The use of virtual reality and haptics in the training of students in restorative dentistry procedures: a systematic review
Article information
Abstract
Haptic dental simulators are gaining recognition for training dental students. However, there needs to be more evidence of their pedagogical effectiveness. The primary aims were to (1) identify the published studies related to the application of virtual reality (VR) and haptic technology in the restorative dentistry training of dental students, (2) recognize the outcome criteria used in the published studies, and (3) determine the subjective evaluation of VR and haptic technology in the restorative dentistry training by the students. A comprehensive literature search was conducted to find scholarly articles that assessed the utilization of VR and haptics in training students in restorative dentistry. The investigation was performed via seven online databases: Scopus, Web of Science Core Collection, PubMed, Science Direct Freedom Collection, Latin American & Caribbean Health Sciences Literature (LILACS), EMBASE, and MEDLINE. Of the 268 potential articles assessed, 22 met the inclusion criteria. Findings demonstrated feasibility and acceptability. Additionally, there was improved motor skill acquisition and retention and less time for dental restoration after haptic virtual reality training. With the rising evidence of efficacy and increased utilization of digital technologies, virtual reality, and haptics has a role in improving students’ education outcomes.
Introduction
Recently, virtual reality (VR) has been utilized in dental training to complement conventional skill teaching curricula to educate trainees before handling actual patients [1]. A blend of theoretical knowledge, practical sessions, and clinical practice in dental training distinguishes it from all other medical education [2]. Theoretical knowledge acquisition in dental education needs deep imagination; however, patient-based learning on conventional mannequin imitation does not replicate actual medical setups [3]. Preclinical and clinical training is essential in nurturing preclinical skills to prepare for future meaningful professional engagements [2]. Competency skills in dental education are difficult to obtain, thus mandating consistency in quality training and meaningful practice [4].
The advent of haptic technology revolutionized the VR world, especially with the emergence of dental emulators [5]. Thorough theoretical and laboratory work is essential to a learner’s educational experience [5]. During preclinical years, it is paramount for learners to sharpen their skills via dental emulators. The haptic sensation in a virtual setup is associated with the two-way flow of data between the operator and the processor through the haptic interface that imitates both the tactual and the kinesthetic experience via the application of vibration and motion to the user [5]. Simulator devices that comprise haptic technology transform how users interact with a virtual object by providing a sense of feeling, realism, and touch sensation [6].
Presently, skill attainment and retention in caries management follow a conventional method of close instructor supervision in preclinical setups and transferring such skills into the clinic [7]. This approach subject patients to uneasiness, risks, and a long period of procedures, leading to clinical management dilemma [8]. Additionally, there could be restricted access to apprenticeship training in more challenging situations and limitations in training the learner in a time-effective manner [7].
Interactive graphics, imaging, and tactual sensation from VR and haptic technology have opened novel paradigms in clinical practice [8]. VR entails a computergenerated platform that enables rapid interaction between three-dimensional (3D) models and their associated components with acceptable pace, detail, and accuracy to imitate a sensory experience comparable to reality [7]. The haptic structure offers a force feedback (FFB) vis the tactual receptors in the skin, ligaments, and joints of the user’s fingers. In a caries elimination treatment, tactual sensation in the hands is essential because of the usefulness of contact with the surface [8]. FFB in VR and haptic demonstrates the benefit of calculus and caries detection [8].
Numerous benefits of implementing VR simulation in dental education revolve around the capacity to work with an extensive database of process-based recordings. This permits the evaluation of students learning progress [3]. VR enhances the development, retention, and transfer of users’ hand-eye coordination and fine motor skills during the preclinical stage. Additionally, VR can differentiate between users with various skill levels and facilitate measuring dental performance and training [3].
The utilization of VR in dental training has captured the attention of many researchers [2]. It was claimed that it could improve students’ understanding of theoretical and practical concepts, unlike conventional teaching approaches, especially in teaching restorative dentistry and dental surgery [1,9]. VR and haptics may also find applications in endodontics and orthodontics [2]. VR has been applied in delivering remote lectures via a 3D VR workplace [2]. The versatility of VR and haptic technology permits students to actively participate in learning and facilitate comprehension of theoretical and practical concepts [2].
Health professional education is constantly transforming [10]. Some authors speculate that simulation will be essential in clinical teaching sooner than later [10]. The need for standardization and budgeting pressures on medical institutes are the main driving forces toward simulation in healthcare education [10]. Standardization in the present context means that every student gets an equal opportunity to learn about a comprehensive approach to healthcare, therefore enhancing the quality of medical education [11].
The coronavirus disease 2019 (COVID-19) pandemic has further hastened the adoption of VR-based technology in health professional education [12]. The VR simulations used in dental education are usually obtained from the patient’s 3D intraoral and extraoral scans, fed into the VR software [13]. Students can carry out simulated evaluations and procedures in VR related to multiple dental specialties [13]. Since restorative or operative dentistry procedures form the bulk of all clinical dental treatment procedures, it is essential to provide up-to-date training to all dental students in this specialty [14]. Few dental schools have experimented with the effectiveness of VR in preclinical restorative dentistry training [15].
Though many studies evaluate the effectiveness of novel technologies in preclinical dental training, very few evaluate the students’ perceptions regarding the application of VR and haptics in restorative dentistry. The present review intends to determine the students’ views on VR and haptics in restorative dentistry training. This will be useful in implementing more VR and haptic-based practical sessions to improve the quality of clinical education. Studies have suggested that students can repeat multiple times using VR and haptics without using extra materials (artificial teeth) [16].
Only a few recently published reviews have discussed the studies regarding VR and haptics’ applications for general preclinical dental training [17]. Since the subject is relatively new and has a narrow focus, this paper intends to conduct a systematic review. However, there needs to be more literature on utilizing VR and haptics in training students in restorative dentistry, which forms the bulk of clinical dental procedures. Recently, research papers on the application of VR and haptic technology in preclinical training of several dental specialties have been published [18]. Some studies report the application of VR and haptic technology in preclinical restorative dentistry training [19,20]. There needs to be more organized review to identify the application of VR and haptics in restorative dentistry. The present review intends to address this lacuna in the literature. This systematic review proposes to identify and analyze the available studies regarding VR and haptic technology in the restorative dentistry training of dental students. The aims of this review to (1) identify the published studies related to the application of VR and haptic technology in the restorative dentistry training of dental students, (2) recognize the outcome criteria used in the published studies, and (3) determine students’ subjective evaluation of VR and haptic technology in the restorative dentistry.
Methods
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to identify published studies on VR and haptic technology in restorative dentistry [21]. The outcome criteria were recognized based on the nature of evaluation criteria, such as accuracy, time to task completion, and tooth mass loss. In contrast, the subjective evaluation of the students about VR and haptic technology was determined by the feedback from the questionnaires. Articles fulfilling the modified PICOS criteria were selected [22]. The PICOS criteria for eligible studies were defined as follows: Population (P): undergraduate students, postgraduate students, and faculties of dental programs. Intervention (I): VR and haptic technology-based learning and assessment. Comparison (C): the impact of VR and haptics in the training of dental students and conventional training methods. Primary outcomes (O): preclinical skills of students in restorative dentistry and their influence on clinical competencies measured pre-intervention and post-intervention. The secondary outcomes are the students’ perceptions of VR and haptic technology in restorative dentistry training. Study design (S): randomized controlled trials (RCTs) were considered rich sources of evidence. However, the review had no limits for study design.
1. Publication search
A comprehensive literature search of Science Direct Freedom Collection, Latin American & Caribbean Health Sciences Literature (LILACS), EMBASE, MEDLINE, PubMed, Scopus, Web of Science Core Collection, and Google Scholar for grey literature was done in English for articles published before January 14, 2023. The search was done to find potential scholarly articles that explored the utilization of VR and haptics in the training of students. The following keywords and medical sub-headings were used simultaneously in each set: (“virtual reality,” “dental haptics,” “restorative dentistry,” and “dental training”). Synonyms and alternative spellings were considered. The keywords were used exhaustively in different combinations in various databases. Two autonomous reviewers did the literature search.
2. Inclusion and exclusion criteria
Eligible studies included in this review met the following inclusion criteria: they were scholarly articles; they were published in the English language or could be translated into the English language; they explored the utilization of VR and haptics in the training of students; they explored preclinical skills of dental students in restorative dentistry; they explored perception or acceptability of VR and haptics in operative dentistry.
Ineligible studies were excluded due to the following reasons: they were duplicates or continued work of previous publications; they were reviews, meta-analyses, protocols, bibliometric analyses, opinion pieces abstracts, or editorial articles; they had no methods and results; they explored the utilization of VR without haptics; they assessed the utilization of VR and haptics in non-students.
3. Data selection and extraction
Two reviewers autonomously reviewed all studies. Titles and abstracts were first screened to remove inappropriate studies. Full texts of the remaining studies were additionally assessed based on the current inclusion and exclusion criteria. Differences between the two reviewers were addressed via dialogue with a third party. Final decisions were made after reaching a consensus. Two reviewers extracted data autonomously using a carefully designed data extraction form with key search terms. Relevant studies were evaluated for accuracy.
Results
1. Data selection
Database search produced 268 studies, out of which 96 duplicates were eliminated. The title and abstract screening conducted removed 136 articles. Thirty-six articles were sought for retrieval. Two articles could not be retrieved in spite of making attempts to contact the corresponding authors. Thirty-four articles were assessed for eligibility. Twelve articles were eliminated as they needed to meet the stipulated inclusion criteria (review articles: n=8, reports [without methodology and results]: n=3, and non-English article: n=1). Twenty-two articles were considered eligible for review after the screening, as shown in Fig. 1.
PRISMA Flow Diagram for Systematic Review with Included Searches of Databases
PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis, LILACS: Latin American & Caribbean Health Sciences Literature.
2. Data synthesis
The characteristics (authors, study design, region, sample size, type of technology used, and results of each selected study) were summarized in a study descriptor table (Supplement 1) [4,7,8,16,19,20,23-38]. Primary and secondary outcomes were grouped into five thematically related categories: feedback motor skills development, perception of haptic VR simulator technology, skill acquisition and transfer, and performance predictor and level of confidence. A narrative summary of the significant results was presented with tabular summaries of the extracted data.
3. Methodological quality assessment
The risk of bias was independently assessed by two reviewers, both of whom have experience in conducting systematic reviews and critical appraisal of research. One reviewer has experience in dealing with VR-based simulation studies, while the other specializes in evidence synthesis and methodological quality assessment. To assess the methodological quality of included RCTs, The Cochrane Collaboration Risk of bias Tool was used [39]. The Cochrane Collaboration Risk of bias Tool uses the following bias criteria: bias arising from the randomization process; bias due to deviations from intended intervention; bias due to missing outcome data; bias in measurement of the outcome; and bias in the selection of the reported result and overall risk of bias. The judgment is either low, high, with some concerns, or no information bias. The results are presented in traffic light plots and summary plots for critical appraisal of the studies, as shown in Fig. 2 [8,31,34,36] and Fig. 3. Non-controlled trials were assessed using the modified Newcastle-Ottawa Scale [40]. This scale uses selection, ascertainment, causality, and reporting bias. Prior to the assessment, calibration exercises were conducted to ensure consistency in evaluating bias across studies (Supplement 2) [4,7, 16,19,20,23-30,32,33,35,37,38].
Traffic Light Plot of Critical Appraisal of the Studies
A Summary Plot of the Outcomes of the Critical Appraisal of the Studies
4. Study characteristics
Supplement 1 provides an overview of the included studies. These studies were published between 2007 to 2022. About 64.7% of the studies were published in the last decade. A total of 562 participants were included across all the studies majority of which were students. Most studies were conducted in European and Asian universities. Across the studies, VR and haptic simulator technology was employed.
5. Virtual reality and haptics: primary and
secondary outcomes A thematic analysis, following Braun and Clarke [41], was used to highlight and analyze dominant themes in the included studies. The findings were from RCTs, crosssectional studies, descriptive/survey, prospective, and retrospective studies. The qualitative analysis in this review considered all the 22 included articles. The dominant themes in the study were clustered into five classes: feedback, motor skills development, perception of haptic VR simulation (HVRS) technology, skill acquisition and transfer, and performance predictor and level of confidence.
6. Prediction and level of confidence
Some studies investigated the value of VR and haptic training in skill performance prediction in preclinical and clinical environment [9,23,24]. The performance of a complex haptic exercise and early preclinical restorative dentistry practical assessment were strongly associated. The use of haptic VR training was associated with improved confidence and preparedness [4,25]. According to Suebnukarn et al. [26], using haptics and VR enhanced learners’ performance in attaining basic dentistry procedures [19]. Additionally, students’ learning gradient and progress were significant when trained with the HVRS technology.
7. Skill acquisition and transfer
The short- and long-term effects of skills acquisition and retention using conventional phantom head devices and VR and haptic devices were assessed in some studies. The studies investigated skill transmission from the simulator device to the phantom head and from the haptic device to the extracted teeth [16,23,27]. The studies concluded that both learnings have an equal impact on enhancing the acquisition of elementary manual dexterity and performance of certain tasks, such as cavity preparations and plaque elimination among users. Dwisaptarini et al. [8] found a substantially higher performance in learners trained with the haptic device. Skills obtained from the haptic device were effectively transferred to the phantom head device and the extracted teeth [8]. Across the studies, students were pragmatic and conservative and recorded minimum error scores. This was because the simulator device constantly warned users whenever they advanced past the set boundaries in any dental task.
8. Feedback
The impact of feedback on skill acquisition and performance was evaluated in certain studies, especially FFB from the haptic simulator [20,28]. Another study also assessed kinematic feedback and a combination of pedagogical and kinematic feedback [26]. FFB is the emblem of haptic simulation consisting of the ability to feel the texture of dental tissues, for instance, hard enamel or soft caries [9]. Even though it is difficult or impossible to replicate the full realism of dental tissues technically, FFB enhances the development of tactual skills necessary in dental learning. FFB at specified degrees improves learners’ performance when trained on the haptic device compared to training without FFB. Similarly, kinematic feedback from the simulator improved the student’s performance during the initial stages of skill acquisition and retention; however, its benefits faded with time [26].
9. Motor skills development
Several studies investigated motor skills acquisition, retention, and development outcomes. These studies concluded that the use of a haptic VR dental simulator improves the attainment and retention of elementary motor skills in dental students [9,19,29-31]. Manual dexterity is an important skill in understanding restorative dentistry; therefore, a substantial percentage of the undergraduate curriculum should be devoted to enriching learners’ clinical skills [9].
Farag and Hashem [29] investigated students’ psychomotor skills attainment of cavity preparation posthaptic VR simulator training and reported improved learners’ performance in class I cavity preparation. The improvements were due to consistent assessment provided by HVRS, which boosted the knowledge of hand-eye coordination and fine psychomotor control. Additionally, the simulator’s visual system boosts hand-eye harmonization and enlargement of smaller details, enhancing the cognitive acquisition of the tasks and improving students’ confidence. Moreover, Al-Saud et al. [7] recorded improvements in manual dexterity skills post-haptic VR simulator training, and low error scores and less time to task completion. The study further demonstrated that the attainment and retention of motor skills accelerated when participants received both HVRS and proficient instructor feedback.
10. Perception of HVRS technology
Certain studies investigated learners’ and instructors’ perceptions of HVRS technology as an educational tool via experimental surveys. The questionnaire-based surveys permitted students to conduct elementary procedures on the haptic device and then fill out the forms. The questionnaires explored the VR and haptic simulator in two distinct categories: the first was on the received realism and technical functionalities of the device, and the last was on training value and potential. The utilization of VR simulator technology in undergraduate dental training was well tolerated and accepted by novice students because of its useability, utility, and user experience [4,19,23,25,30-33,39]. Acceptance of new technology has been a challenge in the health sector. There is more to health technology success than just designing functional software. In a study by Rodrigues et al. [33] to assess DENTIFY’s (an immersive multimodal simulator) usability and acceptance by dentists, all users revealed that they had a magical experience with the technology.
Furthermore, participants reported a short learning curve due to the increased ease of controlling the haptic simulator features [33]. The use of HVRS can improve students, curiosity, and interest and serve as a tool for teaching and learning novel skills. According to Koo et al. [19], participants revealed that the game feature of haptic technology made it more fun and exciting. Steinberg et al. [30] also investigated students’ perception of haptic VR simulator technology and reported that the participants were enthusiastic about the technology. The adoption of HVRS technology would serve as a complement to traditional techniques.
11. Statistical analysis
All data were statically analyzed using Review Manager ver. 5.4.1 for Windows (RevMan; Cochrane, London, UK). Analyses were conducted as averages and deviations about the mean. A p-value less than 0.05 was considered statistically significant.
12. Performance comparison before and after training on a haptic simulator: metaanalysis results
In assessing the performance outcome of novice dental students before and after training on a haptic simulator, 37 were included. Farag and Hashem [29] in 2021 recorded the highest precision (50.7%), while Dwisaptarini et al. [8] in 2018 recorded the least precision (49.3%). In the overall meta-analysis, a random-effects model was used, yielding a pooled summary effect of –5.06 (95% confidence interval [CI], –9.16 to –0.96). This effect size, though large, reflects the variability in study methodologies, sample sizes, and assessment criteria across included studies. The direction and magnitude of the effect suggest an improvement in skill acquisition post-haptic VR training, but the heterogeneity in study designs should be considered when interpreting the results. The included studies had high heterogeneity (p=0.0003 and I2=92%). The overall effect was Z=2.42 (p=0.02). The results show that using VR and a haptics simulator improves novice dental students’ performance in cavity preparation or caries removal in dentin. Novice dental students performed better posttraining with the haptic simulator than before training (Fig. 4) [8,29].
Forest Plot of Comparison: Performance before and after Training on a Haptic Simulator
SD: Standard deviation, IV: Inverse variance, CI: Confidence interval, df: Degree of freedom.
13. Time to task completion rate before and after training on a haptic simulator: metaanalysis results
In evaluating the outcome of the time-to-task completion rate among novice dental students before and after training on a haptic simulator, 37 novice dental students were included. A random effect model was used, the pooled summary effect was 8.03, and the 95% CI was –0.39 and 16.45. The included studies had high heterogeneity (p=0.02, I2=80%). The overall effect was Z=1.87 (p=0.06). The results indicate a reduction in task completion time among novice dental students after training with a haptic simulator. However, this finding did not reach statistical significance (p=0.06), suggesting that while there may be a positive trend, further studies with larger sample sizes are needed to establish a definitive effect. The observed reduction in task completion time aligns with previous research suggesting that haptic VR training enhances procedural efficiency, but caution is warranted in interpreting this outcome given the statistical threshold (Fig. 5) [8,29].
Forest Plot of Comparison: Time to Task Completion Rate before and after Training on a Haptic Simulator
SD: Standard deviation, IV: Inverse variance, CI: Confidence interval, df: Degree of freedom.
Discussion
This review offers a productive compilation of information on VR and haptic technology in dental education. It could assist scholars in comprehending past, present, and future trends in this technology. Additionally, it advocates for future research and implementation of VR and haptics into the dental curriculum. This review demonstrated that using VR and haptics significantly improves education outcomes such as manual dental skills and theoretical knowledge acquisition and retention. Students have different learning approaches, which remains challenging for instructors [2]. Adopting VR and haptics in dental training and using its data to predict students’ learning progress would provide a modest opportunity to tailor the learning process to suit students’ diverse needs. This would permit students to learn at their speed and optimize their performance.
From the results of this review, haptic technology was preferably used in tasks that needed drilling and tooth preparation [4]. Haptic technology provides an extra dimension to VR via the sense of touch and FFB of various tooth-layered structures and bones. Therefore, haptic technology was effective in junior training learners’ hand-eye coordination and imagination skills [42]. It also enhanced students’ preparation precision, reduced preparation time, and augmented a conservative preparation technique [42]. Nonetheless, since dental procedures are special, FFB should be enhanced and added as a vital feature in any educational dental emulator to improve the perception of tooth structures. Training with the FFB enables a sense of realism and permits students to appreciate the feel of an invasive procedure in a computer-generated learning platform [28]. Haptic and FFB technology, in conjunction with a VR simulator, could compensate for the drawbacks of conventional PHB motor skill training. Using haptic and force-feedback narrows the gap between the preclinical and clinical level, minimize anxiety among new dental students and enhance patient safety [43]. In 2015, the United Nations publicized the Sustainable Development Goals, among them, quality education, good health, and well-being, which have become a common job for all dental schools [43]. Thus, haptic VR simulators have become novel favorites because of their capacity to offer high-quality education, minimize inequality, and reduce waste [43].
Additionally, using VR and haptics was very useful in acquiring motor skills in preclinical settings. Students’ acquisition and retention of psychomotor skills is the key feature and core competency of preclinical restorative dentistry and an area where most of the preclinical training is dedicated [29]. The dental curriculum apportions more time for practicing and enhancing psychomotor skills than theoretical or didactic teaching [44]. The most common method in training psychomotor skills is the traditional demonstration method. In this approach, the lecturer lectures the content as a package of information and shows the learners how to perform the task. The learners then practice the task in the lab and assess their work with the instructor according to the criteria. So clinically unacceptable mistakes may be met more regularly after they are made in the early stages of psychomotor skill development [29]. The learners depend on lecturer feedback and availability and may need help to easily develop skills of self-evaluation and critical thinking [29].
From the outcomes of the meta-analyses, using VR and a haptics simulator improves novice dental students’ performance in cavity preparation or caries removal in dentin. Novice dental students performed better posttraining with the haptic simulator than before training. This highlights the impact of VR and haptic simulators on skill acquisition, retention, and mastery of content. The two studies showed a statistically significant increase in average marks scored by novice dental students after training with the haptic simulator [8,29]. Therefore, VR and haptic simulators are useful training tools in restorative dentistry.
The improvements in novice dental students’ scores were due to various reasons. Firstly, the continuous assessments offered by the VR and haptic simulator made it easier to comprehend hand-eye coordination and fine psychomotor control [29]. Secondly, the haptic device’s visual system improved hand-eye coordination and the enlargement of smaller features, which further enhanced learners’ confidence in the cognitive acquisition of tasks [29]. Thirdly, most learners preferred to work in 3D vision in the computer-generated learning platform and scored substantially better in various dexterity exercises, unlike in two-dimensional vision [29]. Finally, the accessibility and availability of haptic training devices to novice dental students enabled them to train effortlessly at their own pace and peak learning hours [29].
Regarding time-to-task completion rate, while a reduction was observed, the result did not reach statistical significance (p=0.06). This suggests a potential benefit, but further research with larger sample sizes is needed to establish a definitive effect. The findings indicate that haptic VR training may contribute to procedural efficiency, but caution is warranted in interpreting this outcome due to the statistical threshold. Novice dental students performed tasks such as cavity preparation or caries removal in dentin. Identifying and eliminating infected and affected carious dentin are vital in training minimally invasive caries treatment [8]. Conventional caries management in operative dentistry proposes to remove all the softer parts of a cavity, which is a must in the caries termination process [8]. Numerous approaches have been used to eliminate various layers selectively [8]. These methods include traditional slowpace tungsten carbide bur, laser, caries detector, and FACE (fluorescence-aided caries excavation), a simple technique to distinguish between affected and infected carious dentin [8].
Students find it relatively easy to familiarize themselves with new technologies without going through many seminars, unlike other populations [45]. Thus, dental students will be able to overcome the inevitable difficulties of implementing VR and haptics in the undergraduate and postgraduate syllabus. Furthermore, several undergraduate and postgraduate programs incorporate aids in teaching and learning dental simulations mainly because there are no clinical consequences associated with virtual technologies [46]. Additionally, virtual technologies permit multiple repetitions, which are essential for the learning and practicing new concepts [46].
The included studies exhibited substantial heterogeneity (p=0.02, I2=80%; p=0.0003, I2=92%), which reflects the diversity of study designs, participant characteristics, and evaluation methodologies. One key source of heterogeneity is the variation in students’ proficiency levels— some studies assessed novice learners, while others included participants with prior clinical experience. Additionally, differences in evaluation criteria, such as skill acquisition measures (e.g., accuracy, time-to-task completion, procedural errors) and training duration, likely contributed to the observed variability. The heterogeneity may also stem from differences in the VR and haptic systems used across studies, as these technologies vary in their FFB mechanisms and levels of immersion.
To address this variability, a random-effects model was applied in the meta-analysis, accommodating differences between studies. However, the presence of moderate-tohigh heterogeneity suggests that findings should be interpreted with caution, as the diverse methodologies and participant backgrounds may have influenced the results. Future studies should prioritize standardized evaluation criteria and participant selection methods to enhance comparability across research in this field.
More information about the “perceptions” of students in the grey literature may need to be included. The articles included in this study were either written in English or could be translated into English; therefore, non-English studies could have been neglected. The sample sizes used in the included studies were relatively small and may not accurately portray the characteristics of the entire student population. The retrospective nature of this review integrating evidence from scholarly articles rather than from actual patients, limit the availability of some information, such as long-term follow-up of participants and the impact of VR and haptics on clinical practice. The possible implications of the findings of this review are as follows:
Enhanced training quality: The review demonstrates that the use of VR and haptic technology can significantly improve the quality of training for dental students. This implies that dental schools should consider incorporating these technologies into their curricula to enhance skill acquisition and retention.
Improved student performance: The findings indicate that students trained with VR and haptic simulators perform better in terms of motor skills and procedural tasks. This suggests that these technologies can bridge the gap between preclinical and clinical training, potentially leading to better clinical outcomes.
Feasibility and acceptability: The review confirms the feasibility and acceptability of VR and haptic technology among dental students, which is crucial for the successful implementation of these tools in educational settings.
Reduced training time: The review found that VR and haptic training can reduce the time required for students to achieve competency in dental procedures. This has implications for more efficient use of training resources and potentially faster progression of students through their education.
Enhanced feedback mechanisms: The use of haptic feedback can provide students with immediate, tangible feedback on their performance, which is essential for learning complex motor skills. This can lead to a deeper understanding and better retention of skills.
Adaptation to modern educational needs: With the increasing emphasis on digital learning and remote education, especially accelerated by the COVID-19 pandemic, VR and haptic technologies can offer innovative solutions to meet these modern educational needs.
The recommendations of this review are as follows:
Integration into curricula: Dental schools should integrate VR and haptic technologies into their curricula. This includes developing specific modules that utilize these technologies for training in restorative dentistry and other dental specialties.
Training for educators: Educators should be trained in using VR and haptic technologies to effectively incorporate these tools into their teaching practices. This can include workshops, seminars, and hands-on training sessions.
Standardization of training protocols: Develop standardized training protocols and assessment criteria for using VR and haptic simulators. This will ensure consistency in training quality and outcomes across different institutions.
Investment in technology: Institutions should invest in the necessary hardware and software to support VR and haptic training. This includes purchasing simulators, maintaining the technology, and ensuring that there is adequate technical support.
Ongoing research and evaluation: Continuous research should be conducted to evaluate the long-term effectiveness of VR and haptic training. This includes tracking student performance over time and comparing outcomes with traditional training methods.
Student feedback mechanisms: Implement mechanisms to regularly collect and analyze feedback from students regarding their experiences with VR and haptic training. This will help in refining the technologies and training approaches to better meet student needs.
Interdisciplinary collaboration: Encourage collaboration between dental educators, technology developers, and cognitive scientists to further improve the design and application of VR and haptic technologies in dental education.
Policy development: Develop policies at the institutional and national levels to support the integration of VR and haptic technologies in dental education. This includes funding, accreditation, and quality assurance measures.
By following these recommendations, dental education can be significantly enhanced, leading to better-trained professionals and improved patient care outcomes.
Conclusion
With the rising evidence of efficacy and increased access to digital technologies, the use of VR and haptics plays a central role in improving dental students’ confidence and preclinical skills. Incorporating VR and haptics into the dental curricula requires consideration to maximize its potential in motor skill training and complement existing simulation methods. The outcomes of this study demonstrate the feasibility and acceptance of haptic VR technology among dental students chiefly because of utility and usability.
Supplementary materials
Supplementary files are available from https://doi.org/10.3946/kjme.2025.335
Showing Brief Details of the Selected Studies.
Quality Assessment of Included Noncontrolled Trials (Modified Newcastle-Ottawa Scale).
Notes
Acknowledgements
None.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conceptualization: SRS, AE. Data collection: SRS, AE, SN, HA, GS. Data analysis: SRS, AE, SN, HA, GS. Manuscript writing: SRS, AE, SN, HA, GS. Final approval of the manuscript: all authors.