Interdisciplinary all-on-four® concept for mandibular jaw in dental education - do students benefit from individual 3d printed models from real patient cases?

Although the analysis does not corroborate the primary hypothesis suggesting greater subjective knowledge gain among students from an individually planned and model-transferred hands-on course compared to a traditional model course, the present study elucidates several significant observations.

Notably, students’ acceptance of an individualized course is notably high, as evidenced by an 81% acceptance rate in the current study. This finding underscores the potential benefits of implementing such courses, as heightened acceptance among students is recognized to enhance learning capabilities [40]. Despite the absence of statistical significance in the data regarding the usefulness of an individually planned jaw model for implant-course use, students consistently rated the individualized model as helpful and desirable. This subjective perception among students may significantly enhance motivation in learning digital implantology, thereby facilitating the acquisition of application-specific knowledge [22, 41].

Implantology has become an indispensable component of contemporary dental practice, with its principles firmly entrenched in the national learning curriculum for dentists. However, practical implant courses are not universally emphasized. Students appear to recognize this gap, as evidenced by a high proportion (65%) within the study population reporting personal involvement in either planning or assisting with implant procedures. Consequently, it appears that the demand for implantological education remains unfulfilled within dental education programs. A 2021 study showed that students who were allowed to implant under supervision had comparable results to postgraduate dentists [42]. These results are also supported by a study which showed an implant survival rate of 98% for 294 implants placed by students in the University of Kentucky [43]. In both studies, various patient scenarios were employed for training purposes. These studies explored the implantation of four support implants in edentulous patients to facilitate a removable prosthetic denture, as well as single-tooth restorations. Similarly, our study examined the restoration of edentulous patients among students through the implementation of the all-on-four concept®, albeit without subsequent fixed denture—a procedure of highest complexity. Nonetheless, this approach encompasses all essential tools, both theoretically and practically, necessary for comprehensive implantation planning, thus ensuring a proficient execution of the procedure. Studies have indicated that students express a desire for implantology-focused education during their undergraduate dental studies, a sentiment that was positively evaluated by Schweyen et al. [31]. However, the integration of such programs is not constantly detectable. This phenomenon may be attributed in part to economic considerations. Hands-on implant courses are seldom organized without the backing of industrial partners. The expenses associated with machines, burs, dental implants or implant dummies, and jaw models must be taken into account when devising such a course model, particularly given that implants and models are typically single-use items. Many departments lack the resources necessary for the regular implementation of hands-on courses independently [26, 27]. Utilizing low-budget 3D printers presents an opportunity to mitigate costs, as models can be produced more affordably compared to commercially available alternatives [2, 44].

A rough estimation for the current study revealed that costs were approximately €20 per model, inclusive of the gingiva mask, based solely on material expenses. These costs may ostensibly be comparable to a confectioned jaw model but personnel costs and expenses associated with maintaining a printer system were not factored into this calculation. While these additional costs may slightly increase the overall expenditure, leveraging low-budget 3D printers has the potential to significantly reduce the economic burden of hands-on courses, particularly if printing facilities are already available onsite. Consequently, implementing a simulation course may become a more appealing option for dental schools and university departments.

Simulation courses offer a valuable assessment platform for evaluating student proficiency. Moreover, these methods have been shown to enhance student performance and are effective for teaching procedural skills [8]. Additionally, they provide a risk-free environment for students to practice patient-centered applications.

Simulations in medical education must adhere to specific criteria [8], including:

For hands-on implant courses, it has been demonstrated that most of these criteria (2, 5, and 7–10) are met [25]. Through the utilization of 3D printed models, it becomes feasible to cost-effectively integrate repeated applications with adjustable difficulty levels, based on real patient cases, into an implant course. This approach facilitates the mapping of clinical variation and allows for individualized learning experiences. From a simulation-didactic standpoint, it appears that a simulation involving self-planned 3D print models would be a valuable addition to dental teaching implant courses.

In the current study, a formative evaluation was not conducted; however, other research teams have demonstrated that similar courses are well-suited for this purpose [27, 37]. Therefore, in future applications, a similar course could potentially be utilized to assess implantological skills and knowledge acquisition, thus warranting consideration for implementation in curricular teaching. Despite the lack of a statistically significant increase in knowledge, the positive perception reported by the students supports this assumption. Nevertheless, before full implementation, it is advisable to reassess the suitability of a course individualized by 3D printing for formative testing. A potential limitation of our study is that students in both cohorts may have exhibited a general satisfaction with the opportunity to participate in an implant course, thereby potentially masking any discernible differences between confectioned jaw models and individual 3D-printed cases. It is conceivable that implementing the implant course earlier in the curriculum, subsequent to students acquiring foundational knowledge with confectioned jaw models, could provide a valuable progression. This approach would afford students the opportunity to practice on their own patients using models, thereby gaining insights into the challenges and constraints inherent in real-world dental practice.