Virtual and Interprofessional Objective Structured Clinical Examination in Dentistry and Dental Technology: Development and User Evaluations.

BACKGROUND: Interprofessional education (IPE) facilitates interprofessional collaborative practice (IPCP) to encourage teamwork among dental care professionals and is increasingly becoming a part of training programs for dental and dental technology students. However, the focus of previous IPE and IPCP studies has largely been on subjective student and instructor perceptions without including objective assessments of collaborative practice as an outcome measure. OBJECTIVE: The purposes of this study were to develop the framework for a novel virtual and interprofessional objective structured clinical examination (viOSCE) applicable to dental and dental technology students, to assess the effectiveness of the framework as a tool for measuring the outcomes of IPE, and to promote IPCP among dental and dental technology students. METHODS: The framework of the proposed novel viOSCE was developed using the modified Delphi method and then piloted. The lead researcher and a group of experts determined the content and scoring system. Subjective data were collected using the Readiness for Interprofessional Learning Scale and a self-made scale, and objective data were collected using examiner ratings. Data were analyzed using nonparametric tests. RESULTS: We successfully developed a viOSCE framework applicable to dental and dental technology students. Of 50 students, 32 (64%) participated in the pilot study and completed the questionnaires. On the basis of the Readiness for Interprofessional Learning Scale, the subjective evaluation indicated that teamwork skills were improved, and the only statistically significant difference in participant motivation between the 2 professional groups was in the mutual evaluation scale (P=.004). For the viOSCE evaluation scale, the difference between the professional groups in removable prosthodontics was statistically significant, and a trend for negative correlation between subjective and objective scores was noted, but it was not statistically significant. CONCLUSIONS: The results confirm that viOSCE can be used as an objective evaluation tool to assess the outcomes of IPE and IPCP. This study also revealed an interesting relationship between mutual evaluation and IPCP results, further demonstrating that the IPE and IPCP results urgently need to be supplemented with objective evaluation tools. Therefore, the implementation of viOSCE as part of a large and more complete objective structured clinical examination to test the ability of students to meet undergraduate graduation requirements will be the focus of our future studies.

Magnetic solid phase extraction coupled to HPLC-UV for highly sensitive analysis of mono-hydroxy polycyclic aromatic hydrocarbons in urine.

BACKGROUND: As a common pollutant, the carcinogenic properties of polycyclic aromatic hydrocarbons have garnered considerable attention. Trace metabolites of polycyclic aromatic hydrocarbons can be detected in urine as a non-invasively approach to monitor the exposure level. Nonetheless, the urine samples have the disadvantages of being large in volume and containing numerous impurities. Given the growing demand to study metabolites with low abundance and potential biomarkers, there is a pressing need for a preconcentration and high-throughput technique for effectively handling complex liquid samples. RESULTS: Polystyrene-coated magnetic nanoparticles were used to establish a novel magnetic extraction method for monohydroxy polycyclic aromatic hydrocarbons in urine samples. Polystyrene magnetic nanoparticles are an ideal absorbent for solid-phase extraction. After the material was mixed with the sample and adsorbed the target analyte, the analytes on the material were eluted and quantified using high-performance liquid chromatography. Influencing factors were optimized, and the proposed method achieved desirable sensitivity in analyzing low-abundance metabolites in large volumes of complex urine samples. The recoveries of intra-day and inter-day were 78.0-118.0 % and 81.0 %-115.0 %, respectively. The intra-day and inter-day reproducibility were less than 4.5 % and 8.6 %, respectively. The limits of detection were in the range of 0.009-0.041 ng mL-1, and the limits of quantification were in the range of 0.030-0.135 ng mL-1. SIGNIFICANCE AND NOVELTY: The application of reusable polystyrene-coated magnetic solid-phase nanoparticles as adsorbents makes the extraction of monohydroxy polycyclic aromatic hydrocarbons from urine samples economical and environmentally benign. The proposed method is simple, sensitive, and efficient compared to existing techniques. The nanoparticles are easy to prepare, showing potential for rapid screening of complex bulk bio-samples in batches with high efficiency and low budget.

Efficacy of a Virtual 3D Simulation-Based Digital Training Module for Building Dental Technology Students' Long-Term Competency in Removable Partial Denture Design: Prospective Cohort Study.

Background: Removable partial denture (RPD) design is crucial to long-term success in dental treatment, but shortcomings in RPD design training and competency acquisition among dental students have persisted for decades. Digital production is increasing in prevalence in stomatology, and a digital RPD (D-RPD) module, under the framework of the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT) system reported in our previous work, may improve on existing RPD training models for students. Objective: We aimed to determine the efficacy of a virtual 3D simulation-based progressive digital training module for RPD design compared to traditional training. Methods: We developed a prospective cohort study including dental technology students at the Stomatology College of Chongqing Medical University. Cohort 1 received traditional RPD design training (7 wk). Cohort 2 received D-RPD module training based on text and 2D sketches (7 wk). Cohort 3 received D-RPD module pilot training based on text and 2D sketches (4 wk) and continued to receive training based on 3D virtual casts of real patients (3 wk). RPD design tests based on virtual casts were conducted at 1 month and 1 year after training. We collected RPD design scores and the time spent to perform each assessment. Results: We collected the RPD design scores and the time spent to perform each assessment at 1 month and 1 year after training. The study recruited 109 students, including 58 (53.2%) female and 51 male (56.8%) students. Cohort 1 scored the lowest and cohort 3 scored the highest in both tests (cohorts 1-3 at 1 mo: mean score 65.8, SD 21.5; mean score 81.9, SD 6.88; and mean score 85.3, SD 8.55, respectively; P<.001; cohorts 1-3 at 1 y: mean score 60.3, SD 16.7; mean score 75.5, SD 3.90; and mean score 90.9, SD 4.3, respectively; P<.001). The difference between cohorts in the time spent was not statistically significant at 1 month (cohorts 1-3: mean 2407.8, SD 1370.3 s; mean 1835.0, SD 1329.2 s; and mean 1790.3, SD 1195.5 s, respectively; P=.06) but was statistically significant at 1 year (cohorts 1-3: mean 2049.16, SD 1099.0 s; mean 1857.33, SD 587.39 s; and mean 2524.3, SD 566.37 s, respectively; P<.001). Intracohort comparisons indicated that the differences in scores at 1 month and 1 year were not statistically significant for cohort 1 (95% CI -2.1 to 13.0; P=.16), while cohort 3 obtained significantly higher scores 1 year later (95% CI 2.5-8.7; P=.001), and cohort 2 obtained significantly lower scores 1 year later (95% CI -8.8 to -3.9; P<.001). Conclusions: Cohort 3 obtained the highest score at both time points with retention of competency at 1 year, indicating that progressive D-RPD training including virtual 3D simulation facilitated improved competency in RPD design. The adoption of D-RPD training may benefit learning outcomes.

Virtual sketching-based dental anatomy module improves learners' abilities to use computer-aided design to create dental restorations and prostheses.

Dental anatomy education for dental technology students should be developed in alignment with digital dental laboratory practices. We hypothesized that a virtually assisted sketching-based dental anatomy teaching module could improve students' acquisition of skills essential for digital restoration design. The second-year dental technology curriculum included a novel virtual technology-assisted sketching-based module for dental anatomy education. Pre- and post-course assessments evaluated students' skill sets and knowledge bases. Computer-aided design (CAD) scores were analyzed after one year to assess how the skills students developed through this module impacted their subsequent CAD performance. Participants who undertook the dental sketching-based teaching module demonstrated significantly improved theoretical knowledge of dental anatomy, dental aesthetic perception, and spatial reasoning skills. A partial least squares structural equation model indicated that the positive effects of this module on subsequent CAD performance were indirectly mediated by dental aesthetic perception, spatial reasoning, and practice time. A virtually assisted sketching-based dental anatomy teaching module significantly improved students' acquisition of skills and knowledge and positively mediated dental technology students' CAD performance.

Co-exposure of maize to polyethylene microplastics and ZnO nanoparticles: Impact on growth, fate, and interaction.

Microplastics (MPs), especially polyethylene MPs (PE MPs), which are the primary component of mulch, have attracted increasing attention in recent years. ZnO nanoparticles (NPs), which constitute a metal-based nanomaterial commonly used in agricultural production, co-converge with PE MPs in the soil. However, studies revealing the behavior and fate of ZnO NPs in soil-plant systems in the presence of MPs are limited. In this study, a pot experiment was used to evaluate the effects of maize co-exposure to PE MPs (0.5 % and 5 % w/w) and ZnO NPs (500 mg/kg) on growth, element distribution, speciation, and adsorption mechanism. The results demonstrate that individual exposure to PE MPs posed no significant toxicity; however, it significantly decreased maize grain yield (essentially 0). ZnO NP-exposure treatments significantly increased the Zn concentration and distribution intensity in maize tissues. Among them, the Zn concentration in the maize root exceeded 200 mg/kg, compared with 40 mg/kg in the grain. Moreover, the Zn concentrations in various tissues decreased in the following order: stem, leaf, cob, bract, and grain. Reassuringly, ZnO NPs still could not be transported to the maize stem under co-exposure to PE MPs. ZnO NPs had been biotransformed (64 % of the Zn was associated with histidine, with the remainder being associated with P [phytate] and cysteine) in maize stem. This study provides new insights into the plant physiological risks of PE MP and ZnO NP co-exposure in the soil-plant system and assesses the fate of ZnO NPs.

Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study.

BACKGROUND: With the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems. OBJECTIVE: This study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost. METHODS: The OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams. RESULTS: The OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students' practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students' skill level and the common sense transformation of educators in the virtual simulation technology environment. CONCLUSIONS: The development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified.

Mixed Reality and Haptic-Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation.

BACKGROUND: Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR. OBJECTIVE: This study aimed to describe the research and development of a newly developed MR and haptic-based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity. METHODS: A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator. RESULTS: Of the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator's ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD's resolution (P=.03) and simulation of the preparation process (P=.001). CONCLUSIONS: The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills.

Haptic Rendering of Diverse Tool-Tissue Contact Constraints During Dental Implantation Procedures.

Motor skill learning of dental implantation surgery is difficult for novices because it involves fine manipulation of different dental tools to fulfill a strictly pre-defined procedure. Haptics-enabled virtual reality training systems provide a promising tool for surgical skill learning. In this paper, we introduce a haptic rendering algorithm for simulating diverse tool-tissue contact constraints during dental implantation. Motion forms of an implant tool can be summarized as the high degree of freedom (H-DoF) motion and the low degree of freedom (L-DoF) motion. During the H-DoF state, the tool can move freely on bone surface and in free space with 6 DoF. While during the L-DoF state, the motion degrees are restrained due to the constraints imposed by the implant bed. We propose a state switching framework to simplify the simulation workload by rendering the H-DoF motion state and the L-DoF motion state separately, and seamless switch between the two states by defining an implant criteria as the switching judgment. We also propose the virtual constraint method to render the L-DoF motion, which are different from ordinary drilling procedures as the tools should obey different axial constraint forms including sliding, drilling, screwing and perforating. The virtual constraint method shows efficiency and accuracy in adapting to different kinds of constraint forms, and consists of three core steps, including defining the movement axis, projecting the configuration difference, and deriving the movement control ratio. The H-DoF motion on bone surface and in free space is simulated through the previously proposed virtual coupling method. Experimental results illustrated that the proposed method could simulate the 16 different phases of the complete implant procedures of the Straumann® Bone Level(BL) Implants Φ4.8-L12 mm. According to the output force curve, different contact constraints could be rendered with steady and continuous output force during the operation procedures.

Six Degree-of-Freedom Haptic Simulation of Probing Dental Caries Within a Narrow Oral Cavity.

Haptic simulation of handling pathological tissues is a crucial component to enhance virtual surgical training systems. In this paper, we introduce a configuration-based optimization approach to simulate the exploration and diagnosis of carious tissues in dental operations. To simulate the six Degree-of-Freedom (6DoF) haptic interaction between the dental probe and the oral tissues, we introduce two interaction states, the sliding state and the penetration state, which simulate the exploration on the surface of and inside of the caries, respectively. Penetration criteria considering a contact force threshold are defined to trigger the switch between the two states. By utilizing a simplified friction model based on the optimization approach, various multi-region frictional contacts between the probe and carious tissues are simulated. To simulate the exploration within the carious tissues for diagnosing the depth of the caries, a dynamic sphere tree is used to constrain the insertion/extraction of the probe within carious tissues along a fixed direction while enabling simulation of additional contacts of the probe with neighboring oral tissues during the insertion/extraction process. Experimental results show that decays with different levels of stiffness and friction coefficients can be stably simulated. Preliminary user studies show that users could easily identify the invisible boundary between the decay and healthy tissues and correctly rank the depth of target decays within a required time limit. The proposed approach could be used for training delicate motor skill of probing target carious teeth in a narrow oral cavity, which requires collaborated control of tool posture and insertion/extraction force, while avoiding damages to adjacent healthy tissues of the tongue and gingiva.