SimodontSimodont Training in virtual reality to prepare for the Training in virtual reality to prepare for the

realityreality

Current educational Current educational circumstancescircumstances

• Golden standard from the “best” preparation.Golden standard from the “best” preparation.• Criteria – inter and intra observer reliability low.Criteria – inter and intra observer reliability low.• Mental model developed on preparation model Mental model developed on preparation model

on plastic teeth.on plastic teeth.• Internal model not based on pathology.Internal model not based on pathology.• Problem solving is taught as a separate skill.Problem solving is taught as a separate skill.• Only in the clinic problem solving, pathology and Only in the clinic problem solving, pathology and

preparation design are integrated.preparation design are integrated.

Why change?Why change?•Educational reasonsEducational reasons -- improve integration theory and practice improve integration theory and practice - process and outcome evaluation- process and outcome evaluation - incorporation of problem solving in - incorporation of problem solving in preclinical trainingpreclinical training

- practice in realistic context closing the - practice in realistic context closing the gap to the clinicgap to the clinic

Why change?Why change?• Practical reasonsPractical reasons - - reduction of maintenance costsreduction of maintenance costs - no waste of materials- no waste of materials - no water problems ( legionella)- no water problems ( legionella) - unlimited availability of practice - unlimited availability of practice

materialmaterial

Practical skill development Practical skill development and caries treatmentand caries treatment

•Accurate realistic 3D simulation of both manual Accurate realistic 3D simulation of both manual dexterity and pathologic concepts. dexterity and pathologic concepts. Proper haptics and realistic images. Realistic Proper haptics and realistic images. Realistic mental modeling, muscle memory, mental modeling, muscle memory, proprioceptive training. proprioceptive training. •Integration of existing and present knowledge.Integration of existing and present knowledge.This is the case, why are you going to do what This is the case, why are you going to do what and how are you going to do it?and how are you going to do it?•Realistic interaction with the virtual patientRealistic interaction with the virtual patient Simulation of space limitations (tongue, cheek) Simulation of space limitations (tongue, cheek) and patients perceptions.and patients perceptions.

Advantage of complete Advantage of complete virtual imitationvirtual imitation

• Integration of techniques and theory.Integration of techniques and theory.• Unlimited practicing in a safe and almost real-life Unlimited practicing in a safe and almost real-life

situation.situation.• Time and partially space independent ( lap top Time and partially space independent ( lap top

work station).work station).• Level of skill can be easily adapted.Level of skill can be easily adapted.• Development from skills to competenciesDevelopment from skills to competencies• Saving of materials, equipment and staff.Saving of materials, equipment and staff.

Borders of the virtual Borders of the virtual dimensionsdimensions

• Complete patient.Complete patient.• Complete oral cavity.Complete oral cavity.• Dental arch(es) with soft tissue. Dental arch(es) with soft tissue. • Dental arch(es) only.Dental arch(es) only.• Single tooth.Single tooth.

Haptic feedback

Stereo Projection

Courseware

3D models of real teeth

System borders selectedSystem borders selectedfor for Simodont Simodont version Iversion I

•Realistic force feedback.Realistic force feedback.•Realistic imaging.Realistic imaging.-resolution of 3D models.resolution of 3D models.-hardness and color of tissue structures.hardness and color of tissue structures.-stereo imagingstereo imaging-collocation of image and haptics . collocation of image and haptics . •Dental arch(es) only.Dental arch(es) only.

ClinicPatients

Precliniclab

Simodont

SimodontPreclinic/lab

ClinicPatients

Purpose of the studyPurpose of the study• To investigate if students without To investigate if students without

any dental experience practicing any dental experience practicing at the Simodont will develop skills at the Simodont will develop skills transferable to reality at a similar transferable to reality at a similar level as students practicing in the level as students practicing in the traditional preclinical settingtraditional preclinical setting

ExperimentExperimentS (n=10)S (n=10) P (n=10)P (n=10) C (n=8)C (n=8)

Day 1Day 1 test + practice (2x30)test + practice (2x30) test + practice (2x30)test + practice (2x30) testtest

Day 2Day 2 practice (3x30)practice (3x30) practice (3x30)practice (3x30)

Day 3Day 3 test + practice (2x30)test + practice (2x30) test + practice (2x30)test + practice (2x30) testtest

Day 4Day 4 practice (2x30) + testpractice (2x30) + test practice (2x30) + testpractice (2x30) + test testtest

DesignDesign• Students practice after an initial Students practice after an initial

test their manual dexterity for test their manual dexterity for handling a dental bur either on handling a dental bur either on the Simodont or with a real bur on the Simodont or with a real bur on resin plates.resin plates.

• Thereafter they perform a similar Thereafter they perform a similar test on plastic blockstest on plastic blocks

2004/22/23

Courseware

Courseware

Courseware

Courseware

CriteriaCriteriaPreparation border within 1st and 2nd circle

Wall perpendicular to the bottom and outer surface.

Bottom within certain level and flat

Circle

0.00.51.01.52.02.53.03.54.04.5

1 2 3

Timepoint

Ass

essm

ent

ControlPhantomSimodont

Kruskall Wallis Control vs Ph and Simodont p< .05

Time point 1 vs 3 Ph, Simod p<.05

Total

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1 2 3

Timepoint

Ass

essm

ent

ControlPhantomSimodont

Kruskall Wallis Control vs Ph and Simodont p<.05

Time point 1 vs 3 Ph –Simo p< .05

ConclusionsConclusions• Practicing resulted in a better Practicing resulted in a better

performance than without practicing.performance than without practicing.• Skills transfer from the Simodont to Skills transfer from the Simodont to

reality was equal as from reality to reality was equal as from reality to reality.reality.

• Practicing after the second test did not Practicing after the second test did not show any improvement probably due to show any improvement probably due to reduced concentration and fatiguereduced concentration and fatigue

ClinicPatients

Precliniclab

Simodont

SimodontPreclinic/lab

ClinicPatients

Decision strategy in new Decision strategy in new developmentdevelopment

Innovation or evidence, what first?Innovation or evidence, what first?

Thanks

p.wesselink@acta.nl