Improvement of surgical skills in students using a newly developed 3D printed osteotomy model of a partially retained wisdom tooth

Improvement of surgical skills in students using a newly developed 3D printed osteotomy model of a partially retained wisdom tooth | 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 Improvement of surgical skills in students using a newly developed 3D printed osteotomy model of a partially retained wisdom tooth Katharina Schaffrath, Mark Ooms, Anna Bock, Marie Sophie Katz, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7565410/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted 14 You are reading this latest preprint version Abstract Objectives Against the background of digitalization, practicing on 3-D models for dental education has become more important. To improve the surgical skills of dental students, this study aimed to develop a 3-D-printed model for osteotomy of a partially retained lower wisdom tooth and evaluate surgical skills of students with practical experience acquired through phantom exercises compared to students who acquired experience only by assisting oral surgeons. Materials and Methods We developed a 3-D model that allows dental students to perform an osteotomy of a partially retained real wisdom tooth in region 48. The model was evaluated by oral surgeons (OS; n = 5), students with phantom experience (PE; n = 26), and students with experience with clinical assistance (CE; n = 29). Additionally, student performance was rated. Results The OS, PE, and CE groups all evaluated the model as suitable for student courses, except for the gingiva mask. The CE group developed slightly better. In the exercise, the PE group showed better incision results, while the CE group was slightly better in the preparation of the working field. Conclusions The osteotomy model is suitable for hands-on courses for dental students, but the gingiva should be improved. However, phantom exercise cannot replace clinical experience. Clinical Relevance To improve education, knowledge and self confidence of students in dental school. dental student osteotomy model wisdom tooth oral surgery 3-D print Figures Figure 1 Figure 2 Figure 3 Introduction Evidenced by the rising number of publications, digitalization in dentistry is developing rapidly [1]. More and more practices and clinics own 3-D scanners and printers, as they are used in chairside treatment [2] as well as for operative guides in fully guided implantation [3]. Likewise, dental education has drastically changed in recent years. Especially during the COVID-19 pandemic, teaching formats became more digital. Although students tolerate high levels of digital learning and benefit from online courses according to theoretical lectures [4], dentistry in particular cannot be taught without practical experience because it is more important than the methods of teaching [5]. There is a huge step between undergraduate learning processes and the combination of practical skills and the responsibility of working on a patient as a graduated dentist. Therefore, practical exercises are essential for dentistry students. In addition to the improvement of their manual skills, students gain an understanding of anatomical structures better by practicing in hands-on-courses [6]. Even though industrial models (Frasaco GmbH, Tettnang, Germany) and animal models, such as porcine jaws, continue to be used for courses [7], the number of 3-D-printed models is rising. They are used for interactive visual demonstration and operative planning [8] as well as for oral and maxillofacial surgeons who benefit from practicing submental flaps [9] and dysgnathia surgery [10] on phantom models. Antunes et al. developed a 3-D-printed oral surgery flap training model for undergraduates, which is promising for participants as it is realistic and useful for hands-on-training [11]. 3-D models can be used to allow students to experience caries simulations [12] [13] and complete endodontic requirements such as practicing on the apical region [14], special ledge management [15], and even electronically determining working length [16]. All of these models have received good evaluations from students and participants. The skills for tooth preservation and smaller prosthodontics can be improved using the typodont model [17]. Even pediatric dentistry (pulpotomy and stainless steel pediatric crowns) can be practiced [18], which is quite meaningful considering that pediatric courses are rare. In dental school, oral surgery seems to be underrepresented compared to other subjects, such as prosthodontics, in terms of teaching hours. However, practical phantom learning using 3-D-printed models to practice special oral surgery skills seems to be beneficial for students, teachers, and patients because students might have much more self-confidence and knowledge on their first operation with a real patient. Therefore, the aims of this study were to develop a realistic model for osteotomy that can be used and individually changed by every student, depending on their skill level, and to evaluate students’ surgical skills at different levels of education using this 3-D-printed model for the removal of a lower wisdom tooth. Materials and Methods Preparation of the osteotomy model We designed a prototype of the model using a fully toothed plaster model of the lower jaw. To simulate the ascending course of the jaw, we extended the model with silicone in this region. A hole in the region of teeth 47 to 48 was milled to allow a tooth to be replaced later. Additionally, we milled a hole in the middle of the model to put in a fixation. 3-D scanning was performed using a T710 scanner (MEDIT), which allowed the digital model to be printed as often as needed. 3-D printing was carried out using a formlabs 3 printer with stereolithography (Photopolymer Resin SLA, model V3, formlabs, Somerville, Massachusetts, USA). One model was printed for each student. A nut was set into the bottom of the model with pattern resin (PATTERN RESIN LS, GC Germany) for fixing into a demo patient (Fig.1a). To evaluate the status of the neighboring tooth, we designed a model of tooth 47 using modeling plastics (PATTERN RESIN LS, GC Germany) in red. We collected original wisdom teeth from patients who provided their teeth for a student training session. For this study, we used teeth with uncomplicated root designs, such as taproots. The disinfected teeth were submerged into pink modeling wax (Gebdi) only on the root side to simulate the periodontal gap (Fig.1b). The crown remained clean. To simulate different levels of difficulty, the thickness of the wax can be changed. One model tooth 47 and one original wisdom tooth were positioned in a single model and fixed with Luxatemp (Luxatemp Star, DMG) simulating the bone (Fig.2a). According to the level of difficulty, more or less of the surrounding bone can be placed. For this study, we designed a bone lamella from the distal side lying half over the occlusal surface of tooth 48 (Fig.2b). The same angulation was chosen for every model, with the crown lying at an angle of approximately 45° toward tooth 47. The depth depended on the size of the wisdom tooth but always enabled osteotomy, most likely class IIA or IIB, following the classification of Pell and Gregory [19]. To simulate the incision, uncovering, and suture, we used a gingiva mask (millable gum mask silicone, BRIEGELDENTAL) and attached it in a way simulating a partially retained tooth (Fig.3). Evaluation of the model by oral surgeons Before using the model for students, it was evaluated by five oral surgeons and dentists (OS; n = 5) with at least three years of surgical and teaching experience. All participants answered a questionnaire focusing on structure, realistic feeling, and exercise quality using a 10-point Likert scale. Osteotomy exercise by students Following the approval of the ethics committee of RWTH Aachen University (EK 24-370), which did not have any objections regarding data protection or the procedure, the exercise was performed. Informed consent to participate was obtained from all the participants. We compared the level of education of third-year undergraduate students with practical phantom exercise experience but no clinical experience (Group 1: PE; n = 37) to fifth-year undergraduate students who acquired their experience only by assisting oral surgeons, but without phantom exercise experience (Group 2: CE; n = 29). All participating students had theoretical knowledge of wisdom teeth removal from theoretical lectures. During the exercise, the following criteria were evaluated by a dentist on a scale divided into 0 (not fulfilled), 1 (uncertain), 2 (partially fulfilled), and 3 (fulfilled): preparation of working field, demonstration of incision, performing anesthesia, and operation including suture. The maximum number of points was 57. All students answered an evaluation sheet (Supp. 1) after the osteotomy concerning structure, realistic feeling, and the quality of the exercise, followed by a personal evaluation (Supp. 2) focusing on their own skills using a 10-point Likert scale. Both of the evaluation questionnaires were developed for this study. Thirty-seven third-year students in the PE group completed the exercise as part of their preclinical exam. Participation of the CE group was voluntary. All participants who missed more than eight questions (n = 5) or baseline information (n = 1) in the evaluation sheet or indicated that they had clinical experience besides the phantom exercise (n = 6) were excluded (n = 11). In total, 26 students were included in the PE group. In the CE group, all 29 fifth-year participants were included. For all students, this specific osteotomy model was new and unknown. Development of the evaluation sheets All evaluation sheets and questionnaires were designed by two dentists of the Clinic for oral and maxillofacial surgery, hospital of RWTH Aachen as part of the dental preliminary medical examination. Statistical analysis Data were expressed as numbers (with percentages) for categorial data and as medians (with interquartile range) for metric data. Testing for differences between groups in baseline data was performed using a chi-squared test, the Fisher–Freeman–Halton test was used for categorial data, and the Mann–Whitney test was used for metric data. Testing for differences between groups in evaluation data was performed using the Mann–Whitney test. Testing for correlation was performed by calculating Spearman correlation coefficients. P-values below 0.05 were considered significant. Statistical analysis was carried out using Excel 2016 (Microsoft, Redmond, USA), GraphPad Prism 10 (GraphPad Software, Boston, USA), and SPSS Version 28 (IBM, New York, USA). Results Evaluation of the osteotomy model by oral surgeons Oral surgeons evaluated the gingiva, neighbored tooth, osteotomy tooth, bone, and fixation in terms of structure and realistic feeling. The best results were obtained for teeth and bone, while the worst results were obtained for the gingiva (Table 1). Table 1 Evaluation of the model structure and realistic feeling by oral surgeons Model Structure Realistic feeling Gingiva 3 (5) 3 (5) Neighboured tooth 9 (1) 9 (2) Osteotomy tooth 9 (2) 10 (1) Bone 7 (7) 8 (7) Fixation 10 (9) - Data described as median (interquartile range) concerning model structure and realistic feeling for each question separately. They also evaluated the quality of exercise, finding that it was most suitable for students but was also suitable for residents (Table 2). Nevertheless, a combination of model exercises and clinical experience is valued as the best for preparing participants for patients’ treatment (10 (5)). Phantom models alone cannot replace clinical experience (3 (6)). For oral surgeons, model osteotomy enables realistic operation simulations in almost every rating point, except for the apical granuloma and incision with medium rating (Table 2). Table 2 Evaluation of the quality of exercise by oral surgeons Quality of exercise OS Suitable for residents 6 (6) Suitable for students 10 (3) Enables all operative steps 8 (6) Simple and intuitive 9 (3) Model replaces clinic experience 3 (6) Combination of model and clinic is best 10 (5) Only clinical experience eduacates 6 (6) Model prepares for clinical treatment 7 (2) Operation feels realistic Coloured neighboured tooth gives safety 6 (5) Ascending jaw 10 (6) Incision 6 (7) Uncovering of the tooth 7 (5) Periodontal gap 8 (6) Relaxation of the tooth 10 (5) Removal of the tooth 9 (6) Apical granuloma 3 (6) Data described as median (interquartile range) for each question separately. Osteotomy exercise and evaluation by students Concerning baseline information, there was a significant difference between the groups in age (PE: median = 22 (2), CE: median: 24 (7); p = 0.001) but not in sex (PE: m = 10, f = 16; CE: m = 7, f = 22, p = 0.381). During the analysis of the exercise results, the CE group achieved better results in preparing their working field in terms of mirror, probe, and tweezers (PE: 3 (0), CE: 3 (1); p = 0.033) and pliers and clamps (PE: 2 (2), CE: 3 (0); p = 0.001), while the PE group had better results in terms of respiratory (PE: 3 (1), CE: 3 (0); p = 0.015) (Table 3). Nevertheless, both groups showed good performance in preparing their working field. Regarding the incision, the PE group showed significantly better results, especially in drawing the marginal course (PE: 3 (0), CE: 3 (1); p = 0.006) and mesial discharge (PE: 3 (0), CE: 2 (2); p = 0.001) (Table 3). Both groups were able to save the lingual nerve (PE: 3 (0), CE: 3 (1); p = 0.613). Concerning other clinical steps like performing anesthesia (PE: 3 (1), CE: 3 (0); p = 0.008), uncovering of the tooth (PE: 3 (1), CE: 3 (0); p = 0.002), and removal of the tooth (PE: 3 (0), CE: 3 (0); p = 0.007) CE group performed better (Table 3), while values of the curettage of the apical granuloma were higher in the PE group (PE: 3 (0), CE: 3 (1); p = 0.026). However, the total score was equal between the groups (PE: 52 (4), CE: 54 (5); p = 0.131) (Table 3). Table 3 Students exercise results Students exercise results PE CE p-value Preparation working field Mirror, probe, tweezers 3 (0) 3 (1) 0,033 Syringe 3 (0) 3 (0) 1,000 Scalpel 3 (0) 3 (0) 1,000 Rasparatory 3 (1) 3 (0) 0,015 Drill 3 (0) 3 (0) 0,291 Lever 3 (0) 3 (0) 0,132 Pliers and clamps 2 (2) 3 (0) 0,001 Sharp spoon 3 (0) 3 (0) 0,291 Needle holder and stitch 3 (0) 3 (0) 0,132 Demonstration of Incision Drawing marginal incision 3 (0) 3 (1) 0,006 Protection of the lingual nerve (buccal direction) 3 (0) 3 (1) 0,613 Mesial discharge 3 (0) 2 (2) 0,001 Operation Performing anesthesia 3 (1) 3 (0) 0,008 Preparation of operation field 3 (0) 3 (0) 0,062 Uncovering the tooth 3 (1) 3 (0) 0,002 Removal of the tooth 3 (0) 3 (0) 0,007 Sound neighboring tooth 3 (0) 3 (0) 1,000 Curettage of apical granuloma 3 (0) 3 (1) 0,026 Suture 3 (0) 3 (0) 0,493 Total score 52 (4) 54 (5) 0,131 Data described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons. In general, the model was evaluated with good results but was evaluated better by the CE group in terms of model structure (PE: 7.5 (3.3), CE: 10 (2); p = 0.001). All students indicated that the gingiva mask was not adequate (Table 4) because it often tears. Table 4 Evaluation of the model by students Evaluation Model structure PE CE p-value Gingiva 3 (3) 2 (5) 0,704 Neighboured tooth 8 (3) 10 (2) 0,030 Osteotomy tooth 10 (2) 10 (0) 0,002 Bone 9 (2) 8,5 (2) 0,318 Fixation 3 (6) 10 (3) 0,001 Total (model structure) 7,5 (3,3) 10 (2) 0,001 Realistic feeling Gingiva 4 (4) 4 (6) 0,844 Neighboured tooth 8 (4) 8 (4) 0,227 Osteotomy tooth 10 (1) 10 (0) 0,019 Bone 8 (3) 8 (3) 0,311 Total (realistic feeling) 7,5 (3) 8 (3) 0,324 By perceiving I feel prepared for clinical practice: Ascending jaw 5 (4) 6 (3) 0,233 Periodontal gap 5,5 (4) 5 (5) 0,425 Relaxation of the tooth 7 (3) 8 (3) 0,811 Apical granuloma 5 (5) 7 (3) 0,062 Incision 7,5 (6) 8 (2) 0,377 Uncovering of the tooth 7,5 (3) 9 (2) 0,050 Coloured neighboured tooth gives safety 8 (4) 8 (3) 0,437 Total (preparation for clinic) 7 (2,5) 8 (3) 0,305 Data described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons; Total build as a median of its section. In general, all students thought that the model was suitable for increasing the experience of students and residents. All participants (PE: 8.5 (3), CE: 10 (1) and OS: 10 (5)) agreed that the combination of practicing on the model with clinical experience is the best option to prepare for daily practice (Table 5). Table 5 What students think, the model is suitable for Evaluation by students What I think about the model… PE CE p-value Suitable for residents 6,5 (3) 9 (4) 0,001 Suitable for students 7,5 (2) 10 (1) 0,001 Model replaces clinic experience 2,5 (3) 3 (4) 0,931 Combination of the model and clinic is best 8,5 (3) 10 (1) 0,017 Only clinical experience eduacates 6 (5) 5 (5) 0,377 Enables all operative steps 4,5 (3) 6 (4) 0,038 Simple and intuitive 7,5 (2) 8 (3) 0,069 Level of difficulty fits to my level of knowledge 9 (3) 9 (2) 0,186 Model prepares for clinical treatment 7 (3) 8 (3) 0,140 Skills can be improved by the model 8 (2) 9 (2) 0,021 Data described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons. To avoid any falsification of the results, we excluded a correlation between the exercise results (total score) and the total evaluation values of model structure (PE: ɸ = 0.280 (0.165), CE ɸ = 0.257 (0.179)), realistic feeling (PE: ɸ = 0.222 (0.275), CE: ɸ = 0.346 (0.066)), and preparation for clinic (PE: ɸ = 0.241 (0.237), CE: ɸ = 0.160 (0.407)). Discussion The evaluation of the model was an important step in giving students the opportunity to practice and pass their preclinical exam. Therefore, one limitation of this study is that the PE group did the exercise as a real exam, while the CE group participated voluntarily. To reduce bias, we chose evaluation sheets strictly and excluded those that were not fulfilled ordinary. Another limitation of this study is that the evaluation sheets were not validated. Moreover, not every model is exactly the same due to variations in the roots and sizes of the original wisdom teeth. Against this background, the level of difficulty can differ. However, the students particularly liked that they had to remove a real tooth, as it makes the exercise more realistic. Actually, it is an advantage of the model that it can be used individually, as it matches personal requirements, as shown by Arroyo-Bote et al. [17]. In future exercises, students should be able to choose the teeth, design the expression of the periodontal gap, or try different tooth positions according to skill level. Just as Reymus et al. concluded from their study, 3-D printing technology offers new possibilities for dental schools to create their own customized teaching models according to the specific curricula [20]. In our case, the base of the models can be recycled and can be filled with a new tooth as another advantage. Additionally, the simple and fast production and reproduction are important arguments for students who already pay a lot of money for materials and instruments. Nevertheless, students and oral surgeons criticized the quality of the gingiva mask, as reported by Hanisch et al. [21]. This could be a hint to develop printable gingiva. Feng et al. reported that their gingiva mask is often describes as too fragile [22]. That met out oberservation as it was possible to perform sutures on the model, but the material used for the gingiva mask torn often. Students and oral surgeons evaluated it as not flexible enough. Factors that are also missing from the model are the periosteum and the inferior alveolar nerve. In future developments, these factors should be improved to provide a more realistic feeling. To complete the realistic experience, the possibility of X-rays, which is not possible yet, could be discussed. If future developments include nerves, the use of X-rays will be particularly important for diagnostic and positional relationships to the roots. We found that students without phantom experience (only knowledge from theoretical lectures and experience assisting oral surgeons) chose significant other incision than those with phantom experience. Although they were able to save the lingual nerve through incision in a vestibular direction, they often did not extend it to tooth 47 or even tooth 46; instead, they put the discharge directly in region 48. Therefore, there remains the suspicion that there is not enough sight by assisting oral surgeons. Often, the working field is confusing due to saliva, blood, a moving tongue, and a reduced mouth opening, even for the surgeon. Because of these factors, teaching is even more difficult. Additionally, students are busy with suction and holding the tongue, so they cannot concentrate on the details of the operation. Although Peters et al. demonstrated that the number of practical exercises (in their case, surgical sutures) is a good determinant of competence improvement [23], Bock et al. showed that structured feedback has a major impact on improvement [24], which is simply not possible when students do not perform the operation themselves. Kulasegaram et al. stated that allowing learners to experiment before interacting with an instructor can improve their learning skills [25]. Against this background, it may be beneficial to allow students to discover their skills on a model before assisting oral surgeons in operations on real patients and to experience operating by themselves so they can benefit more while assisting. Hattar et al. stated that the enhancement of students’ clinical skills and directed exposure is necessary to raise the level of perceived confidence, which will improve their current and future professional performance [26]. This is supported in our study by the assessment of oral surgeons and students at each level of experience, as they all agree that a combination of phantom and clinical experience is the best preparation for future daily practice as dentists. However, the evaluation showed that a model cannot replace clinical experience. Gaballah et al. found that one of the main reasons for a perceived lack of confidence is limited clinical exposure [27]. Dobros et al. noted that the participants in the studies under review thoroughly recommend introducing 3-D models into hands-on practice [28]. This matches our recommendations, as students and oral surgeons gave positive feedback—Fifth-year students who haven’t had the opportunity to use phantom models before evaluated even better than third-year students. Conclusions The osteotomy model is suitable for hands-on courses for dental students, but the gingiva mask must be improved in future developments. Fifth-year students without phantom experience would have liked to practice on this 3-D model, as it is now established in dental school. Although phantom exercise can improve surgical skills and confidence, it cannot replace clinical experience. Abbreviations OS: Oral surgeons and dentists with at least three years of clinical experience who evaluated the osteotomy model PE: Third-year dental students with practical experience through phantom exercises CE: Fifth-year dental students without practical or phantom experience, experience acquired by assisting oral surgeons only Declarations Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katharina Schaffrath, Anna Bock, Marie Sophie Katz and Ali Modabber. Katharina Schaffrath and Mark Ooms performed the statistical analysis. The first draft of the manuscript was written by Katharina Schaffrath and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding No funding to report. Conflict of interest All authors declare that they have no conflict of interest. Ethics approval The questionnaire and methodology for this study was approved by the Ethics committee of the University of RWTH Aachen University (EK 24-370). The authors confirm that the study was performed in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments. Consent to participate Informed consent to participate was obtained from all the participants. Data availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements We would like to thank all the students and colleagues who participated in the study. References Oberoi, G., et al., 3D Printing-Encompassing the Facets of Dentistry. Front Bioeng Biotechnol, 2018. 6 : p. 172. Waltenberger, L., et al., Effect of immediate all-digital restoration of single posterior implants: The SafetyCrown concept on patient-reported outcome measures, accuracy, and treatment time-A randomized clinical trial. Clin Implant Dent Relat Res, 2024. 26 (6): p. 1135-1148. Mohlhenrich, S.C., et al., Effects on primary stability of three different techniques for implant site preparation in synthetic bone models of different densities. Br J Oral Maxillofac Surg, 2016. 54 (9): p. 980-986. Bock, A., et al., One year of COVID-19 pandemic: a cross sectional study on teaching oral and maxillofacial surgery. Head Face Med, 2021. 17 (1): p. 51. Montero, J., et al., Dental Students' Perceived Clinical Competence in Prosthodontics: Comparison of Traditional and Problem-Based Learning Methodologies. J Dent Educ, 2018. 82 (2): p. 152-162. Bock, A., et al., Improvement of anatomical knowledge and surgical skills in head and neck region - An interdisciplinary hands-on course for clinical students. Ann Anat, 2019. 224 : p. 97-101. Kniha, K., et al., Guided discovery learning: A follow-up study of try-it-yourself surgery and subsequent video-assisted teaching for oral surgical skills training. Eur J Dent Educ, 2023. 27 (1): p. 29-35. Haribabu, P.K., M. Verma, and A. Vij, Model-assisted marsupialization of a large odontogenic keratocyst in the maxillofacial region using a multicolored 3D-printed model: A novel approach in surgical planning and teaching. Clin Case Rep, 2023. 11 (5): p. e7286. Tahami, H., et al., Development and evaluation of a surgical 3D simulation model on submental flap surgery training. J Dent Educ, 2024. 88 (12): p. 1601-1608. Yoshida, S., et al., Osteotomy training for dental students using three-dimensional simulation software and maxillofacial three-dimensional-printed models. J Dent Educ, 2022. 86 (5): p. 526-534. Antunes, D., et al., 3D-printed model for gingival flap surgery simulation: Development and pilot test. Eur J Dent Educ, 2024. 28 (2): p. 698-706. Ballester, B., et al., Evaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal. Eur J Dent Educ, 2024. 28 (1): p. 161-169. Carnier, L., et al., 3D-printed tooth for caries excavation. BMC Med Educ, 2024. 24 (1): p. 1243. Zou, H., et al., Three-dimensional printed apical barrier model technology for pre-clinical dental education. Technol Health Care, 2025. 33 (1): p. 659-669. Zhang, R., et al., Three-Dimensional Printed Tooth Model with Root Canal Ledge: A Novel Educational Tool for Endodontic Training. Dent J (Basel), 2023. 11 (9). Wolgin, M., et al., Development and Evaluation of an Endodontic Simulation Model for Dental Students. J Dent Educ, 2015. 79 (11): p. 1363-72. Arroyo-Bote, S., et al., Development of a three-dimensional printed model from a digital impression of a real patient for aesthetic dentistry undergraduate teaching. J Dent Educ, 2024. 88 (8): p. 1144-1158. Marty, M., et al., Comparison of student's perceptions between 3D printed models versus series models in paediatric dentistry hands-on session. Eur J Dent Educ, 2019. 23 (1): p. 68-72. Pell, G. and B. Gregory, Impacted mandibular third molars: classification and modified techniques for removal. 1933. Reymus, M., et al., Development and evaluation of an interdisciplinary teaching model via 3D printing. Clin Exp Dent Res, 2021. 7 (1): p. 3-10. Hanisch, M., et al., 3D-printed Surgical Training Model Based on Real Patient Situations for Dental Education. Int J Environ Res Public Health, 2020. 17 (8). Feng, J., et al., Three-dimensional printed model of impacted third molar for surgical extraction training. J Dent Educ, 2021. Peters, P., et al., Effect of head-mounted displays on students' acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: a randomized controlled trial. Int J Surg, 2023. 109 (8): p. 2228-2240. Bock, A., et al., Introduction of mini-clinical evaluation exercise in teaching dental radiology-A pilot study. Eur J Dent Educ, 2020. 24 (4): p. 695-705. Kulasegaram, K., et al., Do One Then See One: Sequencing Discovery Learning and Direct Instruction for Simulation-Based Technical Skills Training. Acad Med, 2018. 93 (11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 57th Annual Research in Medical Education Sessions): p. S37-S44. Hattar, S., et al., Dental students' experience and perceived confidence level in different restorative procedures. Eur J Dent Educ, 2021. 25 (1): p. 207-214. Gaballah, K., et al., Perceived confidence of dental students and new graduates in performing tooth extractions-An exploratory study. Eur J Dent Educ, 2024. 28 (1): p. 191-205. Dobros, K., J. Hajto-Bryk, and J. Zarzecka, Application of 3D-printed teeth models in teaching dentistry students: A scoping review. Eur J Dent Educ, 2023. 27 (1): p. 126-134. Additional Declarations No competing interests reported. Supplementary Files Supp.1.docx Supp.2.docx Cite Share Download PDF Status: Published Journal Publication published 10 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 03 Oct, 2025 Reviews received at journal 26 Sep, 2025 Reviewers agreed at journal 21 Sep, 2025 Reviews received at journal 21 Sep, 2025 Reviewers agreed at journal 21 Sep, 2025 Reviews received at journal 19 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 15 Sep, 2025 Editor assigned by journal 15 Sep, 2025 Editor invited by journal 15 Sep, 2025 Submission checks completed at journal 13 Sep, 2025 First submitted to journal 13 Sep, 2025 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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Schaffrath","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYBACCSBmZmCQ4wfSbAwfGBKANA8DRBC/FmPJBgZmNsYZJGth5iFGi2T78YefC2oMJMzbzx97bNuWJs/ffvbg4wIGazlcWqR5coylZxwzkJA5k8xunNuWYzjjTF6y8QyGdGNcWuQYcoDuYftTJ8GQzCad21bB2HCDx0yah+FwYgMuLfzPnzHz/DOQkOB/zCZt2VZhP/8Gj/lvoJZ6XFqkJRLMmHnbgFokgLYwtuUkbgDaAgyHwwk4vT/jjbE0bx9Iy2MzyZ5zackbzwB9x2OQbojLFonz6Q8/83wDOSzxmcSPsmTbecfPGH7mqbCWx2ULLmBAqoZRMApGwSgYBcgAAII2SfL3VoHEAAAAAElFTkSuQmCC","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":true,"prefix":"","firstName":"Katharina","middleName":"","lastName":"Schaffrath","suffix":""},{"id":518374684,"identity":"3b44f030-f8cb-493a-9b18-d21236a40bf2","order_by":1,"name":"Mark Ooms","email":"","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"","lastName":"Ooms","suffix":""},{"id":518374685,"identity":"e885b624-7423-4c3f-a6e7-ff169e2db925","order_by":2,"name":"Anna Bock","email":"","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Bock","suffix":""},{"id":518374686,"identity":"4d124562-a80d-41e2-bec4-e3fc9668ac25","order_by":3,"name":"Marie Sophie Katz","email":"","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"Sophie","lastName":"Katz","suffix":""},{"id":518374688,"identity":"834a4cd2-ac2b-40c4-a842-80ca66372b3b","order_by":4,"name":"Frank Hölzle","email":"","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Hölzle","suffix":""},{"id":518374689,"identity":"3bce8c71-38c0-4b3c-9cdd-def3e86c1656","order_by":5,"name":"Ali Modabber","email":"","orcid":"","institution":"University Hospital RWTH Aachen","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Modabber","suffix":""}],"badges":[],"createdAt":"2025-09-08 14:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7565410/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7565410/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08394-y","type":"published","date":"2025-12-10T15:58:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92048414,"identity":"004a0586-c92d-49fc-9396-21844dd6c99b","added_by":"auto","created_at":"2025-09-24 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05:14:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53491,"visible":true,"origin":"","legend":"","description":"","filename":"Supp.1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/a3b2942acd92cd4daaed0e6d.docx"},{"id":92063249,"identity":"ea332ba3-9898-48eb-a036-9d45dcbc4cb6","added_by":"auto","created_at":"2025-09-24 08:37:31","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27977,"visible":true,"origin":"","legend":"","description":"","filename":"Supp.2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/3451b8b8366c42453f16f509.docx"},{"id":92062916,"identity":"28c28e7d-5497-49dd-8d10-490ee62748d3","added_by":"auto","created_at":"2025-09-24 08:35:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":187020,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea \u003c/strong\u003e3D printed model base\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e Wisdom tooth covered with wax\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/2e59676ce56b732c34cbfe2d.png"},{"id":92063157,"identity":"863971db-dd70-4a1e-bf62-e34d19cab79b","added_by":"auto","created_at":"2025-09-24 08:37:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":240594,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e Placed neighboured tooth\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e Inserted wisdom tooth\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/560d0067ce88e726edab34a7.png"},{"id":92048410,"identity":"9f2ea54d-4304-402a-83c9-a2d0c5484bf3","added_by":"auto","created_at":"2025-09-24 05:14:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":240347,"visible":true,"origin":"","legend":"\u003cp\u003eFinished model from buccal and occlusal\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/98d4286fe46328caf193dc4a.png"},{"id":98243876,"identity":"d4f0a8ce-929f-4f05-b7f9-45662efc0fa5","added_by":"auto","created_at":"2025-12-15 16:11:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1701091,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/c28f2947-92b6-4b19-a91d-a3b0c57fe4f3.pdf"},{"id":92063158,"identity":"c233c1db-d21e-4b76-8c4f-ea5e387cb840","added_by":"auto","created_at":"2025-09-24 08:37:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":53491,"visible":true,"origin":"","legend":"","description":"","filename":"Supp.1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/c731a7e192e6d8fd6021b58b.docx"},{"id":92063149,"identity":"76b1a112-cf00-4bb0-a725-5104a1ae6896","added_by":"auto","created_at":"2025-09-24 08:37:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27977,"visible":true,"origin":"","legend":"","description":"","filename":"Supp.2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7565410/v1/23cf36220f72cb4a9935480d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improvement of surgical skills in students using a newly developed 3D printed osteotomy model of a partially retained wisdom tooth","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEvidenced by the rising number of publications, digitalization in dentistry is developing rapidly [1]. More and more practices and clinics own 3-D scanners and printers, as they are used in chairside treatment [2] as well as for operative guides in fully guided implantation [3]. Likewise, dental education has drastically changed in recent years. Especially during the COVID-19 pandemic, teaching formats became more digital. Although students tolerate high levels of digital learning and benefit from online courses according to theoretical lectures [4], dentistry in particular cannot be taught without practical experience because it is more important than the methods of teaching [5]. There is a huge step between undergraduate learning processes and the combination of practical skills and the responsibility of working on a patient as a graduated dentist. Therefore, practical exercises are essential for dentistry students. In addition to the improvement of their manual skills, students gain an understanding of anatomical structures better by practicing in hands-on-courses [6].\u003c/p\u003e\n\u003cp\u003eEven though industrial models (Frasaco GmbH, Tettnang, Germany) and animal models, such as porcine jaws, continue to be used for courses [7], the number of 3-D-printed models is rising. They are used for interactive visual demonstration and operative planning [8] as well as for oral and maxillofacial surgeons who benefit from practicing submental flaps [9] and dysgnathia surgery [10] on phantom models. Antunes et al. developed a 3-D-printed oral surgery flap training model for undergraduates, which is promising for participants as it is realistic and useful for hands-on-training [11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3-D models can be used to allow students to experience caries simulations [12] [13] and complete endodontic requirements such as practicing on the apical region [14], special ledge management [15], and even electronically determining working length [16]. All of these models have received good evaluations from students and participants. The skills for tooth preservation and smaller prosthodontics can be improved using the typodont model [17]. Even pediatric dentistry (pulpotomy and stainless steel pediatric crowns) can be practiced [18], which is quite meaningful considering that pediatric courses are rare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn dental school, oral surgery seems to be underrepresented compared to other subjects, such as prosthodontics, in terms of teaching hours. However, practical phantom learning using 3-D-printed models to practice special oral surgery skills seems to be beneficial for students, teachers, and patients because students might have much more self-confidence and knowledge on their first operation with a real patient. Therefore, the aims of this study were to develop a realistic model for osteotomy that can be used and individually changed by every student, depending on their skill level, and to evaluate students\u0026rsquo; surgical skills at different levels of education using this 3-D-printed model for the removal of a lower wisdom tooth.\u0026nbsp;\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003ePreparation of the osteotomy model\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe designed a prototype of the model using a fully toothed plaster model of the lower jaw. To simulate the ascending course of the jaw, we extended the model with silicone in this region. A hole in the region of teeth 47 to 48 was milled to allow a tooth to be replaced later. Additionally, we milled a hole in the middle of the model to put in a fixation. 3-D scanning was performed using a T710 scanner (MEDIT), which allowed the digital model to be printed as often as needed. 3-D printing was carried out using a formlabs 3 printer with stereolithography (Photopolymer Resin SLA, model V3, formlabs, Somerville, Massachusetts, USA). One model was printed for each student. A nut was set into the bottom of the model with pattern resin (PATTERN RESIN LS, GC Germany) for fixing into a demo patient (Fig.1a).\u003c/p\u003e\n\u003cp\u003eTo evaluate the status of the neighboring tooth, we designed a model of tooth 47 using modeling plastics (PATTERN RESIN LS, GC Germany) in red. We collected original wisdom teeth from patients who provided their teeth for a student training session. For this study, we used teeth with uncomplicated root designs, such as taproots. The disinfected teeth were submerged into pink modeling wax (Gebdi) only on the root side to simulate the periodontal gap (Fig.1b). The crown remained clean. To simulate different levels of difficulty, the thickness of the wax can be changed. One model tooth 47 and one original wisdom tooth were positioned in a single model and fixed with Luxatemp (Luxatemp Star, DMG) simulating the bone (Fig.2a). According to the level of difficulty, more or less of the surrounding bone can be placed. For this study, we designed a bone lamella from the distal side lying half over the occlusal surface of tooth 48 (Fig.2b).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe same angulation was chosen for every model, with the crown lying at an angle of approximately 45\u0026deg; toward tooth 47. The depth depended on the size of the wisdom tooth but always enabled osteotomy, most likely class IIA or IIB, following the classification of Pell and Gregory [19]. To simulate the incision, uncovering, and suture, we used a gingiva mask (millable gum mask silicone, BRIEGELDENTAL) and attached it in a way simulating a partially retained tooth (Fig.3).\u003c/p\u003e\n\u003cp\u003eEvaluation of the model by oral surgeons\u003c/p\u003e\n\u003cp\u003eBefore using the model for students, it was evaluated by five oral surgeons and dentists (OS; n = 5) with at least three years of surgical and teaching experience. All participants answered a questionnaire focusing on structure, realistic feeling, and exercise quality using a 10-point Likert scale.\u003c/p\u003e\n\u003cp\u003eOsteotomy exercise by students\u003c/p\u003e\n\u003cp\u003eFollowing the approval of the ethics committee of RWTH Aachen University (EK 24-370), which did not have any objections regarding data protection or the procedure, the exercise was performed. Informed consent to participate was obtained from all the participants. We compared the level of education of third-year undergraduate students with practical phantom exercise experience but no clinical experience (Group 1: PE; n = 37) to fifth-year undergraduate students who acquired their experience only by assisting oral surgeons, but without phantom exercise experience (Group 2: CE; n = 29). All participating students had theoretical knowledge of wisdom teeth removal from theoretical lectures. During the exercise, the following criteria were evaluated by a dentist on a scale divided into 0 (not fulfilled), 1 (uncertain), 2 (partially fulfilled), and 3 (fulfilled): preparation of working field, demonstration of incision, performing anesthesia, and operation including suture. The maximum number of points was 57. All students answered an evaluation sheet (Supp. 1) after the osteotomy concerning structure, realistic feeling, and the quality of the exercise, followed by a personal evaluation (Supp. 2) focusing on their own skills using a 10-point Likert scale. Both of the evaluation questionnaires were developed for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThirty-seven third-year students in the PE group completed the exercise as part of their preclinical exam. Participation of the CE group was voluntary. All participants who missed more than eight questions (n = 5) or baseline information (n = 1) in the evaluation sheet or indicated that they had clinical experience besides the phantom exercise (n = 6) were excluded (n = 11). In total, 26 students were included in the PE group. In the CE group, all 29 fifth-year participants were included. For all students, this specific osteotomy model was new and unknown.\u003c/p\u003e\n\u003cp\u003eDevelopment of the evaluation sheets\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll evaluation sheets and questionnaires were designed by two dentists of the Clinic for oral and maxillofacial surgery, hospital of RWTH Aachen as part of the dental preliminary medical examination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eData were expressed as numbers (with percentages) for categorial data and as medians (with interquartile range) for metric data. Testing for differences between groups in baseline data was performed using a chi-squared test, the Fisher\u0026ndash;Freeman\u0026ndash;Halton test was used for categorial data, and the Mann\u0026ndash;Whitney test was used for metric data. Testing for differences between groups in evaluation data was performed using the Mann\u0026ndash;Whitney test. Testing for correlation was performed by calculating Spearman correlation coefficients. P-values below 0.05 were considered significant. Statistical analysis was carried out using Excel 2016 (Microsoft, Redmond, USA), GraphPad Prism 10 (GraphPad Software, Boston, USA), and SPSS Version 28 (IBM, New York, USA).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eEvaluation of the osteotomy model by oral surgeons\u003c/p\u003e\n\u003cp\u003eOral surgeons evaluated the gingiva, neighbored tooth, osteotomy tooth, bone, and fixation in terms of structure and realistic feeling. The best results were obtained for teeth and bone, while the worst results were obtained for the gingiva (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Evaluation of the model structure and realistic feeling by oral surgeons\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"416\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRealistic feeling\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGingiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNeighboured tooth \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOsteotomy tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFixation \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData described as median (interquartile range) concerning model structure and realistic feeling for each question separately.\u003c/p\u003e\n\u003cp\u003eThey also evaluated the quality of exercise, finding that it was most suitable for students but was also suitable for residents (Table 2). Nevertheless, a combination of model exercises and clinical experience is valued as the best for preparing participants for patients\u0026rsquo; treatment (10 (5)). Phantom models alone cannot replace clinical experience (3 (6)). For oral surgeons, model osteotomy enables realistic operation simulations in almost every rating point, except for the apical granuloma and incision with medium rating (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Evaluation of the quality of exercise by oral surgeons\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"378\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuality of exercise\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSuitable for residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSuitable for students \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eEnables all operative steps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eSimple and intuitive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eModel replaces clinic experience\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eCombination of model and clinic is best\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eOnly clinical experience eduacates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eModel prepares for clinical treatment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation feels realistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eColoured neighboured tooth gives safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eAscending jaw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eIncision\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eUncovering of the tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePeriodontal gap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eRelaxation of the tooth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eRemoval of the tooth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eApical granuloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData described as median (interquartile range) for each question separately.\u003c/p\u003e\n\u003cp\u003eOsteotomy exercise and evaluation by students\u003c/p\u003e\n\u003cp\u003eConcerning baseline information, there was a significant difference between the groups in age (PE: median = 22 (2), CE: median: 24 (7); p = 0.001) but not in sex (PE: m = 10, f = 16; CE: m = 7, f = 22, p = 0.381). During the analysis of the exercise results, the CE group achieved better results in preparing their working field in terms of mirror, probe, and tweezers (PE: 3 (0), CE: 3 (1); p = 0.033) and pliers and clamps (PE: 2 (2), CE: 3 (0); p = 0.001), while the PE group had better results in terms of respiratory (PE: 3 (1), CE: 3 (0); p = 0.015) (Table 3). Nevertheless, both groups showed good performance in preparing their working field. Regarding the incision, the PE group showed significantly better results, especially in drawing the marginal course (PE: 3 (0), CE: 3 (1); p = 0.006) and mesial discharge (PE: 3 (0), CE: 2 (2); p = 0.001) (Table 3). Both groups were able to save the lingual nerve (PE: 3 (0), CE: 3 (1); p = 0.613). Concerning other clinical steps like performing anesthesia (PE: 3 (1), CE: 3 (0); p = 0.008), uncovering of the tooth (PE: 3 (1), CE: 3 (0); p = 0.002), and removal of the tooth (PE: 3 (0), CE: 3 (0); p = 0.007) CE group performed better (Table 3), while values of the curettage of the apical granuloma were higher in the PE group (PE: 3 (0), CE: 3 (1); p = 0.026). However, the total score was equal between the groups (PE: 52 (4), CE: 54 (5); p = 0.131) (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Students exercise results\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudents exercise results\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreparation working field\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eMirror, probe, tweezers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eSyringe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eScalpel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eRasparatory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eDrill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eLever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003ePliers and clamps\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eSharp spoon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eNeedle holder and stitch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemonstration of Incision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eDrawing marginal incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eProtection of the lingual nerve (buccal direction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eMesial discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePerforming anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePreparation of operation field\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eUncovering the tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eRemoval of the tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eSound neighboring tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eCurettage of apical granuloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eSuture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 333px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e52 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e54 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 333px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons.\u003c/p\u003e\n\u003cp\u003eIn general, the model was evaluated with good results but was evaluated better by the CE group in terms of model structure (PE: 7.5 (3.3), CE: 10 (2); p = 0.001). All students indicated that the gingiva mask was not adequate (Table 4) because it often tears.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eEvaluation of the model by students\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvaluation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eModel structure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eGingiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eNeighboured tooth \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eOsteotomy tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eBone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8,5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eFixation \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cem\u003eTotal (model structure)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003e7,5 (3,3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003e10 (2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRealistic feeling\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eGingiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eNeighboured tooth \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eOsteotomy tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eBone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,311\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cem\u003eTotal (realistic feeling)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003e7,5 (3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003e8 (3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,324\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBy perceiving I feel prepared for clinical practice:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eAscending jaw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,233\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003ePeriodontal gap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5,5 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eRelaxation of the tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eApical granuloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eIncision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7,5 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eUncovering of the tooth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7,5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eColoured neighboured tooth gives safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,437\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cem\u003eTotal (preparation for clinic)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003e7 (2,5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003e8 (3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,305\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons; Total build as a median of its section.\u003c/p\u003e\n\u003cp\u003eIn general, all students thought that the model was suitable for increasing the experience of students and residents. All participants (PE: 8.5 (3), CE: 10 (1) and OS: 10 (5)) agreed that the combination of practicing on the model with clinical experience is the best option to prepare for daily practice (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e What students think, the model is suitable for\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvaluation by students\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWhat I think about the model\u0026hellip;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSuitable for residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6,5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSuitable for students \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7,5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eModel replaces clinic experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2,5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,931\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eCombination of the model and clinic is best\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8,5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eOnly clinical experience eduacates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eEnables all operative steps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4,5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSimple and intuitive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7,5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eLevel of difficulty fits to my level of knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eModel prepares for clinical treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSkills can be improved by the model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0,021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData described as median (with interquartile range) for each question separately for groups (PE vs. CE); p-value corresponding to testing for differences between groups with Mann Whitney test; abbreviations: PE: students with practical experience on phantom exercise, CE: students without practical experience, experience acquired by assisting oral surgeons.\u003c/p\u003e\n\u003cp\u003eTo avoid any falsification of the results, we excluded a correlation between the exercise results (total score) and the total evaluation values of model structure (PE: ɸ = 0.280 (0.165), CE ɸ = 0.257 (0.179)), realistic feeling (PE: ɸ = 0.222 (0.275), CE: ɸ = 0.346 (0.066)), and preparation for clinic (PE: ɸ = 0.241 (0.237), CE: ɸ = 0.160 (0.407)).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe evaluation of the model was an important step in giving students the opportunity to practice and pass their preclinical exam. Therefore, one limitation of this study is that the PE group did the exercise as a real exam, while the CE group participated voluntarily. To reduce bias, we chose evaluation sheets strictly and excluded those that were not fulfilled ordinary. Another limitation of this study is that the evaluation sheets were not validated. Moreover, not every model is exactly the same due to variations in the roots and sizes of the original wisdom teeth. Against this background, the level of difficulty can differ. However, the students particularly liked that they had to remove a real tooth, as it makes the exercise more realistic. Actually, it is an advantage of the model that it can be used individually, as it matches personal requirements, as shown by Arroyo-Bote et al. [17]. In future exercises, students should be able to choose the teeth, design the expression of the periodontal gap, or try different tooth positions according to skill level. Just as Reymus et al. concluded from their study, 3-D printing technology offers new possibilities for dental schools to create their own customized teaching models according to the specific curricula [20]. In our case, the base of the models can be recycled and can be filled with a new tooth as another advantage. Additionally, the simple and fast production and reproduction are important arguments for students who already pay a lot of money for materials and instruments. Nevertheless, students and oral surgeons criticized the quality of the gingiva mask, as reported by Hanisch et al. [21]. This could be a hint to develop printable gingiva. Feng et al. reported that their gingiva mask is often describes as too fragile [22]. That met out oberservation as it was possible to perform sutures on the model, but the material used for the gingiva mask torn often. Students and oral surgeons evaluated it as not flexible enough. Factors that are also missing from the model are the periosteum and the inferior alveolar nerve. In future developments, these factors should be improved to provide a more realistic feeling. To complete the realistic experience, the possibility of X-rays, which is not possible yet, could be discussed. If future developments include nerves, the use of X-rays will be particularly important for diagnostic and positional relationships to the roots.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe found that students without phantom experience (only knowledge from theoretical lectures and experience assisting oral surgeons) chose significant other incision than those with phantom experience. Although they were able to save the lingual nerve through incision in a vestibular direction, they often did not extend it to tooth 47 or even tooth 46; instead, they put the discharge directly in region 48. Therefore, there remains the suspicion that there is not enough sight by assisting oral surgeons. Often, the working field is confusing due to saliva, blood, a moving tongue, and a reduced mouth opening, even for the surgeon. Because of these factors, teaching is even more difficult. Additionally, students are busy with suction and holding the tongue, so they cannot concentrate on the details of the operation. Although Peters et al. demonstrated that the number of practical exercises (in their case, surgical sutures) is a good determinant of competence improvement [23], Bock et al. showed that structured feedback has a major impact on improvement [24], which is simply not possible when students do not perform the operation themselves. Kulasegaram et al. stated that allowing learners to experiment before interacting with an instructor can improve their learning skills [25]. Against this background, it may be beneficial to allow students to discover their skills on a model before assisting oral surgeons in operations on real patients and to experience operating by themselves so they can benefit more while assisting.\u003c/p\u003e\n\u003cp\u003eHattar et al. stated that the enhancement of students\u0026rsquo; clinical skills and directed exposure is necessary to raise the level of perceived confidence, which will improve their current and future professional performance [26]. This is supported in our study by the assessment of oral surgeons and students at each level of experience, as they all agree that a combination of phantom and clinical experience is the best preparation for future daily practice as dentists. However, the evaluation showed that a model cannot replace clinical experience. Gaballah et al. found that one of the main reasons for a perceived lack of confidence is limited clinical exposure [27].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDobros et al. noted that the participants in the studies under review thoroughly recommend introducing 3-D models into hands-on practice [28]. This matches our recommendations, as students and oral surgeons gave positive feedback\u0026mdash;Fifth-year students who haven\u0026rsquo;t had the opportunity to use phantom models before evaluated even better than third-year students.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe osteotomy model is suitable for hands-on courses for dental students, but the gingiva mask must be improved in future developments. Fifth-year students without phantom experience would have liked to practice on this 3-D model, as it is now established in dental school. Although phantom exercise can improve surgical skills and confidence, it cannot replace clinical experience.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOS: Oral surgeons and dentists with at least three years of clinical experience who evaluated the osteotomy model\u003c/p\u003e\n\u003cp\u003ePE: Third-year dental students with practical experience through phantom exercises\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCE: Fifth-year dental students without practical or phantom experience, experience acquired by assisting oral surgeons only\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katharina Schaffrath, Anna Bock, Marie Sophie Katz and Ali Modabber. Katharina Schaffrath and Mark Ooms performed the statistical analysis. The first draft of the manuscript was written by Katharina Schaffrath and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding to report. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflict of interest. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire and methodology for this study was approved by the Ethics committee of the University of RWTH Aachen University (EK 24-370). The authors confirm that the study was performed in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eInformed consent to participate was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the students and colleagues who participated in the study. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOberoi, G., et al., \u003cem\u003e3D Printing-Encompassing the Facets of Dentistry.\u003c/em\u003e Front Bioeng Biotechnol, 2018. \u003cstrong\u003e6\u003c/strong\u003e: p. 172.\u003c/li\u003e\n\u003cli\u003eWaltenberger, L., et al., \u003cem\u003eEffect of immediate all-digital restoration of single posterior implants: The SafetyCrown concept on patient-reported outcome measures, accuracy, and treatment time-A randomized clinical trial.\u003c/em\u003e Clin Implant Dent Relat Res, 2024. \u003cstrong\u003e26\u003c/strong\u003e(6): p. 1135-1148.\u003c/li\u003e\n\u003cli\u003eMohlhenrich, S.C., et al., \u003cem\u003eEffects on primary stability of three different techniques for implant site preparation in synthetic bone models of different densities.\u003c/em\u003e Br J Oral Maxillofac Surg, 2016. \u003cstrong\u003e54\u003c/strong\u003e(9): p. 980-986.\u003c/li\u003e\n\u003cli\u003eBock, A., et al., \u003cem\u003eOne year of COVID-19 pandemic: a cross sectional study on teaching oral and maxillofacial surgery.\u003c/em\u003e Head Face Med, 2021. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 51.\u003c/li\u003e\n\u003cli\u003eMontero, J., et al., \u003cem\u003eDental Students\u0026apos; Perceived Clinical Competence in Prosthodontics: Comparison of Traditional and Problem-Based Learning Methodologies.\u003c/em\u003e J Dent Educ, 2018. \u003cstrong\u003e82\u003c/strong\u003e(2): p. 152-162.\u003c/li\u003e\n\u003cli\u003eBock, A., et al., \u003cem\u003eImprovement of anatomical knowledge and surgical skills in head and neck region - An interdisciplinary hands-on course for clinical students.\u003c/em\u003e Ann Anat, 2019. \u003cstrong\u003e224\u003c/strong\u003e: p. 97-101.\u003c/li\u003e\n\u003cli\u003eKniha, K., et al., \u003cem\u003eGuided discovery learning: A follow-up study of try-it-yourself surgery and subsequent video-assisted teaching for oral surgical skills training.\u003c/em\u003e Eur J Dent Educ, 2023. \u003cstrong\u003e27\u003c/strong\u003e(1): p. 29-35.\u003c/li\u003e\n\u003cli\u003eHaribabu, P.K., M. Verma, and A. Vij, \u003cem\u003eModel-assisted marsupialization of a large odontogenic keratocyst in the maxillofacial region using a multicolored 3D-printed model: A novel approach in surgical planning and teaching.\u003c/em\u003e Clin Case Rep, 2023. \u003cstrong\u003e11\u003c/strong\u003e(5): p. e7286.\u003c/li\u003e\n\u003cli\u003eTahami, H., et al., \u003cem\u003eDevelopment and evaluation of a surgical 3D simulation model on submental flap surgery training.\u003c/em\u003e J Dent Educ, 2024. \u003cstrong\u003e88\u003c/strong\u003e(12): p. 1601-1608.\u003c/li\u003e\n\u003cli\u003eYoshida, S., et al., \u003cem\u003eOsteotomy training for dental students using three-dimensional simulation software and maxillofacial three-dimensional-printed models.\u003c/em\u003e J Dent Educ, 2022. \u003cstrong\u003e86\u003c/strong\u003e(5): p. 526-534.\u003c/li\u003e\n\u003cli\u003eAntunes, D., et al., \u003cem\u003e3D-printed model for gingival flap surgery simulation: Development and pilot test.\u003c/em\u003e Eur J Dent Educ, 2024. \u003cstrong\u003e28\u003c/strong\u003e(2): p. 698-706.\u003c/li\u003e\n\u003cli\u003eBallester, B., et al., \u003cem\u003eEvaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal.\u003c/em\u003e Eur J Dent Educ, 2024. \u003cstrong\u003e28\u003c/strong\u003e(1): p. 161-169.\u003c/li\u003e\n\u003cli\u003eCarnier, L., et al., \u003cem\u003e3D-printed tooth for caries excavation.\u003c/em\u003e BMC Med Educ, 2024. \u003cstrong\u003e24\u003c/strong\u003e(1): p. 1243.\u003c/li\u003e\n\u003cli\u003eZou, H., et al., \u003cem\u003eThree-dimensional printed apical barrier model technology for pre-clinical dental education.\u003c/em\u003e Technol Health Care, 2025. \u003cstrong\u003e33\u003c/strong\u003e(1): p. 659-669.\u003c/li\u003e\n\u003cli\u003eZhang, R., et al., \u003cem\u003eThree-Dimensional Printed Tooth Model with Root Canal Ledge: A Novel Educational Tool for Endodontic Training.\u003c/em\u003e Dent J (Basel), 2023. \u003cstrong\u003e11\u003c/strong\u003e(9).\u003c/li\u003e\n\u003cli\u003eWolgin, M., et al., \u003cem\u003eDevelopment and Evaluation of an Endodontic Simulation Model for Dental Students.\u003c/em\u003e J Dent Educ, 2015. \u003cstrong\u003e79\u003c/strong\u003e(11): p. 1363-72.\u003c/li\u003e\n\u003cli\u003eArroyo-Bote, S., et al., \u003cem\u003eDevelopment of a three-dimensional printed model from a digital impression of a real patient for aesthetic dentistry undergraduate teaching.\u003c/em\u003e J Dent Educ, 2024. \u003cstrong\u003e88\u003c/strong\u003e(8): p. 1144-1158.\u003c/li\u003e\n\u003cli\u003eMarty, M., et al., \u003cem\u003eComparison of student\u0026apos;s perceptions between 3D printed models versus series models in paediatric dentistry hands-on session.\u003c/em\u003e Eur J Dent Educ, 2019. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 68-72.\u003c/li\u003e\n\u003cli\u003ePell, G. and B. Gregory, \u003cem\u003eImpacted mandibular third molars: classification and modified techniques for removal.\u003c/em\u003e 1933.\u003c/li\u003e\n\u003cli\u003eReymus, M., et al., \u003cem\u003eDevelopment and evaluation of an interdisciplinary teaching model via 3D printing.\u003c/em\u003e Clin Exp Dent Res, 2021. \u003cstrong\u003e7\u003c/strong\u003e(1): p. 3-10.\u003c/li\u003e\n\u003cli\u003eHanisch, M., et al., \u003cem\u003e3D-printed Surgical Training Model Based on Real Patient Situations for Dental Education.\u003c/em\u003e Int J Environ Res Public Health, 2020. \u003cstrong\u003e17\u003c/strong\u003e(8).\u003c/li\u003e\n\u003cli\u003eFeng, J., et al., \u003cem\u003eThree-dimensional printed model of impacted third molar for surgical extraction training.\u003c/em\u003e J Dent Educ, 2021.\u003c/li\u003e\n\u003cli\u003ePeters, P., et al., \u003cem\u003eEffect of head-mounted displays on students\u0026apos; acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: a randomized controlled trial.\u003c/em\u003e Int J Surg, 2023. \u003cstrong\u003e109\u003c/strong\u003e(8): p. 2228-2240.\u003c/li\u003e\n\u003cli\u003eBock, A., et al., \u003cem\u003eIntroduction of mini-clinical evaluation exercise in teaching dental radiology-A pilot study.\u003c/em\u003e Eur J Dent Educ, 2020. \u003cstrong\u003e24\u003c/strong\u003e(4): p. 695-705.\u003c/li\u003e\n\u003cli\u003eKulasegaram, K., et al., \u003cem\u003eDo One Then See One: Sequencing Discovery Learning and Direct Instruction for Simulation-Based Technical Skills Training.\u003c/em\u003e Acad Med, 2018. \u003cstrong\u003e93\u003c/strong\u003e(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 57th Annual Research in Medical Education Sessions): p. S37-S44.\u003c/li\u003e\n\u003cli\u003eHattar, S., et al., \u003cem\u003eDental students\u0026apos; experience and perceived confidence level in different restorative procedures.\u003c/em\u003e Eur J Dent Educ, 2021. \u003cstrong\u003e25\u003c/strong\u003e(1): p. 207-214.\u003c/li\u003e\n\u003cli\u003eGaballah, K., et al., \u003cem\u003ePerceived confidence of dental students and new graduates in performing tooth extractions-An exploratory study.\u003c/em\u003e Eur J Dent Educ, 2024. \u003cstrong\u003e28\u003c/strong\u003e(1): p. 191-205.\u003c/li\u003e\n\u003cli\u003eDobros, K., J. Hajto-Bryk, and J. Zarzecka, \u003cem\u003eApplication of 3D-printed teeth models in teaching dentistry students: A scoping review.\u003c/em\u003e Eur J Dent Educ, 2023. \u003cstrong\u003e27\u003c/strong\u003e(1): p. 126-134.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"dental student, osteotomy, model, wisdom tooth, oral surgery, 3-D print","lastPublishedDoi":"10.21203/rs.3.rs-7565410/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7565410/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives \u003c/strong\u003eAgainst the background of digitalization, practicing on 3-D models for dental education has become more important. To improve the surgical skills of dental students, this study aimed to develop a 3-D-printed model for osteotomy of a partially retained lower wisdom tooth and evaluate surgical skills of students with practical experience acquired through phantom exercises compared to students who acquired experience only by assisting oral surgeons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e We developed a 3-D model that allows dental students to perform an osteotomy of a partially retained real wisdom tooth in region 48. The model was evaluated by oral surgeons (OS; n = 5), students with phantom experience (PE; n = 26), and students with experience with clinical assistance (CE; n = 29). Additionally, student performance was rated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe OS, PE, and CE groups all evaluated the model as suitable for student courses, except for the gingiva mask. The CE group developed slightly better. In the exercise, the PE group showed better incision results, while the CE group was slightly better in the preparation of the working field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThe osteotomy model is suitable for hands-on courses for dental students, but the gingiva should be improved. However, phantom exercise cannot replace clinical experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance\u003c/strong\u003e To improve education, knowledge and self confidence of students in dental school.\u003c/p\u003e","manuscriptTitle":"Improvement of surgical skills in students using a newly developed 3D printed osteotomy model of a partially retained wisdom tooth","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 05:13:57","doi":"10.21203/rs.3.rs-7565410/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-03T09:44:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-26T18:08:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2944751683312904132149516878903608114","date":"2025-09-21T23:41:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-21T18:21:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333443261689230291327128036345773168767","date":"2025-09-21T11:02:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-19T10:11:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285902203430932254714256899422710203728","date":"2025-09-18T09:25:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300340523245080057772575233357492016613","date":"2025-09-16T06:20:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149606676981510034767687423035055685158","date":"2025-09-15T18:05:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-15T14:58:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-15T14:51:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-15T08:41:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-13T11:40:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-13T11:39:11+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":"7b955566-8ddd-4413-ab54-11dfb49e0788","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:03:08+00:00","versionOfRecord":{"articleIdentity":"rs-7565410","link":"https://doi.org/10.1186/s12909-025-08394-y","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-10 15:58:15","publishedOnDateReadable":"December 10th, 2025"},"versionCreatedAt":"2025-09-24 05:13:57","video":"","vorDoi":"10.1186/s12909-025-08394-y","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08394-y","workflowStages":[]},"version":"v1","identity":"rs-7565410","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7565410","identity":"rs-7565410","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}