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Development and Validation of a Haptic Virtual Reality Simulator for Tooth Extraction and Inferior Alveolar Nerve
YingQi Ren1, YiHan Xu1, ZiYa Yuan1
1College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China; Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China.
Introduction And Aims:
Exodontia and local anaesthesia are critical competencies in dental education, yet existing simulators lack integration. This study aimed to develop and validate a Tooth Extraction and Local Anaesthesia simulator (TELA-sim), one of the first haptic virtual reality platforms to immerse learners in the complete clinical workflow for tooth extraction (TE) and inferior alveolar nerve block (IANB).
Methods:
Dental students (undergraduates without clinical experience) and residents (postgraduate trainees with clinical experience) (N = 155) were grouped as novices (n = 72) or intermediates (n = 83) based on clinical experience for face and construct validity assessment. A separate skill-transfer cohort compared fourth-year undergraduates who received TELA-sim training (n = 79) with a historical control group that received only traditional training (n = 77). Performance was evaluated via simulator metrics, questionnaires, and practical skills examination (PSE) scores on phantom heads.
Results:
The simulator showed strong face validity (median Likert scores > 3.0; no significant group differences). Construct validity was demonstrated by significant intergroup differences, with novices unexpectedly outperforming intermediates on overall protocol adherence (TE: median 91.50 vs 85.00, P < .001, δ = 0.39; IANB: 71.00 vs 62.00, P = .004, δ = 0.27). The TELA-sim group achieved markedly higher PSE scores 6 months later (median 84.00 vs 75.00, P < .001, δ = 0.76).
Conclusions:
This study successfully developed the TELA-sim and established its face and construct validity. The TELA-sim led to superior skill retention and transfer to clinical practice compared with traditional training alone. However, longer‑term retention beyond 6 months requires further investigation, while not all students responded favourably to the simulator during face validity assessment.
Clinical Relevance:
The TELA-sim may help preclinical students prevent errors through repeated practice of standardised protocols in a risk-free environment. Its alignment with licensing requirements suggests potential for objective skills assessment. For practising clinicians, the simulator could offer skill refinement and retraining opportunities to reinforce safe protocols and support continuous professional development, though further study is needed.