealed that for every unit increase in the PSCES, there is 0.46 to 0.57 increase in the SDS value. CONCLUSION: The results of this pilot study revealed that a novel CBCT-based index can be used as a reliable tool for predicting the surgical difficulty of sinus-augmentation procedures. However, the novel index needs to be tested on a larger sample of patients and evaluators for a more concrete validity and reliability.

Introducing a comprehensive high-stake online exam to final-year dental students during the COVID-19 pandemic and evaluation of its effectiveness.

BACKGROUND: Dental education involves teaching and assessing the acquisition of verifiable domains that require superior psychomotor, communication, and cognitive skills. Evolving technologies and methods of assessment could enhance student learning environment and improve tutor assessment experience. OBJECTIVE: The aim of this study was to introduce the application of a comprehensive high-stakes online exam to final-year dental students during the COVID-19 pandemic and evaluate its effectiveness. DESIGN: A high-stakes exam was introduced and implemented online to the final-year dental students prior to their graduation. The exam consisted of four components: MEQs, MCQs, OSCE and an oral exam. The exam and invigilation were conducted using Blackboard and MS Teams programs. Stakeholders' views of the exam were obtained using two tailored surveys, one for students and another for faculty; both included closed- and open-ended questions. RESULTS: The exam was run successfully without untoward events. Both students and staff were satisfied with the online exam with the latter being more satisfied than the former. Students with previous experience in online learning system were more satisfied with the online exam compared with those with less experience (p < 0.05). The main issues raised by students' satisfaction with the exam were: inadequacy of time for the MEQ part, prevention of back tracking in the MCQ part and minor technological issues, whereas those raised by faculty members were increased time required to complete the exam setup and grading compared to the paper-based exam and minor technological issues. CONCLUSIONS: A newly introduced, multi-format, online high-stakes exam was implemented successfully to final-year dental students with minor technological issues and good satisfaction by students and staff alike.

Rethinking Assessment Concepts in Dental Education.

INTRODUCTION: Dental education involves teaching and assessing the acquisition of verifiable domains that require superior psychomotor, communication, and cognitive skills. Evolving technologies and methods of assessment could enhance student's learning environment and improve tutor assessment experience. The aim of this study was to review the current body of research and evaluate the effectiveness of various methods of assessments in improving learning and performance in preclinical and clinical dental practice. MATERIALS AND METHODS: A search strategy was implemented using electronic search in major databases. The following key terms, clinical skills, preclinical, dental students, and assessment, were included in the search. Two reviewers independently screened all the articles retrieved following very specific inclusion criteria. RESULTS: The initial search generated 5371 articles and 24 articles were selected for review and data extraction. Cohen's kappa coefficient was used to measure interrater agreement and a score of 94.7% was obtained. CONCLUSION: Preclinical assessment is an effective tool for promoting skills transfer to clinical phase. Early psychomotor skills assessment is valuable. It allows early intervention in the learning process and assists in effective utilization of learning resources. Technology-enhanced assessment systems allow better patient simulation, enhance learning and self-assessment experiences, and improve performance evaluation. However, these systems serve as an adjunct to conventional assessment methods. Further research should aim at calibrating and integrating these systems to optimize students learning and performance.

Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials.

BACKGROUND: To investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods. METHODS: A comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool. RESULTS: A total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students' performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies. CONCLUSIONS: Technology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students' performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.