Effectiveness of a digital educational system on the learners’ performance in preclinical fixed prosthodontic training
Effectiveness of the digital software in improving student’s performance of tooth preparation
Preclinical fixed prosthodontic training is essential for students to improve their skills in operational procedures and dexterity. Nowadays, with the development of computer-based technology, interactive digital dental softwares give students real-time visual feedback as they explore three-dimensional tooth preparation in the software’s interface [22]. This study aimed to determine the effectiveness of the Dental Teacher system in dental students’ repetitive preclinical training on all-ceramic crown preparation.
The study revealed that this digital software may significantly improve the overall outcome of tooth reduction for all ceramic crowns. Undergraduate students of the experimental group, who used merely the Dental Teacher system during five practical training sessions, achieved tooth preparation scores in session 5 and session 6 significantly different from those in the first session, validating the system’s preclinical training effectiveness after multiple repetitive sessions. Nagy et al. [23] investigated the impact of digital feedback using the Dental Teacher software on preparing onlays, compared to the conventional group. The experimental group demonstrated significant improvements in all parameters, while the control group showed similar scores between the first and second preparation attempts [23]. The other previous studies also showed that the Dental Teacher software enabled an efficient educational method for learning preclinical skills [24, 25]. The primary benefits were significant magnification, three-dimensional visibility, and the capacity for quantifying objective measurements in different planes and directions. The digital software allowed them to identify errors, make relevant corrections, and achieve higher scores [1, 14]. Students used the innovative pedagogical softwares as self-training aids, and had the freedom to set their own learning pace, as some studies suggested [12, 23, 26]. The digital software provided a simulated self-directed learning environment for interactive student exercises, unlike traditional textbooks or teacher-led instructions [14, 26, 27]. Nowadays, the rising student-to-faculty ratio necessitates students’ independent learning with digital software, compensating for the faculty shortage and potential bias in crown evaluations [28]. The benefits above show that digital software encourages tooth preparation skills as well as student-centered learning and strengthens students’ self-critical skills.
However, different training effects among tooth areas were observed in this study. Occlusal reduction showed improvement after the 3rd training session (for the buccal second) and 4th session (for the lingual second), maintaining until the end of the study. The assessment using the digital software and putty index showed clear vision in the buccal second, while the lingual second was less visible, delaying the improvement. The cervical second of the proximal surfaces is generally harder to prepare than the occlusal surface, considering the ease of access to manipulate and evaluate by visualization. This finding is also in line with previous research results, in which the students scored lowest on axial reduction [3, 29, 30]. The study by Rosella et al. highlighted that precise control of tooth tissue removal depth and direction posed a significant challenge for prosthodontists [31]. Therefore, to enhance students’ crown preparation performance, a 4-session digital training is sufficient for occlusal clearance, while longer practice will be beneficial for axial reduction.
Digital applications have an additional problem of time consumption. Implementing digital softwares in dental schools will necessitate a period of adjustment during which faculty train students on the software: adequate time and training are essential to optimizing the scan and assessment flow. Students of the digital training might need time to familiarize themselves with the novel digital evaluation system; consequently, the actual practical exercise time was reduced [16, 32]. Gratton et al. [33] revealed that even with a student-to-scanner ratio of 10:1 considered satisfactory, students did not have sufficient time to familiarize themselves with the new software [33]. In our research, the ratio was approximately 10:1. As the practical sessions progressed, students became more proficient in using the scanner and software, allowing them less time for assessment of their preparation and more time for refinement. Consequently, their scores showed a statistically significant improvement in session 5 and session 6.
Contrasting with the studies mentioned above, some researchers indicated digital softwares are insufficient to improve autonomous student performance in crown preparation [9, 17, 19, 33]. In these studies, the digital training group didn’t score significantly better than the traditional group on tooth preparation. Even with the visualization of the three-dimensional images of the tooth preparation, students had difficulty comprehending all the operational flaws within the allowed time [34]. The conventional instructors offered individualized feedback throughout the exercise, providing comprehensive guidance that was proven effective in developing skill proficiency [1]. The aforementioned factors may account for the insignificant difference of all component scores as well as the overall score between the summative (without digital software) and first-session scores. The results equally showed a lack of improvement in students’ autonomous performance when not using digital control softwares. The third-year dental students who participated in this study were in the early stage of preclinical training, so they exhibited a lack of self-assessment skills, which are typically acquired through practical experience in clinical settings [35]. An analytical rubric system provided students with detailed criteria, facilitating a comprehensive understanding of their scores as well as pinpointing their strengths and weaknesses without instructor feedback [3]. Integrating digital scanning and software in the preclinical curriculum fosters valuable evaluation and introduces dental students to their practical application. However, the value of traditional assessment is an irreplaceable element. The role of a teacher extends beyond simply identifying a student’s strength and weakness; it critically involves pointing out the way to correct the flaws or creating a plan to help each student improve upon any deficiencies. While digital software is supplemental for educators to give students more detailed feedback on any defects in preparation, the process of offering constructive criticism requires the thoughtful consideration and nuanced perspective that only a human being can offer [1, 8, 19].
The summative assessment was implemented to assess if students could prepare teeth without digital software. In clinical practice, the assessment of tooth preparations through digital software is convenient and accurate. However, repeated digital scans of crown preparations solely to assess tooth reduction are impractical. The clinician typically assesses the tooth abutment through intraoral scanning after completing all conventional assessments and the operator has deemed the tooth suitable for crown fabrication [36]. Operators are required to demonstrate proficiency in visually assessing preparations, using both the putty index and direct observation. Although students recognize the digital software as a valuable tool within the preclinical laboratory setting, they should develop the capacity for critical analysis and self-evaluation of their work, emulating real-world clinical scenarios and minimizing dependence on digital software [32, 37].
Student’s perception of digital application in preclinical fixed prosthodontic practice
A comprehensive analysis of the questionnaires revealed a clear trend that the vast majority of students were enthusiastically in favor of incorporating digital systems into their practical training for tooth preparation. An overwhelming majority of students (97.5%) reported the user-friendliness of the digital software, and a significant proportion (92.5 and 85%) showed that digital software aided in improving their preparation and their assessment skills, respectively, in preclinical fixed prosthodontic practice. Various studies also presented a positive outlook regarding handling, pedagogical value, and motivational aspects [14, 27, 38,39,40]. Students likewise reported that self-assessment using digital software was crucial for visualization and identifying preparation flaws [1, 32]. However, after the summative session without the digital software, 60% of students remained neutral or uncertain regarding self-assessment, this proportion of neutral responses may indicate a need for additional support in fostering students’ confidence in self-assessment. Despite the software’s benefits, students largely disagreed that it could fully replace instructors for guidance (57.5%) or evaluation (42.5%), emphasizing the ongoing necessity of instructors in dental education. Students expressed positive opinions regarding the use of digital software as a supplementary assessment method for tooth preparation procedures because it is valuable for examining different characteristics of teeth, such as damage to adjacent teeth, smoothness of walls, depth of preparation, and convergence/divergence walls [19, 32, 41].
Limitations
This study’s limitation is the utilization of phantom heads which cannot simulate clinical scenarios, and subsequent investigation is necessary to evaluate and compare the quality of tooth preparations completed by clinical students, and to determine the effectiveness of the digital learning techniques employed. The study performed a comparative analysis of tooth structure reduction according to component and overall surface reduction. The analysis included an average of 24 points (for mesial/distal surface) and 36–48 points (for occlusal/facial/lingual surface). Each point was measured, compared to the rubric, calculated a score, and then averaged for the component/overall reduction. The existing method for comparing points permits the analysis of several points at each surface, as done in some studies [23, 42]. In the future, area-based analysis will be useful for analyzing tooth surface reduction. Increased student participation and implementation of a range of analytical software for evaluating tooth preparations are also recommended. Additional research is necessary to explore the combined implementation of digital and conventional systems. These approaches may allow for a more thorough analysis of dental students’ educational outcomes.
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