Effect of preclinical training in periodontal instrumentation on undergraduate students’ anxiety, clinical performance, satisfaction | BMC Oral Health

Dentistry is inherently a practice-based profession, requiring both clinical skills and theoretical knowledge [16]. Periodontal treatments, which involve intricate procedures such as mechanical debridement, require precise manual skills. Comprehending, applying, and memorizing knowledge and skills are essential aspects of learning periodontal treatments [1, 8, 17]. Dental simulation, a crucial component of pre-clinical education, can support the cultivation of these manual skills by mimicking clinical conditions and providing opportunities for repeated practice. The primary objective of the current study was to assess the impact of using phantom head typodont on the development of periodontal skills among undergraduate students and their satisfaction with the training. Additionally, the study aimed to examine the effects of preclinical training on students’ anxiety levels before treating first patients.

The objectives of pre-clinical education in dentistry encompass the refinement of students’ hand-eye coordination, the acquisition of manipulation skills, and the development of clinical motor skills [4]. Historically, dental simulations relied on relatively primitive methods, including the use of plastic teeth and extracted teeth. In contrast, contemporary approaches incorporate sophisticated technologies such as phantom heads with jaws, virtual reality, and haptic feedback systems [16, 17]. The present study revealed that preclinical training using a typodont mounted in phantom head, in addition to theoretical training with multimedia, improved students’ clinical performance and satisfaction with the training. Phantom heads are advanced simulation models incorporating plastic teeth and/or anatomical structures designed to replicate both hard and soft oral tissues. They serve as a realistic training platform, enabling student operators to simulate patient care and procedural techniques in a hands-on setting that closely approximates clinical treatment on a live patient [18, 19]. These simulators offer several benefits, including an ergonomic design that enhances the proper use of dental mirrors and handpieces, as well as a finger rest that provides stability during instrumentation, promoting precision and control. Additionally, working on typodonts allows students to develop essential motor skills and hand-eye coordination. However, while phantom head simulators facilitate skill acquisition in a controlled environment, they lack real-time feedback, requiring instructor evaluation, and do not fully replicate patient responses and soft tissue behavior [17, 19]. Notably, research has demonstrated that remote simulation-based training with typodonts can yield comparable outcomes to traditional hands-on approaches. For instance, Oh SL et al. [20] reported that students who underwent remote periodontal preclinical training using typodonts through online and offline simulation-based video content performed at a level similar to those who received in-person, hands-on training. Similarly, Gartenmann et al. [21] demonstrated that an 8.5-hour preclinical skills course focused on periodontal instrumentation with a typodont, following theoretical training, led to significant improvements in students’ calculus removal rates. Their post-training performance was comparable to that of dental hygienists with at least two years of experience. This finding aligns with our results, highlighting that preclinical training with typodonts effectively develops fundamental skills in scaling and root planing.

Emerging technologies have the potential to enhance dental education by expanding beyond the limitations of traditional methods. Innovations such as virtual reality (VR) and haptic feedback systems can provide more realistic and interactive learning experiences. By incorporating force feedback mechanisms, it accurately simulates the interaction between the bur and the tooth, as well as the dynamics of the mouth mirror and both soft and hard tissues, thereby enhancing the realism of the training experience. This technology allows for a comprehensive reproduction of the dental clinical skill training process, making it reversible, repeatable, and environmentally sustainable. Dental simulator training offers a diverse range of learning experiences by incorporating various procedural content and tooth positions. These simulations can be rendered in three dimensions on a computer screen, enabling instructors to provide real-time assessment and feedback, thereby enhancing the effectiveness of skill development [22,23,24]. However, traditional methods still offer significant advantages, such as foundational skill development and cost-effectiveness. Recent limited studies have integrated virtual reality technology into preclinical periodontal education, demonstrating its potential to complement traditional training methods. A study involving sixty undergraduate students compared four training methods: traditional jaw model (Group J), virtual reality (Group V), virtual-jaw combination (Group V-J), and jaw-virtual combination (Group J-V). The combination of virtual reality and traditional jaw models (V-J and J-V groups) showed significant improvement in their theoretical scores compared to their initial theoretical knowledge scores. In addition, performance scores in clinical operation and scaling processes were notably higher for the V-J and J-V groups (72.00 ± 5.92; 70.00 ± 3.05) than for the J (60.67 ± 2.58) and V (61.67 ± 7.85) groups. The Student’s Satisfaction Questionnaire scores revealed that participants in Groups V-J and J-V were significantly more satisfied with the training than the other groups. The findings suggest that while no significant difference was found between the traditional jaw model and virtual reality, integrating virtual reality with jaw models provides superior educational outcomes, particularly in terms of periodontal skill acquisition and performance [15]. Fu et al. [25] also found that virtual simulation technology provided the best overall performance in ultrasonic periodontal scaling teaching among pre-clinical students, significantly improving calculus removal efficacy. However, the traditional typodont with head simulators outperformed the VR group in pivot stability practice and body position training. In addition, while VR simulations offer improved realism over time, they may fall short of providing the tactile feedback that phantom heads deliver. Systems based solely on joystick manipulation and computer-generated imagery may be inadequate for developing essential psychomotor skills, such as handpiece grip, posture, and finger support. Furthermore, some VR systems may lack foot pedals or exhibit input-display delays, leading to discrepancies with actual clinical practice and presenting greater challenges in controlling soft tissues [17]. Although combining technological advancements with traditional techniques can offer a more robust educational approach by leveraging the strengths of both, more investigations are needed to understand and fully optimize the benefits of traditional methods.

Anxiety can be conceptualized as a cognitive-emotional state characterized by heightened apprehension and distress in response to perceived threats, often arising from uncertainties regarding future events or outcomes [26]. A new experience, such as performing a procedure for the first time, can cause anxiety and stress even in both inexperienced and experienced physicians. Therefore, preclinical education and first-patient interactions may cause anxiety in dental students new to the periodontal practice [27]. Studies have shown that performing actions that may cause physical harm to the patient can induce anxiety, particularly in lower-grade students [27, 28]. Gerreth et al. [29] revealed anxiety levels in third-year dental students performing their first pediatric procedure, finding that a significant portion experienced high state and trait anxiety. The study investigating local anesthesia applications among 63 pre-clinical dental students revealed a preference among participants to administer their initial applications on dental models rather than on peers. Moreover, heightened levels of anxiety were observed among students who practiced on each other, underscoring the significance of pre-clinical simulation models [30]. According to our study results, no difference was found between the two student groups in terms of anxiety. However, the grading conducted by the supervisor may have increased students’ anxiety. In Obarisiagbon et al.‘s study, it was observed that senior dentistry students experienced greater difficulty in identifying subgingival dental calculus. The supervisor’s evaluation of calculus detection following the student’s scaling was recognized as a significant trigger of clinical anxiety among students [31]. Taysi et al. [32] investigated the impact of preclinical training on anxiety levels among dental students by comparing groups: group 1 received both theoretical and practical training on a tooth extraction phantom model, and group 2 received only theoretical education. In line with our study, Group 1 was more comfortable performing sequential motions with dental tools and felt better prepared for their first clinical tooth extraction, whereas Group 2 exhibited higher anxiety levels and lower self-confidence, although these differences were not statistically significant. There is no existing literature evaluating the impact of preclinical periodontal education on student anxiety, making our study the first to address this gap.

In the present study, the principles of working with periodontal hand instruments were first taught to all students through multimedia presentations. Demonstrations were then conducted on patients. Interactive videos, animations, and multimedia presentations can significantly enrich the learning experience by effectively illustrating complex concepts. These tools provide dynamic and engaging content that can help explain complex concepts more effectively than traditional text-based materials. Several studies indicate that online videos improve students’ ability to learn skills, grasp clinical procedures, and prepare for practical applications on patients [1]. In a study on dentistry, the majority of students reported that watching the instructional video before the preclinical courses helped them perform the procedure of fixed prosthodontics more easily in the laboratory [33]. On the other hand, in a study, the enhanced video demonstration improved the students’ short-term knowledge acquisition and led to better retention of theoretical knowledge, but did not enhance the practical performance of dental students [34]. The current study demonstrated that combining multimedia presentations with additional practical training provides significant added benefits.

Student satisfaction is also important in evaluating teaching methods. Positive feedback from students can encourage educational advancement, as it fosters lasting memory and engagement through enjoyable learning experiences [35]. A study [36] by Shbeer concludes that simulation-based training significantly enhances both student satisfaction and self-confidence, highlighting the importance of learner-centered methods and interactive learning in medical education. Ganesh et al.‘s [37] study pointed out students’ dissatisfaction with the lack of practical training in online theoretical learning. This finding underscores the importance of incorporating preclinical practical experiences into online and theoretical learning environments. Similarly, the current study revealed that students who engaged in practical training achieved notably higher satisfaction scores. In addition, Zhang [15] et al. reported that the highest level of student satisfaction was reported in the groups using the typodont jaw model combined with VR technology.

The study’s limitation includes the absence of repeated theoretical and practical training sessions, which could have potentially enhanced the depth of skill acquisition and contributed to a greater reduction in anxiety. Repeated preclinical training sessions might have provided students with more opportunities for practice and refinement, thereby improving their proficiency and confidence. Additionally, the study assessed students’ anxiety using a state anxiety test, aiming to capture their transient psychological and physiological responses to specific situations. However, even transient anxiety levels can be influenced by long-term stressors, such as socioeconomic background, life experiences, and individual differences. In addition, the lack of feedback-providing models in the preclinical training also limited the opportunity for students to receive real-time corrections and targeted learning. These factors may have influenced the study’s outcomes, highlighting the need for further research to explore in more detail.