Examining gaze behavior in undergraduate students and educators during the evaluation of tooth preparation: an eye-tracking study.

BACKGROUND: Gaze behavior can serve as an objective tool in undergraduate pre-clinical dental education, helping to identify key areas of interest and common pitfalls in the routine evaluation of tooth preparations. Therefore, this study aimed to investigate the gaze behavior of undergraduate dental students and dental educators while evaluating a single crown tooth preparation. METHODS: Thirty-five participants volunteered to participate in the study and were divided into a novice group (dental students, n = 18) and an expert group (dental educators, n = 17). Each participant wore a binocular eye-tracking device, and the total duration of fixation was evaluated as a metric to study the gaze behavior. Sixty photographs of twenty different tooth preparations in three different views (buccal, lingual, and occlusal) were prepared and displayed during the experimental session. The participants were asked to rate the tooth preparations on a 100 mm visual analog rating scale and were also asked to determine whether each tooth preparation was ready to make an impression. Each view was divided into different areas of interest. Statistical analysis was performed with a three-way analysis of the variance model with repeated measures. RESULTS: Based on the participants' mean rates, the "best" and the "worst" tooth preparations were selected for analysis. The results showed a significantly longer time to decision in the novices compared to the experts (P = 0.003) and a significantly longer time to decision for both the groups in the best tooth preparation compared to the worst tooth preparation (P = 0.002). Statistical analysis also showed a significantly longer total duration of fixations in the margin compared to all other conditions for both the buccal (P < 0.012) and lingual (P < 0.001) views. CONCLUSIONS: The current study showed distinct differences in gaze behavior between the novices and the experts during the evaluation of single crown tooth preparation. Understanding differences in gaze behavior between undergraduate dental students and dental educators could help improve tooth preparation skills and provide constructive customized feedback.

3D-printed tooth for caries excavation.

BACKGROUND: To date, no suitable model tooth has been available for all standard restorative and prosthodontic procedures. To fill this gap, a realistic multilayer tooth with enamel, dentin, integrated caries, pulp, and electrometric and X-ray imaging abilities was developed. The aim of this study was to test the printed tooth while focusing on caries excavation and pulp capping. METHODS: Based on micro-CT data, a tooth was designed and produced via 3D printing. A total of 396 teeth were tested and evaluated by 66 fourth- and fifth-year students experienced in caries excavation at standard typodonts, extracted teeth and patients. They excavated the caries and capped the pulp on six teeth and rated them in a questionnaire. RESULTS: Compared with natural teeth, the printed teeth were generally rated positively and significantly better in all criteria than typodonts used previously (p < .001). They were rated as a suitable training option (Ø 2.3 ± 0.9) with fair examination conditions (Ø 2.1 ± 0.8) and easy to use (Ø 2.0 ± 0.8). Subjective learning success was also significantly greater (Ø 2.3 ± 0.9) than that of standard typodonts (Ø 3.2 ± 1.1) (p < .001). In general, the students desired more exercises with 3D-printed teeth for their studies (Ø 1.8 ± 0.8). CONCLUSIONS: Multilayered 3D-printed teeth were successfully tested and can improve and extend the teaching methods used for caries excavation and pulp capping. Its other abilities will be tested in subsequent studies. YEAR OF THE STUDY: 2023.

Template-aided and freehand guiding plane preparation for removable partial dentures: A randomized controlled trial.

PURPOSE: To evaluate the accuracy of guiding plane preparation for removable partial dentures (RPDs) using 3D-printed templates compared to the freehand method. MATERIALS AND METHODS: Twenty partially edentulous patients requiring RPDs were randomly divided into two groups: the template-aided group (n = 10) and the freehand group (n = 10). Fifty-six guiding planes were prepared by a single clinician using two different methods. The angle deviation between the prepared guiding plane and the RPD path of placement was measured for both groups. The 3D deviations between the prepared guiding plane and the designed guiding plane were measured for the template-aided group. Patient satisfaction with the RPD was evaluated 2 weeks post-RPD wearing. RESULTS: The angular deviation observed in the template-aided group (1.77±1.11 degrees) was significantly lower than that (6.29±4.18 degrees) in the freehand group (p < .001). Additionally, the 3D deviation between the prepared guiding plane and the designed guiding plane of the template-aided group was 106.2±40.9 µm. No significant difference in patient satisfaction scores related to RPD wearing was found between the two groups. CONCLUSIONS: Utilizing the cobalt-chromium (CoCr) alloy template significantly improved the accuracy of guiding plane preparation in the clinic, irrespective of the site of the abutment tooth.

Clinical guidelines for posterior semidirect composite resin restorations: a case report with a 17-month follow-up.

Patients are always looking for conservative, esthetic, and long-lasting dental restorations, and the technique used directly influences the longevity of the treatment. The location of the restoration in the mouth and the extent of the decay influence the treatment choice. The larger the dimensions of the cavity preparation, the greater the difficulties in restoring the tooth using direct techniques. The semidirect technique, when indicated, can achieve satisfactory results. It is a relatively easy procedure, consisting of tooth preparation to receive an indirect restoration, fabrication of an alginate impression, fabrication of the composite resin restoration on a flexible cast, cementation, removal of excess cement, and occlusal adjustment. The aim of this case report is to present a viable alternative to direct and indirect restorations for posterior teeth with extensive decay. The article describes the extraoral semidirect technique for fabricating a composite resin restoration, highlighting its indications and discussing advantages and disadvantages.

Contemporary concepts on periodontal complications from prosthetic and restorative therapies.

The clinical outcome of every prosthetic and restorative procedure depends on the maintenance of a healthy periodontium. It is, therefore, important that the prosthodontist and restorative dentist cause no harm or permanent damage to the underlying hard and soft tissues when performing clinical procedures necessary to carry out the planned treatment. Several factors involved in these procedures have been described to have an impact on gingival health. For the present article, a selection of four of these factors are presented with the goal of evaluating the current trends and their influence on periodontal structures: (1) tooth preparation configuration and apical extension, (2) gingival tissue sulcular expansion/retraction, (3) prosthetic contours, and (4) prosthesis marginal adaptation and the consequences of excess cement remnants. Based on the available scientific evidence and clinical experience, recommendations for the practitioner are given.

Efficiency of HEPA-filtered extra-oral suction unit on aerosols during prosthetic dental preparation: A pilot study.

OBJECTIVES: Aerosols formed during dental treatments have a huge risk for the spread of bacteria and viruses. This study is aimed at determining which part of the working area and at what size aerosol is formed and ensuring more effective use of HEPA-filtered devices. MATERIALS AND METHODS: Anterior tooth preparation was performed by one dentist with one patient. Particle measurements were made using an airborne particle counter and were taken at four different locations: the chest of the patient, the chest of the dentist, the center of the room, and near the window. Three groups were determined for this study: group 1: measurement in a 24-h ventilated room (before the tooth preparation, empty room), group 2: measurement with the use of saliva ejector (SE), and group 3: measurement with the use of saliva ejector and HEPA-filtered extra-oral suction (HEOS) unit. RESULTS: The particles generated during tooth preparation were separated according to their sizes; the concentration in different locations of the room and the efficiency of the HEOS unit were examined. CONCLUSIONS: The present study showed that as the particle size increases, the rate of spread away from the dentist's working area decreases. The HEPA-filtered extra-oral suction unit is more effective on particles smaller than 0.5 microns. Therefore, infection control methods should be arranged according to these results. CLINICAL RELEVANCE: The effective and accurate use of HEPA-filtered devices in clinics significantly reduces the spread of bacterial and viral infections and cross-infection.

A pilot study on the use of a novel digital real-time evaluation system in undergraduate preclinical training of tooth preparation in fixed prosthodontics.

INTRODUCTION: In the light of the digital teaching, it is necessary that the effectiveness of a new digital real-time evaluation system in the preclinical training of tooth preparation be evaluated. MATERIALS AND METHODS: Forty undergraduate dental students of the fourth year were randomly divided into the control group and the experimental group to complete the training task of tooth preparation for porcelain fused to metal (PFM) crown restoring the upper right central incisor. The control students received conventional training with instructor's guidance. The experimental students received training with the digital system without instructor's guidance. Every student exercised preparation in two resin incisors in 3 h training by respective training methods. A third incisor was prepared on a dental model in the simulated head phantom by each student as the test on the next day. All students' tooth preparations were scored by the same two experienced experts. The experimental students were asked to answer a questionnaire regarding their attitudes and opinions on the digital evaluation system in preclinical training. RESULTS: There was no significant difference between the scores of the experimental group and the control group (p > .05). The students of two groups obtained the similar scores in the test (p > .05). Most of the students were supportive of the application of digital training system in the preclinical tooth preparation training course. CONCLUSIONS: The digital real-time evaluation system could provide effective training effects for the dental undergraduate students in the preclinical training of tooth preparation in fixed prosthodontics.

Impact of marginal defects on the accuracy of automated finish line detection in tooth preparation.

AIM: The present study aimed to evaluate the accuracy of automated detection of preparation finish lines in teeth with defective margins. MATERIALS AND METHODS: An extracted first molar was prepared for a full veneer crown, and marginal defects were created and scanned (discontinuity of finish line: 0.5, 1.0, and 1.5 mm; additional line angle: connected, partially connected, and disconnected). Six virtual defect models were entered into CAD software and the preparation finish line was designated by 20 clinicians (CAD-experienced group: n = 10; CAD-inexperienced group: n = 10) using the automated finish line detection method. The accuracy of automatic detection was evaluated by calculating the 3D deviation of the registered finish line. The Kruskal-Wallis and Mann-Whitney U tests were used for between-group comparisons (α = 0.05). RESULTS: The deviation values of the registered finish lines were significantly different according to conditions with different amounts of finish line discontinuity (P < 0.001). There was no statistical difference in the deviation of the registered finish line between models with additional line angles around the margin. Moreover, no statistical difference was found in the results between CAD-experienced and CAD-inexperienced operators. CONCLUSIONS: The accuracy of automated finish line detection for tooth preparation can differ when the finish line is discontinuous. The presence of an additional line angle around the preparation margin and prior experience in dental CAD software do not affect the accuracy of automated finish line detection.

Comparison of digital and conventional assessment methods for a single tooth preparation and educational satisfaction.

INTRODUCTION: Digital feedback for tooth preparation can provide dental practitioners with more objective and accurate evaluations compared to conventional methods. This study aimed to evaluate the educational effect and satisfaction of digital feedback compared with those of the conventional putty index method for tooth preparation. MATERIAL AND METHODS: Forty-eight third-grade dental students were selected. All students performed a full-coverage preparation on a right mandibular first molar resin tooth. They were randomly divided into four groups (n = 12)-no guide (control), putty index, digital feedback, and digital and putty index assessment. Three-dimensional analysis was performed using an analysis software (GomInspect 2018, Gom) to evaluate the amount of tooth structure removed. At the end of the practice, the students completed a questionnaire to evaluate the educational satisfaction of the respective methods. RESULTS: There was no statistical significance of the amount of preparation amongst groups in most of the measured areas only except for several specific points. Overall occlusal surface showed 0.99 ± 0.27 mm in the N group (no guide) and 1.15 ± 0.31 mm in the D group (digital feedback), and overall axial surface showed no statistical differences (p > .05). The groups that used digital assessment showed a high level of satisfaction compared with conventional assessment. CONCLUSIONS: It was difficult to confirm that the digital-based feedback promotes accurate tooth preparation compared to conventional feedback within the limitation of this study. However, it improved educational satisfaction and permitted objective evaluation.

Effect of cement gap and drill offset on the marginal and internal fit discrepancies of crowns designed with different tooth preparations.

AIM: The aim of the present study was to evaluate the effect of cement gap and drill offset on the marginal and internal fit discrepancies of crowns designed with different tooth preparations. MATERIALS AND METHODS: Five tooth preparations were constructed, and crowns with different cement gaps and drill offsets were obtained. Then, best-fit alignment was performed on the crowns with the corresponding tooth preparations, and the fit discrepancies were expressed by color-coded difference images and root mean square (RMS) values. The RMS values of each group were analyzed by the rank-based Scheirer-Ray-Hare test (α = 0.05). RESULTS: The color segments in the sharp line angles area of the Sharp line angles group changed significantly before and after the drill offset. The cement gap had a significant effect on the marginal, internal, or overall fit discrepancies of the five design groups (P < 0.001), while the drill offset had a significant effect on the marginal fit discrepancies of the Shoulder-lip group and the internal or overall fit discrepancies of the Sharp line angles group (P < 0.001). Additionally, the interaction effect between cement gap and drill offset was significant for the marginal fit discrepancies of the Shoulder-lip group and the internal or overall fit discrepancies of the Sharp line angles group (P < 0.01). CONCLUSIONS: The cement gap and drill offset had a significant adverse effect on the marginal or internal fit discrepancies of the crowns designed with the shoulder-lip and sharp line angles designs. Tooth preparation designs with intense curvature changes such as shoulder-lip and sharp line angles should be avoided clinically.

[Prediction, analysis and application of learning curve of tooth preparation for all ceramic crowns of maxillary central incisors].

OBJECTIVE: To predict the learning curve of tooth preparation for all ceramic crowns of maxillary central incisors on phantom head simulators for graduate students participating in standardized dental resident training based on the modified Wright learning curve model, then to analyze and applicate the learning curve. METHODS: Twelve graduate students participating in standardized dental resident training were selected to prepare the resin maxillary central incisors on phantom head simulators for all ceramic crowns 4 times. The results of preparation were evaluated by 3 prosthetic experts with at least 10 years' experience focusing on the reduction, contour, taper, shoulder, finish line, margin placement, adjacent tooth injury, and preparation time for tooth preparation. The learning rate of tooth preparation was calculated by scores of tooth preparation of 4 times. The learning curve of tooth preparation was predicted based on the modified Wright learning curve model. According to the criteria of standardized training skill examinations for dental residents in Beijing, 80 was taken as the qualified standard score. The minimum training times for tooth preparation to satisfy the qualified standard score (80) was calculated, to analyze the characteristics of learning curve and evaluate the effectiveness of tooth preparation. RESULTS: The scores of 4 tooth preparation were 64.03±7.80, 71.40±6.13, 74.33±5.96, and 75.98±4.52, respectively. The learning rate was (106±4)%, which showed the learning curve an upward trend. There were no significant differences between the qualified standard score and the predicted scores of tooth preparation from the 5th preparation to the 13th preparation (P > 0.05). The predicted score of the 14th preparation was higher than the qualified standard score (P < 0.05). CONCLUSION: The trend of the learning curve of tooth preparation for all ceramic crowns of maxillary central incisors on phantom head simulators for graduate students participating in standardized dental resident training is upward, which predicts the minimum training times higher than the qualified standard score is 14 times.

Comparison of marginal accuracy in two different materials used in provisional crown and bridge - an in vitro experimental study.

OBJECTIVE: To determine the difference in the marginal accuracy at buccal, lingual, mesial and distal margins of temporary crowns fabricated with bisacryl-based temporary crown material. METHODS: The in-vitro, experimental, laboratory-based study was conducted at the Aga Khan University, Karachi, from September to December 2019, and comprised two bisacryl-based temporary crown material, Integrity and Protemp 4, which were used to fabricate a sample of 24 temporary crowns. A pre-operative polyvinyl siloxane impression served as a template for temporary crown fabrication. A right mandibular molar tooth on a typodont was prepared to receive a crown. The provisional crown material was syringed onto the template and was allowed to cure. All four surfaces of the crown were observed under a stereomicroscope equipped with digital single-lens reflex camera at 25.6x magnification. An image of each surface was captured and a photographic record was maintained. An image processing software was used for the measurement of marginal discrepancy. Marginal accuracy among the four surfaces was assessed. Data was analysed using SPSS 23. RESULTS: Mean marginal discrepancy for provisional crowns fabricated with Protemp 4 and Integrity was 410±222µm and 319±176µm, respectively. The marginal discrepancy between the two groups was statistically significant (p=0.027), with buccal margin exhibiting the most discrepancy (p<0.01). CONCLUSIONS: Integrity showed less microleakage than Protemp 4. Among all the walls, the buccal wall showed the most microleakage. Marginal accuracy was found to be dependent upon the type of provisional crown material and the side of the prepared axial wall.

Technique to restore the midline space of central incisors using a two-in-one template: A clinical report.

Using composite resin restoration of full-coverage crowns to obtain a completely symmetrical esthetic restoration of individual central incisors remains difficult. Freehand direct composite resin restoration is challenging even for highly skilled dentists. This clinical report describes a digital protocol for achieving symmetrical restoration of two central incisors using a custom-designed, two-in-one template.

Removable Partial Denture - Functional Impression Techniques: Review.

The objective of this article is to concisely review the main clinical techniques used to make the functional impression to manufacture a removable partial denture. Through this review, the dentist can develop his clinical knowledge.

Influence of the Operator`s Experience, Working Time, and Working Position on the Quality of the Margin Width: In Vitro Study.

Background and Objectives: Appropriate tooth preparation is mandatory to obtain a perfect marginal fit of fixed restorations. The heavy chamfer is the most commonly used finish line, especially for minimally invasive tooth preparation. The aim of the study was to compare the width of the finish line obtained during tooth preparation performed by experienced (university lecturers) and inexperienced persons (dental students) in different working times and positions. Materials and Methods: Forty left upper-second molars were prepared on the simulator by each participant, totalizing 160 prepared teeth. A new round-end tapered diamond was used to obtain the 0.5 mm width of the heavy chamfer. The prepared teeth were photographed using a Canon D5300 camera with a macro lens attached to a tripod. The measurements were made with the Image-Pro Insight software selecting the same eight reference points. From these points, perpendicular lines were drawn above the finish line to the axial walls and the distance between the chamfer's outer edge and the axial wall's inner edge was measured. GraphPad Instat and NCSS Dowson Edition software were used. The statistical significance was set at p < 0.05. The mean (M) and standard deviation (SD) were calculated. The used tests: one sample t-test, ANOVA test, and Tukey-Kramer Multiple Comparisons Test. Results: Statistically significant differences were obtained according to the experience of the participant, preparation time, patient's position, and the chamfer width on the prepared tooth different surfaces. Conclusions: Daytime or weeklong tiredness and patient position do not affect the width of the heavy chamfer prepared by experienced and inexperienced persons. The experience and the operator's working position influence the width of the prepared finish line.

The Effect of Dentine Desensitizing Agents on the Retention of Cemented Fixed Dental Prostheses: A Systematic Review.

Background and Objectives: The use of desensitizing agents (DA) after tooth preparation to prevent hypersensitivity is well documented in the literature. A fixed dental prosthesis (FDP) should have good retention to be successful. Inadequate retention may result in microleakage, secondary caries, and, eventually, dislodgement of the FDP. The effect of DAs on the retention of FDPs has been widely studied in the literature, but the results are conflicting. Thus, this study aimed to conduct a systematic review to assess the effect of dentine desensitizing agents, used to prevent post-cementation hypersensitivity, on the retention of cemented FDPs. The null hypothesis framed was that there is no effect of dentine desensitizing agents on the retention of cemented FDPs. The focused PICO question was as follows: "Does the application of dentine desensitizing agents (I) affect the retention (O) of cemented fixed dental prosthesis (P) when compared to non-dentine desensitizing groups (C)"? Materials and Methods: Four electronic databases were systematically searched and, on the basis of the predefined inclusion and exclusion criteria, 23 articles were included in this systematic review. A modified CONSORT scale for in vitro studies was used to assess the quality of the selected studies, as all included studies were in vitro studies. Results: Most of the studies compared the effect of more than one type of DA on retention. The results of the selected studies varied due to differences in the composition of tested dentine DAs and types of luting cements. Conclusions: Within the limitations of this study, it can be concluded that the retention values of FDPs cemented using zinc phosphate cement were reduced with most of the DAs, whereas retention values increased when GIC, resin-modified GIC, and resin cements were used with the majority of DAs. These findings are important, as they can guide dentists in selecting the DA before cementing the crowns with the luting agent of their choice, without compromising the retention of the crowns.

Influence of flow rate and different size of suction cannulas on splatter contamination in dentistry: results of an exploratory study with a high-volume evacuation system.

OBJECTIVES: SOPs recommend high-volume evacuation (HVE) for aerosol-generating procedures (AGPs) in dentistry. Therefore, in the exploratory study, the area of splatter contamination (SCON in %) generated by high-speed tooth preparation (HSP) and air-polishing (APD) was measured when different suction cannulas of 6 mm diameter (saliva ejector (SAE)), 11 mm (HC11), or 16 mm (HC16) were utilized versus no-suction (NS). MATERIALS AND METHODS: Eighty tests were performed in a closed darkened room to measure SCON (1m circular around the manikin head (3.14 m2) via plan metrically assessment through fluorescence technique. HSP (handpiece, turbine (Kavo, Germany)) or APD (LM-ProPowerTM (Finland), Airflow®-Prophylaxis-Master (Switzerland)) for 6 min plus 5 s post-treatment were performed either without suction or with low-flow (150 l/min for SAE) or high-flow rate (250 l/min/350 l/min for HC11/HC16) suction. All tests were two-tailed (p≤0.05, Bonferroni corrected for multi-testing). RESULTS: Irrespective the AGP, SCON was higher for NS (median [25th; 75th percentiles]: 3.4% [2.6; 5.4]) versus high-flow suction (1.9% [1.5; 2.5]) (p=0.002). Low-flow suction (3.5% [2.6; 4.3]) versus NS resulted in slightly lower but not statistically significantly lower SCON (p=1.000) and was less effective than high-flow suction (p=0.003). Lowest contamination values were found with HC16 (1.9% [1.5; 2.5]; p≤0.002), whereat no significant differences were found for HC11 (2.4% [1.7; 3.1]) compared to SAE (p=0.385) or NS (p=0.316). CONCLUSIONS: Within study's limitations, the lowest splatter contamination values resulted when HC16 were utilized by a high-flow rate of ≥250 l/min. CLINICAL RELEVANCE: It is strongly recommended to utilize an HVE with suction cannulas of 16mm diameter for a high-flow rate during all AGPs and afterwards also to disinfect all surface of patients or operators contacted.

Three-dimensional evaluation of tooth preparation forms in paediatric zirconia crowns: An in vitro study.

BACKGROUND: Though prefabricated zirconia crowns (PZCs) differ from stainless steel crowns and have different preparation guidelines for optimal crown adaptation, little is known about how clinicians prepare teeth for PZCs. AIM: To investigate the prepared tooth forms for PZCs and identify the shared patterns of tooth preparation. DESIGN: Twenty participants prepared primary maxillary first molars and mandibular second molars for PZCs. A model with ideally prepared tooth was digitally generated as a reference. The prepared teeth were digitally scanned and superimposed on the reference. Three-dimensional analysis software was used to evaluate the discrepancy between ideal and prepared surface for overall surface and subdivided area. RESULTS: Half of the surfaces received excessive reduction, and 24% showed error within 0.2 mm (p < .001) in maxilla. 41.6% of surfaces showed error within 0.2 mm, and 20% were excessively prepared (p = .002) in mandible. The highest discrepancies were found at the mesiopalatal line angles (maxillary) and at the distobuccal line angles (mandibular). Significant discrepancies were observed on the occlusal surfaces, especially at the cusps. CONCLUSIONS: Tooth preparations for PZCs showed wide variations related to depth among the participants.

Stress distribution in pediatric zirconia crowns depending on different tooth preparation and cement type: a finite element analysis.

BACKGROUND: In clinical settings, tooth preparation for prefabricated zirconia crowns (PZCs) in the primary dentition varies widely. However, knowledge about the biomechanical behavior of PZCs in various clinical settings is limited. This study was conducted to evaluate the biomechanical behavior of PZCs in different clinical settings using 3-dimensional finite element analysis. METHODS: 3-dimensional models of the PZC, cement, and tooth with six different conditions were simulated in primary molar teeth, incorporating cement thickness (100, 500, and 1000 µm) and cement type (resin-modified glass ionomer cement and resin cement). A total of 200 N of occlusal force was applied to the models, both vertically and obliquely as representative cases. A general linear model univariate analysis with partial eta-squared (ηp2) was performed to evaluate the relative effects of the variables. RESULTS: The overall stress of tooth was increased as the cement space increases under oblique loading. The von Mises stress values of the resin cements were significantly higher than those of the resin-modified glass ionomer cements for all cement thicknesses (p < .05). The effect size of the cement type (ηp2 = .519) was more dominant than the cement thickness (ηp2 = .132) in the cement layer. CONCLUSIONS: Within the limits of this study, cement type has a greater influence on the biomechanical behavior of PZCs than cement thickness.

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.