3D‑Printed Training Model for Periodontal Splinting: A Randomized Preclinical Study

3D‑Printed Training Model for Periodontal Splinting: A Randomized Preclinical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article 3D‑Printed Training Model for Periodontal Splinting: A Randomized Preclinical Study Christian Höhne, Sören Rehling, Johannes Schrenker, Yvonne Jockel-Schneider, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8786911/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract For students it is essential to practice before clinical treatment with preclinical simulation. We designed 3D-printed wobbly teeth to train periodontal splinting and evaluate their educational benefits and objective performance. 43 students in their fourth year completed two palatal slot splints from 13 to 23 in a randomized order using a polyethylene ribbon and a pre-impregnated unidirectional glass-fibre bundle. Outcomes were evaluated by a questionnaire with german school grades and geometric deviation of each tooth to an ideal position. The course was rated “good” overall and “highly clinically relevant”. Self-efficacy improved during the course from “insufficient” to “good”. Median deviations of correct positioning ranged from 0.3 to 0.7mm across teeth. Non-parametric test with Bonferroni correction showed no significant pairwise differences between materials, first and second attempt or tooth position. This inexpensive, reproducible printed model enabled realistic periodontal splinting and improved confidence. Accuracy did not differ between both splinting systems in novice hands. Health sciences/Health care Health sciences/Medical research 3D printing additive manufacturing dental education periodontal splinting fibre‑reinforced composite Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Simulation using physical models enhances didactic instruction. It offers safe and repeatable practice of procedural steps before real patient treatment. Additive manufacturing has expanded dental simulation beyond typodonts. It enables the production of accurate models with realistic anatomy, surface quality and mechanical behaviour at low cost. Training models can be fabricated to specific learning situations. Across all dental disciplines - prosthodontics, endodontics, orthodontics, and oral surgery - in the last years 3D-printed teaching models have been developed to demonstrate and teach complex workflows [ 1 – 7 ]. However, periodontal practical training remains underrepresented despite its clinical relevance, especially stabilizing mobile teeth with periodontal splinting. The main reason for a splint is to distribute forces across multiple teeth to reduce pathological mobility [ 8 , 9 ]. The main utilized contemporary chairside approaches use fibre-reinforced composited (FRCs) made from polyethylene ribbons or pre-impregnated glass-fibre bundles [ 10 – 12 ]. After some minimal preparation they are bonded into a shallow palatal channel and covered with composite. Improved patient comfort and mobility reduction are reported, but the technique is sensitive. We developed maxillary anterior wobbly teeth to reproduce displacement and mobility and evaluated the model under preclinical conditions with students. They performed two splints in randomized material order. The hypotheses were that (1) students evaluate the model as realistic and the training as clinically relevant; (2) handling of the polyethylene ribbon would be rated better than the glass-fibre bundle; (3) second attempt would improve geometric accuracy. Methods Study Design and Setting A total of 43 fourth-year dental students (24 women and 19 men; mean age 25) with prior phantom-head experience in their first clinical prosthodontics course participated in a voluntary hands-on training course. Each student completed two splints in randomised material order divided into two weeks. They were randomly assigned to start with either polyethylene ribbon (Ribbond Ultra, Ribbond Inc., Seattle, Washington) or pre-impregnated unidirectional glass-fibre bundles (everStickPERIO, GC Germany GmbH, Bad Homburg, Deutschland). CAD Design and 3D-Printing of Training Teeth We developed a printable set of maxillary anterior wobbly teeth from 13 to 23 (Fig. 1a). They reproduce displacement and mobility from natural teeth. For this effect the base and retention geometry was modified (Fig. 1b). They were constructed to fit into a standard dental study model (KaVo, Biberach an der Riß, Germany) for universal usage not only at a single institution. Teeth 13 and 23 were not modified to be stable for the splint like often seen in patients. For the production process the models were nested closely and printed on a Form 2 3D printer (Formlabs Inc., Somerville, MA, USA) (Fig. 1c). White photopolymer resin was used for printing (RS-F2-GPWH-04, Formlabs Inc.). After printing, the teeth were post-processed according to the manufacturer guidelines. This includes cleaning with isopropanol (Form Wash, Formlabs Inc.), UV curing (Form Cure, Formlabs Inc.) and manual removing of support structures. Figure 1. The 3D model after the repositioning of the anterior teeth (a); the finished construction of the printed teeth (b); the anterior teeth prepared for printing with included supports (c). Training Protocol The printed teeth were fitted into the standard dental study model (Fig. 2a). Then the teeth were manually repositioned to approximate the ideal arch and verified by testing the occlusion (Fig. 2b). A palatal channel with approximately 1.5mm depth and width was prepared from 12–22 and slightly extended to the canines. For realistic practice enamel etching (35% phosphoric acid, Ultradent, Brunnthal, Germany) (Fig. 2c) and adhesive were applied (OptiBond FL, Kerr, Orange, CA, USA), followed by a thin layer of flowable composite (Filtek Flowable Composite, 3M ESPE, St. Paul, MN, USA) (Fig. 2d). One of the two splint materials was adapted to the channel length and embedded into it (Fig. 2e). After this the splint was fully covered with flowable composite, light-cured, finished and polished (Fig. 2f). Questionnaire After the second course students completed an electronic questionnaire (EvaSys GmbH, Lüneburg, Germany). This includes questions about realism, handling, learning and relevance, plus free-text questions about material preference and course organisation (Table 1). Similar questionnaires have been used before by students to evaluate other studies with printed teeth [13]. The questionnaire was adapted to the present study. The evaluation was based on German school grades and closed-format rating scale questions (1 = Excellent, 2 = Good, 3 = Satisfactory, 4 = Adequate, 5 = Poor, 6 = Unsatisfactory). For visualization purposes, the mean grade and standard deviation were calculated and the results of the distribution of grades were displayed in a bar chart and shown in percentage (Fig. 3). 1. Personal Data 1.1. Please enter your gender 1.2. Please enter your age 2. Handling of the printed teeth 2.1. How realistic was the tooth loosening? 2.2. How realistic was the repositioning into the dental arch? 3. Splinting of the printed teeth 3.1. Please evaluate the splinting exercise. 3.2. Evaluate the handling of “everStickPERIO”. 3.3. Evaluate the handling of “Ribbond Ultra”. 4. Evaluation of the learning process Rate your preparation to perform a periodontal splint on a patient … 4.1. … before the course. 4.2. … after the course. 4.3. Evaluate the learning effect of this course. 4.4. Evaluate the practical relevance of this exercise. 4.5. Do you prefer to use “everStickPERIO”. 4.6. Do you prefer to use “Ribbond Ultra”. 5. Free text questions 5.1. What advantages do you see in this exercise? 5.2. What could be improved in this excercise? 5.3. Your opinion about the usage of “everStickPERIO”. 5.4. Your opinion about the usage of “Ribbond Ultra”. Table 1. The questionnaire for the evaluation of the course. 3D Scanning and Analysis A total of 86 models and one reference model were scanned with an inEos X5 (Dentsply Sirona, Bensheim, Germany) dental laboratory scanner. STL meshes were generated and aligned with GOM Inspect (GOM, Braunschweig, Germany) (Fig. 4a). This was done by initial coarse alignment on posterior teeth followed by local best-fit (Fig. 4b). To the CAD of the posterior teeth 12–22 6mm spheres were added to the incisal edges for reproducible centers for distance measurements (Fig. 4c). In the spheres is also a rectangular face with three semicircular recesses embedded. This was for analyzing rotation, angle and movement differences (Fig. 4d). Statistical Analysis All data was analyzed using SPSS (Version 26; IBM Corp., Armonk, NY, USA). Several groups were not normally distributed, confirmed by Kolmogorov-Smirnov test. Overall differences were analysed by Kruskal-Wallis test and logical pairs with Mann-Whitney U test (e.g. same tooth and attempt across materials, and same material across attempts). No formal a priori power calculation was performed; as an educational evaluation, the cohort size was determined by the class size. Results Questionnaire outcomes The results are described descriptive and important results are mentioned here. The realism of mobility and repositioning were both “satisfactory” (Fig. 3.2.1: Ø 2.5 ± 0.8 and 3.2.2: Ø 2.5 ± 1.0). The course was rated “good” overall (Fig. 3.3.1: Ø 1.8 ± 0.7). Material handling was only slightly but not significantly different for questions 3.3.2 vs. 3.3.3 (p = .11) and 3.4.5 vs. 3.4.6 (p = .38). Ribbond Ultra was rated “good” (Fig. 3.3.3: Ø 2.4 ± 0.9) and everStickPERIO was “satisfactory” (Fig. 3.3.2: Ø 2.7 ± 0.9). A substantial learning gain was reported by the students. Self-efficacy for doing a splint improved from “poor” (Fig. 3.4.1: Ø 4.6 ± 1.1) to a post‑course “good” (Fig. 3.4.2: Ø 2.3 ± 0.6). Also, the clinical relevance was rated highly (Fig. 3.4.4: Ø 1.5 ± 0.7). There was also no clear favorite for clinical usage, 23 preferred Ribbond Ultra and 18 everStickPERIO and 2 found them equal. For both materials the handling was criticized for different reasons but also positively evaluated by other students. For details see the free-text analysis. Free‑text Analysis The results of the free-text questions were analysed (Table 1. 5.1-4). Similar answers were grouped and counted. Advantages of the exercise realistic challenge of repositioning (n = 25) script and video material (n = 12) comparison of both materials (n = 6) good staff support (n = 6) using real material (n = 5) positive learning effect between sessions (n = 2) Overall, two participants did not fill out question 5.1, resulting in a participation rate of 95.3%. Improvements for the exercise realism of the exercise (n = 3) no improvements needed (n = 2) degree of loosening is unrealistic (n = 2) occlusion in the phantom head not ideal (n = 2) more time for a discussion of the results (n = 2) Overall, 15 participants did not fill out question 5.2, resulting in a participation rate of 65.1%. Opinions about everStickPERIO better handling and adaptation to the tooth (n = 18) difficult handling and adaptation into the prepared groove (n = 13). considered as too thick (n = 5) splinting was faster (n = 4) and easier (n = 2) too rigid/stiff (n = 3) or too sticky (n = 2) more stable and resistant (n = 3) Overall, 6 participants did not fill out question 5.3, resulting in a participation rate of 86.0%. Opinions about Ribbond Ultra better handling, positioning and adaptation (n = 20) poorer handling, more difficult adaptation to the tooth (n = 13) material - and thus the splint - was thinner (n = 7) material was more flexible (n = 3) processing time was shorter or too short (n = 3) fiber-like consistency was criticized (n = 2) material was partially exposed during splint finishing (n = 2) better adhesion to the tooth or in the prepared groove (n = 2) Overall, 5 participants did not fill out question 5.4, resulting in a participation rate of 88.4%. Geometric Accuracy The range for deviation of median distances for incisal-sphere centres (Fig. 4 d) was 0.34 to 0.68mm across teeth and sessions. At the first attempt with Ribbond Ultra was 0.48 mm deviation measurable with a range from 0.25–1.10 mm and for the second 0.50mm (0.24–1.56 mm). everStickPERIO had a deviation of 0.62 mm (0.24–1.56) and for the second attempt 0.51 mm (0.31–1.37). Statistical screening revealed that Kolmogorov-Smirnov test indicates some not normally distributed groups. Because of this non-parametric test was used. With Kruskal-Wallis test differences across subgroups were identified. The subgroups consisted of different teeth. Pairwise Mann-Whitney U test found no significant differences regarding materials or first to second session. Tooth 21 had the largest tendency for deviation. This is in accordance with the initial larger displacement. Discussion In the questionnaire and geometric analysis were no material-dependent differences found. This indicates that for beginners’ success is more influenced by fundamental procedural handling basics, which are tooth repositioning, moisture control and composite coverage of the FRC system. This is in common with reports that polyethylene ribbon and glass fibres can produce durable splints when correctly handled [ 8 – 12 , 14 ]. Under clinical conditions, long-term durability is affected by fibre architecture, impregnation quality, and composite coverage. Early performance is influenced mostly by user-dependent factors [ 15 ]. The students as novice beginners showed no accuracy differences between both FRC systems, but a small subjective handling gap was there. Ribbond Ultra was rated “good” and everStickPERIO “satisfactory”. This suggests that a small advantage is there for thinner and more adaptable ribbon in tight palatal channels. This was also mentioned in the free text questions by better handling, positioning and adaptation (n = 20). Students reported a clear confidence level after the training in splinting technique. This aligns with other simulation studies where enhanced confidence and reduced anxiety before patient treatment was reported [ 16 – 23 ]. Our findings are congruent to competency‑based education principles. Structured practice and more challenging tasks support new skill acquisition. Self-assessment was promoted with the questionnaire, scanning and derived feedback [ 24 , 25 ]. The two training sessions were not enough to detect a significant learning effect. The consolidation phase of the learning curve was not completed. It can be assumed that additional sessions across weeks could enhance the consolidation and lead to measurable performance gains [ 26 , 27 ]. The found largest tendency for deviation at tooth 21 shows that a variety of different difficulties can be generated in the future. Example for these are milder displacements, then a progression to greater rotation or elasticity. Geometric accuracy was measured as distances between incisal-sphere centres of students against reference teeth. This method offers robustness against local mesh artefacts and variability in landmarking by operators. By this approach differences are collapsed into a single value and angular misalignment is under-represented. Educational Implications The integration of this splinting exercise into clinical and preclinical curricula offers a structured opportunity to practice splinting with or without assistance, train with different materials and handling. The production cost of approximately 0.20 € including resin, consumables and work times are very low per tooth. This makes it easy to perform repeated practice without financial pressure on students or institutions. Printing 31 six‑tooth sets at once in approximately 11 h 33 m makes it possible to produce course‑scale numbers on a single desktop printer (Form 2, Formlabs Inc.). Depending on the print technology with the fastest desktop printers this can be drastically reduced. For example, with a Form 4 3D printer (Formlabs Inc.) 28 six‑tooth sets can be printed in only 2 hours. This new 3D-printed model is an effective training method before clinical patient treatment. Future work should focus on expanding cohort sizes and incorporate more 3D metrics (e.g. angular deviations). Also, assisted versus unassisted workflows should be compared in regard to self-assessment and performance. While the here performed metrics have a focus on the arch conformity, clinical outcomes also rely on patient-specific factors like periodontal stability, occlusion, hygienical aspects and splint maintenance. Conclusion This preclinical evaluation shows that an inexpensive printed “wobbly tooth” model is a realistic, reproducible tool for training periodontal splinting. Students gained self-efficacy and rated the model as highly clinically relevant. 3D measurement of the models showed no significant differences between polyethylene ribbons and pre-impregnated glass-fibre bundles used by beginners. Declarations Ethics approval and consent to participate The study and the experimental protocol were approved by the Institutional Review Board of the University of Würzburg (2026-2-ka). All students that participated in the voluntary course were thoroughly informed and no personal data was collected. An informed consent to participate was obtained from all of the participants in the study. All methods were performed in accordance with the named guidelines, regulations and Declaration of Helsinki. Competing interests The authors declare no competing interests. Funding The authors received no funding for this work. Author Contribution Christian Höhne: Conceptualization, Methodology, Data curation, Formal analysis, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing; Sören Rehling: Investigation, Formal analysis, Data curation, Validation, Visualization, Writing - review & editing; Johannes Schrenker: Methodology, Validation, Writing - review & editing; Yvonne Jockel-Schneider: Project administration, Resources, Supervision, Validation, Writing - review & editing; Gabriel Krastl: Project administration, Resources, Supervision, Validation, Writing - review & editing; Marc Schmitter: Project administration, Resources, Supervision, Validation, Writing - review & editing. Acknowledgements We thank all participants and the teaching staff who supported logistics and scanning. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8786911","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":592766075,"identity":"4ca3e5e8-506c-4a58-9adc-5cbae0db5d08","order_by":0,"name":"Christian Höhne","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACAwYGNjCDH0yzkaJFsoFkLQYHiNVizt587HFBBYO88Y20NAmGMhvCWix7jqUbzzjDYLjtRtoxCYZzaUQ47EaOmTRvG0OC2Y30thuMbYeJ0ZL/TZr3H0OC8Qywlv9E2cImzdvAkGAgkXYMqOUAEVrOHDOT5jnGYDjjzLP0HwnnkonQcrz5mTRPDYM8f3uascGHMjvCWqAA6oUEojWMglEwCkbBKMALAAtrNPjiFv+pAAAAAElFTkSuQmCC","orcid":"","institution":"University of Würzburg","correspondingAuthor":true,"prefix":"","firstName":"Christian","middleName":"","lastName":"Höhne","suffix":""},{"id":592766078,"identity":"5b7ae204-751a-4b7a-8a80-5a1fab9af7c1","order_by":1,"name":"Sören Rehling","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Sören","middleName":"","lastName":"Rehling","suffix":""},{"id":592766079,"identity":"cbd14ac3-5201-4bca-9bbb-0da6b1029b04","order_by":2,"name":"Johannes Schrenker","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Schrenker","suffix":""},{"id":592766083,"identity":"0bcd3ce0-f27e-4116-bc62-3fb8cfe473a8","order_by":3,"name":"Yvonne Jockel-Schneider","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Yvonne","middleName":"","lastName":"Jockel-Schneider","suffix":""},{"id":592766086,"identity":"ac329141-3714-4ac5-b7da-b9a092a96f89","order_by":4,"name":"Gabriel Krastl","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Gabriel","middleName":"","lastName":"Krastl","suffix":""},{"id":592766092,"identity":"ec877838-bada-4374-ae5f-442a2e21747b","order_by":5,"name":"Marc Schmitter","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Marc","middleName":"","lastName":"Schmitter","suffix":""}],"badges":[],"createdAt":"2026-02-04 13:09:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8786911/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8786911/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103000025,"identity":"086a2b43-998c-41bc-8945-07cbaa94153b","added_by":"auto","created_at":"2026-02-19 13:09:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3800080,"visible":true,"origin":"","legend":"\u003cp\u003eThe 3D model after the repositioning of the anterior teeth (a); the finished construction of the printed teeth (b); the anterior teeth prepared for printing with included supports (c).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8786911/v1/7b394fcd8e9f3d5e53139ca7.png"},{"id":103000028,"identity":"7c7d8484-35f0-40d5-9dfc-1d7993ab2ff9","added_by":"auto","created_at":"2026-02-19 13:09:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8559747,"visible":true,"origin":"","legend":"\u003cp\u003eThe printed teeth in the standard dental study model (a); the teeth after repositioning into the dental arch (b); selective etching (c); application of resin before the splint (d); positioning of the splint into the resin (e); the completed splint after covering with resin (f).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8786911/v1/837d43fc84a35152c12b47ea.png"},{"id":103000029,"identity":"67e5ccbd-ef22-4cbb-a1d2-34c2ed17f2e9","added_by":"auto","created_at":"2026-02-19 13:09:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5889509,"visible":true,"origin":"","legend":"\u003cp\u003eResults from the questionnaire in a stacked bar chart. The percentages of given grades are displayed, mean values and standard deviation below corresponding questions.\u0026nbsp;\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8786911/v1/c893054a978a4bd53241a434.png"},{"id":103000027,"identity":"9f83c66a-e91b-4091-b6a2-c759ac66ec6f","added_by":"auto","created_at":"2026-02-19 13:09:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":4205261,"visible":true,"origin":"","legend":"\u003cp\u003eReference model is visible in blue and scanned model in grey (a); matching of both models (b); constructed reference teeth with spheres (c); matching of reference teeth with scan model (d).\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-8786911/v1/41921f77e54991826f480f1d.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"3D‑Printed Training Model for Periodontal Splinting: A Randomized Preclinical Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSimulation using physical models enhances didactic instruction. It offers safe and repeatable practice of procedural steps before real patient treatment. Additive manufacturing has expanded dental simulation beyond typodonts. It enables the production of accurate models with realistic anatomy, surface quality and mechanical behaviour at low cost. Training models can be fabricated to specific learning situations. Across all dental disciplines - prosthodontics, endodontics, orthodontics, and oral surgery - in the last years 3D-printed teaching models have been developed to demonstrate and teach complex workflows [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, periodontal practical training remains underrepresented despite its clinical relevance, especially stabilizing mobile teeth with periodontal splinting.\u003c/p\u003e \u003cp\u003eThe main reason for a splint is to distribute forces across multiple teeth to reduce pathological mobility [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The main utilized contemporary chairside approaches use fibre-reinforced composited (FRCs) made from polyethylene ribbons or pre-impregnated glass-fibre bundles [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. After some minimal preparation they are bonded into a shallow palatal channel and covered with composite. Improved patient comfort and mobility reduction are reported, but the technique is sensitive.\u003c/p\u003e \u003cp\u003eWe developed maxillary anterior wobbly teeth to reproduce displacement and mobility and evaluated the model under preclinical conditions with students. They performed two splints in randomized material order. The hypotheses were that (1) students evaluate the model as realistic and the training as clinically relevant; (2) handling of the polyethylene ribbon would be rated better than the glass-fibre bundle; (3) second attempt would improve geometric accuracy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\n \u003cp\u003eA total of 43 fourth-year dental students (24 women and 19 men; mean age 25) with prior phantom-head experience in their first clinical prosthodontics course participated in a voluntary hands-on training course. Each student completed two splints in randomised material order divided into two weeks. They were randomly assigned to start with either polyethylene ribbon (Ribbond Ultra, Ribbond Inc., Seattle, Washington) or pre-impregnated unidirectional glass-fibre bundles (everStickPERIO, GC Germany GmbH, Bad Homburg, Deutschland).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCAD Design and 3D-Printing of Training Teeth\u003c/h3\u003e\n\u003cp\u003eWe developed a printable set of maxillary anterior wobbly teeth from 13 to 23 (Fig.\u0026nbsp;1a). They reproduce displacement and mobility from natural teeth. For this effect the base and retention geometry was modified (Fig.\u0026nbsp;1b). They were constructed to fit into a standard dental study model (KaVo, Biberach an der Ri\u0026szlig;, Germany) for universal usage not only at a single institution. Teeth 13 and 23 were not modified to be stable for the splint like often seen in patients. For the production process the models were nested closely and printed on a Form 2 3D printer (Formlabs Inc., Somerville, MA, USA) (Fig.\u0026nbsp;1c). White photopolymer resin was used for printing (RS-F2-GPWH-04, Formlabs Inc.). After printing, the teeth were post-processed according to the manufacturer guidelines. This includes cleaning with isopropanol (Form Wash, Formlabs Inc.), UV curing (Form Cure, Formlabs Inc.) and manual removing of support structures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure\u0026nbsp;1.\u003c/strong\u003e The 3D model after the repositioning of the anterior teeth (a); the finished construction of the printed teeth (b); the anterior teeth prepared for printing with included supports (c).\u003c/p\u003e\n\u003ch3\u003eTraining Protocol\u003c/h3\u003e\n\u003cp\u003eThe printed teeth were fitted into the standard dental study model (Fig.\u0026nbsp;2a). Then the teeth were manually repositioned to approximate the ideal arch and verified by testing the occlusion (Fig.\u0026nbsp;2b). A palatal channel with approximately 1.5mm depth and width was prepared from 12\u0026ndash;22 and slightly extended to the canines. For realistic practice enamel etching (35% phosphoric acid, Ultradent, Brunnthal, Germany) (Fig.\u0026nbsp;2c) and adhesive were applied (OptiBond FL, Kerr, Orange, CA, USA), followed by a thin layer of flowable composite (Filtek Flowable Composite, 3M ESPE, St. Paul, MN, USA) (Fig.\u0026nbsp;2d). One of the two splint materials was adapted to the channel length and embedded into it (Fig.\u0026nbsp;2e). After this the splint was fully covered with flowable composite, light-cured, finished and polished (Fig.\u0026nbsp;2f).\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eAfter the second course students completed an electronic questionnaire (EvaSys GmbH, L\u0026uuml;neburg, Germany). This includes questions about realism, handling, learning and relevance, plus free-text questions about material preference and course organisation (Table\u0026nbsp;1). Similar questionnaires have been used before by students to evaluate other studies with printed teeth [13]. The questionnaire was adapted to the present study. The evaluation was based on German school grades and closed-format rating scale questions (1\u0026thinsp;=\u0026thinsp;Excellent, 2\u0026thinsp;=\u0026thinsp;Good,\u003c/p\u003e\n\u003cp\u003e3\u0026thinsp;=\u0026thinsp;Satisfactory, 4\u0026thinsp;=\u0026thinsp;Adequate, 5\u0026thinsp;=\u0026thinsp;Poor, 6\u0026thinsp;=\u0026thinsp;Unsatisfactory). For visualization purposes, the mean grade and standard deviation were calculated and the results of the distribution of grades were displayed in a bar chart and shown in percentage (Fig.\u0026nbsp;3).\u003c/p\u003e\n\u003ch3\u003e1. Personal Data\u003c/h3\u003e\n\u003cp\u003e1.1. Please enter your gender\u003c/p\u003e\n\u003cp\u003e1.2. Please enter your age\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Handling of the printed teeth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.1. How realistic was the tooth loosening?\u003c/p\u003e\n\u003cp\u003e2.2. How realistic was the repositioning into the dental arch?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Splinting of the printed teeth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.1. Please evaluate the splinting exercise.\u003c/p\u003e\n\u003cp\u003e3.2. Evaluate the handling of \u0026ldquo;everStickPERIO\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e3.3. Evaluate the handling of \u0026ldquo;Ribbond Ultra\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Evaluation of the learning process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRate your preparation to perform a periodontal splint on a patient \u0026hellip;\u003c/p\u003e\n\u003cp\u003e4.1. \u0026hellip; before the course.\u003c/p\u003e\n\u003cp\u003e4.2. \u0026hellip; after the course.\u003c/p\u003e\n\u003cp\u003e4.3. Evaluate the learning effect of this course.\u003c/p\u003e\n\u003cp\u003e4.4. Evaluate the practical relevance of this exercise.\u003c/p\u003e\n\u003cp\u003e4.5. Do you prefer to use \u0026ldquo;everStickPERIO\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e4.6. Do you prefer to use \u0026ldquo;Ribbond Ultra\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Free text questions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e5.1. What advantages do you see in this exercise?\u003c/p\u003e\n\u003cp\u003e5.2. What could be improved in this excercise?\u003c/p\u003e\n\u003cp\u003e5.3. Your opinion about the usage of \u0026ldquo;everStickPERIO\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e5.4. Your opinion about the usage of \u0026ldquo;Ribbond Ultra\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1.\u003c/strong\u003e The questionnaire for the evaluation of the course.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3D Scanning and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 86 models and one reference model were scanned with an inEos X5 (Dentsply Sirona, Bensheim, Germany) dental laboratory scanner. STL meshes were generated and aligned with GOM Inspect (GOM, Braunschweig, Germany) (Fig.\u0026nbsp;4a). This was done by initial coarse alignment on posterior teeth followed by local best-fit (Fig.\u0026nbsp;4b). To the CAD of the posterior teeth 12\u0026ndash;22 6mm spheres were added to the incisal edges for reproducible centers for distance measurements (Fig.\u0026nbsp;4c). In the spheres is also a rectangular face with three semicircular recesses embedded. This was for analyzing rotation, angle and movement differences (Fig.\u0026nbsp;4d).\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eAll data was analyzed using SPSS (Version 26; IBM Corp., Armonk, NY, USA). Several groups were not normally distributed, confirmed by Kolmogorov-Smirnov test. Overall differences were analysed by Kruskal-Wallis test and logical pairs with Mann-Whitney U test (e.g. same tooth and attempt across materials, and same material across attempts). No formal a priori power calculation was performed; as an educational evaluation, the cohort size was determined by the class size.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire outcomes\u003c/h2\u003e \u003cp\u003eThe results are described descriptive and important results are mentioned here. The realism of mobility and repositioning were both \u0026ldquo;satisfactory\u0026rdquo; (Fig.\u0026nbsp;3.2.1:\u003c/p\u003e \u003cp\u003e\u0026Oslash; 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 and 3.2.2: \u0026Oslash; 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0). The course was rated \u0026ldquo;good\u0026rdquo; overall (Fig.\u0026nbsp;3.3.1: \u0026Oslash; 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7). Material handling was only slightly but not significantly different for questions 3.3.2 vs. 3.3.3 (p = .11) and 3.4.5 vs. 3.4.6 (p = .38). Ribbond Ultra was rated \u0026ldquo;good\u0026rdquo; (Fig.\u0026nbsp;3.3.3: \u0026Oslash; 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9) and everStickPERIO was \u0026ldquo;satisfactory\u0026rdquo; (Fig.\u0026nbsp;3.3.2: \u0026Oslash; 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9). A substantial learning gain was reported by the students. Self-efficacy for doing a splint improved from \u0026ldquo;poor\u0026rdquo; (Fig.\u0026nbsp;3.4.1: \u0026Oslash; 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1) to a post‑course \u0026ldquo;good\u0026rdquo; (Fig.\u0026nbsp;3.4.2: \u0026Oslash; 2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6). Also, the clinical relevance was rated highly (Fig.\u0026nbsp;3.4.4: \u0026Oslash; 1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7). There was also no clear favorite for clinical usage, 23 preferred Ribbond Ultra and 18 everStickPERIO and 2 found them equal. For both materials the handling was criticized for different reasons but also positively evaluated by other students. For details see the free-text analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFree‑text Analysis\u003c/h2\u003e \u003cp\u003eThe results of the free-text questions were analysed (Table\u0026nbsp;1. 5.1-4).\u003c/p\u003e \u003cp\u003eSimilar answers were grouped and counted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAdvantages of the exercise\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003erealistic challenge of repositioning (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003escript and video material (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ecomparison of both materials (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003egood staff support (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eusing real material (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003epositive learning effect between sessions (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOverall, two participants did not fill out question 5.1,\u003c/p\u003e \u003cp\u003eresulting in a participation rate of 95.3%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImprovements for the exercise\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003erealism of the exercise (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eno improvements needed (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003edegree of loosening is unrealistic (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eocclusion in the phantom head not ideal (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003emore time for a discussion of the results (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOverall, 15 participants did not fill out question 5.2,\u003c/p\u003e \u003cp\u003eresulting in a participation rate of 65.1%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eOpinions about everStickPERIO\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ebetter handling and adaptation to the tooth (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003edifficult handling and adaptation into the prepared groove (n\u0026thinsp;=\u0026thinsp;13).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003econsidered as too thick (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003esplinting was faster (n\u0026thinsp;=\u0026thinsp;4) and easier (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003etoo rigid/stiff (n\u0026thinsp;=\u0026thinsp;3) or too sticky (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003emore stable and resistant (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOverall, 6 participants did not fill out question 5.3,\u003c/p\u003e \u003cp\u003eresulting in a participation rate of 86.0%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eOpinions about Ribbond Ultra\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ebetter handling, positioning and adaptation (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003epoorer handling, more difficult adaptation to the tooth (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ematerial - and thus the splint - was thinner (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ematerial was more flexible (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eprocessing time was shorter or too short (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003efiber-like consistency was criticized (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ematerial was partially exposed during splint finishing (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ebetter adhesion to the tooth or in the prepared groove (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOverall, 5 participants did not fill out question 5.4,\u003c/p\u003e \u003cp\u003eresulting in a participation rate of 88.4%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eGeometric Accuracy\u003c/h2\u003e \u003cp\u003eThe range for deviation of median distances for incisal-sphere centres (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003ed) was 0.34 to 0.68mm across teeth and sessions. At the first attempt with Ribbond Ultra was 0.48 mm deviation measurable with a range from 0.25\u0026ndash;1.10 mm and for the second 0.50mm (0.24\u0026ndash;1.56 mm). everStickPERIO had a deviation of 0.62 mm (0.24\u0026ndash;1.56) and for the second attempt 0.51 mm (0.31\u0026ndash;1.37). Statistical screening revealed that Kolmogorov-Smirnov test indicates some not normally distributed groups. Because of this non-parametric test was used. With Kruskal-Wallis test differences across subgroups were identified. The subgroups consisted of different teeth. Pairwise Mann-Whitney U test found no significant differences regarding materials or first to second session. Tooth 21 had the largest tendency for deviation. This is in accordance with the initial larger displacement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the questionnaire and geometric analysis were no material-dependent differences found. This indicates that for beginners\u0026rsquo; success is more influenced by fundamental procedural handling basics, which are tooth repositioning, moisture control and composite coverage of the FRC system. This is in common with reports that polyethylene ribbon and glass fibres can produce durable splints when correctly handled [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Under clinical conditions, long-term durability is affected by fibre architecture, impregnation quality, and composite coverage. Early performance is influenced mostly by user-dependent factors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The students as novice beginners showed no accuracy differences between both FRC systems, but a small subjective handling gap was there. Ribbond Ultra was rated \u0026ldquo;good\u0026rdquo; and everStickPERIO \u0026ldquo;satisfactory\u0026rdquo;. This suggests that a small advantage is there for thinner and more adaptable ribbon in tight palatal channels. This was also mentioned in the free text questions by better handling, positioning and adaptation (n\u0026thinsp;=\u0026thinsp;20). Students reported a clear confidence level after the training in splinting technique. This aligns with other simulation studies where enhanced confidence and reduced anxiety before patient treatment was reported [\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur findings are congruent to competency‑based education principles. Structured practice and more challenging tasks support new skill acquisition. Self-assessment was promoted with the questionnaire, scanning and derived feedback [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The two training sessions were not enough to detect a significant learning effect. The consolidation phase of the learning curve was not completed. It can be assumed that additional sessions across weeks could enhance the consolidation and lead to measurable performance gains [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The found largest tendency for deviation at tooth 21 shows that a variety of different difficulties can be generated in the future. Example for these are milder displacements, then a progression to greater rotation or elasticity.\u003c/p\u003e \u003cp\u003eGeometric accuracy was measured as distances between incisal-sphere centres of students against reference teeth. This method offers robustness against local mesh artefacts and variability in landmarking by operators. By this approach differences are collapsed into a single value and angular misalignment is under-represented.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eEducational Implications\u003c/h2\u003e \u003cp\u003eThe integration of this splinting exercise into clinical and preclinical curricula offers a structured opportunity to practice splinting with or without assistance, train with different materials and handling. The production cost of approximately 0.20 \u0026euro; including resin, consumables and work times are very low per tooth. This makes it easy to perform repeated practice without financial pressure on students or institutions. Printing 31 six‑tooth sets at once in approximately 11 h 33 m makes it possible to produce course‑scale numbers on a single desktop printer (Form 2, Formlabs Inc.). Depending on the print technology with the fastest desktop printers this can be drastically reduced. For example, with a Form 4 3D printer (Formlabs Inc.) 28 six‑tooth sets can be printed in only 2 hours. This new 3D-printed model is an effective training method before clinical patient treatment.\u003c/p\u003e \u003cp\u003eFuture work should focus on expanding cohort sizes and incorporate more 3D metrics (e.g. angular deviations). Also, assisted versus unassisted workflows should be compared in regard to self-assessment and performance. While the here performed metrics have a focus on the arch conformity, clinical outcomes also rely on patient-specific factors like periodontal stability, occlusion, hygienical aspects and splint maintenance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis preclinical evaluation shows that an inexpensive printed \u0026ldquo;wobbly tooth\u0026rdquo; model is a realistic, reproducible tool for training periodontal splinting. Students gained self-efficacy and rated the model as highly clinically relevant. 3D measurement of the models showed no significant differences between polyethylene ribbons and pre-impregnated glass-fibre bundles used by beginners.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study and the experimental protocol were approved by the Institutional Review Board of the University of W\u0026uuml;rzburg (2026-2-ka). All students that participated in the voluntary course were thoroughly informed and no personal data was collected. An informed consent to participate was obtained from all of the participants in the study. All methods were performed in accordance with the named guidelines, regulations and Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no funding for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eChristian H\u0026ouml;hne: Conceptualization, Methodology, Data curation, Formal analysis, Supervision, Validation, Visualization, Writing - original draft, Writing - review \u0026amp; editing; S\u0026ouml;ren Rehling: Investigation, Formal analysis, Data curation, Validation, Visualization, Writing - review \u0026amp; editing; Johannes Schrenker: Methodology, Validation, Writing - review \u0026amp; editing; Yvonne Jockel-Schneider: Project administration, Resources, Supervision, Validation, Writing - review \u0026amp; editing; Gabriel Krastl: Project administration, Resources, Supervision, Validation, Writing - review \u0026amp; editing; Marc Schmitter: Project administration, Resources, Supervision, Validation, Writing - review \u0026amp; editing.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe thank all participants and the teaching staff who supported logistics and scanning.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDobroś, K., Hajto-Bryk, J. \u0026amp; Zarzecka, J. 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Rep.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e, 13564. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-020-70418-y\u003c/span\u003e\u003cspan address=\"10.1038/s41598-020-70418-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e\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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"3D printing, additive manufacturing, dental education, periodontal splinting, fibre‑reinforced composite","lastPublishedDoi":"10.21203/rs.3.rs-8786911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8786911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFor students it is essential to practice before clinical treatment with preclinical simulation. We designed 3D-printed wobbly teeth to train periodontal splinting and evaluate their educational benefits and objective performance. 43 students in their fourth year completed two palatal slot splints from 13 to 23 in a randomized order using a polyethylene ribbon and a pre-impregnated unidirectional glass-fibre bundle. Outcomes were evaluated by a questionnaire with german school grades and geometric deviation of each tooth to an ideal position. The course was rated \u0026ldquo;good\u0026rdquo; overall and \u0026ldquo;highly clinically relevant\u0026rdquo;. Self-efficacy improved during the course from \u0026ldquo;insufficient\u0026rdquo; to \u0026ldquo;good\u0026rdquo;. Median deviations of correct positioning ranged from 0.3 to 0.7mm across teeth. Non-parametric test with Bonferroni correction showed no significant pairwise differences between materials, first and second attempt or tooth position. This inexpensive, reproducible printed model enabled realistic periodontal splinting and improved confidence. Accuracy did not differ between both splinting systems in novice hands.\u003c/p\u003e","manuscriptTitle":"3D‑Printed Training Model for Periodontal Splinting: A Randomized Preclinical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 13:09:39","doi":"10.21203/rs.3.rs-8786911/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-27T12:22:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T16:25:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-07T16:58:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219856784671178949441251560690782047215","date":"2026-03-05T07:51:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253073826465945292863852492168406529708","date":"2026-02-27T15:40:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T08:19:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50198023736794262892371885932492880192","date":"2026-02-27T08:10:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174805156853104594896182391709778109323","date":"2026-02-14T13:25:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T12:34:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T18:07:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-05T06:45:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T06:42:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-04T12:44:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aefc533c-80b1-43a0-9413-ecc1254dc45d","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63073493,"name":"Health sciences/Health care"},{"id":63073494,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-08T16:56:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 13:09:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8786911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8786911","identity":"rs-8786911","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}