Review Article

A Review of the Use of Simulation in Dental Education

Suzanne Perry, BDS, MFDS
RCPS(Glas) MOrth(HK)
MOrthRCS(Edin);
Susan Margaret Bridges, BA (Qld),
DipEd (Qld), GradCertTESOL
MAAppLing, EdD (Griffith);
Michael Francis Burrow, BDS
MDS, DDSc (Adel), PhD (Tokyo
Med & Dent U), MEd (Melb)
Abstract: In line with the advances in technology and communication, medical simu-
lations are being developed to support the acquisition of requisite psychomotor skills
before real-life clinical applications. This review article aimed to give a general overview
of simulation in a cognate field, clinical dental education. Simulations in dentistry are not
a new phenomenon; however, recent developments in virtual-reality technology using
computer-generated medical simulations of 3-dimensional images or environments are
providing more optimal practice conditions to smooth the transition from the traditional
model-based simulation laboratory to the clinic. Evidence as to the positive aspects of
virtual reality include increased effectiveness in comparison with traditional simulation
teaching techniques, more efficient learning, objective and reproducible feedback,
unlimited training hours, and enhanced cost-effectiveness for teaching establishments.
Negative aspects have been indicated as initial setup costs, faculty training, and the lack
of a variety of content and current educational simulation programs.
(Sim Healthcare 00:00Y00, 2015)

Key Words: Dental education, Simulation, Virtual reality, Dentistry, Haptics.

I n the current economic climate, clinical education providers

are increasingly aware of both the tightening of government
funding and accountability issues.1 In modern health care, pa-
tient safety is of utmost concern. Standards of care need to be
adhered to, and breaching such not only results in patient neglect
but also opens the door to litigation. Time-restricted curricula
and more demanding surgical techniques are adding pressure
for educators to assist students to achieve the requisite high
psychomotor skill levels in a short time frame. It has been argued
that decreasing operative time in overcrowded curricula of
health care professionals may be restricting opportunities for
the surgical trainee.2 Updating simulation techniques and
modalities may act as a way to enhance efficiency in the de-
livery of surgical training. The most recent efforts have been in
the area of virtual reality (VR), which in this context is defined
as a computer-generated medical simulation of a 3-dimensional
(3D) image or environment with which a learner interacts in a
seemingly real or physical way. Simulation in health care has
evolved since the late 1960s when mannequins were first in-
troduced for anesthetic training.2 In the 1990s, with expanding
interest in minimally invasive surgery, the first simple laparo-
scopic simulators were developed.3 Ensuing studies indicated
that this technology was useful, with evidence that motor skills
gained on a VR simulator could be transferred into the real
setting.4 Major benefits of VR, therefore, include skill acquisi-
tion before patient exposure, the ability to repeatedly practice
From the Centre for Enhancement of Teaching Learning (S.M.B), Faculty of Education
(S.P), University of Hong Kong, Hong Kong Special Administrative Region, Peoples
Republic of China. Melbourne Dental School (M.F.B), The University of Melbourne, 720
Swanston St, Carlton, Victoria, 3010, Australia.
Reprints: Susan Margaret Bridges, BA(Qld), DipEd (Qld), GradCertTESOL (Griffith),
Centre for the Enhancement of Teaching and Learning, Faculty of Education,
Centennial Campus, The University of Hong Kong (e<mail: sbridges@hku.hk).
The authors declare no conflict of interest.
Copyright * 2015 Society for Simulation in Healthcare
DOI: 10.1097/SIH.0000000000000059
identical procedures to establish skill levels, and the ability to
provide standardized feedback with independence from direct
supervision.
As with all health care professions, dentistry is constantly
evolving. For dentistry, the irreversible nature of most operative
procedures means students must have the skills for safe delivery
at the point of patient treatment and care. Past clinical tech-
niques reflected a more surgical, aggressive approach to dental
caries (decay) removal and tooth restorationVthe mainstay of
general dentistry. Current philosophies have moved toward a
focus on prevention and conservation of tooth structures, even
when operative intervention is necessary. Differing from the
medical profession, where only a particular subset of specialties
routinely require a defined set of surgical psychomotor skills,
dentistry encompasses a wide range of procedures, each re-
quiring a task-specific skill base. As a field, VR simulations in
dental education, including haptic simulations, have not as yet
provided the full gamut of possible case scenarios for student
practice.5Y8
As a practical vocation, dentistry has always drawn on
simulation as an essential part of student clinician education.
In the early days of dental training, real teeth were used in a
bench-top setting before the introduction of the phantom
head. These phantom heads or mannequins enable removal
and insertion of a complete artificial dentition that use in-
dividual plastic teeth, or, to a lesser extent given the scarcity
of resources, real, extracted teeth. Relatively realistic simula-
tion was evident, and so current dental programs routinely
incorporate phantom head instruction in both undergraduate
and postgraduate skills training. Less widely but increasingly
apparent is the incorporation of virtual environments and VR
clinical simulators into dental training, the most recent in-
novation being in the form of haptic VR simulators provid-
ing sensory feedback. The word haptic is derived from the late
19th century Greek word Haptikos (able to touch or grasp),

Vol. 00, Number 00, Month 2015 1

Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.

FIGURE 1. A sketch of the first phantom head designed by
Oswald Fergus in 1894.
with modern haptics being the science of interacting with the
external environment through the manipulation of objects using
the senses of touch and proprioception.9 Haptic simulators may
improve the realism of simulation and, as such, be increasingly
used in health care skill training. Ideally, VR simulation should
be available to all dentists, allowing them to develop the required
skills for new techniques or simply to update current practice
safely through continuing education for further professional
development.
This article reviews the historical development of simu-
lation in dental education as well as the current applications and
recent developments, including the latest field of VR simula-
tion with haptic feedback. Finally, future needs and directions
for the implementation of supportive simulation technolo-
gies for student learning are identified. The literature review
was performed using the search terms dental education, sim-
ulation, virtual reality, dentistry, haptics, and healthcare using
the PubMed database and Google Scholar.
FIGURE 2. Timeline of simulations in dental education.
2 The Use of Simulation in Dental Education
Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
CONVENTIONAL DENTAL EDUCATION SIMULATIONS
The first college of dental surgery was founded in 1840 in
Baltimore, Ohio, United States, which served as the founda-
tion for the formation of other dental schools worldwide.10
Restorative techniques at that time were practiced using extracted
teeth and bench-top simulation. A major problem in the 1800s
was the lack of availability of natural human teeth for practicing
on the simulators, mainly because of the demand of such teeth
for use in dentures. Denture teeth had been previously carved
from ivory, but human teeth were much more desired because of
their realistic appearance. Supplies of teeth had come from war
victims such as those of Waterloo, giving rise to the name of the
Waterloo denture.11 The use of ‘‘resin-based’’ teeth became much
more commonplace in the late 20th century when dental edu-
cation was developing rapidly and the supply of real teeth was
limited. The first phantom head simulators were used in 1894 in
an effort to improve realism. These were assembled with 1 metal
rod with 2 brass jaws as can be seen in Figure 1, a sketch of the first
phantom head simulator created by Oswald Fergus in 1894.12
Natural teeth are now used only when readily available and often
for more complicated training where true anatomic features are
necessary, such as root canal therapy (endodontics).
The combination of bench-top and phantom head train-
ing for the acquisition of dental surgical skills seems to have
been the norm from the early 1900s and still exists in an updated
form in dental schools today. Figure 2 shows the relationship
of important key events in the development of clinical dental
education.
The phantom head simulator has been the iconic and
mainstay simulation device for dental education since its cre-
ation. There are many benefits of such a device; it is ergo-
nomically correct and allows proper handling of both the dental
mirror and handpiece. It also allows the possibility of a finger
rest to maintain stability when performing instrumentation,
an essential, foundational concept that a novice must acquire
before developing more complex skills. Modern phantom head
Simulation in Healthcare
simulators (Fig. 3) also include a water spray to add realism, and
natural teeth can be inserted, if available. Unfortunately, the
opportunity for students to practice on natural, extracted teeth
is diminishing. Plastic teeth may provide an adequate substi-
tute, but it would be a challenge to create synthetic teeth to be
equal to that of natural teeth for learning the fine motor skills
required in restorative dentistry.
Concerns when using phantom heads may include pos-
sible water line contamination and infection control. In ad-
dition, the cost of handpiece maintenance and disposable items
such as dental burs may also increase expenses. Supervision is
required for phantom head exercises for safety because of the use
of air or electrically driven dental handpieces (drills) with real
burs and also to provide feedback during training exercises.
Evidence for the use of the traditional bench top or
phantom heads is limited. One study13 compared the bench-
top technique with a phantom head simulator to assess which
produced the best motor skills in students. The phantom head
simulator was found to be preferable as the students who had
trained on the bench top found difficulty in the transfer of
skills to the phantom head but not vice versa. Another study14
examined the effects on the clinical environment by assessing
the results of student preparations of tooth cavities performed
on mannequins in a clinic and mannequins in a simulation
laboratory. Contrary to the study mentioned earlier, no dif-
ference was apparent.
TECHNOLOGICAL TRENDS IN DENTAL EDUCATION
Computer-Supported and VR Simulators
The introduction of computer-supported and VR simu-
lators began to enter dental schools of North America and
Europe in the early 2000s, creating a new avenue for motor skill
learning in dentistry. Computer-generated virtual teeth were
used in combination with a variety of devices to simulate
FIGURE 3. A modern phantom head simulator.
Vol. 00, Number 00, Month 2015
Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
control of the dental handpiece, such as joysticks and pen
devices. One of the first systems that allowed for a wide variety
of restorative procedures to be performed was DentSim. The
advantage of this system was that it blended mannequin-based
learning with 3D visuals. This improved realism because of the
prospect of a finger rest, water spray, and a dental handpiece
while incorporating infrared technology to project an image
of the students’ preparation on a computer screen for real-time
evaluation and feedback, a known asset in complex motor skill
learning.15 An increasing number of computer-supported and
virtual reality simulators have been introduced worldwide.5
Models of the dentition can now be scanned and simulated in
a 3D form, allowing for improved access and accuracy of
measurements.16 Across the dental specialties, simulation soft-
ware has increasingly provided support for orthognathic sur-
gical planning and implant treatment as well as the diagnosis
and treatment of periodontal (gum) disease. In dental educa-
tion, simulations are available for the extraction of teeth5 and
practicing dental injections.17 Robotic simulated patients with
the ability to move independently, secrete saliva, and have a
limited conversation with the trainee have also been recently
introduced, mainly in Japan.18,19 Advanced software has also been
used to create an immersive virtual dental school as a supportive
learning environment.19 Such technological advances may be a
useful addition to the education of dental students, adding ex-
perience and patient management skills earlier in the curriculum
and before the provision of direct patient care.
With the introduction of computer-generated simula-
tions, dental students were, for the first time, able to repeatedly
practice the same tooth preparation without the need for su-
pervision and with synchronous computer feedback. For the
most effective motor skill development, awareness of when and
how an error was made (knowledge of performance) is more
important than the final result itself (knowledge of result).20
Real-time, process-based recordings of a preparation allow
students and their tutors to review errors at the exact time point
they occurred for detailed feedback and correction. Inconsistent
feedback on surgical preparations due to tutor subjectivity has
been a topic of controversy in dental education.21 The provision
of objective, standardized computer-generated feedback able to
be reviewed may be one way to overcome this concern. Virtual-
reality simulators also increase the possibility of students being
able to practice in their own time. Although initial VR simulator
installation costs are substantial with time-consuming staff
training and software updates, the savings in terms of handpiece
replacements and disposables such as plastic teeth make the VR
simulator not only a viable teaching tool but also possibly more
cost-effective over the long term. Simulators also avoid the need
for water pipes and suction, and so the threat of water-borne
diseases such as Legionella is eliminated.
Simulations may, however, lack some of the realism found
to be beneficial with phantom heads. Systems only relying on
the use of joysticks with computer-generated images lose critical
psychomotor skills such as correct handpiece grip, posture, and
associated finger rest. Some systems also do not have foot pedals
or require control of soft tissues, and so the transferability of
skills from computerized simulation to clinical settings may be
questionable. The limited number of programmed cases results
in restricted exposure to the range of procedures available on
* 2015 Society for Simulation in Healthcare 3
mannequins, and some may allow cutting of teeth but not res-
toration and vice versa. Performative aspects of the procedures
themselves may be unrealistic because of time lag between input
device and image display, in some cases with voxelization oc-
curring or unrealistic outcomes (‘‘floating’’ section in Fig. 4).
The study of Quinn et al22 in 2003 investigating possible
differences in skill level found that undergraduate students
trained with DentSim were actually worse at some aspects
of cavity preparation than those trained on a traditional
phantom head and recommended that novices should not
use ‘‘virtual representations’’ for training exclusively. However,
other small-scale studies have emerged with more encouraging
results, suggesting that students may learn fine motor skills
more quickly with VR simulation (DentSim) when compared
with traditional phantom head simulation.7,23,24 The most
likely reason for this positive effect may be in the ability to
practice a greater number of preparations using VR simulators
than in the same practice time as with mannequins. This may
indicate the improved efficiency of motor skill learning when
VR simulators are used and so make the process potentially
more cost-effective. This increase in time efficiency does not
seem to affect quality.
A 2004 study found that although computer simulators
seem to reduce the number of staff-student interactions, the
quality of resultant preparations showed no difference to the
control group using noncomputer simulations.25 Another
study showed that dental students using computerized sim-
ulation were also found to learn procedures faster than those
using ‘‘older, traditional, preclinical’’ laboratory equipment yet
still maintain or have superior skill levels.7 On the contrary, not
only was the study of Quinn et al22 negative with regard to
performance outcomes, but also a questionnaire with the same
study group was less than positive with 95% of the students
preferring conventional techniques because of ‘‘excessive criti-
cal feedback,’’ ‘‘lack of personal contact,’’ and ‘‘technical hard-
ware difficulties’’ experienced with the computer-supported
simulators. This suggests that not all students will embrace new
FIGURE 4. Unrealistic simulation where a ‘‘floating’’ piece of
tooth remains on the image.
4 The Use of Simulation in Dental Education
Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
technologies and the need for further refinements of simulators
for user-friendliness and effectiveness in student learning.
A retrospective study26 also compared staff perceptions
of 2 groups of students, one with experience using a VR sim-
ulator and one with traditional bench-top and phantom head
learning. The staff perceived the abilities of the VR students to
be higher than those who had traditional learning. However,
staff perceptions of the VR students’ abilities were much higher
than their actual final overall ability. So, in some way, the staff
may have overestimated the strength of the VR training. In-
terestingly, a strong point of VR training was the observation
that the students had correct hand and body posture, something
this particular simulator (DentSim) alerted students to during
training. They also felt that students with the VR training were
more apt at self-assessment, a concept which may be associated
with continual feedback from the simulator. Other studies7,8
have indicated further positive outcomes from students using
a variety of simulators over differing periods, suggesting that
overall perceptions of VR in dental education seem to be positive.
Surveys demonstrate that students are relatively com-
fortable with simulator technology, even when not completely
computer literate.24 Virtual-reality simulators may be used as
a predictive tool to screen for students who may struggle to
gain motor skill competency within a restricted curriculum.27
Virtual-reality simulation also provides identical clinical sim-
ulations for all students, allowing standardization for grading if
used for assessment purposes. Students are able to replicate
procedures they may find difficult, allowing more individual-
ized learning, and as such, the provision of reproducible, un-
biased criticism can occur.
Haptic-Enhanced VR Simulation
The trend toward haptic-enhanced VR simulation came
in the late 1970s from the areas of flight simulation28 and
computer gaming as a result of a desire to improve realism
via heightened sensory feedback. Cross-disciplinary applied
research has indicated the importance of haptics for speed29
and accuracy30 in psychomotor skill development and for
practice in perilous conditions.31 It is in the field of surgery,
however, that the use of haptics has gained a niche foothold
to replicate surgical conditions for skills training. Because
surgical techniques have become more intricate and less inva-
sive, patient demands for less radical and intrusive procedures
have also increased. A greater number of surgical procedures are
being performed laparoscopically, which is heavily dependent
on sensory perception rather than a direct line of sight; hence,
appropriate training is essential before attempting such com-
plex procedures.
Studies of haptics in surgery have been generally en-
couraging. The review of Van Der Meijden et al32 found that
haptics were of benefit in robotic-assisted surgery but not
when used with VR simulators. It seemed that there was a lack
of evidence to substantiate the claim that haptic simulators
were superior to nonhaptic but the addition of haptics was
seen to reduce surgical errors and could be deemed as im-
portant in the early phase of psychomotor skill acquisition and
development.32 Sewell et al33 suggested that haptic training
allows a student to start further along the learning curve when
brought into reality. Bethea et al34 noted that practice using
Simulation in Healthcare
FIGURE 5. Simodont VR haptic units in use at the University of Hong Kong.

a haptic knot-tying simulator increased the number of suc- tomographic images for individualized treatment planning and
cessful sutures. Strom et al35 found that haptic-trained residents practice before the actual clinical procedure.
were able to perform diathermy tasks significantly better than Within dentistry, limited evidence-based practical research
nonYhaptic-trained practitioners. Panait et al36 observed su- has been performed to validate the use of haptic-enhanced
perior precision, speed of task completion, and fewer technical VR simulators for clinical education. One small-scale study
errors with haptic-based simulators and concluded that their performed by Bakker et al39 took 3 groups of students, trained
extra expense was justified. one group on a haptic simulator, one group using traditional
phantom head, and a third control group. Those who were
Haptic-Enhanced VR in Dentistry
trained on either haptic or phantom head (compared with the
The restoration of teeth is an extremely tactile process
control group) had better final skills, as expected, but there was
with differences in sensation between drilling enamel and
no increased skill level for those who had trained on the haptic
dentine. Heightened sensitivity is also required to perceive
units. Overall, the numbers in this study were low, and repli-
when dental pulpal (nerve) tissue has been involved. With
cation of such a study with a larger sample size would be of value.
the use of the technology from the aeronautical industry and
Gal et al40 found that both staff and students believed that
surgical fields, prototype dental haptic simulators began to
haptic simulators would be a useful addition to the teaching
be constructed, leading to the implementation of the first
facilities, with students more positively disposed than staff;
dental haptic simulator in dental schools in the early 2000s.5,6
however, both groups suggested improvements to make the
This recent development has excited many dental educators
sensation more convincing. Students noted that it would allow
who see potential applications for a device that not only aims
them to perform tasks in their own time rather than being
to realistically replicate the clinical situation but also can identify
dictated to by dental school timetables, whereas staff saw the
and pinpoint errors in skill learning.
potential for evaluating the entire process of the preparation
Dental haptic-enhanced VR simulators are now being
used to assess periodontal disease, prepare for implant and
maxillofacial surgery, and restore 3D simulated teeth. The
Simodont (MOOG, the Netherlands) was developed partially
using technology from the aircraft simulation industry and has
the ability to simulate removal of caries (dental decay) and the
finishing of restorations. Figure 5 shows the Simodont sim-
ulator units in use at the University of Hong Kong, with Figure
6 illustrating a tooth preparation exercise. Another system,
PerioSim (University of Illinois at Chicago, Collage of Den-
tistry, Chicago, IL), allows students to experience differences
in tactile sensation when treating periodontal (gum) disease
and removing dental calculus (tartar). A staff perception survey
indicated positive opinions of the device and its potential in
evaluating student performance.37 In 2011, a team from Osaka
University, Japan, developed the Bone Navi,38 a haptic simulator
with sound and virtual vibration when drilling bone for im-
proved realism. The Bone Navi can use the patient computed FIGURE 6. A haptic tooth preparation exercise.

Vol. 00, Number 00, Month 2015 * 2015 Society for Simulation in Healthcare 5

Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
rather than just the outcome. Other studies of undergraduate
dental student perceptions of haptic simulators have also been
positive.40,41
FUTURE NEEDS AND DIRECTION
Global Trends
Education systems and trends are constantly changing
with new concepts and technology. Distance learning is com-
monplace and has influenced the medical field with staff
members or specialists able to analyze preparations performed
by students and provide an expert opinion from remote lo-
cations. In supporting face-to-face delivery of undergraduate
clinical surgical skill development, the notion of blended learn-
ing is not uncommon.42 Programs on some units not only are
able to provide skill-based exercises but also can simulate virtual
patients to support more holistic approaches to patient treat-
ment planning. In an era of globally competitive staffing for
dental facilities, recruitment of academic staff is increasingly
difficult.43Y45 Virtual-reality simulation may be beneficial in this
work force context, especially if the simulators themselves are
able to provide timely and useful feedback.
More broadly, in terms of the relationship between ac-
ademia and industry, the OECD1 [Organization for Economic
Co-operation and Development] has suggested increased in-
tegration to support and enable collaborations. This concept
is already being embraced in dental education, and it is such
developments that can provide innovative knowledge and
equipment. One example is the knowledge transfer between
the flight simulator company, MOOG, in collaboration with
a Dutch dental school, ACTA, to create a haptic simulator
for dentistry, Simodont. Education in general has to evolve as
we are living in an era of continuous technological develop-
ment. Publications1,46 suggest global changes in the future of
higher education with greater global migration of students for
educational purposes; more cross-continental collaborations;
increased urbanization placing more stress on tertiary estab-
lishments; increased demands on educational standards by
stakeholders, including parents; and continued rapid tech-
nological development. Additional to these forces of change
are the increasing calls for accountability by governments and
professional bodies for maintaining and advancing educational
and professional standards. In responding to these forces of
change, the education sector has recognized the need to become
more flexible, efficient, and evidence based. Virtual-reality
simulation technologies and haptic simulation, in particular,
are providing one avenue of opportunity where such demands
can be met.
The use of VR simulation in licensing and examination
has been considered by a number of health care professions
but has not been extensively applied to date because of a
perceived lack of technical sophistication.47 The aim of
simulation for examination or licensing differs from training
in that the aim is not to improve skill level but for gate-
keeping, ensuring a candidate has achieved a certain level of
competency so they can be deemed ‘‘safe’’ to treat the general
public.12 In dentistry, like general surgery, VR simulation
for licensing or examination is not currently applied in the
United States, United Kingdom, or Asia.
6 The Use of Simulation in Dental Education
Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
Future Research in VR Simulations in Dental Education
Virtual-reality and haptic-enhanced VR simulations in
dentistry are still in its infancy, but increasing interest in its
future direction and development is apparent. In terms of
technological advancements, further development of haptic
units with improvements in sensory feedback, real-time sim-
ulation, ergonomics, and recording of the procedure would be
beneficial. Expansion of software to increase the number of
dental procedures available would also be advantageous. Many
research questions have yet to be answered both to direct these
technological developments and to establish a wider acceptance
of simulation in dental education. An evidence base is lacking as
to the effectiveness of VR or haptic simulations compared with
the traditional phantom head techniques. Studies to date show
some promise, indicating that the introduction of haptic units
may assist in improving realism to a level where the transfer of
skills can occur from the simulation laboratory to the dental
clinic; however, these are mainly small-scale studies, and the
benefits have yet to be proven. Further studies need to be
conducted comparing the effectiveness of skill acquisition
between various VR simulation units with that of traditional
techniques. Larger-scale studies in dental education may be
problematic given the curriculum constraints and generally
small size of cohorts.
Research questions that should to be considered might
be how many hours of simulation training is sufficient for
the majority of students to reach the required competency?
Would fewer training hours be acceptable on a simulator if
it were more efficient? Where do simulators fit in in a dental
curriculumVis it best for them to be used extensively at the
start or to be used as the first step when learning a new
procedure? Do some particular students respond better to
simulation training than others? Further research is required
into these areas before the majority of the dental teaching
population will embrace VR simulation training.
CONCLUSIONS
Simulation in dentistry is an evolving and exciting sphere.
For further integration into dental curricula and use as a po-
tential examination and licensing tool, additional development
of hardware and software is required. If this is possible, the
opportunities are extensive and varied, allowing dental schools
to be able to encourage learning of a variety of procedures not
just to a limited level of preclinical competency but closer to in
vivo proficiency. Such advancements would be beneficial to the
general public in improving the boundaries for standards of
care. Crossover of information between the dental sphere and
other health care disciplines in the development of simulations
has been limited. Dentistry can learn from advances in surgical
research in this area and vice versa, as both fields encompass fine
motor skill development and clinical decision making. If further
efforts can be made to advance simulation technologies through
research collaborations across specialties, there is no reason why
VR simulation cannot become an integral and beneficial part of
modern dental curricula.
REFERENCES
1. OECD. Higher Education to 2030 Back to the Future? The
Academic Professions in the 21st Century. 2008. Available at: http://
www.oecd.org/edu/ceri/41939654.pdf. Accessed January 14, 2014.
Simulation in Healthcare
 2. Levine A, DeMaria S Jr, Schwarta A, Sim A. The Comprehensive Textbook
of Healthcare Simulation. New York, NY: Springer; 2013.
3. Wilson MS, Middlebrook A, Sutton C, Stone R, McCloy RF. MIST VR:
a virtual reality trainer for laparoscopic surgery assesses performance.
Ann R Coll Surg Engl 1997;79:403Y404.
4. Scott DJ, Bergen PC, Rege RV, et al. Laparoscopic training on bench
models: better and more cost effective than operating room experience?
J Am Coll Surg 2000;191:272Y283.
5. Duta M, Amariei CI, Bogdan CM, Popovivi DM, Ionescu N, Nuca CI.
An overview of virtual and augmented reality in dental education.
Oral Health Dent Manag 2011;10:42Y49.
6. Xia P, Lopes AM, Restivo MT. Virtual reality and haptics for dental
surgery: a personal review. The Visual Computer 2012;29:433Y447.
7. Buchanan JA. Use of simulation technology in dental education.
J Dent Educ 2001;65:1225Y1231.
8. Suvinen TI, Messer LB, Franco E. Clinical simulation in teaching
preclinical dentistry. Eur J Dent Educ 1998;2:25Y32.
9. Oxford Dictionary Online. Available at: http://
www.oxforddictionaries.com/definition/english/haptic?q=haptic.
Accessed January 14, 2014.
10. Murtomaa H. Dental education in europe. Eur J Dent 2009;3:1Y2.
11. Engelmeier RL. The history and development of posterior denture
teethVintroduction, part I. J Prosthodont 2003;12:219Y226.
12. Fugill M. Defining the purpose of phantom head. Eur J Dent Educ
2013;17:e1Ye4.
13. Clancy JM, Lindquist TJ, Palik JF, Johnson LA. A comparison of student
performance in a simulation clinic and a traditional laboratory
environment: three-year results. J Dent Educ 2002;66:1331Y1337.
14. Green TG, Klausner LH. Clinic simulation and preclinical performance.
J Dent Educ 1984;48:665Y668.
15. Sanderson DJ, Cavanagh PR. Use of augmented feedback for the
modification of the pedaling mechanics of cyclists. Can J Sport Sci
1990;15:38Y42.
16. Yang Y, Zhang L, Bridges SM. Blended learning in dentistry: 3-D
resources for inquiry-based learning. KM&EL 2012;4:217Y230.
17. Lee JS, Oliker A, Hossaini M. Effectiveness of a Dental Injection Simulator
as a Training Tool AADR/CADR Annual Meeting and Exhibition.
Tampa, FL: AADR/CADR; 2012.
18. Tanzawa T, Futaki K, Tani C, et al. Introduction of a robot patient into
dental education. Eur J Dent Educ 2012;16:e195Ye199.
19. Eaton KA, Reynolds PA, Grayden SK, Wilson NH. A vision of dental
education in the third millennium. Br Dent J 2008;205:261Y271.
20. Weeks DL, Kordus RN. Relative frequency of knowledge of performance
and motor skill learning. Res Q Exerc Sport 1998;69:224Y230.
21. Burnett AC, Linden GJ. The reproducibility of the assessment of
restorations by dental students and their teachers. J Dent Educ
1988;52:568Y570.
22. Quinn F, Keogh P, McDonald A, Hussey D. A study comparing the
effectiveness of conventional training and virtual reality simulation in
the skills acquisition of junior dental students. Eur J Dent Educ
2003;7:164Y169.
23. LeBlanc VR, Urbankova A, Hadavi F, Lichtenthal RM. A preliminary
study in using virtual reality to train dental students. J Dent Educ
2004;68:378Y383.
24. Buchanan JA. Overview of three years experience with virtual reality
based technology in dental education. J Dent Educ 2001;65:58.
25. Jasinevicius TR, Landers M, Nelson S, Urbankova A. An evaluation of
two dental simulation systems: virtual reality versus contemporary
nonYcomputer-assisted. J Dent Educ 2004;68:1151Y1162.
26. Gottlieb R, Lanning SK, Gunsolley JC, Buchanan JA. Faculty
impressions of dental students’ performance with and without virtual
reality simulation. J Dent Educ 2011;75:1443Y1451.
Vol. 00, Number 00, Month 2015
Copyright © 2015 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
27. Imber S, Shapira G, Gordon M, Judes H, Metzger Z. A virtual reality
dental simulator predicts performance in an operative dentistry
manikin course. Eur J Dent Educ 2003;7:160Y163.
28. Sheridan TB. Human and machine haptics in Historical perspective,
Workshop on Human and Machine Haptics, CA: Stanford University; 1997.
29. Adams RJ, Klowden D, Hannaford B. Virtual Training for a Manual
Assembly Task. haptics-e 2001;2 Available at: http://www.haptics-e.org.
Accessed January 14, 2014.
30. Todorov E, Shadmehr R, Bizzi E. Augmented feedback presented in
a virtual environment accelerates learning of a difficult motor task.
J Mot Behav 1997;29:147Y158.
31. Lannen D. Deakin’s unique bomb disposal robot Geelong advertiser.
2013. Available at: http://www.geelongadvertiser.com.au/article/2013/
05/02/364129_news.html. Accessed January 14, 2014.
32. van der Meijden OA, Schijven MP. The value of haptic feedback in
conventional and robot-assisted minimal invasive surgery and virtual
reality training: a current review. Surg Endosc 2009;23:1180Y1190.
33. Sewell C, Blevins NH, Peddamatham S, Tan HZ, Morris D, Salisbury K.
The Effect of Virtual Training on Real Surgical Drilling Proficiency
EuroHaptics Conference, 2007 and Symposium on Haptic Interfaces for
Virtual Environment and Teleoperator Systems World Haptics 2007
Second Joint. Tsukaba: IEEE; 2007:601Y603.
34. Bethea BT, Okamura AM, Kitagawa M, et al. Application of haptic
feedback to robotic surgery. J Laparoendosc Adv Surg Tech A
2004;14:191Y195.
35. Strom P, Hedman L, Sarna L, Kjellin A, Wredmark T, Fellander-Tsai L.
Early exposure to haptic feedback enhances performance in surgical
simulator training: a prospective randomized crossover study in surgical
residents. Surg Endosc 2006;20:1383Y1388.
36. Panait L, Akkary E, Bell RL, Roberts KE, Dudrick SJ, Duffy AJ. The role
of haptic feedback in laparoscopic simulation training. J Surg Res
2009;156:312Y316.
37. Steinberg AD, Bashook PG, Drummond J, Ashrafi S, Zefran M.
Assessment of faculty perception of content validity of PerioSim, a
haptic-3D virtual reality dental training simulator. J Dent Educ
2007;71:1574Y1582.
38. Yamaguchi S, Ohtani T, Ono S, Yamanishi SY, Sohmura T, Yatani H.
Chapter 13. Intuitive surgical navigation system for dental implantology
by using retinal imaging display. In: Turkyilmaz PI, ed. Implant
DentistryVA Rapidly Evolving Practice. Rijeka, Croatia: InTech;
2011:301Y316.
39. Bakker D, Lagerweij M, Wesselink P, Vervoon M. Transfer of manual
dexterity skills acquired on the Simodont, a dental haptic trainer with a
virtual environment, to reality. A pilot study. Bio-Algorithms and
Med-systems 2010;6:21Y24.
40. Gal GB, Weiss EI, Gafni N, Ziv A. Preliminary assessment of faculty and
student perception of a haptic virtual reality simulator for training
dental manual dexterity. J Dent Educ 2011;75:496Y504.
41. Lund B, Fors U, Sejersen R, Sallnas EL, Rosen A. Student perception of
two different simulation techniques in oral and maxillofacial surgery
undergraduate training. BMC Med Educ 2011;11:82.
42. Gardner K, Bridges S, Walmsley D. International peer review in
undergraduate dentistry: enhancing reflective practice in an online
community of practice. Eur J Dent Educ 2012;16:208Y212.
43. Murray JJ. Pressures on dental educationVa personal view. Br Dent J
2002;192:433Y435.
44. Corbet E, Akinwade J, Duggal R, et al. Staff recruitment, development
and global mobility. Eur J Dent Educ 2008;12(suppl 1):149Y160.
45. Donaldson ME, Gadbury-Amyot CC, Khajotia SS, et al. Dental
education in a flat world: advocating for increased global collaboration
and standardization. J Dent Educ 2008;72:408Y421.
46. CERI. Trends Shaping Education 2013. Available at: http://
www.keepeek.com/Digital-Asset-Management/oecd/education/
trends-shaping-education-2013_trends_edu-2013-en. Accessed
January 14, 2014.
47. Khera G, Millburn J, Hornby S, Malone P. Simulation in Surgical
Training: Association of Surgeons in Training. 2011.
* 2015 Society for Simulation in Healthcare 7