Virtual Reality Haptic Technology: Dental Education, Skill Development and Robotics

Virtual Reality Haptic Technology: Dental Education, Skill Development and Enhancement

Haptic technology (HT) was first developed over 50 years ago, before being introduced more broadly in amusement arcade games a decade later.1Costello S. What Are Haptics and How Do They Work? Haptic feedback simulates tactile experiences using vibration. Lifewire May 29, 2021 (updated). https://www.lifewire.com/what-are-haptics-5077068. Tactile, force, texture, thermal, kinesthetic, and electrotactile feedback all play a role in haptics,1Costello S. What Are Haptics and How Do They Work? Haptic feedback simulates tactile experiences using vibration. Lifewire May 29, 2021 (updated). https://www.lifewire.com/what-are-haptics-5077068. and HT is now broadly incorporated into everyday life (e.g., in smartphones). Ultrasound waves produce the sensation of vibration, for example in wearable devices, and can also produce a feeling of pressure or texture – collectively referred to as ultrasound feedback.1Costello S. What Are Haptics and How Do They Work? Haptic feedback simulates tactile experiences using vibration. Lifewire May 29, 2021 (updated). https://www.lifewire.com/what-are-haptics-5077068.^,2Gill A. What Is Haptics? Types, Benefits and Applications. Cloud Science, March 28, 2024. https://cloud-science.com/what-is-haptics/. Together with virtual reality (VR), HT is being used for training purposes across an array of professions, such as haptic gloves in combination with virtual reality used in training astronauts.3Rouse M. Techopedia explains haptics. Techopedia, November 11, 2024. https://www.techopedia.com/definition/haptics. ^,4Virtual Reality Society. History of Virtual Reality—Virtual Reality Society; July 2020. https://www.vrs.org.uk/. VR and HT make it possible to enhance learning (e.g., anatomy, healthcare procedures, infection control), to acquire and develop skills such as for restorative procedures or the provision of local anesthesia, and to practice patient communication using case scenarios.5Zafar S, Zachar JJ. Evaluation of HoloHuman augmented reality application as a novel educational tool in dentistry. Eur J Dent Educ 2020;24:259-65. https://doi.org/10.1111/eje.12492.^,6Mladenovic R, Pereira LAP, Mladenovic K et al. Effectiveness of augmented reality Mobile simulator in teaching local anesthesia of inferior alveolar nerve block. J Dent Educ 2019;83:423-8.^,7Mladenovic R, Dakovic D, Pereira L et al. Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients. Eur J Dent Educ 2020;24:507-12.^,8Liebermann A, Erdelt K. Virtual education: Dental morphologies in a virtual teaching environment. J Dent Educ 2020;84(10):1143-50. doi: 10.1002/jdd.12235.^,9Kim‐Berman H, D'Angelo O, Nor F et al. Donning and doffing training using augmented reality and text‐based educational methods. J Dent Ed 2024 Oct 17. 10.1002/jdd.13750. Online ahead of print.

Virtual reality haptic simulators are now being used in dental education and training, providing for visual experiences and the sensations of touch, force and pressure with force feedback simulating the feeling of pushing, pulling, or pressing against virtual objects (e.g., simulated tissues).

Virtual Reality Haptic Simulators (VRHS)
Traditionally, manikins/phantom heads and typodonts have been used for simulations in dentistry.10Nebu P, Kamran A, Monty D et al. Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric Dentistry: A Pilot Pedagogical Study. Int J Environ Res Pub Health 2023;20(5):4226. 10.3390/ijerph20054226. More recently, VRHS has been introduced for skill acquisition and enhancement, and is being incorporated into training for preclinical and clinical dental students, and residents.10Nebu P, Kamran A, Monty D et al. Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric Dentistry: A Pilot Pedagogical Study. Int J Environ Res Pub Health 2023;20(5):4226. 10.3390/ijerph20054226.^,11Zorzal ER, Paulo SF, Rodrigues P et al. An immersive educational tool for dental implant placement: a study on user acceptance. Int J Med Inform 2021;146:104342. VRHS delivers simulated procedures that can be repeated as necessary in a safe environment until the skill is learned or enhanced,12Correia Lima B, Grillo L, Quinta Reis BA et al. Haptic devices as an educational approach for oral and maxillofacial surgical procedures. J Stomatol Oral Maxillofac Surg 2024;125(5S2):101856. doi:10.1016/j.jormas.2024.101856. and can help students develop essential fine motor skills and hand-eye coordination.13Serrano CM, Wesselink PR, Vervoorn JM. First experiences with patient-centered training in virtual reality. J Dent Educ 2020;84:607-14. https://doi.org/10.1002/jdd.12037. In addition, VRHS can be used by students, residents and clinicians for case-specific learning.12Correia Lima B, Grillo L, Quinta Reis BA et al. Haptic devices as an educational approach for oral and maxillofacial surgical procedures. J Stomatol Oral Maxillofac Surg 2024;125(5S2):101856. doi:10.1016/j.jormas.2024.101856. Studies on VRHS in dentistry have variously involved novices, pre-clinical and clinical students, and experienced practitioners. To date, the majority of studies have evaluated its use for simulations in oral and maxillofacial surgery and restorative procedures.

Learning Effectiveness with VRHS
In a systematic review and meta-analysis (2024) that included 23 studies published between 2010 and 2022, the efficacy of VRHS training for pre-clinical students was evaluated across multiple disciplines, including restorative dentistry, pediatric dentistry, prosthodontics, periodontics, implantology, and dental surgery.14Bandiaky ON, Lopez S, Hamon L et al. Impact of haptic simulators in preclinical dental education: A systematic review. J Dent Educ 2024;88:366-79. https://doi.org/10.1002/jdd.13426. Study locations included Australia, Brazil, China, France, Japan, Saudi Arabia, Thailand, The Netherlands, United Kingdom and USA. The researchers concluded that VRHS improves pre-clinical dental students’ motor skills. In a second systematic review (2024) with 9 studies, VRHS was found to enhance psychomotor skills and fine movements compared to VR alone.15Patil S, Bhandi S, Awan KH et al. Effectiveness of haptic feedback devices in preclinical training of dental students-a systematic review. BMC Oral Health 2023;23(1):739. doi: 10.1186/s12903-023-03410-3. In a third systematic review (2024) with 14 studies, the researchers concluded that VRHS can improve psychomotor and practical skills, knowledge and self-confidence.16Koolivand H, Shooreshi MM, Safari-Faramani R et al. Comparison of the effectiveness of virtual reality-based education and conventional teaching methods in dental education: a systematic review. BMC Med Educ 2024;24(1):8. doi:10.1186/s12909-023-04954-2. In addition, researchers performing a meta-analysis (2024) found statistically significant improvements in performance, and reductions in the time required for restorative preparations.17Mai HN, Ngo HC, Cho SH et al. Effectiveness of virtual reality interactive simulation practice in prosthodontic education: A systematic review and meta-analysis. Eur J Dent Educ 2024 Mar 4. doi: 10.1111/eje.12997. In an earlier systematic review (2022) with 14 studies, it was concluded that VRHS is a useful adjunct to traditional training methods for undergraduates and clinicians.18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871. In another systematic review published in 2022, 73 studies on virtual technologies were included of which approximately one-third evaluated VRHS.19Moussa R, Alghazaly A, Althagafi N et al. Effectiveness of virtual reality and interactive simulators on dental education outcomes: systematic review. Eur J Dent 2022;16(01):14-31. Overall, it was concluded that educational outcomes appear to be enhanced with the use of virtual technology. Some systematic reviews have noted risk for bias, with the researchers in one review noting that all studies were at risk of bias with respect to allocation concealment.18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871.

Restorative and prosthodontic procedures
Among studies on skill acquisition and development for restorative procedures, compared to traditional simulations (TS) alone, superior outcomes and reduced procedure time have been observed for VRHS alone and in combination with TS.20Farag A, Hashem D. Impact of the haptic virtual reality simulator on dental students' psychomotor skills in preclinical operative dentistry. Clin Pract 2021;12(1):17-26.^,21Murbay S, Chang JWW, Yeung S, Neelakantan P. Evaluation of the introduction of a dental virtual simulator on the performance of undergraduate dental students in the pre-clinical operative dentistry course. Eur J Dent Educ 2020;24(1):5-16.^,22Al-Saud LM, Mushtaq F, Allsop MJ et al. Feedback and motor skill acquisition using a haptic dental simulator. Eur J Dent Educ 2017;21(4):240-7.^,23de Boer IR, Lagerweij MD, de Vries MW et al. The effect of force feedback in a virtual learning environment on the performance and satisfaction of dental students. Simul Healthc 2017;12(2):83-90. In one study, greater retention of learned skills was found one month after training using VRHS and feedback from a dental instructor, than with either method alone.22Al-Saud LM, Mushtaq F, Allsop MJ et al. Feedback and motor skill acquisition using a haptic dental simulator. Eur J Dent Educ 2017;21(4):240-7. However, while skills improved in other studies, no significant differences were found between TS- and VRHS-trained groups for outcomes in drilling procedures or simulated caries removal using a 3D multi-layered caries lesion model.24Vincent M, Joseph D, Amory C et al. Contribution of haptic simulation to analogic training environment in restorative dentistry. J Dent Educ 2020;84(3):367-76.^,25Dwisaptarini A P, Suebnukarn S, Rhienmora P et al. Effectiveness of the multilayered caries model and visuo-tactile virtual reality simulator for minimally invasive caries removal: a randomized controlled trial. Oper Dent 2018;43(03):E110-8. doi:10.2341/17-083-C. In a separate study, the accuracy and efficacy of simulated caries removal and cavity preparation was compared for VRHS- and TS-trained first-year dental students.26San Diego JP, Newton TJ, Sagoo AK et al. Learning Clinical Skills Using Haptic vs. Phantom Head Dental Chair Simulators in Removal of Artificial Caries: Cluster-Randomized Trials with Two Cohorts’ Cavity Preparation. Dent J 2022;10:198. https://doi.org/10.3390/dj10110198. No difference was seen in the quality of simple preparations, while TS-trained students performed better in more complex procedures. In another study where VRHS training followed TS training, no significant skill enhancement was observed.27Koo S, Kim A, Donoff RB, Karimbux NY. An initial assessment of haptics in preclinical operative dentistry training. J Investig Clin Dent 2015;6(1):69-76. (Table 1) It should be noted that VRHS technologies have continued to develop since earlier studies were published and continue to evolve.

Table 1. Results in simulated restorative procedures for pre-clinical students based on VRHS or TS training.

Conflicting results have been reported for the effect of VRHS training in prosthodontics. In one study, VRHS was found to help with skill acquisition for crown preparations and together with instructor feedback to result in superior performance compared to VRHS alone.28Kikuchi H, Ikeda M, Araki K. Evaluation of a virtual reality simulation system for porcelain fused to metal crown preparation at Tokyo Medical and Dental University. J Dent Educ 2013;77(6):782-92. In contrast, the accuracy of margin design and the volume of material removed for abutment preparations was more accurate for TS-trained students than VRHS-trained students in another study, with statistically significant differences.29Hattori A, Tonami K, Tsuruta J et al. Effect of the haptic 3D virtual reality dental training simulator on assessment of tooth preparation. J Dent Sci 2022;17(1):514-20. https://doi.org/10.1016/j.jds.2021.06.022.

Endodontics
Among studies in endodontics, three were randomized controlled trials dating from 2010 to 2012 in which skills in access opening were evaluated, and another was on surgical apicectomies.30Suebnukarn S, Haddawy P, Rhienmora P et al. Augmented kinematic feedback from haptic virtual reality for dental skill acquisition. J Dent Educ 2010;74(12):1357-66. ^,31Wang D, Zhao S, Li T et al. Preliminary evaluation of a virtual reality dental simulation system on drilling operation. Biomed Mater Eng 2015;26(Suppl 1):S747-56. doi:10.3233/BME-151366. ^,32Suebnukarn S, Hataidechadusadee R, Suwannasri N et al. Access cavity preparation training using haptic virtual reality and microcomputed tomography tooth models. Int Endod J 2011;44(11):983-9. doi: 10.1111/j.1365-2591.2011.01899.x. ^,33Suebnukarn S, Rhienmora P, Haddawy P. The use of cone-beam computed tomography and virtual reality simulation for pre-surgical practice in endodontic microsurgery. Int Endod J 2012;45(07):627-32. doi: 10.1111/j.1365-2591.2012.02018.x. In three studies, VRHS enhanced performance skills, while in the fourth study no significant differences in access performance were observed with or without VRHS although the procedure took less time for the VRHS-trained group.30Suebnukarn S, Haddawy P, Rhienmora P et al. Augmented kinematic feedback from haptic virtual reality for dental skill acquisition. J Dent Educ 2010;74(12):1357-66. In postgraduate endodontics courses, clinicians are also being educated using VRHS.18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871.

Implantology and Oral Surgery
VRHS is considered beneficial for surgical simulation and training inexperienced surgeons.12Correia Lima B, Grillo L, Quinta Reis BA et al. Haptic devices as an educational approach for oral and maxillofacial surgical procedures. J Stomatol Oral Maxillofac Surg 2024;125(5S2):101856. doi:10.1016/j.jormas.2024.101856. With respect to implantology, in one study quicker skill development for implant site preparation was found with use of VRHS, and in a second study the accuracy of implant drilling was similar for dentists with implant experience and VRHS-trained students.34Vincent M, Giess R, Balthazard R et al. Virtual aids and students' performance with haptic simulation in implantology. J Dent Educ 2022;86(8):1015-22.^,35Joseph D, Jehl JP, Maureira P et al. Relative contribution of haptic technology to assessment and training in implantology. Biomed Res Int 2014; 2014:413951. In oral and maxillofacial surgery, surgeons can now use digital surgical plans, augmented intelligence, haptic technology and robotics for patient treatment.36Drobinsky S, de la Fuente M, Puladi B, Radermacher K. Accuracy of on-site teleoperated milling with haptic assistance. Int J Comput Assist Radiol Surg 2023;18(11):1969-76. doi: 10.1007/s11548-023-02983-2. In addition, the accuracy of teleoperated robotics for milling structures is being investigated.

Periodontology
In a study comparing outcomes in scaling and root planing procedures for VRHS-trained and TS-trained fourth-year students, VRHS training was found to be more effective. In patient treatment after training, less residual calculus was observed and overall scores were higher for the VRHS-trained group.37Wu S, Gao L, Fu J et al. The Application of Virtual Simulation Technology in Scaling and Root Planing Teaching. Int Dent J 2024;74(2):303-9. doi:10.1016/j.identj.2023.09.007. These results are corroborated by an earlier study where improvements in the accuracy of periodontal probing and calculus removal were observed for VRHS-trained students.38Wang D, Zhang Y, Hou J. iDental: a haptic-based dental simulator and its preliminary user evaluation. IEEE Trans Haptics 2012;5(04):332-43. doi:10.1109/TOH.2011.59. Further, in a single-blind randomized trial, pre-clinical students received 90 minutes of VRHS training, TS training, or modified TS training using a quail egg instead of a typodont.39Fu J, Lao Z, Gao L et al. Effectiveness of typodont, quail egg and virtual simulation for ultrasonic periodontal scaling teaching among pre-clinical students: a randomized trial. BMC Oral Health 2024;24(1):86. doi:10.1186/s12903-023-03767-5. After training, the VRHS-trained group received the highest scores, while the quail egg group performed better on force application, and ergonomics was superior in the TS-trained group.

Benefits, learner and educator perspectives on VRHS

In addition to the opportunity for increased effectiveness, reported benefits of VRHS include enhanced hand-eye coordination and skill development, self-paced learning, potentially unlimited training hours, immediate and objective feedback and self-assessment for pre-clinical students, as well as reductions in the amount of instructor time necessary for supervision and skill development.14Bandiaky ON, Lopez S, Hamon L et al. Impact of haptic simulators in preclinical dental education: A systematic review. J Dent Educ 2024;88:366-79. https://doi.org/10.1002/jdd.13426.^,15Patil S, Bhandi S, Awan KH et al. Effectiveness of haptic feedback devices in preclinical training of dental students-a systematic review. BMC Oral Health 2023;23(1):739. doi: 10.1186/s12903-023-03410-3.^,23de Boer IR, Lagerweij MD, de Vries MW et al. The effect of force feedback in a virtual learning environment on the performance and satisfaction of dental students. Simul Healthc 2017;12(2):83-90.^,40Perry S, Bridges SM, Burrow MF. A review of the use of simulation in dental education. Simul Healthc 2015;10(1):31-7.^,41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print. Students have reported that they can see better and correct their mistakes, appreciate the opportunity for self-learning and confidence-building, and that VRHS training feels more realistic and clinically relevant (than TS training).13Serrano CM, Wesselink PR, Vervoorn JM. First experiences with patient-centered training in virtual reality. J Dent Educ 2020;84:607-14. https://doi.org/10.1002/jdd.12037.^,42Collaço E, Kira E, Sallaberry LH et al. Immersion and haptic feedback impacts on dental anesthesia technical skills virtual reality training. J Dent Educ 2021;85(4):589-98. doi:10.1002/jdd.12503.^,43Osnes C, Duke A, Wu J et al. Investigating the construct validity of a haptic virtual caries simulation for dental education. BMJ Simul Technol Enhanc Learn 2021;7(02):81-5. doi:10.1136/bmjstel-2019-000549. For example, when receiving VRHS training on inferior alveolar nerve block (IANB) procedures, the individual can experience the sensation of inserting the syringe needle and receive haptic force feedback that helps with training on the correct location and needle insertion.44Corrêa CG, Machado MA de AM, Ranzini E et al. Virtual reality simulator for dental anesthesia training in the inferior alveolar nerve block. J Appl Oral Sci 2017;25(4):357-66. In a study with both beginners and experienced clinicians, VRHS training was the preferred learning method for IANB procedures.45Serrano CM, Bakker DR, Zamani M et al. Virtual reality and haptics in dental education: Implementation progress and lessons learned after a decade. Eur J Dent Educ 2023;27(4):833-40. doi:10.1111/eje.12873. Students also report appreciating the ability to simulate procedures with VRHS before performing procedures on patients, and thereby the benefit of safety,13Serrano CM, Wesselink PR, Vervoorn JM. First experiences with patient-centered training in virtual reality. J Dent Educ 2020;84:607-14. https://doi.org/10.1002/jdd.12037. and VRHS training is perceived as motivating and engaging.41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print.^,45Serrano CM, Bakker DR, Zamani M et al. Virtual reality and haptics in dental education: Implementation progress and lessons learned after a decade. Eur J Dent Educ 2023;27(4):833-40. doi:10.1111/eje.12873. The belief among students that VRHS should be complimentary to traditional learning, but not replace it, has been reported in numerous studies.10Nebu P, Kamran A, Monty D et al. Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric Dentistry: A Pilot Pedagogical Study. Int J Environ Res Pub Health 2023;20(5):4226. 10.3390/ijerph20054226.^,19Moussa R, Alghazaly A, Althagafi N et al. Effectiveness of virtual reality and interactive simulators on dental education outcomes: systematic review. Eur J Dent 2022;16(01):14-31.^,46Ziane-Casenave S, Mauroux M, Devillard R, Kérourédan O. Influence of practical and clinical experience on dexterity performance measured using haptic virtual reality simulator. Eur J Dent Educ 2022;26:838-48. doi:10.1111/eje.12767.^,47Zafar S, Lai Y, Sexton C, Siddiqi A. Virtual Reality as a novel educational tool in pre-clinical paediatric dentistry training: Students' perceptions. Int J Paediatr Dent 2020;30:791-7. doi:10.1111/ipd.12648.^,48Daud A, Matoug-Elwerfelli M, Daas H et al. Enhancing learning experiences in pre-clinical restorative dentistry: the impact of virtual reality haptic simulators. BMC Med Educ 2023;23(1):948. doi:10.1186/s12909-023-04904-y. (Table 2) (Figures 2, 3)

Similar to feedback from students and their perceptions, educators’ responses to surveys indicate that they consider the realistic simulations and objective real-time feedback provided by VRHS to be advantageous for the development and enhancement of skills.16Koolivand H, Shooreshi MM, Safari-Faramani R et al. Comparison of the effectiveness of virtual reality-based education and conventional teaching methods in dental education: a systematic review. BMC Med Educ 2024;24(1):8. doi:10.1186/s12909-023-04954-2.^,41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print. Other benefits noted by educators include safety and reductions in waste compared to TS with typodonts and plastic teeth. The future potential of VRHS for remote training without the need for an academic clinical area has also been noted, and reduced hours of instructor time.18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871. VRHS have also been shown to differentiate between skill levels among individuals, with the potential to identify those who could benefit from additional training.15Patil S, Bhandi S, Awan KH et al. Effectiveness of haptic feedback devices in preclinical training of dental students-a systematic review. BMC Oral Health 2023;23(1):739. doi: 10.1186/s12903-023-03410-3.^,49Al-Saud LM, Mushtaq F, Mann RP et al. Early assessment with a virtual reality haptic simulator predicts performance in clinical practice. BMJ Simul Technol Enhanc Learn 2020;6(5):274-8. doi:10.1136/bmjstel-2018-000420. Lastly, it has been proposed that including a manual ability test using haptic simulations could help to determine during the school admissions process which individuals are more likely to be able to develop the fine motor skills needed in dentistry.35Joseph D, Jehl JP, Maureira P et al. Relative contribution of haptic technology to assessment and training in implantology. Biomed Res Int 2014; 2014:413951. (Table 2)

Limitations and barriers to adoption

Some users have reported that more time is required for clinical training,13Serrano CM, Wesselink PR, Vervoorn JM. First experiences with patient-centered training in virtual reality. J Dent Educ 2020;84:607-14. https://doi.org/10.1002/jdd.12037. and in another study, some students reported that their sense of distance and perspective was lessened using simulated 3D images.28Kikuchi H, Ikeda M, Araki K. Evaluation of a virtual reality simulation system for porcelain fused to metal crown preparation at Tokyo Medical and Dental University. J Dent Educ 2013;77(6):782-92. In separate studies focusing on training with simulated abutment preparations and for scaling and root planing, students reported that they found it difficult not being able to have a finger rest or master positioning with the haptic simulator they were using, which they could do with a mannekin.28Kikuchi H, Ikeda M, Araki K. Evaluation of a virtual reality simulation system for porcelain fused to metal crown preparation at Tokyo Medical and Dental University. J Dent Educ 2013;77(6):782-92.^,37Wu S, Gao L, Fu J et al. The Application of Virtual Simulation Technology in Scaling and Root Planing Teaching. Int Dent J 2024;74(2):303-9. doi:10.1016/j.identj.2023.09.007. In this regard, it is important to recognize that VRHS technologies differ in their features and capabilities, such as which disciplines they provide simulated training on, and whether ergonomic posturing can be learned while using VRHS.51Huang T-K, Yang C-H, Hsieh Y-H et al. Augmented reality (AR) and virtual reality (VR) applied in dentistry. Kaohsiung J Med Sci 2018;34:243-8. https://doi.org/10.1016/j.kjms.2018.01.009. In other feedback, more differences in perceived hardness were still desired for dental tissues (e.g., dentin vs enamel), and VRHS does not provide for soft tissue movement, oral fluids, reflexes, or the body movements that patients may make during treatment.13Serrano CM, Wesselink PR, Vervoorn JM. First experiences with patient-centered training in virtual reality. J Dent Educ 2020;84:607-14. https://doi.org/10.1002/jdd.12037.^,18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871.^,19Moussa R, Alghazaly A, Althagafi N et al. Effectiveness of virtual reality and interactive simulators on dental education outcomes: systematic review. Eur J Dent 2022;16(01):14-31. Current limitations noted by dental educators include the learning curve for both students and educators, and the lack of standardization on integrating VRHS into training and education.41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print.^,50Bakr MM, Idris G, Al Ankily M. The potential integration of Simodont® Dental Trainer in different stages of the dental curriculum. Saudi Dent J 2024;36(11):1449-55. doi:10.1016/j.sdentj.2024.09.002. (Table 3)

Barriers to adoption and a higher level of implementation include the capital investment and high resource costs to acquire and use VRHS, the space required for the VRHS laboratory, skepticism on the part of some individuals, and the need for greater VRHS expertise among clinicians and instructors.41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print. In addition, knowledge or experience on the relative cost-benefit of VRHS systems is limited, while a lack of standardization and the allocation of resources are other potential barriers to adoption.18Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ 2022;00:1-19. doi:10.1111/eje.12871.^,41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print.(Table 4)

Recent developments

Globally, as of 2023 less than 200 dental institutions had adopted VRHS.41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print. Recommendations from educators include expanding the range of procedures available with VRHS training, improving software in areas such as tissue simulation, improving hardware, and gamification to make VRHS learning ‘competitive’.41Felszeghy S, Mutluay M, Liukkonen M et al. Benefits and challenges of the integration of haptics-enhanced virtual reality training within dental curricula. J Dent Educ 2024 Dec 17. doi:10.1002/jdd.13800. Epub ahead of print. It has been recommended that more studies be conducted on the effectiveness of VRHS as a learning tool, with international collaboration, and that its use be further promoted. In early 2024, the VR-Haptic Thinkers Consortium was created.52Felszeghy S, Liukkonen M, Flacco N et al. Establishing the VR-haptic thinkers group: Insights and progress in dental training technologies. Saudi Dent J 2024;36(12):1655-9. https://doi.org/10.1016/j.sdentj.2024.11.008. At a subsequent meeting, VRHS in dentistry and the evolution of the educational curriculum were addressed. This consortium now includes companies, institutions and 36 universities, providing a strong platform for discussion, development and the future support of VRHS training.

Conclusions

The number of reviews, studies and other publications on VRHS continues to increase, and VRHS is now being used increasingly for training in several disciplines within dentistry. It has been recommended that robust studies on VRHS training outcomes be conducted, as well as evaluations on the cost-effectiveness of VRHS in academic institutions.16Koolivand H, Shooreshi MM, Safari-Faramani R et al. Comparison of the effectiveness of virtual reality-based education and conventional teaching methods in dental education: a systematic review. BMC Med Educ 2024;24(1):8. doi:10.1186/s12909-023-04954-2.^,53Plessas A. Computerized virtual reality simulation in preclinical dentistry: can a computerized simulator replace the conventional phantom heads and human instruction? Simul Healthc 2017;12(5):332-8. Further developments should also address current limitations and barriers.

In the meantime, feedback from students and educators is positive with respect to skill acquisition and development, the opportunity for immediate and objective feedback, outcomes, and the realism that VRHS offers compared to TS. Based on surveys, there is also the belief that VRHS should be complimentary to traditional learning and not replace it. Future developments, including those encouraged by the recently formed VR-Haptic Thinkers Consortium, should result in further adoption of VRHS in both educational and clinical settings, benefiting students, educators and clinicians.

References

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