Undergraduate and postgraduate perceptions of a 3D-printed educational simulator for endodontic microsurgery: A cross-sectional study

Undergraduate and postgraduate perceptions of a 3D-printed educational simulator for endodontic microsurgery: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Undergraduate and postgraduate perceptions of a 3D-printed educational simulator for endodontic microsurgery: A cross-sectional study Mathieu IZART, Aylin SARI, Elisa CAUSSIN, Yasmine SMAIL, Fleur BERES, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8661165/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Endodontic microsurgery requires precise psychomotor and cognitive skills, which are challenging to acquire through observational learning alone. Effective preclinical training models are crucial for structured skill acquisition. Methods A cost-effective 3D-printed educational simulator was developed to allow the practice of key endodontic microsurgery steps, including osteotomy, root resection, canal preparation, and suturing. Thirty-two dental students (18 endodontic postgraduate students and 14 final-year undergraduate students) performed surgeries on designated maxillary teeth using standard clinical instruments and microscopes. Student perceptions were evaluated via pre- and post-training questionnaires with a Likert scale. Results The simulator was well received overall, significantly improving the self-reported confidence and perceived competence of undergraduate students (Mann‒Whitney U test, p < 0.01). Postgraduates who were familiar with clinical procedures also reported positive experiences, albeit with fewer statistically significant improvements. Both groups indicated high overall satisfaction, acknowledging that the simulator is a valuable training tool despite its limitations in tactile realism, notably regarding gingival tissue. Conclusions This study demonstrates the educational effectiveness of a custom-made, 3D-printed simulator for endodontic microsurgery. Its versatility, affordability, and modularity support structured, incremental learning and standardized training. Such simulators may democratize access to high-quality surgical education and improve pedagogical outcomes across dental education programs. 3D Printing Education Endodontics Simulation Surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Endodontic microsurgery is a technically demanding procedure that requires the acquisition of a wide range of psychomotor and cognitive skills. Theoretical knowledge alone is often insufficient (Tricio et al., 2022 ); prior to performing their first clinical procedure, trainees must demonstrate a certain level of manual competence (Baaij et al., 2024 ). Observational learning or assisting in surgeries often falls short of providing the depth of experience needed, especially as procedures become increasingly complex and minimally invasive. This fact highlights the need for structured, preclinical training that facilitates progressive learning and effective skills assessment (Grall et al., 2021 ). To this end, simulation-based education has become a cornerstone of clinical training (Cleland et al., 2016 ). This approach involves deliberate practice as a “strategic instructional design for purposeful action to acquire psychomotor skills” (Cook et al., 2011 ). Moreover, it consists of structured outcomes with progressive difficulty that allow, with consistent feedback, incremental improvements and a transition to mastery (Higgins et al., 2020b ). The specific skills of dentistry can then be taught specifically by in-hand manipulation (Higgins et al., 2020a ). A variety of models exist for this purpose, ranging from extracted teeth to sophisticated manikins (Akaike et al., 2012 ; Lv et al., 2025 ). Among these models, printed simulators are particularly valued because of their reproducibility, standardization and ability to be carefully designed to facilitate the learning of a specific skill (Ye et al., 2020 ). These models allow for the segmentation of complex procedures and the stepwise acquisition of skills prior to full procedural execution. An ideal simulator should allow students to gain technical proficiency, access to expert tutors, and map onto real-life clinical experience as well as include an affective component that provides a conducive way to learn (Kneebone, 2005 ). In this context, three-dimensional (3D) printing has emerged as a common and viable tool in medical education (Dobroś et al., 2023 ; Langridge et al., 2018 ). Unlike subtractive methods such as milling, 3D printing is an additive manufacturing technique that minimizes material waste and enables the fabrication of complex geometries with minimal needs for assembly (Zhou et al., 2024 ). It allows for the design of highly specific and customizable training models, which can be easily modified and reproduced in large quantities. Moreover, the diversity of printing materials and technologies enables the production of both realistic anatomical replicas and educational models tailored to specific learning objectives (Grall et al., 2021 ; Marty et al., 2019 ). A 3D-printed model was previously developed for periodontal training, and students and faculty members provided encouraging feedback (Author et al., 2024). A similar approach was applied to endodontic microsurgery. The goal was to create a cost-effective, fully 3D-printed model designed to simulate clinical conditions as closely as possible. Although several training models for endodontic microsurgery have been described in the literature (Chen et al., 2023 ; Hanisch et al., 2020 ), none of them offer a fully integrated 3D-printed simulation that replicates the clinical scenario in a comprehensive and affordable manner. The aim of this study was to evaluate postgraduate students’ perceptions of this custom-designed, cost-effective, 3D-printed simulator for training in dental apical microsurgery. Each participant received a model accompanied by instructions and was given the opportunity to perform the procedure using standard clinical instruments under realistic conditions. Feedback was collected through an anonymous questionnaire with a Likert scale that was inspired by previous publications (Author et al., 2024; Smail et al., 2025 ), and the responses were subjected to statistical analysis, as presented in the following sections. Methods Study design In this study, data were collected from participants who were enrolled in a newly created course in a university dental school. All the participants consented to complete a questionnaire inspired by previous publications. Ethical approval was obtained from the institutional review board (details blinded for peer review). Postgraduate endodontic students and final-year undergraduate students were recruited from the university. As in previous studies, 40 participants (20 postgraduate endodontics students and 20 undergraduate students) were included in this study. All the postgraduate students enrolled in the endodontic program were invited to attend this new preclinical session, which was incorporated into their training curriculum. These students, who were in their final year, had already observed, assisted with, or participated in several endodontic surgeries. All agreed to participate, except for two who were unable to attend for personal reasons and were excluded from the study. Undergraduate students were selected on a voluntary basis. A message was sent to the mailing list of final-year undergraduates, and the first 20 respondents were selected for the session. None of these undergraduates had any previous clinical experience in endodontic microsurgery. However, six students could not participate and were excluded from the study. A flow diagram, following STROBE statement (Elm et al., 2007), summarizing participant inclusion is presented in Figure 1. Creation and development of the 3D-printed simulator The primary goals of the session were discussed, with a focus on the main steps of endodontic microsurgery: flap raising, osteotomy, root resection, canal desobturation and preparation, canal obturation, and suturing (Setzer & Kratchman, 2022). Biological aspects such as anesthesia and hemostasis were excluded because of the limitations of the model. Three maxillary teeth were selected for the procedure, given their accessibility: - Right maxillary lateral incisor: a 1 cm-wide lesion perforating the vestibular cortical bone. - Right maxillary first molar: a 5 mm-wide lesion on both the mesiovestibular and distovestibular roots, perforating the vestibular cortical bone. - Left maxillary first premolar: a 1 mm-wide lesion, leaving 1 mm of intact vestibular cortical bone. The simulators were adapted from intermediate files previously acquired and published internationally (Author et al., 2024). The files were modified using dental (Exocad, Align Tech) and nondental (Meshmixer, AutoDesk) software. A view of the modified model mentioned above is shown in Figure 2. The final designs included the following: - Bone base: Adjusted for apical access with modeled lesions based on CBCT (Cone Beam Computed Tomography) scans. - Teeth: Segmented from CBCT scans with anatomically accurate roots and crowns, including prepared canals and separable crown-root sections. An example of the structure of one of these teeth is shown in Figure 3. - Gingiva: a continuous, flexible pink structure matching the bone base and teeth, as shown in Figure 3. The components were 3D-printed using a high-volume SLA (stereolithography) printer (Form 3BL, Formlabs) with the following materials: - Bone base: Model V3 resin (Formlabs) because of its bone-like resistance. - Teeth: Denture teeth resin (Formlabs) because of affordability and distinct color. - Gingiva: Flexible 80A resin (Formlabs) dyed pink with the Formlabs Color Kit (Formlabs). After printing and post-treatment, the roots of the teeth were filled with gutta-percha, and crown-root sections were assembled using cyanoacrylate (as shown in Figure 4). Granulation tissue was prepared using pink-dyed elastic 50A resin mixed with Vaseline oil (20 wt%) and camphorquinone (0.5 wt%). The simulators were assembled by injecting granulation tissue into the lesions, bonding the gingiva to the bone base with cyanoacrylate, and placing the teeth in their sockets. The granulation tissue was photopolymerized through the gingiva using a Valo Grand Cordless (Ultradent) curing light in Boost mode (3000 mW/cm²). An assembled simulator is shown in Figure 5. Evaluation of the 3D-printed simulator After forty simulators were produced, the two groups were scheduled to perform the procedure. The sessions were conducted in June, 2025. The undergraduate students completed their session on the first day, followed by the postgraduate students on the second day. This scheduling minimized methodological bias and allowed adequate time to prepare for the subsequent session. Test procedure The program featured an oral presentation that outlined the objectives of endodontic surgery, provided a step-by-step explanation of the procedure, and offered practical guidance for performing it on the supplied models. Each participant received a model and practiced the surgery on three designated teeth: the maxillary right lateral incisor, the maxillary left first premolar, and the maxillary left first molar. Additionally, the students were provided with the following specialized endodontic instruments: - A table-mounted microscope ( OPMI Pico , Zeiss) - A complete endodontic microsurgery kit (Acteon) - A full Endo Success Apical Surgery set (Acteon) - An ultrasonic motor ( Newtron P5 Xs , Acteon) - Zekrya bur H269 and round bur H141 (Komet) - 15C scalpels ( 15C disposable scalpels; Swann Morton) - Cavit (3M ESPE) to simulate obturation material - Paper points ( Absorbent Points #35, FKG) - 6-0 suture thread ( Prolene , Ethicon) The participants were tasked with the following steps: 1. Model observation 2. Incision and flap raising 3. Osteotomy 4. Root resection: 3 mm resection for all teeth 5. Retrograde preparation: 3 mm for teeth 16 and 6 mm for teeth 12 and 24 6. Drying the canal using paper points 7. Canal obturation with a low-cost material that handles like the putty bioceramics used in this indication ( Cavit , 3M ESPE) 8. Flap suturing Assessment questionnaire The questionnaire was developed on the basis of examples from previous studies (Author et al., 2024; Sinha et al., 2022), although it was not formally validated. It consisted of two parts, written in French. The complete questionnaire (translated into English) is provided in Additional File 1. The first part of the questionnaire was administered at the beginning of the sessions, prior to the introductory presentation. Participants were asked to self-assess their knowledge and skills in endodontic microsurgery. The second part was completed at the end of the sessions, after the three surgeries had been performed, to gather feedback regarding the realism and pedagogical value of the training model. Questionnaires were anonymous and completed without tutor presence. Both groups received the same questionnaire in paper format and were given identical instructions. A 5-point Likert scale was used to rate each item, with responses ranging from 1 ( strongly disagree ) to 5 ( strongly agree ), with 3 serving as a neutral option for participants who preferred not to express a definitive opinion (Jebb et al., 2021). Additionally, open-ended questions were included to allow participants to share opinions and suggestions for improving the models and the questionnaire itself. However, these answers were excluded from the statistical analysis. Statistical analysis Descriptive statistics were used to summarize responses to the questionnaire. For each item, only mean values are reported in the result tables in order to enhance readability, as commonly done in studies using Likert-scale data. To compare perceptions between the two independent group, final-year undergraduate students (Group G1, n = 14) and postgraduate students (Group G2, n = 18), the Mann–Whitney U test was applied. This non-parametric test is suitable for ordinal data and small-to-moderate sample sizes when the assumption of normality may not be met. The significance level (α) was set at 0.05. All statistical analyses were performed using R software (version 3.6.1; R Foundation for Statistical Computing, Vienna, Austria). Results A total of 32 participants were included in this study (G1 = 14 undergraduates; G2 = 18 postgraduates). Participants were not characterized demographically, as the aim of the study was to assess perceptions rather than conduct subgroup analyses. There were no missing questionnaire data. Regarding the first part of the questionnaire, completed before the course, significant differences were found in the level of confidence and self-assessed practical skills between undergraduate and postgraduate students, with postgraduate students reporting higher confidence levels. Only the theoretical knowledge item did not significantly differ between groups. These answers can be found in Table 1. In the second part of the questionnaire, completed after the session, participants evaluated the realism of the model. No significant differences were found between the two groups across all items. The gingival texture and the suturing items were the only items that received mean scores below 3 in both groups. In contrast, the global volume of the model, the obturated canal (both in appearance and tactile feeling) and the root end appearance were rated above 4 by both groups. These results are detailed in Table 2. As for the final section of the questionnaire, which addressed perceived educational impact, only the theoretical knowledge improvement item significantly differed between groups; with undergraduates reporting greater perceived improvement than postgraduates. Confidence levels increased for both groups compared to the pre-session questionnaire. For example, undergraduates’ mean score for “practicing without help” increased from 1.64 to 3.29, and the mean score for “practicing with expert guidance” from 3.79 to 4.50. Similar trends were observed among postgraduates, although changes appeared less pronounced (2.94 to 3.56 and 4.50 to 4.72, respectively). All remaining items received mean scores above 4 in both groups. Complete results for this section are shown in Table 3. Discussion The aim of this study was to evaluate the pedagogical relevance and user perception of a custom-made, cost-effective, 3D-printed simulator specifically designed for endodontic microsurgery training. Both undergraduate and postgraduate students performed the procedure using this model and subsequently completed a structured questionnaire. The simulator was generally well received, with undergraduate students reporting a significant increase in confidence and perceived competence. This finding was confirmed by a Mann–Whitney U test, which revealed a significant increase in postintervention scores (p = 0.0014), suggesting a strong educational impact of the simulator on less experienced learners. From the perspective of Kirkpatrick’s evaluation model (Johnston et al., 2018 ), these outcomes align with levels 1 and 2: participants expressed satisfaction with the training (reaction) and reported having learned from it (learning), albeit this latter outcome was self-reported. Progression to levels 3 and 4—reflecting changes in clinical behavior and measurable benefits in real patient care—would require longitudinal follow-up and more complex study designs, especially because a single course is rarely sufficient to induce lasting changes in clinical practice (Samuel et al., 2021 ). These findings position the present study as an effective initial step in the evaluation of simulation-based training for endodontic microsurgery, highlighting the need for future longitudinal research to determine whether the observed short-term gains in confidence and competence translate into sustained behavioral change and measurable clinical outcomes. Interestingly, confidence scores at the end of the course were not significantly different between undergraduates and postgraduates, despite the former having no prior endodontic surgery experience and the latter having already assisted or performed such procedures. One possible explanation is the Dunning–Kruger effect, which suggests that individuals with limited knowledge may overestimate their abilities. Although its validity remains debated (Magnus & Peresetsky, 2022 ; McIntosh et al., 2022 ), this phenomenon has been explored in medical education (Knof et al., 2024 ; Surdilović et al., 2022 ). Neurocognitive evidence further indicates that over-estimators tend to rely on a sense of familiarity even in the absence of detailed knowledge, whereas underestimators rely more on recollection, with prior experience sometimes diminishing confidence, particularly when associated with negative outcomes (Muller et al., 2021 ). In this context, undergraduates, who assessed their confidence immediately after the training and for whom this relatively straightforward exercise represented their only “surgical” experience, may have perceived endodontic microsurgery as relatively easy. Conversely, postgraduates were more aware of the challenges of real procedures and thus rated their confidence more cautiously. Despite some limitations, particularly regarding the tactile sensation of the gingiva, which received the lowest rating, the model was positively evaluated overall. Both satisfaction and perceived training value were high, suggesting that it fulfilled its educational purpose. These findings highlight that high-fidelity realism may not be essential for achieving meaningful learning outcomes. As observed in other contexts such as anatomy education (Ye et al., 2020 ), low-fidelity models can be pedagogically effective, a view also endorsed by the Society for Simulation in Healthcare (Stefanidis et al., 2024 ). Although the clinical experience of undergraduates was limited, their evaluation of the model was consistent with that of postgraduates, suggesting that both groups recognized its pedagogical intent. Senior practitioners, by contrast, might be more critical of its clinical fidelity because their perspective would be shaped primarily by comparison with real surgical conditions. Because skill acquisition progresses in incremental stages, increasing model sophistication in stepwise practice sessions may represent an appropriate curricular approach. Accordingly, the absence of significant improvement among postgraduates suggests that the simulator may be better suited for use as a refresher or assessment tool for advanced learners, whereas more complex skills may require higher-fidelity models (Apara et al., 2024 ). The educational value of simulation-based learning in dentistry is well established, particularly in the development of procedural skills in a low-risk, feedback-rich environment (Stefanidis et al., 2024 ). Another important dimension highlighted by participants was the role of tutoring: although self-directed practice was possible with this model, students still considered tutor support to be beneficial, which is consistent with previous research (Akaike et al., 2012 ). The 3D-printed model thus appeared to be beneficial for both undergraduate and postgraduate learners, albeit in different ways. For undergraduates, it served as a low-risk, confidence-building tool that introduced them to the fundamentals of endodontic microsurgery. For postgraduates, the positive reception of the model suggests that it can offer an opportunity to refine existing skills, standardize techniques, and reflect on their operative sequence. This dual applicability highlights the adaptability of the model across varying levels of expertise, supporting both skill acquisition among novices and technique optimization among more experienced clinicians. Although primarily designed for instructional purposes, this model may also support objective performance assessment; for example, it may be integrated into structured OSCE-style evaluations (Objective Structured Clinical Examination, Nie et al., 2018 ). Models may also be used to impact the clinical behavior of already practicing individuals (Leng et al., 2018 ), particularly by reinforcing best practices or introducing new protocols in a risk-free environment. From an instructional standpoint, the modular and cost-effective nature of the 3D-printed model introduces new possibilities for curriculum development. Instructors can tailor model complexity and integrate it into deliberate, customizable, stepwise learning sequences (Reymus et al., 2019 ). In addition, such simulators democratize access to surgical training because they are reproducible and shareable and do not require expensive infrastructure (Klink et al., 2024 ). The positive feedback from both groups suggests that integrating 3D-printed simulators in endodontic education may increase engagement and satisfaction, which are known to influence learning outcomes and long-term knowledge retention. This approach may also be helpful for dental education research because it allows the use of standardized simulations across institutions worldwide. Moreover, the inclusion of two learner profiles, namely, undergraduate and postgraduate students, highlights the simulator’s adaptability and curricular relevance across educational levels, as previously suggested in similar studies (Author et al., 2024). Furthermore, the overall high degree of realism reported by the participants supports the fidelity of the model. The inclusion of specific features, such as simulated granulation tissue, anatomical landmarks, and obturated root canals, increased its clinical relevance and learner immersion. Nevertheless, several limitations must be acknowledged: - First, certain aspects, most notably the feel of soft tissue, need to be improved. Although technologies such as silicone 3D printing or PolyJet® (STRATASYS) 3D printing may increase realism (Hanisch et al., 2020 ; Unkovskiy et al., 2023 ), they are currently less cost effective. A key strength of the present model lies in its affordability, which ensures broader accessibility. Maintaining cost-effectiveness while increasing fidelity will therefore remain an important objective. In addition, ensuring that all the components remain fully 3D printed is essential for reproducibility and minimal manual intervention. - The evaluation relied primarily on self-reported measures of competence and perception, which, although insightful, may not fully reflect actual clinical performance (Rumpel et al., 2023 ). Objective assessments of skill acquisition would strengthen the conclusions and could be included in future studies (Yao et al., 2019 ). Moreover, using a formally validated questionnaire would enhance the reliability of the data collected and reduce the potential for measurement bias. - The sample size, although sufficient for exploratory analysis, remains modest and may limit the universality of these findings. Larger, multicenter studies are recommended to provide more robust data. - The absence of a control group using traditional or alternative models limits the ability to draw comparative conclusions. Although comparisons with animal models have been explored in other studies, such a comparison was not the focus of this study (Gund et al., 2025 ). There is also a potential social desirability bias, as participants might have provided favorable responses due to the presence of instructors, the academic setting, or their awareness of being evaluated. Although the questionnaire was anonymous and participation was voluntary, this type of bias cannot be completely excluded. - Finally, although the model was positively received, its long-term impact on actual clinical performance and transferability to real surgical settings remains to be assessed. Future research should explore how such models influence skill retention, clinical confidence, and patient outcomes over time. Conclusions This study demonstrated the feasibility and educational value of a fully 3D-printed, cost-effective simulator for endodontic microsurgery training. The model proved to be particularly beneficial for undergraduates by increasing confidence and perceived competence while also serving as a refresher and assessment tool for postgraduates. Despite current limitations in material properties and in the production process, ongoing advances in 3D printing are likely to improve tactile fidelity and reproducibility. By offering an accessible and ethical alternative to animal models, this simulator represents a promising tool for structured, stepwise learning and standardized training in endodontic education. Although still a preliminary step, it holds great potential for refinement and improvement, ultimately paving the way for more comprehensive and effective teaching in endodontic surgery. Abbreviations 3D: three-dimensional CBCT: Cone Beam Computed Tomography SLA : Stereolithography OSCE : Objective Structured Clinical Examination Declarations Ethics approval and consent to participate Ethics approval was obtained from the Comité d’Éthique de la Recherche de l’Assistance Publique–Hôpitaux de Paris (AP-HP CER), Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France (IRB: IORG0010044, approval reference: 2025-03-14). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki and relevant institutional and national guidelines. Written informed consent was obtained from all participants prior to participation. Participation was voluntary and had no impact on academic evaluation. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by IDEX Université de Paris Cité 2024: SM/FL IP24V1_SA-013. Authors' contributions Conceptualization: M.I., Y.S., F.B., J-P.A., P.F.; Methodology: M.I., A.S., E.C., S.L-G., S.A-G., V.LM., P.F.; Data analysis: L.J., S.H.; Writing: M.I., P.F.; Reviewing and editing: all authors. Acknowledgements The authors would like to thank Digismile Company (Francesco Zammillo and Olivier Boujenah) for the technical support they provided, especially in redesigning the bone model and the gingiva. 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Stefanidis, D., Cook, D., Kalantar-Motamedi, S.M., Muret-Wagstaff, S., Calhoun, A.W., Lauridsen, K.G. et al. (2024). Society for simulation in healthcare guidelines for simulation training. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare , 19(1S), S4–S22. Surdilović, D., Adtani, P., Ali Fuoa, S., Abdelaal, H. & D’souza, J. (2022). Evaluation of the Dunning-Kruger effects among dental students at an academic training institution in UAE. Acta Stomatologica Croatica, 56(3), 299–310. Tricio, J.A., Kleiman, S.E., Eiriksson, V.I., Vicuña, D.P., Cacciuttolo, F.R., Jorquera, G.A. et al (2022). Students’ and tutors’ perceptions of a deliberate simulated practice using patient‐specific virtual and three‐dimensional printed teeth models: A pilot study. Journal of Dental Education, 86 (8), 1006–1014. https://doi.org/10.1002/jdd.12909 Unkovskiy, A., Spintzyk, S., Kiemle, T., Roehler, A. & Huettig, F. (2023). Trueness and precision of skin surface reproduction in digital workflows for facial prosthesis fabrication. The Journal of Prosthetic Dentistry, 130(3), 402–413. Yao, C. J., Chow, J., Choi, W. W. S. & Mattheos, N. (2019). Measuring the impact of simulation practice on the spatial representation ability of dentists by means of Impacted Mandibular Third Molar (IMTM) Surgery on 3D printed models. European Journal of Dental Education, 23(3), 332–343. Ye, Z., Dun, A., Jiang, H., Nie, C., Zhao, S., Wang, T. et al. (2020). The role of 3D printed models in the teaching of human anatomy: A systematic review and meta-analysis. BMC Medical Education, 20(1), 335. Zhou, L., Miller, J., Vezza, J., Mayster, M., Raffay, M., Justice, Q. et al. (2024). Additive manufacturing: A comprehensive review. Sensors, 24 (9), 2668. https://doi.org/10.3390/s24092668 Tables Table 1. Results of the first part of the questionnaire, completed before the session. Values are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates. Values are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test . Global Mean (SD) G1 G2 p-value Self-assessed theoretical knowledge 3.28 (0.94) 3.07 (1.07) 3.59 (0.86) 0.083 Self-assessed technical skill level 2.64 (1.29) 1.79 (1.00) 3.56 (0.86) 0.001 Confidence in practicing an endodontic surgery without help 2.38 (1.15) 1.64 (1.10) 2.94 (1.16) 0.001 Confidence in practicing an endodontic surgery with an expert guidance 4.19 (0.94) 3.79 (0.83) 4.50 (1.00) 0.009 Table 2 . Results of the second part of the questionnaire focusing on participants’ perceptions of the model. Values are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates. Values are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test . G1 G2 p-value Gingiva Appearance 3.79 (0.58) 3.56 (0.98) 0.787 Tactile feeling 2.29 (0.83) 2.56 (0.92) 0.407 Bone Appearance 3.79 (0.70) 3.72 (0.57) 1.000 Tactile feeling 3.29 (0.83) 3.78 (0.65) 0.075 Granulation tissue Appearance 3.36 (1.01) 2.78 (1.00) 0.186 Tactile feeling 3.79 (0.89) 3.33 (0.84) 0.129 Root end Appearance 4.57 (0.51) 4.22 (0.65) 0.130 Tactile feeling 3.71 (1.14) 3.89 (0.76) 0.826 Obturated canal Appearance 4.64 (0.50) 4.47 (0.62) 0.447 Tactile feeling 4.29 (0.83) 4.53 (0.62) 0.451 Sutures (tactile feeling) 2.09 (1.22) 2.13 (1.06) 0.828 Global volume of the model 4.57 (0.51) 4.39 (0.61) 0.424 Overall Appearance 4.08 (0.51) 3.76 (0.44) 0.097 Tactile feeling 3.42 (0.90) 3.65 (0.49) 0.251 Table 3 . Results of the second part of the questionnaire focusing on participants’ perceptions of the training. Values are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates. Values are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test . G1 G2 p-value Feeling of improvement In terms of knowledge 4.14 (0.66) 3.44 (1.04) 0.047 In terms of practical skills 4.43 (0.51) 4.22 (0.65) 0.399 Confidence in practicing an endodontic surgery Without help 3.29 (1.14) 3.56 (0.86) 0.787 With expert guidance 4.50 (0.65) 4.72 (0.46) 0.336 Overall satisfaction 4.50 (0.52) 4.67 (0.49) 0.360 Would this course be an asset to your formation? 4.71 (0.61) 4.65 (0.49) 0.514 Tutoring was helpful 4.92 (0.28) 4.59 (0.62) 0.083 Overall, this model provides a good simulation to learn the basic skills of endodontic surgery 4.36 (0.50) 4.17 (0.51) 0.324 Additional Declarations No competing interests reported. Supplementary Files BMCAdditionalFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Apr, 2026 Reviews received at journal 29 Apr, 2026 Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 25 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 24 Mar, 2026 Editor invited by journal 02 Mar, 2026 Editor assigned by journal 30 Jan, 2026 Submission checks completed at journal 28 Jan, 2026 First submitted to journal 28 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Cité","correspondingAuthor":false,"prefix":"","firstName":"Sandrella","middleName":"","lastName":"HAMDAN","suffix":""},{"id":612279289,"identity":"e2a03e3d-835a-43ad-9b38-7201b6f4a03f","order_by":11,"name":"Philippe François","email":"","orcid":"","institution":"Université Paris Cité","correspondingAuthor":false,"prefix":"","firstName":"Philippe","middleName":"","lastName":"François","suffix":""}],"badges":[],"createdAt":"2026-01-21 14:45:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8661165/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8661165/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105567267,"identity":"3b8ec2e5-4212-4489-be0e-f79367f04c22","added_by":"auto","created_at":"2026-03-27 12:58:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":375280,"visible":true,"origin":"","legend":"\u003cp\u003eSTROBE flow diagram of participant inclusion and analysis.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/5f731336b4cc09e96013ec2f.jpg"},{"id":105548462,"identity":"30101e64-f975-4478-ad7d-6d7d81cdefb7","added_by":"auto","created_at":"2026-03-27 09:31:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28008,"visible":true,"origin":"","legend":"\u003cp\u003eDigital 3D model of the bone base was modified to incorporate simulated endodontic lesions.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/3fff97d7ddf06b54384cdf8e.png"},{"id":105567104,"identity":"27873e76-732e-4e3a-948c-be4ffa609825","added_by":"auto","created_at":"2026-03-27 12:58:19","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":151482,"visible":true,"origin":"","legend":"\u003cp\u003eDigital 3D models of the right maxillary lateral incisor, left maxillary first premolar, right maxillary first molar, and gingiva (from left to right). \u003cem\u003eThe teeth were segmented into crown and root sections, which were designed with interlocking connectors to allow reproducible repositioning.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/7ae73b41cd2f69c9f4097db1.jpg"},{"id":105567433,"identity":"ad33f9ee-1c2b-4571-85c9-a6a24a915ee9","added_by":"auto","created_at":"2026-03-27 12:59:24","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":32607,"visible":true,"origin":"","legend":"\u003cp\u003eAssembled 3D-printed maxillary first molar filled with gutta-percha, showing crown and root reattachment.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/d84fb8fa089c3313e1ef283f.jpg"},{"id":105548465,"identity":"2b40951d-2693-4d98-b709-113ab3f96492","added_by":"auto","created_at":"2026-03-27 09:31:51","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2644998,"visible":true,"origin":"","legend":"\u003cp\u003eFully assembled 3D-printed endodontic microsurgery simulator, including bone base, initial teeth, and gingiva.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/7d543b47c1d8456b35c4fd70.jpg"},{"id":105570247,"identity":"59906933-a362-4e65-a0d2-a49dba399542","added_by":"auto","created_at":"2026-03-27 13:15:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3945038,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/d8112ff7-6465-4e57-87aa-653f31196670.pdf"},{"id":105567114,"identity":"a6eaeda0-b004-4522-95c2-0d4f446154c5","added_by":"auto","created_at":"2026-03-27 12:58:21","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19000,"visible":true,"origin":"","legend":"","description":"","filename":"BMCAdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8661165/v1/d0c79be281b0d1e21b036c69.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Undergraduate and postgraduate perceptions of a 3D-printed educational simulator for endodontic microsurgery: A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eEndodontic microsurgery is a technically demanding procedure that requires the acquisition of a wide range of psychomotor and cognitive skills. Theoretical knowledge alone is often insufficient (Tricio et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); prior to performing their first clinical procedure, trainees must demonstrate a certain level of manual competence (Baaij et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Observational learning or assisting in surgeries often falls short of providing the depth of experience needed, especially as procedures become increasingly complex and minimally invasive. This fact highlights the need for structured, preclinical training that facilitates progressive learning and effective skills assessment (Grall et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo this end, simulation-based education has become a cornerstone of clinical training (Cleland et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This approach involves deliberate practice as a \u0026ldquo;strategic instructional design for purposeful action to acquire psychomotor skills\u0026rdquo; (Cook et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Moreover, it consists of structured outcomes with progressive difficulty that allow, with consistent feedback, incremental improvements and a transition to mastery (Higgins et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020b\u003c/span\u003e). The specific skills of dentistry can then be taught specifically by in-hand manipulation (Higgins et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020a\u003c/span\u003e). A variety of models exist for this purpose, ranging from extracted teeth to sophisticated manikins (Akaike et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Lv et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Among these models, printed simulators are particularly valued because of their reproducibility, standardization and ability to be carefully designed to facilitate the learning of a specific skill (Ye et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These models allow for the segmentation of complex procedures and the stepwise acquisition of skills prior to full procedural execution. An ideal simulator should allow students to gain technical proficiency, access to expert tutors, and map onto real-life clinical experience as well as include an affective component that provides a conducive way to learn (Kneebone, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, three-dimensional (3D) printing has emerged as a common and viable tool in medical education (Dobroś et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Langridge et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Unlike subtractive methods such as milling, 3D printing is an additive manufacturing technique that minimizes material waste and enables the fabrication of complex geometries with minimal needs for assembly (Zhou et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It allows for the design of highly specific and customizable training models, which can be easily modified and reproduced in large quantities. Moreover, the diversity of printing materials and technologies enables the production of both realistic anatomical replicas and educational models tailored to specific learning objectives (Grall et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Marty et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA 3D-printed model was previously developed for periodontal training, and students and faculty members provided encouraging feedback (Author et al., 2024). A similar approach was applied to endodontic microsurgery. The goal was to create a cost-effective, fully 3D-printed model designed to simulate clinical conditions as closely as possible. Although several training models for endodontic microsurgery have been described in the literature (Chen et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Hanisch et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), none of them offer a fully integrated 3D-printed simulation that replicates the clinical scenario in a comprehensive and affordable manner.\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate postgraduate students\u0026rsquo; perceptions of this custom-designed, cost-effective, 3D-printed simulator for training in dental apical microsurgery. Each participant received a model accompanied by instructions and was given the opportunity to perform the procedure using standard clinical instruments under realistic conditions. Feedback was collected through an anonymous questionnaire with a Likert scale that was inspired by previous publications (Author et al., 2024; Smail et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), and the responses were subjected to statistical analysis, as presented in the following sections.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, data were collected from participants who were enrolled in a newly created course in a university dental school. All the participants consented to complete a questionnaire inspired by previous publications. Ethical approval was obtained from the institutional review board (details blinded for peer review).\u003c/p\u003e\n\u003cp\u003ePostgraduate endodontic students and final-year undergraduate students were recruited from the university. As in previous studies, 40 participants (20 postgraduate endodontics students and 20 undergraduate students) were included in this study.\u003c/p\u003e\n\u003cp\u003eAll the postgraduate students enrolled in the endodontic program were invited to attend this new preclinical session, which was incorporated into their training curriculum. These students, who were in their final year, had already observed, assisted with, or participated in several endodontic surgeries. All agreed to participate, except for two who were unable to attend for personal reasons and were excluded from the study.\u003c/p\u003e\n\u003cp\u003eUndergraduate students were selected on a voluntary basis. A message was sent to the mailing list of final-year undergraduates, and the first 20 respondents were selected for the session. None of these undergraduates had any previous clinical experience in endodontic microsurgery. However, six students could not participate and were excluded from the study. A flow diagram, following STROBE statement (Elm et al., 2007), summarizing participant inclusion is presented in Figure 1.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCreation and development of the 3D-printed simulator\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary goals of the session were discussed, with a focus on the main steps of endodontic microsurgery: flap raising, osteotomy, root resection, canal desobturation and preparation, canal obturation, and suturing (Setzer \u0026amp; Kratchman, 2022). Biological aspects such as anesthesia and hemostasis were excluded because of the limitations of the model.\u003c/p\u003e\n\u003cp\u003eThree maxillary teeth were selected for the procedure, given their accessibility:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Right maxillary lateral incisor: a 1 cm-wide lesion perforating the vestibular cortical bone.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Right maxillary first molar: a 5 mm-wide lesion on both the mesiovestibular and distovestibular roots, perforating the vestibular cortical bone.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Left maxillary first premolar: a 1 mm-wide lesion, leaving 1 mm of intact vestibular cortical bone.\u003c/p\u003e\n\u003cp\u003eThe simulators were adapted from intermediate files previously acquired and published internationally (Author et al., 2024). The files were modified using dental (Exocad, Align Tech) and nondental (Meshmixer, AutoDesk) software. A view of the modified model mentioned above is shown in Figure 2.\u003c/p\u003e\n\u003cp\u003eThe final designs included the following:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bone base: Adjusted for apical access with modeled lesions based on CBCT (Cone Beam Computed Tomography) scans.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Teeth: Segmented from CBCT scans with anatomically accurate roots and crowns, including prepared canals and separable crown-root sections. An example of the structure of one of these teeth is shown in Figure 3.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gingiva: a continuous, flexible pink structure matching the bone base and teeth, as shown in Figure 3.\u003c/p\u003e\n\u003cp\u003eThe components were 3D-printed using a high-volume SLA (stereolithography) printer (Form 3BL, Formlabs) with the following materials:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bone base: Model V3 resin (Formlabs) because of its bone-like resistance.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Teeth: Denture teeth resin (Formlabs) because of affordability and distinct color.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gingiva: Flexible 80A resin (Formlabs) dyed pink with the Formlabs Color Kit (Formlabs).\u003c/p\u003e\n\u003cp\u003eAfter printing and post-treatment, the roots of the teeth were filled with gutta-percha, and crown-root sections were assembled using cyanoacrylate (as shown in Figure 4). Granulation tissue was prepared using pink-dyed elastic 50A resin mixed with Vaseline oil (20 wt%) and camphorquinone (0.5 wt%).\u003c/p\u003e\n\u003cp\u003eThe simulators were assembled by injecting granulation tissue into the lesions, bonding the gingiva to the bone base with cyanoacrylate, and placing the teeth in their sockets. The granulation tissue was photopolymerized through the gingiva using a Valo Grand Cordless (Ultradent) curing light in Boost mode (3000 mW/cm\u0026sup2;). An assembled simulator is shown in Figure 5.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEvaluation of the 3D-printed simulator\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter forty simulators were produced, the two groups were scheduled to perform the procedure. The sessions were conducted in June, 2025. The undergraduate students completed their session on the first day, followed by the postgraduate students on the second day. This scheduling minimized methodological bias and allowed adequate time to prepare for the subsequent session.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTest procedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe program featured an oral presentation that outlined the objectives of endodontic surgery, provided a step-by-step explanation of the procedure, and offered practical guidance for performing it on the supplied models.\u003c/p\u003e\n\u003cp\u003eEach participant received a model and practiced the surgery on three designated teeth: the maxillary right lateral incisor, the maxillary left first premolar, and the maxillary left first molar.\u003c/p\u003e\n\u003cp\u003eAdditionally, the students were provided with the following specialized endodontic instruments:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; A table-mounted microscope (\u003cem\u003eOPMI Pico\u003c/em\u003e, Zeiss)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; A complete endodontic microsurgery kit (Acteon)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; A full \u003cem\u003eEndo Success Apical Surgery\u003c/em\u003e set (Acteon)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; An ultrasonic motor (\u003cem\u003eNewtron P5 Xs\u003c/em\u003e, Acteon)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Zekrya bur H269 and round bur H141 (Komet)\u003c/p\u003e\n\u003cp\u003e- 15C scalpels (\u003cem\u003e15C\u0026nbsp;\u003c/em\u003e\u003cem\u003edisposable scalpels;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eSwann Morton)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Cavit (3M ESPE) to simulate obturation material\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Paper points (\u003cem\u003eAbsorbent Points #35,\u0026nbsp;\u003c/em\u003eFKG)\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 6-0 suture thread (\u003cem\u003eProlene\u003c/em\u003e, Ethicon)\u003c/p\u003e\n\u003cp\u003eThe participants were tasked with the following steps:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Model observation\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Incision and flap raising\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Osteotomy\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Root resection: 3 mm resection for all teeth\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Retrograde preparation: 3 mm for teeth 16 and 6 mm for teeth 12 and 24\u003c/p\u003e\n\u003cp\u003e6.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Drying the canal using paper points\u003c/p\u003e\n\u003cp\u003e7. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Canal obturation with a low-cost material that handles like the putty bioceramics used in this indication (\u003cem\u003eCavit\u003c/em\u003e, 3M ESPE)\u003c/p\u003e\n\u003cp\u003e8. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Flap suturing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAssessment questionnaire\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed on the basis of examples from previous studies (Author et al., 2024; Sinha et al., 2022), although it was not formally validated. It consisted of two parts, written in French. The complete questionnaire (translated into English) is provided in Additional File 1.\u003c/p\u003e\n\u003cp\u003eThe first part of the questionnaire was administered at the beginning of the sessions, prior to the introductory presentation. Participants were asked to self-assess their knowledge and skills in endodontic microsurgery. The second part was completed at the end of the sessions, after the three surgeries had been performed, to gather feedback regarding the realism and pedagogical value of the training model. Questionnaires were anonymous and completed without tutor presence.\u003c/p\u003e\n\u003cp\u003eBoth groups received the same questionnaire in paper format and were given identical instructions. A 5-point Likert scale was used to rate each item, with responses ranging from 1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 5 (\u003cem\u003estrongly agree\u003c/em\u003e), with 3 serving as a neutral option for participants who preferred not to express a definitive opinion (Jebb et al., 2021).\u003c/p\u003e\n\u003cp\u003eAdditionally, open-ended questions were included to allow participants to share opinions and suggestions for improving the models and the questionnaire itself. However, these answers were excluded from the statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to summarize responses to the questionnaire. For each item, only mean values are reported in the result tables in order to enhance readability, as commonly done in studies using Likert-scale data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo compare perceptions between the two independent group, final-year undergraduate students (Group G1, n = 14) and postgraduate students (Group G2, n = 18), the Mann\u0026ndash;Whitney U test was applied. This non-parametric test is suitable for ordinal data and small-to-moderate sample sizes when the assumption of normality may not be met. The significance level (\u0026alpha;) was set at 0.05. All statistical analyses were performed using R software (version 3.6.1; R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 32 participants were included in this study (G1 = 14 undergraduates; G2 = 18 postgraduates). Participants were not characterized demographically, as the aim of the study was to assess perceptions rather than conduct subgroup analyses. There were no missing questionnaire data.\u003c/p\u003e\n\u003cp\u003eRegarding the first part of the questionnaire, completed before the course, significant differences were found in the level of confidence and self-assessed practical skills between undergraduate and postgraduate students, with postgraduate students reporting higher confidence levels. Only the theoretical knowledge item did not significantly differ between groups. These answers can be found in Table 1.\u003c/p\u003e\n\u003cp\u003eIn the second part of the questionnaire, completed after the session, participants evaluated the realism of the model. No significant differences were found between the two groups across all items. The gingival texture and the suturing items were the only items that received mean scores below 3 in both groups. In contrast, the global volume of the model, the obturated canal (both in appearance and tactile feeling) and the root end appearance were rated above 4 by both groups. These results are detailed in Table 2.\u003c/p\u003e\n\u003cp\u003eAs for the final section of the questionnaire, which addressed perceived educational impact, only the theoretical knowledge improvement item significantly differed between groups; with undergraduates reporting greater perceived improvement than postgraduates. Confidence levels increased for both groups compared to the pre-session questionnaire. For example, undergraduates\u0026rsquo; mean score for \u0026ldquo;practicing without help\u0026rdquo; increased from 1.64 to 3.29, and the mean score for \u0026ldquo;practicing with expert guidance\u0026rdquo; from 3.79 to 4.50. Similar trends were observed among postgraduates, although changes appeared less pronounced (2.94 to 3.56 and 4.50 to 4.72, respectively). All remaining items received mean scores above 4 in both groups. Complete results for this section are shown in Table 3.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to evaluate the pedagogical relevance and user perception of a custom-made, cost-effective, 3D-printed simulator specifically designed for endodontic microsurgery training. Both undergraduate and postgraduate students performed the procedure using this model and subsequently completed a structured questionnaire.\u003c/p\u003e \u003cp\u003eThe simulator was generally well received, with undergraduate students reporting a significant increase in confidence and perceived competence. This finding was confirmed by a Mann\u0026ndash;Whitney U test, which revealed a significant increase in postintervention scores (p\u0026thinsp;=\u0026thinsp;0.0014), suggesting a strong educational impact of the simulator on less experienced learners. From the perspective of Kirkpatrick\u0026rsquo;s evaluation model (Johnston et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), these outcomes align with levels 1 and 2: participants expressed satisfaction with the training (reaction) and reported having learned from it (learning), albeit this latter outcome was self-reported. Progression to levels 3 and 4\u0026mdash;reflecting changes in clinical behavior and measurable benefits in real patient care\u0026mdash;would require longitudinal follow-up and more complex study designs, especially because a single course is rarely sufficient to induce lasting changes in clinical practice (Samuel et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These findings position the present study as an effective initial step in the evaluation of simulation-based training for endodontic microsurgery, highlighting the need for future longitudinal research to determine whether the observed short-term gains in confidence and competence translate into sustained behavioral change and measurable clinical outcomes.\u003c/p\u003e \u003cp\u003eInterestingly, confidence scores at the end of the course were not significantly different between undergraduates and postgraduates, despite the former having no prior endodontic surgery experience and the latter having already assisted or performed such procedures. One possible explanation is the Dunning\u0026ndash;Kruger effect, which suggests that individuals with limited knowledge may overestimate their abilities. Although its validity remains debated (Magnus \u0026amp; Peresetsky, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; McIntosh et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), this phenomenon has been explored in medical education (Knof et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Surdilović et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Neurocognitive evidence further indicates that over-estimators tend to rely on a sense of familiarity even in the absence of detailed knowledge, whereas underestimators rely more on recollection, with prior experience sometimes diminishing confidence, particularly when associated with negative outcomes (Muller et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In this context, undergraduates, who assessed their confidence immediately after the training and for whom this relatively straightforward exercise represented their only \u0026ldquo;surgical\u0026rdquo; experience, may have perceived endodontic microsurgery as relatively easy. Conversely, postgraduates were more aware of the challenges of real procedures and thus rated their confidence more cautiously.\u003c/p\u003e \u003cp\u003eDespite some limitations, particularly regarding the tactile sensation of the gingiva, which received the lowest rating, the model was positively evaluated overall. Both satisfaction and perceived training value were high, suggesting that it fulfilled its educational purpose. These findings highlight that high-fidelity realism may not be essential for achieving meaningful learning outcomes. As observed in other contexts such as anatomy education (Ye et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), low-fidelity models can be pedagogically effective, a view also endorsed by the Society for Simulation in Healthcare (Stefanidis et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the clinical experience of undergraduates was limited, their evaluation of the model was consistent with that of postgraduates, suggesting that both groups recognized its pedagogical intent. Senior practitioners, by contrast, might be more critical of its clinical fidelity because their perspective would be shaped primarily by comparison with real surgical conditions. Because skill acquisition progresses in incremental stages, increasing model sophistication in stepwise practice sessions may represent an appropriate curricular approach. Accordingly, the absence of significant improvement among postgraduates suggests that the simulator may be better suited for use as a refresher or assessment tool for advanced learners, whereas more complex skills may require higher-fidelity models (Apara et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe educational value of simulation-based learning in dentistry is well established, particularly in the development of procedural skills in a low-risk, feedback-rich environment (Stefanidis et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Another important dimension highlighted by participants was the role of tutoring: although self-directed practice was possible with this model, students still considered tutor support to be beneficial, which is consistent with previous research (Akaike et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 3D-printed model thus appeared to be beneficial for both undergraduate and postgraduate learners, albeit in different ways. For undergraduates, it served as a low-risk, confidence-building tool that introduced them to the fundamentals of endodontic microsurgery. For postgraduates, the positive reception of the model suggests that it can offer an opportunity to refine existing skills, standardize techniques, and reflect on their operative sequence. This dual applicability highlights the adaptability of the model across varying levels of expertise, supporting both skill acquisition among novices and technique optimization among more experienced clinicians.\u003c/p\u003e \u003cp\u003eAlthough primarily designed for instructional purposes, this model may also support objective performance assessment; for example, it may be integrated into structured OSCE-style evaluations (Objective Structured Clinical Examination, Nie et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Models may also be used to impact the clinical behavior of already practicing individuals (Leng et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), particularly by reinforcing best practices or introducing new protocols in a risk-free environment.\u003c/p\u003e \u003cp\u003eFrom an instructional standpoint, the modular and cost-effective nature of the 3D-printed model introduces new possibilities for curriculum development. Instructors can tailor model complexity and integrate it into deliberate, customizable, stepwise learning sequences (Reymus et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In addition, such simulators democratize access to surgical training because they are reproducible and shareable and do not require expensive infrastructure (Klink et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The positive feedback from both groups suggests that integrating 3D-printed simulators in endodontic education may increase engagement and satisfaction, which are known to influence learning outcomes and long-term knowledge retention. This approach may also be helpful for dental education research because it allows the use of standardized simulations across institutions worldwide.\u003c/p\u003e \u003cp\u003eMoreover, the inclusion of two learner profiles, namely, undergraduate and postgraduate students, highlights the simulator\u0026rsquo;s adaptability and curricular relevance across educational levels, as previously suggested in similar studies (Author et al., 2024).\u003c/p\u003e \u003cp\u003eFurthermore, the overall high degree of realism reported by the participants supports the fidelity of the model. The inclusion of specific features, such as simulated granulation tissue, anatomical landmarks, and obturated root canals, increased its clinical relevance and learner immersion.\u003c/p\u003e \u003cp\u003eNevertheless, several limitations must be acknowledged:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e- First, certain aspects, most notably the feel of soft tissue, need to be improved. Although technologies such as silicone 3D printing or PolyJet\u0026reg; (STRATASYS) 3D printing may increase realism (Hanisch et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Unkovskiy et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), they are currently less cost effective. A key strength of the present model lies in its affordability, which ensures broader accessibility. Maintaining cost-effectiveness while increasing fidelity will therefore remain an important objective. In addition, ensuring that all the components remain fully 3D printed is essential for reproducibility and minimal manual intervention.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e- The evaluation relied primarily on self-reported measures of competence and perception, which, although insightful, may not fully reflect actual clinical performance (Rumpel et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Objective assessments of skill acquisition would strengthen the conclusions and could be included in future studies (Yao et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Moreover, using a formally validated questionnaire would enhance the reliability of the data collected and reduce the potential for measurement bias.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e- The sample size, although sufficient for exploratory analysis, remains modest and may limit the universality of these findings. Larger, multicenter studies are recommended to provide more robust data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e- The absence of a control group using traditional or alternative models limits the ability to draw comparative conclusions. Although comparisons with animal models have been explored in other studies, such a comparison was not the focus of this study (Gund et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThere is also a potential social desirability bias, as participants might have provided favorable responses due to the presence of instructors, the academic setting, or their awareness of being evaluated. Although the questionnaire was anonymous and participation was voluntary, this type of bias cannot be completely excluded.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e- Finally, although the model was positively received, its long-term impact on actual clinical performance and transferability to real surgical settings remains to be assessed. Future research should explore how such models influence skill retention, clinical confidence, and patient outcomes over time.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrated the feasibility and educational value of a fully 3D-printed, cost-effective simulator for endodontic microsurgery training. The model proved to be particularly beneficial for undergraduates by increasing confidence and perceived competence while also serving as a refresher and assessment tool for postgraduates. Despite current limitations in material properties and in the production process, ongoing advances in 3D printing are likely to improve tactile fidelity and reproducibility. By offering an accessible and ethical alternative to animal models, this simulator represents a promising tool for structured, stepwise learning and standardized training in endodontic education. Although still a preliminary step, it holds great potential for refinement and improvement, ultimately paving the way for more comprehensive and effective teaching in endodontic surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003e3D: three-dimensional\u003c/li\u003e\n \u003cli\u003eCBCT: Cone Beam Computed Tomography\u003c/li\u003e\n \u003cli\u003eSLA : Stereolithography\u003c/li\u003e\n \u003cli\u003eOSCE : Objective Structured Clinical Examination\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Comit\u0026eacute; d\u0026rsquo;\u0026Eacute;thique de la Recherche de l\u0026rsquo;Assistance Publique\u0026ndash;H\u0026ocirc;pitaux de Paris (AP-HP CER), Assistance Publique\u0026ndash;H\u0026ocirc;pitaux de Paris (AP-HP), Paris, France (IRB: IORG0010044, approval reference: 2025-03-14). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki and relevant institutional and national guidelines.\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants prior to participation. Participation was voluntary and had no impact on academic evaluation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by IDEX Universit\u0026eacute; de Paris Cit\u0026eacute; 2024: SM/FL IP24V1_SA-013.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: M.I., Y.S., F.B., J-P.A., P.F.; Methodology: M.I., A.S., E.C., S.L-G., S.A-G., V.LM., P.F.; Data analysis: L.J., S.H.; Writing: M.I., P.F.; Reviewing and editing: all authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Digismile Company (Francesco Zammillo and Olivier Boujenah) for the technical support they provided, especially in redesigning the bone model and the gingiva. They would also like to thank Formlabs for the loan of printing devices.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAkaike, M., Fukutomi, M., Nagamune, M., Fujimoto, A., Tsuji, A., Ishida, K. et al. (2012). Simulation-based medical education in clinical skills laboratory. \u003cem\u003eThe Journal of Medical Investigation,\u0026nbsp;\u003c/em\u003e59(1,2), 28\u0026ndash;35.\u003c/li\u003e\n \u003cli\u003eApara, T., Hogan, T. \u0026amp; Peterson, J.L.H. (2024). Death of the paediatric manikin: A scoping review. \u003cem\u003eBMJ Paediatrics Open,\u0026nbsp;\u003c/em\u003e8(1), e002941.\u003c/li\u003e\n \u003cli\u003eAuthor. et al. (2024). Details blinded for peer review.\u003c/li\u003e\n \u003cli\u003eBaaij, A., Kruse, C., Whitworth, J. \u0026amp; Jarad, F. (2024). 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Trueness and precision of skin surface reproduction in digital workflows for facial prosthesis fabrication. \u003cem\u003eThe Journal of Prosthetic Dentistry,\u0026nbsp;\u003c/em\u003e130(3), 402\u0026ndash;413.\u003c/li\u003e\n \u003cli\u003eYao, C. J., Chow, J., Choi, W. W. S. \u0026amp; Mattheos, N. (2019). Measuring the impact of simulation practice on the spatial representation ability of dentists by means of Impacted Mandibular Third Molar (IMTM) Surgery on 3D printed models. \u003cem\u003eEuropean Journal of Dental Education,\u0026nbsp;\u003c/em\u003e23(3), 332\u0026ndash;343.\u003c/li\u003e\n \u003cli\u003eYe, Z., Dun, A., Jiang, H., Nie, C., Zhao, S., Wang, T. et al. (2020). The role of 3D printed models in the teaching of human anatomy: A systematic review and meta-analysis. \u003cem\u003eBMC Medical Education,\u0026nbsp;\u003c/em\u003e20(1), 335.\u003c/li\u003e\n \u003cli\u003eZhou, L., Miller, J., Vezza, J., Mayster, M., Raffay, M., Justice, Q. et al. (2024). Additive manufacturing: A comprehensive review. \u003cem\u003eSensors, 24\u003c/em\u003e(9), 2668. https://doi.org/10.3390/s24092668\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Results of the first part of the questionnaire, completed before the session. \u003cem\u003eValues are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates. Values are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"109%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.8969%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3402%;\"\u003e\n \u003cp\u003eGlobal Mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eSelf-assessed theoretical knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3402%;\"\u003e\n \u003cp\u003e3.28 (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e3.07 (1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e3.59 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eSelf-assessed technical skill level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3402%;\"\u003e\n \u003cp\u003e2.64 (1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e1.79 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e3.56 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eConfidence in practicing an endodontic surgery without help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3402%;\"\u003e\n \u003cp\u003e2.38 (1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e1.64 (1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e2.94 (1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eConfidence in practicing an endodontic surgery with an expert guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3402%;\"\u003e\n \u003cp\u003e4.19 (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e3.79 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e4.50 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.5876%;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Results of the second part of the questionnaire focusing on participants\u0026rsquo; perceptions of the model. \u003cem\u003eValues are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates.\u003c/em\u003e \u003cem\u003eValues are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"519\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003eGingiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.79 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.56 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.29 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.56 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.79 (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.72 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.29 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.78 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003eGranulation tissue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.36 (1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.78 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.79 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.33 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003eRoot end\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.57 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.22 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.71 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.89 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003eObturated canal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.64 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.47 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.29 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.53 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 226px;\"\u003e\n \u003cp\u003eSutures (tactile feeling)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.09 (1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.13 (1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 226px;\"\u003e\n \u003cp\u003eGlobal volume of the model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.57 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.39 (0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 135px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.08 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.76 (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 135px;\"\u003e\n \u003cp\u003eTactile feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.42 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.65 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Results of the second part of the questionnaire focusing on participants\u0026rsquo; perceptions of the training. \u003cem\u003eValues are presented as means with standard deviations (SDs) in parentheses. G1 = undergraduates; G2 = postgraduates. Values are presented as mean (standard deviation) to improve readability, although statistical comparisons were performed using the Mann-Whitney U test\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFeeling of improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eIn terms of knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.14 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3.44 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eIn terms of practical skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.43 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.22 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003eConfidence in practicing an endodontic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eWithout help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3.29 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3.56 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eWith expert guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.50 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.72 (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 293px;\"\u003e\n \u003cp\u003eOverall satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.50 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.67 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 293px;\"\u003e\n \u003cp\u003eWould this course be an asset to your formation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.71 (0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.65 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 293px;\"\u003e\n \u003cp\u003eTutoring was helpful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.92 (0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.59 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 293px;\"\u003e\n \u003cp\u003eOverall, this model provides a good simulation to learn the basic skills of endodontic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.36 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.17 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"3D Printing, Education, Endodontics, Simulation, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-8661165/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8661165/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndodontic microsurgery requires precise psychomotor and cognitive skills, which are challenging to acquire through observational learning alone. Effective preclinical training models are crucial for structured skill acquisition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cost-effective 3D-printed educational simulator was developed to allow the practice of key endodontic microsurgery steps, including osteotomy, root resection, canal preparation, and suturing. Thirty-two dental students (18 endodontic postgraduate students and 14 final-year undergraduate students) performed surgeries on designated maxillary teeth using standard clinical instruments and microscopes. Student perceptions were evaluated via pre- and post-training questionnaires with a Likert scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe simulator was well received overall, significantly improving the self-reported confidence and perceived competence of undergraduate students (Mann‒Whitney U test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Postgraduates who were familiar with clinical procedures also reported positive experiences, albeit with fewer statistically significant improvements. Both groups indicated high overall satisfaction, acknowledging that the simulator is a valuable training tool despite its limitations in tactile realism, notably regarding gingival tissue.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study demonstrates the educational effectiveness of a custom-made, 3D-printed simulator for endodontic microsurgery. Its versatility, affordability, and modularity support structured, incremental learning and standardized training. Such simulators may democratize access to high-quality surgical education and improve pedagogical outcomes across dental education programs.\u003c/p\u003e","manuscriptTitle":"Undergraduate and postgraduate perceptions of a 3D-printed educational simulator for endodontic microsurgery: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 09:31:46","doi":"10.21203/rs.3.rs-8661165/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-30T10:21:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T07:40:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T12:33:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61604485415125277305443779403539946470","date":"2026-04-27T09:56:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T08:16:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175186084920113914408797857225787280830","date":"2026-04-23T10:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147809207156359301820030155113595973488","date":"2026-04-23T09:23:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116424536293154059153490688066307555957","date":"2026-04-23T07:42:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T22:31:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297472568055492102658989995830089526967","date":"2026-03-25T07:39:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71980283123257992801836150591379644450","date":"2026-03-25T02:48:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-25T01:59:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-02T19:00:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T19:57:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T11:02:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-28T09:27:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a03e8612-ecd6-40b3-b61e-4df4c74d4097","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-30T10:21:28+00:00","index":69,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T09:31:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 09:31:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8661165","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8661165","identity":"rs-8661165","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}