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Title: Application of 3D printed teeth models in teaching conservative dentistry and endodontics
Abstract:
INTRODUCTION During their pre-clinical classes, the students carry out dental procedures on the Dental Patient Simulator (DPS) featuring the standard teeth models. Sometimes the extracted ones are also used. None of those teaching aids are free from disadvantages, however. Standard teeth models do not accurately reflect the actual anatomy of the teeth, do not feature the pulp chamber and roots, whereas the hardness of the material does not reflect the hardness of tissue. The extracted teeth, on the other hand, are notoriously hard to match in terms of specific types, and carry an obvious risk of cross-infection. Reports on an appreciable potential for making use of the three-dimensional (3D) models in teaching dental students emerged throughout the last decade. They predominantly focused on prosthodontics, and on dental surgery. Manifestly fewer studies addressed the use of the 3D teeth models in teaching restorative dentistry and endodontics. AIM 1) Based on the scoping review dedicated to assessing the current body of the knowledge on the use of 3D models in teaching dentistry. 2) The study aimed at designing and printing out an original 3D model of the mandible, including the teeth, in conjunction with the replication of carious lesions of different classes (according to Black’s classification), and of the pulp, as well as at addressing specific research questions put f ; orward by the students. 3) Another principal aim consisted in assessing the errors made by the students with no previous experience in the root canal treatment at the crown access stage on the 3D teeth models, as well as evaluating the students' hands-on learning progress. MATERIAL AND METHODS Publication No 1 –been drafted in line with the guidelines for conducting systematic scoping reviews. PubMed and EMBASE were searched in September 2020. The authors’ search strategy was based upon the specific key words. The assessment comprised the studies in which 3D models were used in pre- or post-graduate education in various fields of dentistry. Titles and abstracts were assessed in line with the adopted exclusion criteria, which in the authors’ view were unlikely to contain any pertinent information that might prove useful in addressing the review queries. The exclusion criteria were as follows: reviews, case reports, technical articles, studies available in the languages other than English. Subsequently, all full texts were assessed in line with the same criteria. The studies were assessed in terms of particular areas of dentistry, specific types of procedures carried out, and the actual technology applied to making the 3D models. In Publication No 2 – the 3D teeth models were printed out in full conformity with a Cone Beam Computed Tomography (CBCT) scan of the patient’s mand ; ible. In work on the actual model design, the following software packages were used: Mimics Medical version 21.0 (Materialise, Belgium), Netfabb Standard 2020 (Autodesk, USA) and 3-Matic Medical 13.0 (Materialise, Belgium). Two technologies were applied with a view to having the respective components of the 3D models printed out, i.e. stereolithography (SLA) (Formlabs FORM2 printer, USA) and Fused Deposition Modeling (FDM) (3DGence Industry F340 printer, Poland). Acrylonitrile Butadiene Styrene, Elastic Resin, Rigid Resin, White Resin. The study protocol was attended by 22, 5th-year dental students. All participants were volunteers and already had some experience in treating caries, as well as in the root canal treatment (RCT) to their credit. Before the study protocol commenced, the 3D models of the mandible were fitted into the DPS. The students' tasks consisted in (1) preparing and filling in a Class II carious lesion in the first molar, (2) preparing and filling in a Class III carious lesion in the lateral incisor, (3) preparing a Class I carious lesion in the first premolar, and in the trepanation of the pulp chamber, in conjunction with an application of a temporary filling to the cavity. All procedures were carried out after the teeth had been isolated with a rubber-dam. Following the completion of the treatment procedures, the students were asked to fill in a 3-par ; t questionnaire. In Publication No 3 - extracted incisors, premolars, and molars were imaged with the aid of a CBCT. The collected data were subsequently analysed in the Model Creator (Exocad, Germany) program for creating visualisations of 3D models. The 3D teeth models were made from Dental Model resin with the aid of a 3D Form 2 printer (Formlabs, USA), using SLA technology. Ninety teeth models were printed out, i.e. 30 molars, 30 premolars, and 30 incisors. Then, the teeth were randomly divided into 9 groups. One fourth-year dental student with no experience in root canal treatment was randomly assigned to each group. A dental specialist demonstrated a proper opening of the pulp cavity to the students, and then each student carried out a primary cavity access procedure in 10 identical 3D models. The actual correctness of the implemented procedures was assessed under a microscope, whereas all additional assessments and measurements were pursued in full conformity with the images supplied by a millimetre-scale camera, and with the aid of a scanner. RESULTS The scoping review (Publication No 1) indicated that 3D-printed teeth models, as originally developed for teaching purposes, had already been in use in various areas of dentistry. Their general assessment and usefulness in acquiring pertinent hands-on skills for clinical work was favourably rated in all studies, regard ; less of the specific types of the procedures entailed. The research presented in Publication No 1 indicated widespread use of individualized 3D models in the students' pre-clinical education, whereas the participants of the studies under review recommended the introduction of the 3D models in the hands-on teaching courses. In Publication No 2, the 3D teeth models in the students’ opinion proved well capable of replicating adequately both the tissue hardness and the anatomical characteristics of the teeth, whereas the replication of the soft tissue characteristics was rated by far the weakest component. Replication of carious lesions and the pulp were also rated by most participants as adequately, or perfectly representative of their natural counterparts. When asked about overall usefulness of the 3D teeth models in teaching various procedures in restorative dentistry with endodontics, the highest rated components of the training proved the carious treatment, then rubber-dam placement, and the preparation of endodontic access. On the other hand, the students indicated that the 3D teeth models were not particularly helpful in diagnosing caries. Out of all participants, 21 (95.45%) students recommended the introduction of the 3D teeth models into the teaching of conservative dentistry with endodontics at the pre-clinical stage. In the open questions, they emphasized the value o ; f a gradual transition from the standard models through the 3D models, right up to the clinical treatment. In Publication No 3 - preparation of primary access to the pulp cavity with the aid of the 3D models is believed to appreciably reduce overall risk of encountering complications with each subsequent repetition. During the first attempt, the percentage of errors among students was 100% for incisors, 66.7% for premolars, and 76.2% for molars. With each successive repetition, students committed fewer errors. In the final attempt, the percentage of errors was 19.0% for incisors, 14.3% for premolars, and 33.3% for molars. Students achieved the greatest improvement in the quality of the procedure in the case of incisors. The least progress was noted in the preparation of molars. CONCLUSIONS 1) The 3D teeth models facilitate a hands-on training in particularly complex procedures and may thus effectively improve overall quality of their implementation at the clinical stage. 2) Replication of individual teeth, along with the surrounding anatomical structures, makes the training conditions more closely evocative of the actual dental procedure, therefore facilitating appreciably easier transition from the pre-clinical procedures to the clinical ones. 3) The 3D printing offers a possibility of making the individualized teeth models, which feature high anatomical variability, pre ; ferably in due consideration of any specific pathological changes, as might be encountered.
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Rada Dyscypliny Nauki medyczne
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Feb 6, 2024
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Feb 6, 2024
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http://dl.cm-uj.krakow.pl:8080/publication/5036
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| Edition name | Date |
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| UJCMae4f46d03512412ba4325a325f9ac7b0 | Feb 6, 2024 |
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