The next level of training for early caries and periodontal disease detection

February 10, 2009
Web Exclusive

The next level of training for early caries and periodontal detection

Researchers at UIC are using the PerioSim dental training simulator to apply virtual reality to dental school learning.

by Dr. Arnold Steinberg, professor of periodontics, University of Illinois at Chicago.

Today’s dental schools face rising costs, faculty shortages and an overloaded curriculum. Instructors must find new, innovative ways to stimulate student training and learning, often with smaller per-student budgets.

Merging the worlds of computer games, advanced force feedback haptics and other new technologies makes it possible to help trainees learn the exact ‘feeling’ of specific dental procedures through self-study, unlimited practice and self-testing-while making the learning fun.

THE CASE IN PICTURES: SLIDESHOW
(Refer to slideshow for figures)

A new kind of training device

The PerioSim© (dentaltrainingsimulator.com) is such a prototype simulator program for training in early dental caries and periodontal disease detection (Fig. 1). The program is being developed at the University of Illinois at Chicago (UIC) through a collaboration between the Colleges of Dentistry and Engineering.  

Combining 3D graphics, sound and “3D virtual touch,” it already has been used on a limited trial basis by novice students at the College of Dentistry. Evaluations from first year Cariology class students, who used the simulator for an average of 20 minutes last fall, were positive. We are now evaluating our belief that this system will provide novice dentists and hygienists with a faster way to learn early caries and/or periodontal disease detection than traditional training.

The training

Think of PerioSim as a sophisticated, precision Nintendo® Wii on steroids for dental and hygiene students. Students sit before two computer screens holding a stylus-looking haptic device instead of a computer mouse. This PHANTOM® haptic device, from SensAble Technologies (sensable.com), provides kinesthetic force feedback-pushing back on the user’s hand to simulate the exact feeling of what the student sees on screen. In this training simulator, the student puts on 3D glasses, then lifts the haptic device stylus and begins a self-training program in detecting early dental caries or periodontal disease.

All of this happens with very limited presence of an instructor; instead, the system includes pre-recorded modules created by an instructor using PerioSim. These recordings incorporate anatomically accurate graphics, haptics and audio instructions to guide the user through the procedure (Figs. 2-8). This self-training approach frees up the instructor’s time and clinic time, allowing students to train until mastery is achieved.  

It’s all about tactile sense   

While traditional audio-visual computer training experiences can be helpful, they fall short of their goal if they cannot teach the “finger memory” that is paramount to skill acquisition. The PerioSim is designed to teach the exact “feeling” of the skills needed in the initial steps of detecting the three major oral diseases: initial dental caries (Figs. 2-6), periodontal disease (Figs. 7-8), and oral cancer lymph node palpation (currently in preparation). The system allows students to experience the exact visual, kinesthetic and audio input of the procedure they would perform under instructor supervision in a clinical setting, providing the unlimited repeatability, measurability and data tracking capabilities of a computer-based system.  

The PHANTOM haptic device allows novice students to learn with realism how each disease “feels” in a patient’s mouth. Students hold and manipulate the haptic stylus instead of a dental instrument.

When hand motions deviate from the pre-recorded instructor’s requirements, the guiding forces of the haptic-robotic arm, along with brief audio commands and visual cues, alerts and guides students into the proper movement. An audio/visual alarm tells users if they are off course. After students complete the virtual caries detection training, their performance can be tallied and scored for a variety of parameters so their progress can be evaluated.

A work in progress

While PerioSim is still in a prototype phase, initial indications show it is instructive and appears beneficial. Our published controlled study using dental school instructors supports this conclusion as do unpublished student evaluations.

Haptic-based simulators such as the PerioSim© require less initial investment, maintenance and replacement of parts than earlier generation mannequin-based simulators and are more versatile. The ability of this system to record and playback the instructor-created scenario and the student practice allows PerioSim it to be a true self-training program.

PerioSim could also be designed to be used over the Internet with a haptic device at various locations, making it available to a diverse audience.  

Milos Zefran, Associate Professor Electrical and Computer Engineering and Maxim Kolesnikov, Department of Electrical and Computer Engineering contributed to this story.

Seema Ashrafi, Clinical Assistant Professor Periodontics; Adriana Semprum-Clavier, Clinical Assistant Professor Restorative Dentistry; and  Philip G. Bashook, Research Assistant Professor Medical Education are all involved in various parts of the project.  

More about the PerioSim

The benefits

The PerioSim System replicates the learning process through the combined use of visual, tactile and audio input. Combining these sensory inputs is the way humans normally learn. The simulator provides:

3D instrumentation and 3D anatomically accurate structural models of a lower right jaw quadrant with four teeth, gingiva, bone and connective tissue attachment. Models can be shown with and without the presence of periodontal bone pathology and pocketing and can be used for training.

Visual and kinesthetic information about periodontal probing and active white spot lesion detection, which allows students to view periodontal probe-tooth-gingival relationships, along with dental explorer-tooth surface relationships, from any 3D viewpoint.

Opportunity for students to practice and improve accuracy in the reading of millimeter probing depths of healthy sulcus and pathological gingival sulcus (pockets). They can also self-test the accuracy of their readings.

What it does

When working with this system, users can:

Adjust a variety of haptic parameters found on a separate panel, such as viscosity, stiffness, static friction and dynamic friction (for instructor use only).

Choose from a number of 3D models or any of their parts.

Determine the desired degree of transparency of the models.

Select the instrument to be used from the 15 that are available.

Record procedural scenarios that the user sees on screen for future replays or a PC or view projected in lectures.

Navigate models in all possible 3D views.

Feel and view on a gauge the applied instrument pressure in grams of force being applied to the gingiva or tooth surface.