Virtual Reality Technology in Predoctoral Endodontics Education

Study summary: The efficacy of utilizing Virtual Reality Technology (VR) as an education medium and imaging technique for a tooth undergoing root canal therapy was evaluated. Dental students’ access quality, working length accuracy, and speed using VR, periapical radiographs (PA), and cone beam computed tomography (CBCT) were compared.

Other study contributors: Daniel Ford, TK Baker, Paxton McCammon, Will Richards, Ben Engel, Hunter King, Mark Durham

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Introduction

Immersive VR transports users into a computer-generated world, giving the impression that the user has stepped inside a synthetic world. Some of the modern uses of VR technology involve gaming as well as training simulations for many career fields including pilot flight training. Previous studies have demonstrated VR can be educationally effective in some disciplines. Traditional methods of learning and imaging in endodontics constituting the “standard of care” involve periapical (PA) radiographs and Cone Beam Computed Tomography (CBCT). This study set out to analyze the efficacy of VR as an education medium and imaging technique for a tooth undergoing root canal therapy compared to using only traditional imaging techniques.

Method

A VR image was created using a CBCT of the plastic tooth used in this study. The CBCT data was imported into the VR system and was customized for 3-dimensional viewing of the tooth through a VR headset. Handheld remote controllers could be used to rotate the 3D tooth, make the tooth translucent, and take working length measurements by dropping measurement points along the root curvature while essentially "walking" through the root.

In the image to the left you can see a VR headset in use with handheld remote controllers.

In the image to the right you can see a 3D tooth similar to the one that was visualized with the VR headset.

Two test populations were used in this study, a 3rd and 4th year dental school class, consisting of 69 total participants. Each cohort was split into 3 equal groups. The groups were given either a PA, CBCT + PA, or VR tooth image + PA. Each group had 10 minutes of training focused on how to manipulate their tooth representation(s) and how to estimate root canal working length (WL). Groups were instructed to use their unique tooth image(s) to aid in endodontically accessing a plaster mounted, plastic, mandibular molar and obtaining WL measurements of the 3 roots. Groups were assessed based on the quality of their access, accuracy of their WL measurements, and the overall time to completion.

Results

A series of ANOVAs were used for statistical analysis and when statistically significant p value resulted, a post hoc Tukey test was used to discover where the difference existed.

The major findings are listed below:

• The PA group produced significantly better quality access preparations than the VR group. On a 5 point grade scale the PA group averaged 4.61, while the VR group averaged 3.76. This is likely due to the fact that all dental students are most familiar with PA radiographs as it is the current standard of care.

• The VR group was significantly faster than the PA group at completing access preparations and determining root WLs. The VR group outpaced the PA group by an average of4.87 minutes. The VR group spent on average 13.08 minutes to complete the procedure, while the PA group spent on average 17.95 minutes. This shows that VR training can be used as a time efficient adjunct to traditional methods to enhance dental students’ understanding of tooth and root canal morphology.

• The groups showed no significant difference in participants’ average estimation of the WL of the three tooth roots, thus all groups demonstrated similar WL accuracy, all within clinically acceptable limits averaging 0.88-1.27 millimeters from the true WLs.

In summary, VR training resulted in quicker performance, similar accuracy in working length determination, and lower quality access preparations. These outcomes indicate sufficient potential value to justify incorporating VR into dental education as an adjunct to traditional methods.

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Using the data from this project, I created a secondary project based on more specific criteria. I was fortunate to have this secondary project selected for poster presentation at the American Association of Endodontists annual meeting in Nashville, TN. Unfortunately this meeting was cancelled. However, my abstract for this secondary project will be published in the May 2020 edition of the Journal of Endodontics.

The abstract is inserted below.

The Impact of Immersive Virtual Reality Technology on Root Canal Working Length Determination in Predoctoral Endodontics Education

Predoctoral endodontics courses emphasize that accurate working length (WL) determination is integral to successful root canal treatment outcomes. Dental students utilize periapical radiographs (PA) and cone beam computed tomography (CBCT) to approximate root canal WL. Novel use of immersive virtual reality technology (VR) provides a new strategy for determining WL by creating a 3-Dimensional tooth image. This study investigated the impact of various visual tooth representations on the accuracy and efficiency of dental students’ WL determinations. Sixty-nine dental students were randomly divided into 3 test groups and given various visual tooth representations for WL approximation (Group 1-PA only; Group 2-PA+CBCT; Group 3-PA+VR). Participants completed conventional accesses and coronal preparations on identical plaster-mounted 3-rooted plastic molars and determined all canal WLs using K-files. WL determination times were recorded, and measurements were graded for accuracy. The results show that WL determination times yielded significant variation among groups (ANOVA, F(2,66)=3.88, p<.05). The VR group experienced a statistically significant decrease in WL determination time compared to the PA group, (Post hoc Tukey, p<.05). The VR group outpaced the PA group by an average of 100 seconds. WL accuracy grades yielded no significant variation among groups, (ANOVA, F(2,63)=.29, ns). In conclusion, VR+PA participants were as accurate at approximating WL as CBCT+PA and PA-only participants and were able to determine WL faster. Consequently, VR has a potential use in predoctoral endodontics education, providing students a 3-Dimensional model to assist in understanding root canal morphology and accurately approximating WL.

Here is the original project poster: