Studies in Europe and Australia show that, with the integration of implant dentistry in daily dental practice [20, 21], more universities are including oral implant-related education in their undergraduate courses. Another study in India shows that 91.7% of students are eager to learn more about oral implants in college courses [22]. Thus, implant dentistry is slowly become a necessary part of pre-clinical teaching in dental education.
The purpose of this study is to explore the effects of a teaching mode that combines the virtual simulation system and jaw simulation model in pre-clinical training. This way, we seek to find a better teaching mode and avoid the disadvantages of traditional teaching. Thus, students can acquire the necessary and adequate skills before beginning their clinic practice.
The results of this study show that, compared with the effects of traditional training, a single virtual simulation system, or a single jaw simulation model, a combination of virtual reality simulation and jaw simulation model is better in terms of theory, operation as well as implant accuracy (shoulder deviation, root deviation, and angle deviation).
Jasinevicius [23] showed that students in contemporary non-computer-assisted simulation system groups took five times more time than students in virtual reality computer-assisted simulation system groups in the preparation of cavity and full gold crown. De Boer [24] showed that dental students could improve their operation dexterity skills by using the Simodont dental trainer to repeatedly practice different levels of force feedback training. Studies also show that virtual and augmented reality technologies can promote enjoyment in learning and the acquisition of operational skills. Research [25] has proven that virtual simulation systems have great potential in dentistry teaching, which is consistent with our conclusion. However, the advantages of a pure virtual simulation system are not as obvious as in the prior research. We assume this may be attributed to the different disciplines and equipment required in the virtual simulation system.
In our results, the V-J group made significant progress. Its students achieved higher theoretical scores by first using a virtual simulation system to familiarize themselves with the dental implant operation process and its main points. Then, they performed physical operations on the jaw model. We believe such a combined education system is better because the virtual simulation technology can simulate the entire dental procedure as well as the corresponding environment—from the patient’s clinical admission to the end of the diagnosis and treatment [26]. Thus, students can quickly grasp the entire clinical implantation process. There is also immense theoretical knowledge instilled in the training process. Other virtual simulation systems can also give targeted feedback during training [27–29]; such sustained feedback will maximize the final effect of virtual training [30].
However, we should consider students’ limited concentration [31]; the theoretical knowledge of virtual reality systems should be taught first. Studies have also shown that gender differences can lead to differences in medical tests [32], and hence we grouped our participants to circumvent this difference.
In the final evaluation of the implanting operation in this study, compared with other groups, the V-J and J-V groups showed higher average operation scores; the CBCT planting accuracy was also higher. These results show that our combined training method is conducive to mastering operation skills. However, the sequence of training does not affect the acquisition of implant operations. Although the virtual simulation system can perform screen construction and sensory stimulation in the operation process, the fidelity of its simulation of vision, hearing, and touch cannot be completely compared with actual reality. However, the jaw simulation model can compensate for shortcomings, making a combination system useful.
This research has three important practical significances for future oral implant teaching. First, instructors can use this study as a reference to modify new teaching methods by including virtual simulation systems and jaw simulation models into their teaching courses. This would improve the proficiency in implant skills of dental students. Seifert et al. similarly regarded virtual patient cases as an effective alternative to lecturer-led small group teaching [33].
Second, the use of the virtual simulation system can decrease faculty time in instruction and supervision. Our combined method can save time and human resources expended in implant teaching by reducing trainers’ workload. However, the guiding role of teachers cannot be completely replaced by technology. For instance, Lechermeier and Fassnacht [34] found that feedback from professionals of higher status and expertise was still the most effective in training. However, the cost of virtual simulation systems is lower when used for a long time [35].
Nevertheless, there are some limitations to this study—First, the training time was too short to fully predict the long-term effect of various teaching methods. Second, because the models of virtual simulation system equipment are not uniform across geographies, simulators use different training levels; they have different contexts and levels of difficulty [36]. Due to this limitation, the results of our experiment cannot explain the application value of all virtual simulation systems. Third, although the pig has proven to be a suitable biomodel for both research purposes and for training medical professionals because of its similarity to humans [37], the effect of using it for the evaluation of dental implant operations is still not completely equivalent to real clinical cases.