What types of dental procedures can be simulated using virtual reality?

I’m a dental student, and my university is looking into incorporating virtual reality (VR) training into our curriculum. It seems like a really promising way to get hands-on experience without the risks associated with working on real patients early on. I’m trying to research which specific dental procedures are actually being effectively simulated in VR currently, and what the limitations of those simulations are.

Specifically, I’m interested in knowing:

• Can VR be used for simulations of extractions (simple and surgical)?
• What about restorative procedures like fillings (amalgam and composite) and crown preparations? How accurate are the haptic feedback systems in those simulations?
• Is VR being used to train students in endodontics (root canal therapy)? If so, how does it handle the complexity of the root canal anatomy?
• Are there VR modules for periodontal procedures such as scaling and root planing?
• And finally, are there simulations for implant placement?

I’d really appreciate any information, including specific product names or research studies, about the types of dental procedures that can be effectively learned and practiced using VR technology. Thanks!

Answer

Virtual reality (VR) has emerged as a valuable tool in dental education and training, offering realistic simulations of various dental procedures. These simulations allow students and practitioners to hone their skills in a safe and controlled environment before working on real patients. The range of procedures that can be simulated is continuously expanding as VR technology advances. Here’s a detailed overview of the types of dental procedures that can be simulated using virtual reality:

Basic Operative Procedures:

• Tooth Preparation (Cavity Preparation): VR simulations allow users to practice creating different types of cavity preparations for various restorative materials like amalgam, composite, and ceramic. This includes learning the correct angulation, depth, and outline form for ideal cavity design based on different tooth locations and caries extent. Students can practice using virtual handpieces and burs to remove decayed tooth structure, refine cavity walls, and establish proper retention features. Force feedback can simulate the tactile sensation of cutting through enamel and dentin.
• Restoration Placement: VR simulations enable users to practice placing restorative materials into prepared cavities. This includes techniques for proper material adaptation, contouring, and finishing. Different restorative materials such as composite, amalgam, glass ionomer, and gold can be virtually manipulated. Simulations can also provide feedback on the quality of the restoration, including marginal adaptation, overhanging edges, and anatomical form.
• Dental Impressions: Taking accurate dental impressions is a fundamental skill. VR simulations allow students to practice impression techniques using different materials such as alginate and polyvinyl siloxane (PVS). The simulation can guide the user through the proper steps of mixing the material, loading the tray, inserting the tray into the mouth, and removing the impression. The simulation can then assess the accuracy of the impression based on anatomical landmarks and the absence of voids or distortions.

Endodontic Procedures (Root Canal Treatment):

• Access Cavity Preparation: Creating an access cavity is the first step in root canal treatment. VR simulations enable students to practice locating the pulp chamber and creating an appropriate access cavity through the occlusal or lingual surface of the tooth. This includes using burs to remove tooth structure and create a straight-line access to the root canals. The simulation can provide feedback on the size, shape, and location of the access cavity.
• Canal Negotiation and Instrumentation: This involves locating the root canals, determining their working length, and cleaning and shaping them using endodontic files. VR simulations can provide realistic tactile feedback as the user navigates the canals and instruments them. The simulations can also display the anatomy of the root canal system in 3D, allowing the user to visualize the progress of the instrumentation. The simulation can also assess the quality of the canal preparation based on factors such as canal taper, apical size, and the absence of ledges or perforations.
• Obturation: The final step in root canal treatment involves filling the root canals with a biocompatible material, typically gutta-percha. VR simulations can enable students to practice different obturation techniques, such as lateral condensation and warm vertical condensation. The simulation can provide feedback on the quality of the obturation based on factors such as density, length, and the absence of voids.

Prosthodontic Procedures (Crowns, Bridges, and Dentures):

• Crown Preparation: Preparing a tooth for a crown requires precise reduction of tooth structure to create space for the restorative material. VR simulations allow students to practice preparing teeth for different types of crowns, such as porcelain-fused-to-metal (PFM) crowns and all-ceramic crowns. The simulation can guide the user through the proper reduction guidelines and provide feedback on the amount of tooth structure removed.
• Provisional Restoration Fabrication: After tooth preparation, a temporary crown is often placed to protect the prepared tooth. VR simulations can enable students to practice fabricating provisional restorations using different materials and techniques.
• Removable Prosthodontics (Dentures): VR can simulate various aspects of denture fabrication, including taking impressions, selecting teeth, arranging teeth on the denture base, and adjusting the occlusion.

Periodontal Procedures:

• Scaling and Root Planing: This involves removing plaque and calculus from the teeth and root surfaces. VR simulations can provide realistic tactile feedback as the user instruments the teeth and roots. The simulation can also display the anatomy of the periodontal tissues in 3D, allowing the user to visualize the progress of the instrumentation.
• Surgical Procedures: VR simulations can also be used to practice periodontal surgical procedures, such as flap surgery and guided tissue regeneration. These simulations can provide realistic anatomical models and allow the user to practice surgical techniques in a safe and controlled environment.

Surgical Procedures (Implant Placement and Extractions):

• Tooth Extraction: VR simulation provides the opportunity to practice extracting teeth with varying degrees of difficulty. The simulation can replicate the tactile feedback of using extraction forceps and elevators, while students learn the proper techniques for luxating and removing teeth with minimal trauma.
• Implant Planning and Placement: VR simulations allow users to plan implant placement using cone-beam computed tomography (CBCT) scans and surgical guides. The simulation can guide the user through the proper steps of implant placement, including osteotomy preparation and implant insertion. Haptic feedback can simulate the resistance of bone, allowing the user to develop a feel for bone density and implant stability.

Diagnostic Procedures:

• Radiographic Interpretation: Although not a hands-on procedural simulation, VR can immerse users in radiographic images, allowing them to identify anatomical landmarks, pathologies, and variations in dental structures. This enhances diagnostic skills.

Other Applications:

• Local Anesthesia Administration: VR can simulate the injection of local anesthetics, allowing students to practice needle placement and aspiration techniques without risk to patients. Haptic feedback can simulate the feeling of tissue resistance.
• Patient Communication and Management: VR simulations can be used to train students in communication skills, allowing them to practice interacting with virtual patients in different scenarios.
• Ergonomics and Posture: VR simulations can provide feedback on the user’s posture and ergonomics, helping them to develop proper working habits and prevent musculoskeletal disorders.

The use of virtual reality in dental education is continuously evolving. As technology advances, the realism and complexity of these simulations will increase, further enhancing the training experience for dental students and practitioners.