Virtual simulation for the surgical remove of impacted teeth in practice teaching

Virtual simulation for the surgical remove of impacted teeth in practice teaching | 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 Virtual simulation for the surgical remove of impacted teeth in practice teaching Yushi Zhang, Ming Chi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4163747/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To explore the teaching quality of the virtual simulation practice teaching system for the surgical remove of the impacted teeth in oral and maxillofacial surgery. Methods A total of 60 undergraduate interns majoring in stomatology of China Medical University were selected as the research objects and randomly divided into two groups: VRLG and TLG, with 30 students in each group. After completing all the study plans, the students will take the theoretical and practical examination uniformly. In addition, a self-made questionnaire was distributed at the end of the practical class. Results The theoretical course scores of the VRLG were significantly higher than those of the TLG (89.77 ± 4.11 vs. 87.20 ± 4.82, P < 0.05), and the practical course scores of the VRLG were significantly higher than those of the TLG (88.50 ± 4.11 vs. 84.77 ± 5.20, P < 0.05), and the difference was statistically significant; 86.67% students think that the virtual simulation practice teaching system can assist learning, and 83.33% think that it is easier to understand the learning quality. Conclusion The virtual simulation practice teaching system can stimulate the learning interest and improve the learning effect. Virtual simulation Practice teaching Surgical remove of impacted teeth Stomatological teaching Technical training Oral and maxillofacial surgery Figures Figure 1 Figure 2 Background Dental education typically utilizes traditional approaches, such as didactic instruction and discipline-based curricula, to enhance students' proficiency in essential skills and cultivate professional values in a subject-focused manner [ 1 ] . Many argue that formal lecture-based teaching is an ineffective, outdated, and passive method of learning. It is challenging to guarantee that teaching sessions successfully achieve their intended learning objectives since merely attending does not guarantee the acquisition of new knowledge [ 2 ] . Oral and maxillofacial surgery is a backbone course in the curriculum system of dentistry training, in which the number of teaching hours of practical courses exceeds 1/2 of the total hours. However, at present, most of the teaching in the experimental class is simulated in the simulation of the head model, which cannot restore the real diagnosis and treatment scene. With the development of modern educational technology, the application of digital and network technology to deepen practical teaching has become an urgent need for dental education [ 3 , 4 ] . Therefore, the research group explore the development of virtual simulation experimental program to make up for the current problems in practical teaching, combining information technology with dental professional knowledge. With the help of network platform, virtual simulation breaks the limitation of time and space, so that learning can be carried out anytime and anywhere. In addition, through the construction of virtual simulation teaching platform, to realize the sharing of high-quality teaching resources. Impacted tooth is a tooth that can only partially erupt or completely fail to erupt due to the obstruction of neighboring teeth, bone or soft tissues, and cannot erupt in the future. Impacted tooth extraction is a common treatment method for Impacted teeth, which is a relatively common type of basic clinical surgery and an important part of the final assessment of standardized residency training. The School of Stomatology of China Medical University has developed a virtual simulation teaching system for the extraction of impacted teeth, and the present study applies it to the teaching of oral and maxillofacial surgery, aiming at improving the practical ability of dental students and laying a foundation for clinical diagnosis and treatment. Methods A total of 60 undergraduate students, including 16 males and 44 females; aged 20 to 24 years old, from all of the 2016 undergraduate dental students who were interned at the Oral and Maxillofacial Surgery Department of the Stomatology Hospital of China Medical University from September to October 2020 were selected. All students were divided into a virtual simulation learning group (VRLG) and a traditional learning group (TLG) of 30 students each using the random number table method. All students are unified to receive 22h theoretical course learning (learning plan in Table 1 ) and 24h practical course learning (learning plan in Table 2 ), after the virtual simulation teaching group through the VR review 4h, the traditional teaching group independent review 4h, in order to ensure that the virtual simulation teaching group and the traditional teaching group of the same credit hours, The VRLG and TLG flowchart was summarized in Fig. 1 . After completing all the study plans, the students will take the theoretical and practical examination uniformly. Table 1 Theoretical course program Course modules Learning time (h) Learning content Basic knowledge and operation of oral and maxillofacial surgery 4 Oral and maxillofacial surgery medical history Oral and maxillofacial clinical examination Disinfection and sterilization Basic operation Wound treatment Oral and maxillofacial surgery anesthesia 6 Basic concepts of local anesthesia Drugs, methods and complications of local anesthesia Characteristics of general anesthesia General anesthesia is commonly used in oral and maxillofacial surgery Resuscitation management after general anesthesia in oral and maxillofacial surgery Characteristics and use of sedation and labor pains Dental and alveolar surgery 12 Basic concepts of dental and alveolar surgery Tooth extraction, indications, preoperative assessment, preoperative preparation, extraction instruments, basic procedures Tooth extraction and root extraction Extraction of impacted teeth and healing of extraction wounds Complications of tooth extraction Alveolar surgery Table 2 Practical Course Program Course modules Learning time (h) learning content Basic knowledge and operation of oral and maxillofacial surgery 4 Oral examination, aseptic operation Oral and maxillofacial surgery anesthesia 8 Local anesthesia General anesthesia Dental and alveolar surgery 12 General tooth extraction Extraction of impacted teeth Alveolar surgery Table 3 participants characteristics (n = 60) characteristics VRLG TLG t/X 2 P Age(years)(mean SD) 22.07 ± 1.34 21.87 ± 1.28 0.555 0.583 Gender 0.000 1.000 Male 8 8 female 22 22 SD: standard error; VRLG: Virtual simulation learning group; TLG: Traditional learning group; P < 0.05 Table 4 Comparison of Theoretical course scores and Practical Course scores between the virtual simulation learning group and the traditional learning group (x ± s) Theoretical course scores Practical Course scores VRLG 89.77 ± 4.11 88.50 ± 4.11 TLG 87.20 ± 4.82 84.77 ± 5.20 t 2.309 3.084 P 0.028 0.030 VRLG: Virtual simulation learning group; TLG: Traditional learning group; P < 0.05 Table 5 Survey of Student Teaching Satisfaction in the virtual simulation learning group and the traditional learning group n (%) Degree VRLG TLG Improve diagnostic ability yes 28(93.33) 25(83.33) general 1(3.33) 4(13.33) no 1(3.33) 1(3.33) Familiarize with the diagnosis and treatment process yes 27(90.00) 25(83.33) general 2(6.67) 3(10.00) no 1(3.33) 2(6.67) Improve practical ability yes 26(86.67) 25(83.33) general 3(10.00) 4(13.33 no 1(3.33) 1(3.33) Make learning content easier to understand yes 25(83.33) 23(76.67) general 4(13.33 6(20.00) no 1(3.33) 1(3.33) Participate in surgery faster yes 27(90.00) 24(80.00 general 2(6.67) 4(13.33) no 1(3.33) 2(6.67) Students in the virtual simulation teaching group enter the virtual simulation teaching system for impacted tooth extraction, enter the account number and password, learn the knowledge related to impacted tooth extraction and pass the assessment system. It mainly includes 4 modules: theory review, instrument cognition, knowledge quiz, and virtual diagnosis and treatment. Among them, through the learning of theory review module, students can review the theoretical knowledge related to the extraction of impacted teeth. In the instrument cognition module, the common instruments used in the extraction of impacted teeth are modeled in three dimensions, and the students can view the form of the instruments in all directions and read the related text introduction. In the knowledge quiz module, students review the theoretical knowledge related to extraction of impacted teeth in the form of a knowledge quiz. There will be corresponding hints for incorrect answers, and the students can check and make up for their mistakes according to the answers to the questions. In the virtual diagnosis and treatment module, students are trained and assessed on the operation process and key points of impacted teeth by means of virtual cases. A three-dimensional virtual digital clinic and a virtual standard patient (VSP) are designed in the scene, and the simulation modeling of the virtual patient's stomatognathic system, local oral lesions and other information. Students completed the whole process of extraction of impacted teeth in this virtual scenario (Fig. 2 ). The research team developed the theoretical knowledge examination to evaluate proficiency in theoretical knowledge following training. After being evaluated for content validity by 10 teaching experts, the paper achieved a Scalelevel Content Validity Index (S-CVI/AVe) of 0.917. The Cronbach's α value was 0.739, indicating moderate internal consistency. The difficulty level of the exam paper was classified as medium, and the questions were graded on a scale of 100 points. Teachers scored the students' practical results to compare the students' mastery level of the extraction operation of impacted teeth. In addition, a self-made questionnaire was distributed at the end of the practical class, allowing the students in the 2 groups to evaluate the teaching effect of the practical class in 5 aspects, namely, whether it could improve the diagnostic ability, whether it familiarize with the diagnostic and treatment process, whether it improved practical ability, whether it made the learning content easier to understand, whether it was conducive to participating in surgery faster. SPSS 26.0 software was used to analyze the data statistically. Quantitative data for nurses were analyzed by t-test and expressed as mean ± standard deviation. Categorical data were analyzed by the Kruskal-Wallis test. The significance level for all tests was set at P < 0.05. Ethics approval and consent to participate This retrospective study has been approved by the Institutional ethics committee of School and Hospital of Stomatology, China Medical University (No. k20210015). All our participants were informed about this educational program and adjacent study design prior to the start of the study, and all participants provided their informed consent by signing a consent form. Results Comparison of the 2 groups of students in terms of age and gender showed no statistically significant differences (P > 0.05) (Table 3). The theoretical course scores of the VRLG were significantly higher than those of the TLG (89.77±4.11 vs. 87.20±4.82, t=2.309, P < 0.05), and the difference was statistically significant. The practical course scores of the VRLG were significantly higher than those of the TLG (88.50±4.11 vs. 84.77±5.20, t=3.084, P < 0.05), and the difference was statistically significant (Table 4). The experimental teaching effect of the virtual simulation teaching group was better than that of the traditional teaching group in terms of improving diagnostic ability, familiarizing with the diagnosis and treatment process, improving practical ability, making learning content easier to understand, and participating in surgery faster, as shown in Table 5. In addition, 90.00% of the students in the virtual simulation teaching group believed that the learning through the virtual simulation teaching system could increase the interest in learning; 86.67% of the students thought that the learning content was easier to understand; and 93.33% of the students thought that it was necessary to offer this class. In the survey of what are the shortcomings of traditional teaching methods, 43.33% of the students in the traditional teaching group thought that adding a case discussion session to the teaching program might help the foundation of clinical diagnosis and treatment; 26.67% of the students suggested adding a clinical reflection session. Discussion New graduates are competent when they are capable of functioning (independently) in realistic practice settings [5] . An education built on competency provides several benefits, including: enhanced student performance through active engagement in problem-solving learning, fostering critical thinking skills, improved understanding across disciplines, enhanced research and record-keeping abilities, and stronger connections with dental practice settings and public institutions in terms of educational matters. Most of the clinical operations may be traumatic and dangerous for the patient, and obstruction occurs in a special location, is often adjacent to important anatomical structures, and has a close relationship with neighboring teeth, thus making the procedure more difficult. Due to the close relationship between the mandibular third molar and the mandibular canal, surgery may result in direct or indirect injury to the inferior alveolar nerve. The extraction of an Impacted tooth also carries risks such as injury to neighboring teeth and removal of too much bone. Therefore, failure to ensure the proficiency and standardization of medical students' clinical operations may cause both physical and psychological harm to patients. Lesson education can only utilize verbal descriptions and image displays to allow students to imagine, which is obviously too much to expect from undergraduates who have not been exposed to clinical practice. Current experimental teaching relies more on models, and the high cost of consumables limits the development of experimental teaching, while model practice focuses on standardized operation and improving proficiency, and cannot completely simulate clinical diagnosis and treatment. Due to the lack of vision, it is difficult for medical students to see the extraction process of the inner most retaining teeth in the mouth during clinical teaching. Moreover, with the increasing awareness of patient self-protection, more patients want to be treated by more experienced doctors and refuse to be treated by medical students, which reduces the opportunity of clinical practice for medical students [6, 7] . Virtual reality (VR), the use of technology to create realistic simulated environments, is increasingly becoming a widely utilized tool in daily life. Advances in VR are reshaping the ways people entertain themselves and interact with the world around them, and they are also making significant progress in the field of medicine. Initially, many articles exploring the application of VR in Oral and Maxillofacial Surgery (OMS) focused on its educational purposes. Given that this technology enables learners to demonstrate understanding and practice surgical techniques without any potential harm to patients, it holds the potential to expedite residents' learning process. Simulators, which are more cost-effective than animal and cadaver models, not only facilitate repeated and routine training but also enhance repeatability [8, 9] . VR simulators provide the opportunity for assessing objective and quantitative outcomes through the utilization of data collected from haptic devices. Key measurements encompass time duration, error count, stroke count, and angle of needle insertion. Additionally, immediate feedback and evaluation can be facilitated [10] . The COVID-19 pandemic has led to a widespread adoption of virtual learning in surgical training, with a rapid increase in its use [11, 12] . Virtual learning has been widely utilized in the field of maxillofacial surgery to facilitate professional development on regional, national, and international scales. Traditional didactic teaching days were swiftly replaced with online sessions in response to the pandemic. These online sessions received overwhelmingly positive feedback from both trainees and trainers, who appreciated the content and delivery. A focus group specifically commended the pragmatic approach of the program, the opportunity for interactivity with a diverse group of speakers, and the potential for accessing pre-learning information [13] . Whether the classroom content is vivid and interesting is an important factor to stimulate students' enthusiasm, traditional teaching theoretical knowledge is abstract and difficult to understand. Virtual simulation practical teaching system through the simulation of the operation process, so that students to complete the overall obstruction of the mandibular third molar extraction operation, the organic combination of theoretical knowledge and practical teaching, students in the theoretical learning basis, understand each step of the experimental operation, clear points of the operation, so that the students have an immersive feeling, to promote the combination of virtual and real, to restore the clinical scene [14] . Reduce the cost of maintenance and wear and tear of expensive equipment in the traditional practice, can to a large extent to alleviate the current lack of teacher resources, insufficient training resources and insufficient operating equipment and other issues, is a good complement to the existing hands-on practical training. The virtual simulation practical teaching system integrates the HPL (How People Learn) theory proposed by Bransford et al. in 2000 into teaching, the core of which is that learning should be learner-centered, in addition to taking into account the students' reserve knowledge, cultural values, interests, etc., and should also take into account the convenience of learning. The virtual simulation practical teaching system is not limited to classroom time, allowing students to self-study and assess anytime and anywhere, ensuring that students continue to review after class. Students can repeatedly review the knowledge and operation [15] ，and one study found that the use of virtual teaching methods can reduce a teacher's instructional time by a factor of five [16] 。 Virtual simulation practical teaching system will simulate the object as a real patient to operate, and can correct the wrong operation in a timely manner, which is conducive to enhancing memory and laying a solid foundation for clinical operation. This has played a great role in improving the quality of medical teaching, playing the role of information technology to support teaching, and avoid unnecessary doctor-patient conflicts, which is conducive to building students' self-confidence. Students in the traditional learning group suggested adding case discussion and clinical discernment to the teaching program, while the virtual simulation leaining group did not mention it, indicating that the virtual simulation leaining system makes up for the shortcomings of traditional teaching to a certain extent. Although the virtual simulation practical teaching system has many advantages, it can not completely replace the real practical courses. Virtual simulation practical teaching system is not a substitute for traditional teaching, but only an auxiliary tool to improve teaching effectiveness. Because the virtual simulation experiment is a virtual process of experimentation through the mouse, not a real operation, it can not play a role in standardizing the operation and improving proficiency. Students prefer patients who have feedback rather than those who lack feedback. Some students in the virtual simulation teaching group also suggested that the virtual simulation experimental system lacks teachers' comments and the process of obtaining patient information is complicated (too many clicks) and other shortcomings. Therefore, in the teaching process, we should not only let the students combine the virtual and real, but also let the students have more contact with the clinical internship, so that the theory can really be applied in practice. The virtual simulation practical teaching system contains only a representative single case, and medical students will encounter a variety of complex cases in the process of clinical practice, the future teaching system will increase the number of online cases, expanding the learning environment, more convenient to improve the clinical knowledge of medical students. Increase online teaching resources to produce open class videos to realize resource sharing, so that students can listen to high-quality teaching courses anytime and anywhere. Increase the variety of offline teaching by applying VR technology to display the scene and make the operation process vivid and intuitive. Apply force feedback system to improve the accuracy of operation. The virtual simulation practical teaching system for the extraction of impacted teeth is able to simulate the process of clinical impacted teeth extraction in an unlimited number of times, which is very helpful for teachers to teach and students to learn the knowledge related to impacted teeth, and helps students to memorize, consolidate, and review the mastery, and lays a good foundation for the operation of clinical impacted teeth extraction; moreover, this simulation system also has the advantages of low cost and easy and flexible use, and so on. Conclusion The virtual simulation practice teaching system can stimulate the learning interest and improve the learning effect. We believe that the virtual simulation practical teaching system for the extraction of primary teeth has potential value in the teaching of primary teeth and is worth popularizing and applying. Dental educators training novice practitioners and dental students are continuously exploring the most effective methods to incorporate new and improved approaches in dental education. Declarations Ethics approval and consent to participate This retrospective study has been approved by the Institutional ethics committee of School and Hospital of Stomatology, China Medical University (No. k20210015). All our participants were informed about this educational program and adjacent study design prior to the start of the study, and all participants provided their informed consent by signing a consent form. Consent for publication Informed consent was obtained from all the subjects for publication. Data availability The datasets analyzed in the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions Yushi Zhang: Conceptualization, Methodology, Data curation, Formal Analysis, Writing draft. Ming Chi: Conceptualization, Methodology, Data curation, Supervision, Review & Editing. All authors read and approved the final manuscript. Acknowledgements We express our gratitude to our teachers and trainees for their valuable contributions to this teaching and research endeavor. References YIP H K, SMALES RJ. Review of competency-based education in dentistry [J]. Br Dent J. 2000;189(6):324–6. NANDI P L, CHAN J N, CHAN C P, et al. Undergraduate medical education: comparison of problem-based learning and conventional teaching [J]. Hong Kong Med J. 2000;6(3):301–6. AMINI H, GREGORY M E, ABRAMS M A, et al. Feasibility and usability study of a pilot immersive virtual reality-based empathy training for dental providers [J]. J Dent Educ. 2021;85(6):856–65. ZHANG B, LI S, GAO S, et al. Virtual versus jaw simulation in Oral implant education: a randomized controlled trial [J]. BMC Med Educ. 2020;20(1):272. CHAMBERS D W, GERROW JD. Manual for developing and formatting competency statements [J]. J Dent Educ. 1994;58(5):361–6. OLIVEN A, NAVE R. Long experience with a web-based, interactive, conversational virtual patient case simulation for medical students' evaluation: comparison with oral examination [J]. Med Educ Online. 2021;26(1):1946896. CHEN Y, DENG J, LI B et al. Curriculum setting and students' feedback of pre-clinical training in different dental schools in China-A national-wide survey [J]. Eur J Dent Educ, 2021. YAMASHITA Y, SHIMOHIRA D, AIJIMA R, et al. Clinical Effect of Virtual Reality to Relieve Anxiety During Impacted Mandibular Third Molar Extraction Under Local Anesthesia [J]. J Oral Maxillofac Surg. 2020;78(4):e5451–6. KHELEMSKY R, HILL B. Validation of a Novel Cognitive Simulator for Orbital Floor Reconstruction [J]. J Oral Maxillofac Surg. 2017;75(4):775–85. EIJLERS R, DIERCKX B, STAALS L M, et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial [J]. Eur J Anaesthesiol. 2019;36(10):728–37. GARG M, DHARIWAL D. Providing national level teaching to OMFS specialty trainees in a virtual classroom setting using learning theories of education [J]. Br J Oral Maxillofac Surg. 2022;60(1):3–10. THOMPSON JW, THOMPSON E L, SANGHRAJKA A P. The future of orthopaedic surgical education: Where do we go now? [J]. Surgeon. 2022;20(4):e86–94. ELLEDGE R, WILLIAMS R, FOWELL C, et al. Maxillofacial education in the time of COVID-19: the West Midlands experience [J]. Br J Oral Maxillofac Surg. 2022;60(1):52–7. FERNANDES C I R, BONAN R F, BONAN P R F, et al. Dental Students' Perceptions and Performance in Use of Conventional and Virtual Microscopy in Oral Pathology [J]. J Dent Educ. 2018;82(8):883–90. ROY E, BAKR M M GEORGER. The need for virtual reality simulators in dental education: A review [J]. Saudi Dent J. 2017;29(2):41–7. HUANG T K, YANG C H, HSIEH Y H, et al. Augmented reality (AR) and virtual reality (VR) applied in dentistry [J]. Kaohsiung J Med Sci. 2018;34(4):243–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4163747","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285119721,"identity":"ca570060-ad78-4bcf-8f5a-092f60e0157a","order_by":0,"name":"Yushi Zhang","email":"","orcid":"","institution":"School and Hospital of Stomatology, China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yushi","middleName":"","lastName":"Zhang","suffix":""},{"id":285119723,"identity":"0bdef927-4905-426e-b0ba-12051a8f9582","order_by":1,"name":"Ming Chi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYDACCcYGhgQ4r0JCjp9YLRIQ3hkLY8kGglqQKca2isQNhLTwz25u3fBwR20dv0T6xQ8f50kwbmBgfvjoBj5L7hxsu5F45riE5IycYsmZ2ySYzRnYjI1z8GgxkEgEamk7JmFwIydBmnebBJtlAw+bNLFakn/zzpHgMThAnJYaoJb0Y9K8DRISBLVI3ABrOSA5s+cNm+UMoG2SzQT8wj8j/dnNn211/Pzs6Y9vfKipq+9nb374GJ8WKDgMxDwGEDYzYeUgUAfE7A+IUzsKRsEoGAUjDgAAS/ZO0b3kXYIAAAAASUVORK5CYII=","orcid":"","institution":"Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University","correspondingAuthor":true,"prefix":"","firstName":"Ming","middleName":"","lastName":"Chi","suffix":""}],"badges":[],"createdAt":"2024-03-25 13:42:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4163747/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4163747/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53966424,"identity":"3aeb0b04-8b20-448f-8076-196a5775ce0e","added_by":"auto","created_at":"2024-04-02 19:42:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71113,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of teaching design of the VRLG and TLG\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4163747/v1/58d9a20a719da4c66aff0085.png"},{"id":53966423,"identity":"b87a8a7c-e73e-42b3-98dd-2415cdfcfcd6","added_by":"auto","created_at":"2024-04-02 19:42:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":297392,"visible":true,"origin":"","legend":"\u003cp\u003eVirtual simulation teaching system for impacted tooth extraction\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4163747/v1/f480503c2cac8748bf617c3e.png"},{"id":55481636,"identity":"27cae8c7-83c7-4019-828f-864966d6772d","added_by":"auto","created_at":"2024-04-29 04:37:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":779906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4163747/v1/3bf3e562-074e-47e0-a7b4-811a47fb2b2f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Virtual simulation for the surgical remove of impacted teeth in practice teaching","fulltext":[{"header":"Background","content":"\u003cp\u003eDental education typically utilizes traditional approaches, such as didactic instruction and discipline-based curricula, to enhance students' proficiency in essential skills and cultivate professional values in a subject-focused manner\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Many argue that formal lecture-based teaching is an ineffective, outdated, and passive method of learning. It is challenging to guarantee that teaching sessions successfully achieve their intended learning objectives since merely attending does not guarantee the acquisition of new knowledge\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOral and maxillofacial surgery is a backbone course in the curriculum system of dentistry training, in which the number of teaching hours of practical courses exceeds 1/2 of the total hours. However, at present, most of the teaching in the experimental class is simulated in the simulation of the head model, which cannot restore the real diagnosis and treatment scene. With the development of modern educational technology, the application of digital and network technology to deepen practical teaching has become an urgent need for dental education\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, the research group explore the development of virtual simulation experimental program to make up for the current problems in practical teaching, combining information technology with dental professional knowledge. With the help of network platform, virtual simulation breaks the limitation of time and space, so that learning can be carried out anytime and anywhere. In addition, through the construction of virtual simulation teaching platform, to realize the sharing of high-quality teaching resources. Impacted tooth is a tooth that can only partially erupt or completely fail to erupt due to the obstruction of neighboring teeth, bone or soft tissues, and cannot erupt in the future. Impacted tooth extraction is a common treatment method for Impacted teeth, which is a relatively common type of basic clinical surgery and an important part of the final assessment of standardized residency training. The School of Stomatology of China Medical University has developed a virtual simulation teaching system for the extraction of impacted teeth, and the present study applies it to the teaching of oral and maxillofacial surgery, aiming at improving the practical ability of dental students and laying a foundation for clinical diagnosis and treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e A total of 60 undergraduate students, including 16 males and 44 females; aged 20 to 24 years old, from all of the 2016 undergraduate dental students who were interned at the Oral and Maxillofacial Surgery Department of the Stomatology Hospital of China Medical University from September to October 2020 were selected. All students were divided into a virtual simulation learning group (VRLG) and a traditional learning group (TLG) of 30 students each using the random number table method.\u003c/p\u003e \u003cp\u003eAll students are unified to receive 22h theoretical course learning (learning plan in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and 24h practical course learning (learning plan in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), after the virtual simulation teaching group through the VR review 4h, the traditional teaching group independent review 4h, in order to ensure that the virtual simulation teaching group and the traditional teaching group of the same credit hours, The VRLG and TLG flowchart was summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. After completing all the study plans, the students will take the theoretical and practical examination uniformly.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTheoretical course program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse modules\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLearning time (h)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLearning content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003eBasic knowledge and operation of oral and maxillofacial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOral and maxillofacial surgery medical history\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOral and maxillofacial clinical examination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDisinfection and sterilization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic operation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWound treatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c2\" namest=\"c1\" rowspan=\"6\"\u003e \u003cp\u003eOral and maxillofacial surgery anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic concepts of local anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDrugs, methods and complications of local anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCharacteristics of general anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneral anesthesia is commonly used in oral and maxillofacial surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResuscitation management after general anesthesia in oral and maxillofacial surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCharacteristics and use of sedation and labor pains\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c2\" namest=\"c1\" rowspan=\"6\"\u003e \u003cp\u003eDental and alveolar surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic concepts of dental and alveolar surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTooth extraction, indications, preoperative assessment, preoperative preparation, extraction instruments, basic procedures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTooth extraction and root extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExtraction of impacted teeth and healing of extraction wounds\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplications of tooth extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlveolar surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractical Course Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse modules\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLearning time (h)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003elearning content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic knowledge and operation of oral and maxillofacial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOral examination, aseptic operation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOral and maxillofacial surgery anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLocal anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDental and alveolar surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGeneral tooth extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtraction of impacted teeth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlveolar surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eparticipants characteristics (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVRLG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTLG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et/X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)(mean SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD: standard error; VRLG: Virtual simulation learning group; TLG: Traditional learning group; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Theoretical course scores and Practical Course scores between the virtual simulation learning group and the traditional learning group (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheoretical course scores\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePractical Course scores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVRLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eVRLG: Virtual simulation learning group; TLG: Traditional learning group; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurvey of Student Teaching Satisfaction in the virtual simulation learning group and the traditional learning group n (%)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVRLG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTLG\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eImprove diagnostic ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(93.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(83.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(13.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamiliarize with the diagnosis and treatment process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(90.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(83.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(6.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eImprove practical ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(86.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(83.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(13.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMake learning content easier to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(83.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(76.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(13.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(20.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParticipate in surgery faster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(90.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(80.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(13.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(6.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStudents in the virtual simulation teaching group enter the virtual simulation teaching system for impacted tooth extraction, enter the account number and password, learn the knowledge related to impacted tooth extraction and pass the assessment system. It mainly includes 4 modules: theory review, instrument cognition, knowledge quiz, and virtual diagnosis and treatment. Among them, through the learning of theory review module, students can review the theoretical knowledge related to the extraction of impacted teeth. In the instrument cognition module, the common instruments used in the extraction of impacted teeth are modeled in three dimensions, and the students can view the form of the instruments in all directions and read the related text introduction. In the knowledge quiz module, students review the theoretical knowledge related to extraction of impacted teeth in the form of a knowledge quiz. There will be corresponding hints for incorrect answers, and the students can check and make up for their mistakes according to the answers to the questions. In the virtual diagnosis and treatment module, students are trained and assessed on the operation process and key points of impacted teeth by means of virtual cases. A three-dimensional virtual digital clinic and a virtual standard patient (VSP) are designed in the scene, and the simulation modeling of the virtual patient's stomatognathic system, local oral lesions and other information. Students completed the whole process of extraction of impacted teeth in this virtual scenario (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThe research team developed the theoretical knowledge examination to evaluate proficiency in theoretical knowledge following training. After being evaluated for content validity by 10 teaching experts, the paper achieved a Scalelevel Content Validity Index (S-CVI/AVe) of 0.917. The Cronbach's α value was 0.739, indicating moderate internal consistency. The difficulty level of the exam paper was classified as medium, and the questions were graded on a scale of 100 points. Teachers scored the students' practical results to compare the students' mastery level of the extraction operation of impacted teeth. In addition, a self-made questionnaire was distributed at the end of the practical class, allowing the students in the 2 groups to evaluate the teaching effect of the practical class in 5 aspects, namely, whether it could improve the diagnostic ability, whether it familiarize with the diagnostic and treatment process, whether it improved practical ability, whether it made the learning content easier to understand, whether it was conducive to participating in surgery faster.\u003c/p\u003e \u003cp\u003eSPSS 26.0 software was used to analyze the data statistically. Quantitative data for nurses were analyzed by t-test and expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Categorical data were analyzed by the Kruskal-Wallis test. The significance level for all tests was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis retrospective study has been approved by the Institutional ethics committee of School and Hospital of Stomatology, China Medical University (No. k20210015). All our participants were informed about this educational program and adjacent study design prior to the start of the study, and all participants provided their informed consent by signing a consent form.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eComparison of the 2 groups of students in terms of age and gender showed no statistically significant differences (P \u0026gt; 0.05) (Table 3). The theoretical\u0026nbsp;course scores\u0026nbsp;of the VRLG were significantly higher than those of the TLG (89.77\u0026plusmn;4.11 vs. 87.20\u0026plusmn;4.82, t=2.309, P \u0026lt; 0.05), and the difference was statistically significant.\u003c/p\u003e\n\u003cp\u003eThe practical course scores of the VRLG were significantly higher than those of the TLG (88.50\u0026plusmn;4.11 vs. 84.77\u0026plusmn;5.20, t=3.084, P \u0026lt; 0.05), and the difference was statistically significant (Table 4).\u003c/p\u003e\n\u003cp\u003eThe experimental teaching effect of the virtual simulation teaching group was better than that of the traditional teaching group in terms of improving diagnostic ability, familiarizing with the diagnosis and treatment process, improving practical ability, making learning content easier to understand, and participating in surgery faster, as shown in Table 5. In addition, 90.00% of the students in the virtual simulation teaching group believed that the learning through the virtual simulation teaching system could increase the interest in learning; 86.67% of the students thought that the learning content was easier to understand; and 93.33% of the students thought that it was necessary to offer this class. In the survey of what are the shortcomings of traditional teaching methods, 43.33% of the students in the traditional teaching group thought that adding a case discussion session to the teaching program might help the foundation of clinical diagnosis and treatment; 26.67% of the students suggested adding a clinical reflection session.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNew graduates are competent when they are capable of functioning (independently) in realistic practice settings\u003csup\u003e[5]\u003c/sup\u003e. An education built on competency provides several benefits, including: enhanced student performance through active engagement in problem-solving learning, fostering critical thinking skills, improved understanding across disciplines, enhanced research and record-keeping abilities, and stronger connections with dental practice settings and public institutions in terms of educational matters.\u003c/p\u003e\n\u003cp\u003eMost of the clinical operations may be traumatic and dangerous for the patient, and obstruction occurs in a special location, is often adjacent to important anatomical structures, and has a close relationship with neighboring teeth, thus making the procedure more difficult. Due to the close relationship between the mandibular third molar and the mandibular canal, surgery may result in direct or indirect injury to the inferior alveolar nerve. The extraction of an Impacted tooth also carries risks such as injury to neighboring teeth and removal of too much bone. Therefore, failure to ensure the proficiency and standardization of medical students\u0026apos; clinical operations may cause both physical and psychological harm to patients. Lesson education can only utilize verbal descriptions and image displays to allow students to imagine, which is obviously too much to expect from undergraduates who have not been exposed to clinical practice. Current experimental teaching relies more on models, and the high cost of consumables limits the development of experimental teaching, while model practice focuses on standardized operation and improving proficiency, and cannot completely simulate clinical diagnosis and treatment. Due to the lack of vision, it is difficult for medical students to see the extraction process of the inner most retaining teeth in the mouth during clinical teaching. Moreover, with the increasing awareness of patient self-protection, more patients want to be treated by more experienced doctors and refuse to be treated by medical students, which reduces the opportunity of clinical practice for medical students\u003csup\u003e[6, 7]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVirtual reality (VR), the use of technology to create realistic simulated environments, is increasingly becoming a widely utilized tool in daily life. Advances in VR are reshaping the ways people entertain themselves and interact with the world around them, and they are also making significant progress in the field of medicine. Initially, many articles exploring the application of VR in Oral and Maxillofacial Surgery (OMS) focused on its educational purposes. Given that this technology enables learners to demonstrate understanding and practice surgical techniques without any potential harm to patients, it holds the potential to expedite residents\u0026apos; learning process. Simulators, which are more cost-effective than animal and cadaver models, not only facilitate repeated and routine training but also enhance repeatability\u003csup\u003e[8, 9]\u003c/sup\u003e. VR simulators provide the opportunity for assessing objective and quantitative outcomes through the utilization of data collected from haptic devices. Key measurements encompass time duration, error count, stroke count, and angle of needle insertion. Additionally, immediate feedback and evaluation can be facilitated\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe COVID-19 pandemic has led to a widespread adoption of virtual learning in surgical training, with a rapid increase in its use\u003csup\u003e[11, 12]\u003c/sup\u003e. Virtual learning has been widely utilized in the field of maxillofacial surgery to facilitate professional development on regional, national, and international scales. Traditional didactic teaching days were swiftly replaced with online sessions in response to the pandemic. These online sessions received overwhelmingly positive feedback from both trainees and trainers, who appreciated the content and delivery. A focus group specifically commended the pragmatic approach of the program, the opportunity for interactivity with a diverse group of speakers, and the potential for accessing pre-learning information\u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eWhether the classroom content is vivid and interesting is an important factor to stimulate students\u0026apos; enthusiasm, traditional teaching theoretical knowledge is abstract and difficult to understand. Virtual simulation practical teaching system through the simulation of the operation process, so that students to complete the overall obstruction of the mandibular third molar extraction operation, the organic combination of theoretical knowledge and practical teaching, students in the theoretical learning basis, understand each step of the experimental operation, clear points of the operation, so that the students have an immersive feeling, to promote the combination of virtual and real, to restore the clinical scene\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eReduce the cost of maintenance and wear and tear of expensive equipment in the traditional practice, can to a large extent to alleviate the current lack of teacher resources, insufficient training resources and insufficient operating equipment and other issues, is a good complement to the existing hands-on practical training. The virtual simulation practical teaching system integrates the HPL (How People Learn) theory proposed by Bransford et al. in 2000 into teaching, the core of which is that learning should be learner-centered, in addition to taking into account the students\u0026apos; reserve knowledge, cultural values, interests, etc., and should also take into account the convenience of learning. The virtual simulation practical teaching system is not limited to classroom time, allowing students to self-study and assess anytime and anywhere, ensuring that students continue to review after class. Students can repeatedly review the knowledge and operation\u0026nbsp;\u003csup\u003e[15]\u003c/sup\u003e，and one study found that the use of virtual teaching methods can reduce a teacher\u0026apos;s instructional time by a factor of five\u0026nbsp;\u003csup\u003e[16]\u003c/sup\u003e。\u003c/p\u003e\n\u003cp\u003eVirtual simulation practical teaching system will simulate the object as a real patient to operate, and can correct the wrong operation in a timely manner, which is conducive to enhancing memory and laying a solid foundation for clinical operation. This has played a great role in improving the quality of medical teaching, playing the role of information technology to support teaching, and avoid unnecessary doctor-patient conflicts, which is conducive to building students\u0026apos; self-confidence.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Students in the traditional learning group suggested adding case discussion and clinical discernment to the teaching program, while the virtual simulation leaining group did not mention it, indicating that the virtual simulation leaining system makes up for the shortcomings of traditional teaching to a certain extent.\u003c/p\u003e\n\u003cp\u003eAlthough the virtual simulation practical teaching system has many advantages, it can not completely replace the real practical courses. Virtual simulation practical teaching system is not a substitute for traditional teaching, but only an auxiliary tool to improve teaching effectiveness. Because the virtual simulation experiment is a virtual process of experimentation through the mouse, not a real operation, it can not play a role in standardizing the operation and improving proficiency. Students prefer patients who have feedback rather than those who lack feedback. Some students in the virtual simulation teaching group also suggested that the virtual simulation experimental system lacks teachers\u0026apos; comments and the process of obtaining patient information is complicated (too many clicks) and other shortcomings.\u003c/p\u003e\n\u003cp\u003eTherefore, in the teaching process, we should not only let the students combine the virtual and real, but also let the students have more contact with the clinical internship, so that the theory can really be applied in practice.\u003c/p\u003e\n\u003cp\u003eThe virtual simulation practical teaching system contains only a representative single case, and medical students will encounter a variety of complex cases in the process of clinical practice, the future teaching system will increase the number of online cases, expanding the learning environment, more convenient to improve the clinical knowledge of medical students. Increase online teaching resources to produce open class videos to realize resource sharing, so that students can listen to high-quality teaching courses anytime and anywhere. Increase the variety of offline teaching by applying VR technology to display the scene and make the operation process vivid and intuitive. Apply force feedback system to improve the accuracy of operation.\u003c/p\u003e\n\u003cp\u003eThe virtual simulation practical teaching system for the extraction of impacted teeth is able to simulate the process of clinical impacted teeth extraction in an unlimited number of times, which is very helpful for teachers to teach and students to learn the knowledge related to impacted teeth, and helps students to memorize, consolidate, and review the mastery, and lays a good foundation for the operation of clinical impacted teeth extraction; moreover, this simulation system also has the advantages of low cost and easy and flexible use, and so on.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe virtual simulation practice teaching system can stimulate the learning interest and improve the learning effect. We believe that the virtual simulation practical teaching system for the extraction of primary teeth has potential value in the teaching of primary teeth and is worth popularizing and applying. Dental educators training novice practitioners and dental students are continuously exploring the most effective methods to incorporate new and improved approaches in dental education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study has been approved by the Institutional ethics committee of School and Hospital of Stomatology, China Medical University (No. k20210015). All our participants were informed about this educational program and adjacent study design prior to the start of the study, and all participants provided their informed consent by signing a consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the subjects for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed in the current study are available from the corresponding author on reasonable request.\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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYushi Zhang: Conceptualization, Methodology, Data curation, Formal Analysis, Writing draft. Ming Chi: Conceptualization, Methodology, Data curation, Supervision, Review \u0026amp; Editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to our teachers and trainees for their valuable contributions to this teaching and research endeavor.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYIP H K, SMALES RJ. Review of competency-based education in dentistry [J]. Br Dent J. 2000;189(6):324\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNANDI P L, CHAN J N, CHAN C P, et al. Undergraduate medical education: comparison of problem-based learning and conventional teaching [J]. Hong Kong Med J. 2000;6(3):301\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAMINI H, GREGORY M E, ABRAMS M A, et al. Feasibility and usability study of a pilot immersive virtual reality-based empathy training for dental providers [J]. J Dent Educ. 2021;85(6):856\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG B, LI S, GAO S, et al. Virtual versus jaw simulation in Oral implant education: a randomized controlled trial [J]. BMC Med Educ. 2020;20(1):272.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHAMBERS D W, GERROW JD. Manual for developing and formatting competency statements [J]. J Dent Educ. 1994;58(5):361\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOLIVEN A, NAVE R. Long experience with a web-based, interactive, conversational virtual patient case simulation for medical students' evaluation: comparison with oral examination [J]. Med Educ Online. 2021;26(1):1946896.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN Y, DENG J, LI B et al. Curriculum setting and students' feedback of pre-clinical training in different dental schools in China-A national-wide survey [J]. Eur J Dent Educ, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYAMASHITA Y, SHIMOHIRA D, AIJIMA R, et al. Clinical Effect of Virtual Reality to Relieve Anxiety During Impacted Mandibular Third Molar Extraction Under Local Anesthesia [J]. J Oral Maxillofac Surg. 2020;78(4):e5451\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKHELEMSKY R, HILL B. Validation of a Novel Cognitive Simulator for Orbital Floor Reconstruction [J]. J Oral Maxillofac Surg. 2017;75(4):775\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEIJLERS R, DIERCKX B, STAALS L M, et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial [J]. Eur J Anaesthesiol. 2019;36(10):728\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGARG M, DHARIWAL D. Providing national level teaching to OMFS specialty trainees in a virtual classroom setting using learning theories of education [J]. Br J Oral Maxillofac Surg. 2022;60(1):3\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTHOMPSON JW, THOMPSON E L, SANGHRAJKA A P. The future of orthopaedic surgical education: Where do we go now? [J]. Surgeon. 2022;20(4):e86\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eELLEDGE R, WILLIAMS R, FOWELL C, et al. Maxillofacial education in the time of COVID-19: the West Midlands experience [J]. Br J Oral Maxillofac Surg. 2022;60(1):52\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFERNANDES C I R, BONAN R F, BONAN P R F, et al. Dental Students' Perceptions and Performance in Use of Conventional and Virtual Microscopy in Oral Pathology [J]. J Dent Educ. 2018;82(8):883\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eROY E, BAKR M M GEORGER. The need for virtual reality simulators in dental education: A review [J]. Saudi Dent J. 2017;29(2):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUANG T K, YANG C H, HSIEH Y H, et al. Augmented reality (AR) and virtual reality (VR) applied in dentistry [J]. Kaohsiung J Med Sci. 2018;34(4):243\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Virtual simulation, Practice teaching, Surgical remove of impacted teeth, Stomatological teaching, Technical training, Oral and maxillofacial surgery","lastPublishedDoi":"10.21203/rs.3.rs-4163747/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4163747/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo explore the teaching quality of the virtual simulation practice teaching system for the surgical remove of the impacted teeth in oral and maxillofacial surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 60 undergraduate interns majoring in stomatology of China Medical University were selected as the research objects and randomly divided into two groups: VRLG and TLG, with 30 students in each group. After completing all the study plans, the students will take the theoretical and practical examination uniformly. In addition, a self-made questionnaire was distributed at the end of the practical class.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe theoretical course scores of the VRLG were significantly higher than those of the TLG (89.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11 vs. 87.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the practical course scores of the VRLG were significantly higher than those of the TLG (88.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11 vs. 84.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the difference was statistically significant; 86.67% students think that the virtual simulation practice teaching system can assist learning, and 83.33% think that it is easier to understand the learning quality.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe virtual simulation practice teaching system can stimulate the learning interest and improve the learning effect.\u003c/p\u003e","manuscriptTitle":"Virtual simulation for the surgical remove of impacted teeth in practice teaching","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 19:42:06","doi":"10.21203/rs.3.rs-4163747/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b34bbf5-9c8f-4d27-abde-7552e874275b","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-29T04:34:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-02 19:42:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4163747","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4163747","identity":"rs-4163747","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}