Where Computer Assisted Learning is Still Only a Dream

An Englishman, a Frenchman and a German meet in a tavern in Riga.

The place is called Rozengrals and takes you back to medieval times. In a room lit by thick, white candles you sit on rough wooden chairs at rough wooden tables while crunching roasted nuts and dipping rough bread, served in small jute bags. The sound of flutes and lyres accompanies the waiters, dressed in long robes as they serve delicious lamb on the skewer with lentils and local beer, followed by homemade Vodka.

Says the Englishman to the Frenchman:
“Did you participate in the special interest group ‘Virtual Reality’, today?” – “Yes,” replies the Frenchman with some excitement, “I was very impressed with the innovative technologies”. - “It’s going to take time till this computerized simulation will be fully implemented in the universities, though” objects the German.

Did you expect a joke? Sorry to disappoint you. The three are university professors, who have come for the annual ADEE conference (Association on Dental Education in Europe), that took place in Riga in September.

Don’t be afraid – it doesn’t hurt!
Dentists are needed everywhere and one can acquire the profession almost anywhere in the world. But you probably prefer not to think about a dentist – understandable – and what he actually needs to learn. So be courageous here and look the patient in the mouth. Don’t worry, it’s not a real patient, it’s a puppet, or more accurately a plastic head with plastic teeth to practice on.

You are required to cut a cavity. The instructions and measurements you are given are highly exact and specific. Not only the depth of the cavity is provided by a tenth of the millimeter, also the angles of the walls and the floor, the smoothness, the retention and outline shape etc. have to be extremely accurate. And all this at dimensions, which can hardly be captured with the naked eye. Should you drill a mere 0.5 mm too far to one side, you may damage the neighboring tooth. Should you drill a mere 0.2 mm too deep, you may hit the pulp and…. oh dear!

Dental students sit for hours with such mannequins and try to accomplish their preparations according to precise specifications. When they finish one, the prepared plastic tooth is being measured with a magnifying glass and evaluated manually. That sounds more like it belongs in the time of the Rozengrals. Even though the execution demands highly developed fine-motoric skills and elaborate cognitive constructs to go along, in dental education there is little use of digital equipment to provide support. While the use of computerized technologies is becoming increasingly main stream in other areas of the medical faculties, the dental schools are still far behind when it comes to digital learning equipment.

Why are digital teaching aids still rare in dental education?
It seems only natural to carry out precise measurements and evaluations with the computer, because there is no way the human eye could complement the precision and speed of a computer.

Indeed, some digital scanners for plastic teeth have made it into some universities during the past years. Devices, such as the PREPassistant by KaVo and the PrepCheck by Sirona measure and analyze the preparations which the students have tediously cut and display the results enlarged on a screen. Different color codes show different depth or errors and one can view the cavity or crown preparation from various angles and in different cross-sections. In addition the student can compare his own prep to the original tooth and to what the prep was supposed to look like.

It’s time for real-time!

These types of digital scanners have so far failed to take over practical dental education, though. As elegant, as they appear, they seem more like a ‘nice to have’ tool, than a real educational aid with the capacity to significantly change the face of dental simulation labs. This is what the Israeli company Image Navigation has set as a goal for itself. With the DentSim Augmented Reality Simulator the company hopes to provide noticeable improvement in the way necessary motor skills are acquired. The DentSim simulator combines the traditional phantom head with computer based evaluation in real-time. This means, the student receives feedback while cutting a preparation and not only after he has finished the entire process, which is the case now. He can call up measurements and analysis at any time during his preparation process. This way the dental student knows exactly when he is too deep or too far, when his angle is off and can correct himself in real time while preparing. Thus, the DentSim evaluates the actual process and not only the outcome. Studies have shown that this leads to faster and more effective acquisition of motor skills and less errors. It also helps develop the necessary cognitive structures. Read more on the advantages and features of the DentSim here.

A similar product is offered by the Dutch company Moog. The software of the Simodent Dental Trainer also accompanies and evaluates the cutting process itself. With its touch screen and simplistic design, the device is quite attractive. However, there is no real cutting experience. The system is based on a hydraulic mechanism, which replaces the actual teeth. This raises some problems when it comes to the ergonomic aspect, because the student is positioned differently than in a clinical environment. In addition the visual image the student receives through a type of monitor does not reflect that of a patient and it lacks additional natural restraints. It may be difficult for the student to make the transition from the simulator to the clinic.

Dental professors and students don’t need to feel like in medieval times. They can always have homemade Vodka at the Rozengrals for that. In dental education it is time to adapt to real times.

Students practicing at the DentSim Simulator