Perceptions of the use of a 3D-printed manufactured educational simulator for incisions and sutures

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Traditional methods such as cadaveric dissection and porcine models face ethical, logistical, and reproducibility challenges. In this study, we evaluate a novel 3D-printed simulator produced with Polyjet technology for incision and suture training and compare its educational value to that of animal models. Methods: A total of 69 participants—27undergraduate students, 19 postgraduate students and 23 expert oral surgeons— tested 30 identical simulators at Paris-Cité University. The simulators were created from intraoral scans using GrabCAD software and manufactured with Polyjet 3D printing. The participants observed the model, performed incisions, created gingival flaps, and sutured. They subsequently completed an 11-item satisfaction questionnaire on a 5-point Likert scale. The datawere analyzed using descriptive statistics and the Wilcoxon signed-rank test. Results: Participants in all groups reported a high level of overall satisfaction (mean 4.50). The simulator received particularly high ratings for visual realism (mean 4.14) and educational interest (mean 4.48), with postgraduate students providing the highest visual scores (4.26) and experts providing slightly lower scores (4.04). The participants recommended improvements in tissue adhesion, detachment, thickness, and suture resistance to better mimic human tissues. Conclusions: The 3D-printed simulator offers a reproducible, ethically sound alternative to animal models, delivering excellent visual fidelity and strong educational value. While tactile feedback requires further refinement, this innovative tool shows promise for improving surgical training in dental education. Future work will focus on optimizing haptic properties and expanding the application of the simulator to other surgical procedures. Clinical trial number: Not applicable. Simulation Education 3D Printing Oral Surgery Sutures Incisions Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. BACKGROUND Health care simulation has tangible real-world impacts, including improving patient safety and care quality. “Simulation-based education” (SBE) is a teaching method that offers students and health care professionals a controlled environment to develop and refine their technical skills while ensuring that they are prepared for clinical practice [1]. Oral surgery training has traditionally relied on cadaveric dissection and, more recently, porcine models [2]. These biological specimens provide hands-on experience but present ethical concerns, high costs, and anatomical variability [3]. Despite these limitations, these methods continue to be widely used because alternative methods are still being developed. The fragility of oral tissues, particularly the mucosa, makes it challenging for dental students to master incision and suture techniques. Poor technique can result in torn tissue, impaired surgical access, and compromised healing. Non-animal models, such as synthetic foams, silicone-based models [4] and even fruits, lack the anatomical accuracy and haptic feedback required for realistic training. Given these challenges, there is increasing demand for standardized and reproducible models that mimic human oral tissues while providing an ethical, cost-effective alternative to animal specimens or cadaveric models [5]. In recent years, 3D printing has facilitated the creation of anatomically accurate models for procedural training [6, 7]. Unlike biological specimens or commercial silicone models, 3D-printed simulators can closely replicate anatomical structures and tissue feedback, which can improve learning. Previous studies highlighted the benefits of 3D-printed models in dental education, particularly for teaching regional anesthesia [8] and surgical procedures such as flap design and extraction. However, existing models primarily use wax [9], silicone, or manually assembled printed resins [10-12], which limits their realism for incision and suture training. An effective surgical simulator must achieve a high level of anatomical and haptic realism. Integrating patient-specific data with 3D printing enables the simulation of various clinical scenarios to improve surgical training [13]. A key challenge is replicating the characteristics of soft tissue, including elasticity, tear resistance, and color differentiation. The Polyjet 3D printing technology addresses these challenges by enabling the simultaneous printing of multitextured, multicolored models in a single process. Unlike other technologies that require manual assembly of hard and soft components, Polyjet printing seamlessly integrates different material properties, enhancing realism and durability [9]. This study evaluated the perceptions of undergraduate dental students, postgraduate students and expert oral surgeons regarding the educational value of this 3D-printed simulator compared with porcine jaw models for incision and suture training. By assessing user feedback, we aim to determine the effectiveness of the simulator in improving surgical competence and confidence while reducing the number of animal specimens used in dental education. 2. METHODS 2.1. Study Design All 69 participants voluntarily participated in this study, which was conducted at the Faculty of Dental Surgery of Paris-Cité University. Among the 69 participants, 27 were undergraduate students, 19 were postgraduate students, and 23 were oral surgeons. The AP-HP CER institutional review board granted ethical approval (IRB: IORG0010044; REF: 2024-07-01). The patient whose data were scanned was fully informed about the use of their medical information for 3D printing and provided explicit consent for its application to the creation of the educational model. 2.2. Creation and Development of the 3D-Printed Incisions and Sutures Simulator A 3D gingival model was developed using colored surface scan data (3shape, Copenhagen, Denmark) that were obtained from a real edentulous patient and provided in .dcm format by the University of Paris-Cité. On the basis of this dataset, individual volumetric models of the gingiva, periosteum, and alveolar bone were digitally reconstructed and merged into a unified anatomical structure. The composite model was subsequently processed using GrabCAD Print and Dac-Creator software, and dedicated material presets were assigned to each tissue component. These presets were derived from custom blends of photopolymer resins designed to mimic the mechanical properties and tactile feedback of soft oral tissues. In total, approximately 15 different material blends were developed to accurately represent the heterogeneity of the gingival complex. The model was 3D printed using a Stratasys J850 Digital Anatomy Printer (Stratasys Ltd., Rehovot, Israel), which supports high-resolution, multimaterial printing with a layer thickness of 27 microns. This system utilizes a broad range of proprietary photopolymers, such as Agilus30, Vero, GelMatrix, and BoneMatrix, to reproduce soft and hard tissue structures with high anatomical and tactile fidelity. Postprocessing involved the removal of support material using a caustic solution followed by a water rinse. The printed models then underwent a proprietary infiltration and hydration procedure designed to increase their moisture content and simulate blood-wetted soft tissue. Surface treatments were also applied to reduce surface tension and improve the realism of surgical incisions. Finally, the models were immersed in a preservation fluid to maintain structural integrity and material consistency for up to six months. 2.3. Evaluation of the 3D-Printed Incisions and Sutures Simulator After 30 simulators were produced (Figures 1and 2), they were evaluated by three different groups: - Group 1: undergraduate students (4th-, 5th- and 6th-year dental students) who had previously conducted hands-on surgery on porcine models during their 4th year and had independently managed patients (under the supervision of professors) in surgery, periodontics, restorative dentistry, prosthodontics and endodontics since the start of their 4th year. - Group 2: postgraduate students who had their own private practice and continued their training at the university through enrollment in additional training. - Group 3: expert surgeons in oral surgery and periodontology (full professors, associate professors). The simulators given to the undergraduate students, postgraduate students and experts were similar and were produced on the same day by the same operator, but they were not shared among the three groups to limit methodological bias. One simulator was tested by 2 participants in the same group. 2.3.1. Test Procedure The study was conducted at Paris Cité University (France) in February 2025. After a brief oral presentation of the educational objectives and the creation of the simulator, the participants, i.e., graduate students, postgraduate students and experts who volunteered for testing, completed the following steps: 1 Observation of the simulator 2 Gingiva incision and flap of their choice using surgical instruments 3 Removal of the gingival flap using a detacher or a sickle-shaped syndesmotome 4 Sutures 5 Completion of a cross-sectional satisfaction questionnaire (11 questions) Figure 4 shows some simulators after testing. 2.3.2. Assessment Questionnaire and Statistical Analysis With respect to visual and tactile aspects, the participants compared this model to clinical reality as well as the porcine model that they had used in previous practice. Finally, they assessed the educational value of our model for integration into the university curriculum and compared it with the porcine model that was currently used. The questionnaire was inspired by a previously published article on dental education using a periodontal simulator [14]. To validate the questionnaire, we examined its dimensional structure via principal component analysis (PCA) with an eigenvalue diagram. Internal consistency was assessed by calculating Cronbach's alpha coefficient to ensure the reliability of the scale (Supplementary Data). For each item, the participants had five response options: strongly disagree (1), disagree (2), neither disagree nor agree (3), agree (4), and strongly agree (5) (Table 1). A response of 3, representing a neutral value, allowed respondents to abstain from expressing an opinion if they were uncertain about their answer. A score above 3 was interpreted as an indication of the participant’s satisfaction with the simulator. Additionally, two final items in the questionnaire were used to evaluate the participants’ overall satisfaction with the simulator. The participants also had the opportunity to provide written comments to express any insights that were not covered by the questionnaire. Data were collected from 69 participants: 27 undergraduate students, 19 postgraduate students and 23 expert surgeons. Data management was conducted and missing data (less than 5%) were imputed using the mode corresponding to each participant's status. Descriptive statistics were presented for all scale items as well as for other questionnaire responses. Three key variables were created: visual aspect, tactile aspect, and educational interest. The visual aspect corresponded to Item 1, the tactile aspect was calculated as the mean score of Items 2 to 7, and educational interest was derived from the mean of Items 8 and 9. The questionnaire results are expressed as the mean and standard deviation (SD) for each group. To compare the answers of the graduate students, postgraduate students and experts, the Wilcoxon signed-rank test was performed for each question and for the three components. For the open-ended question, all frequently mentioned adjectives were recorded, allowing the creation of a word cloud in which the adjectives most commonly used by the participants appeared more prominently. In all tests, the significance level was set at α = 0.05. R software (version 4.4.1; R Foundation for Statistical Computing, Vienna, Austria) was used for all the statistical analyses. 3. RESULTS The means and standard deviations (SDs) for each item of the questionnaire in each group are presented in Table 2. We assessed the dimensional structure of the questionnaire using principal component analysis (PCA) and an eigenvalue plot which revealed two distinct dimensions (Figure 3). A two-factor exploratory factor analysis identified the first factor as related to pedagogical value (Items 1, 2, 3, 8 and 9) and the second factor as related to comparison with animal models (Items 5, 6 and 7). The conclusive item, preference over animal models (Item 10), was present in both factors. The internal consistency of the questionnaire was confirmed with a Cronbach’s alpha of 0.84 (95% CI: [0.77–0.89]). The visual appearance of the model received a positive rating (4.14), with higher scores from postgraduate students (4.26) and lower scores from expert surgeons (4.04). The gum texture was rated slightly lower (4.00 on average), with a notable decrease among expert (3.78). With respect to feedback on scalpel insertion, the scores remained consistent across groups and averaged approximately 3.94. Compared with an animal model, the realism of incision and gingival detachment in the tested model received lower scores (3.17 and 3.48, respectively) indicating a moderate perception of realism, although postgraduate students rated these aspects slightly higher (3.26 and 3.63). Suture feedback was rated 4.52 overall, with relatively consistent scores across groups. Educational interest was high (4.48), with the strongest endorsement from students (4.56). Overall appreciation of the model remained positive (3.88), although experts rated it less favorably (3.52). At the end of the questionnaire, the participants suggested improvements to our simulator, mainly with regard to tissue detachment, specifically the adhesion of the periosteum to the bone and the thickness of the gingiva (Figure 4a). Figure 4b presents the positive adjectives used to describe the simulator. 4. DISCUSSION This study evaluated a novel 3D-printed educational simulator for incision and suture training produced using Polyjet technology and compared its performance with that of traditional animal models. The simulator was designed to improve the quality of surgical education by providing a high-fidelity, reproducible, and ethically favorable alternative for training [7]. This study involved three distinct groups, undergraduate students, postgraduate students, and expert surgeons, which assessed the simulator in terms of visual realism, tactile feedback, and educational value. The results revealed that the simulator excelled in several key areas, particularly visual accuracy and pedagogical utility. However, some limitations remained in replicating the complex tactile properties of human tissues. 4.1. General Discussion and Visual A spects Overall, the simulator received positive feedback in terms of visual appearance and gum texture. The mean scores for visual appearance and gum texture were 4.23 ± 0.75 and 4.14 ± 0.73, respectively, indicating that the model closely replicates the anatomical details of oral tissues. These high ratings can be attributed to the advanced capabilities of Polyjet technology, which enables the simultaneous reproduction of multiple materials with distinct color and texture properties [9]. Unlike conventional 3D printing methods that require separate production and manual assembly of hard and soft components, Polyjet printing creates a monolithic structure that results in a highly realistic simulation of patient anatomy. This feature is further enhanced by the incorporation of dynamic elements such as simulated bleeding at the gum incision (Figure 5), adding an extra layer of realism [9]. The visual fidelity of our simulator is in line with previous studies that have employed digital fabrication techniques for surgical training. For example, Antunes et al. [10] reported that 3D-printed models based on patient data offered a realistic visual representation that was comparable to that of cadaveric or animal models. Similarly, Meglioli et al. [15] highlighted the importance of high-fidelity visual models in improving surgical planning and execution in oral and maxillofacial surgery. Our study not only demonstrates the effectiveness of Polyjet technology but also shows that a carefully designed digital workflow can yield models that closely mimic clinical reality. 4.2. Educational Implications The educational value of the simulator was highly rated by all groups, with educational interest and overall appreciation receiving mean scores of 4.52 ± 0.68 and 4.48 ± 0.58, respectively. These results are consistent with those of Seifert et al. [5] and suggest that the simulator not only is visually accurate but also serves as a powerful teaching tool. The high score indicates that the participants believe that the simulator can enhance learning by providing a realistic and consistent platform for practicing incisions and sutures. This is particularly important because traditional training methods, such as cadaveric dissection or the use of animal models, often present ethical concerns, high costs, and variability in anatomical structures [5]. The literature supports the integration of digital simulators in surgical education. Studies by Chae et al. [12] and Feng et al. [11] have demonstrated that digital models can significantly improve the acquisition of surgical skills by offering repeated, standardized training sessions without the ethical and logistical complications associated with animal models. The findings of this study further corroborate these reports by showing that the participants, especially undergraduate and postgraduate students, had a strong preference for simulator models, primarily due to these models’ consistent quality and ease of use. The reproducibility of digital models also allows educators to develop a standardized curriculum, which is essential for ensuring that all students receive the same high level of instruction. 4.3. Analysis of Tactile and Haptic Aspects Despite the model’s strong performance in visual realism and educational utility, tactile feedback remains the primary area for improvement [16]. Items related to tactile sensations, such as scalpel insertion (Item 3), gingival detachment (Item 6), and suturing feedback (Item 7), —showed more variability in responses. Notably, gingival detachment received a mean score of 3.17 ± 1.18, but 53% of the senior respondents reported neutral or negative experiences regarding the realism of gingival detachment and suturing feedback, indicating that while the simulator provides a reasonably tactile experience, it does not yet fully replicate the nuanced haptic properties of human soft tissues. However, the participants responded positively to the presence of a layer mimicking the periosteum (Figure 6). The challenges of mimicking the tactile properties of biological tissues are well documented in the literature. For example, Feng et al. [11] and Antunes et al. [10] noted that while 3D-printed models offer excellent visual realism, achieving accurate haptic feedback remains difficult owing to the limitations of current resin materials. In our study, senior surgeons with extensive experience with live tissues were critical of the tactile aspects. This finding suggests that while the simulator is highly effective for visual and educational purposes, further material innovation is needed to better mimic the elasticity, adhesion, and resistance of human tissues. The participants provided several constructive suggestions for improving tactile feedback. Recommendations included improving the simulation of tissue adhesion and detachment forces, refining the thickness and resistance of the simulated gum, and incorporating a visual demarcation between the attached gingiva and mucosa. These modifications are feasible given the versatility of Polyjet technology, which allows for fine-tuning of material properties during the printing process. By adjusting the formulation of the photopolymerizable resins used, future iterations of the simulator may offer improved haptic responses that more closely resemble those of animal models and actual clinical conditions. 4.4. Group-Specific Feedback and Animal M odel Comparisons A total of66.7% of the undergraduates and 100% of the postgraduates approved of the model's visual realism, and nearly 60% and 84.3%, respectively, strongly supported its educational utility. This enthusiasm among novice learners suggests that the simulator's high visual fidelity and consistent performance make it an ideal training tool. However, senior surgeons provided a more nuanced view. While they greatly appreciated the simulator's visual and educational qualities (78.3% and. 100%), they were more critical of the tactile feedback; lower mean scores reflect their higher expectations on the basis of extensive clinical experience with live tissue. In particular, the difference in preference between simulator and animal models (Item 10) was statistically significant (p = 0.03), with undergraduates giving the simulator a rating of 4.22 ± 1.12 and experts providing a rating of 3.53 ± 1.04. This discrepancy highlights the importance of refining the tactile aspects of the simulator to meet the requirements of experienced clinicians. 4.5. Future Directions The integration of 3D-printed simulators into surgical training is a growing trend, as highlighted by recent systematic reviews [15] and individual studies [10, 12]. These works collectively demonstrate that digital models can provide high levels of visual realism and reproducibility, thereby enhancing the overall quality of surgical education. However, as our study and others indicate, the challenge of replicating haptic feedback remains. The variability in tactile responses observed in our study is consistent with previous findings showing that the soft tissue components of simulators often lag behind their bony counterparts in terms of realism. Future research should consider a longitudinal approach that assesses the impact of the repeated use of simulators on skill retention and clinical performance. By comparing the long-term outcomes of trainees who use 3D-printed simulators with the outcomes of trainees who rely on traditional animal models, educators can better understand the practical benefits of digital simulation in surgical training, as in the study conducted by Karagkounaki et al. [7]. 5. CONCLUSIONS Overall, the 3D-printed model received positive feedback from all participants. The 3D-printed model offers a compelling alternative to animal models by significantly reducing the time required to manage pig jaws (i.e., reception, freezing, defrosting, and recycling) and allowing for streamlined medical training. Our future objectives include the development of similar models for teaching oral mucosal pathology and biopsy techniques as well as for preprosthetic surgery, mucogingival procedures and both implant and pre-implant surgery. ABBREVIATIONS 3 dimensional: 3D Simulation-based education: SBE. Principal component analysis: PCA. Standard Deviations: SDs. DECLARATIONS Ethics Approval and Consent to Participate The present study was approved by the “comité d’éthique de la recherche de l’APHP Centre, Université Paris Cité, PARIS”. Informed consent was obtained from all participants. Consent for Publication Not applicable. Availability of Data and Materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing Interests The authors of this manuscript declare that they have no conflicts of interest or other disclosures. Funding This study was funded by ARS Ile de France 2024 (C2024DOSRHS062_BIOPSIM ARS FIR 2024 BIOPSIM ODONTOLOGIE). Authors’ Contributions Concept and design: YS, ALE. Acquisition, analysis, and interpretation of data: YS, FC, ALE. Writing—original draft preparation: YS, ALE. Writing—review and editing: YS, ALE, JPA, AH, PF. Statistical analyzes: FC. All authors have read and approved the final manuscript. Acknowledgements Thanks to Arnaud Toutain from Stratasys who believed in this project from the start. Thanks to Eden Bansard and Jerome Barraco for the loan of the TRIOS 4 camera (3Shape). Thanks to Jean-Michel Lucas and Olivier Cambo from Cylaos for printer specifications. Thanks to Petronille Frenel from Medprint for the first model tests. REFERENCES Cleland J, Patey R, Thomas I, Walker K, O'Connor P, Russ S. Supporting transitions in medical career pathways: the role of simulation-based education. Adv Simul. 2016;1:14. Gonzalez-Navarro AR, Quiroga-Garza A, Acosta-Luna AS, Salinas-Alvarez Y, Martinez-Garza JH, de la Garza-Castro O, et al. Comparison of suturing models: the effect on perception of basic surgical skills. BMC Med Educ. 2021;21:250. European Parliament and Council. Directive 2010/63/EU of the European parliament and of the council of 22 September 2010 on the protection of animals used for scientific purposes. 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Evaluation of a local anesthesia simulation model with dental students as novice clinicians. J Dent Educ. 2015;79:1411-7. Hanisch M, Kroeger E, Dekiff M, Timme M, Kleinheinz J, Dirksen D. 3D-printed surgical training model based on real patient situations for dental education. Int J Environ Res Public Health. 2020;17:2901. Antunes D, Mayeur O, Mauprivez C, Nicot R. 3D‐printed model for gingival flap surgery simulation: development and pilot test. Eur J Dent Educ. 2024;28:698-706. Feng J, Qi W, Duan S, Bao C, Zhang X, Cai B, et al. Three‐dimensional printed model of impacted third molar for surgical extraction training. J Dent Educ. 2021;85:1828-36. Chae YK, Lee H, Jih MK, Lee HS, Lee JW, Kim SH, et al. Validation of a three‐dimensional printed model for training of surgical extraction of supernumerary teeth. Eur J Dent Educ. 2020;24:637-43. Chakravarthy C, Malyala SK, Aranha D, Suryadevara SS, Sunder V. Comparative evaluation of hybrid 3D-Printed models versus cadaveric animal jaws: a student's perspective. J Maxillofac Oral Surg. 2022;21:1044-51. Jannot M, Attal JP, Marteleur VL, Le‐Goff S, Colombier ML, Gouze H, et al. Perceptions regarding the use of a three‐dimensionally‐printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions. J Dent Educ. 2024;88:1133-43. Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med. 2020;6:30. Gund MP, Strähle UT, Naim J, Waldmeyer M, Hannig M, Rupf S. Comparison of 3D‐printed patient model versus animal cadaveric model in periodontal surgery block course-what is more feasible for beginners? A pilot study. Eur J Dent Educ. 2025. doi:10.1111/eje.13090. Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx SupplementaryData.docx Cite Share Download PDF Status: Published Journal Publication published 19 Aug, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 07 Jul, 2025 Reviews received at journal 05 Jul, 2025 Reviews received at journal 02 Jul, 2025 Reviewers agreed at journal 28 Jun, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Editor assigned by journal 03 Jun, 2025 Editor invited by journal 02 Jun, 2025 Submission checks completed at journal 30 May, 2025 First submitted to journal 30 May, 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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model.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/457346336daa1d4d32f367ed.png"},{"id":84214968,"identity":"14ef894a-792c-4ea5-bf97-94ab305ed928","added_by":"auto","created_at":"2025-06-09 10:35:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39715210,"visible":true,"origin":"","legend":"\u003cp\u003eFront view of the model.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/add891f66ff7a30a4d180023.png"},{"id":84214963,"identity":"d721d4ee-649c-4f5e-abbb-6911690a2e76","added_by":"auto","created_at":"2025-06-09 10:35:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18079,"visible":true,"origin":"","legend":"\u003cp\u003eDimensional structure of the questionnaire using principal component analysis (PCA) and an eigenvalue plot, which revealed two distinct dimensions.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/158a97835d98f70e37ad7aed.png"},{"id":84216267,"identity":"3be4cbbb-bf28-4004-952b-706194ea87ee","added_by":"auto","created_at":"2025-06-09 10:43:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71973,"visible":true,"origin":"","legend":"\u003cp\u003eWord cloud showing the positive (b) and negative (a) aspects of the model, with colors ranging from blue to red indicating increasing frequency and size reflects word frequency.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/5b63cbd55f8dff4245ddaaa8.png"},{"id":84214967,"identity":"a525d77e-f195-4428-890b-87b109bf3a9e","added_by":"auto","created_at":"2025-06-09 10:35:05","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":53907071,"visible":true,"origin":"","legend":"\u003cp\u003eIncision showing\u003cstrong\u003e \u003c/strong\u003ethe bleeding.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/5816e13b026c5dc964bd975b.png"},{"id":84216268,"identity":"a0ec5389-4e81-498e-8262-ffdfe33839e1","added_by":"auto","created_at":"2025-06-09 10:43:05","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":29684309,"visible":true,"origin":"","legend":"\u003cp\u003eIncision showing\u003cstrong\u003e \u003c/strong\u003ethe presence of a layer mimicking the periosteum.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/dea58d1f72e907ea487972ac.png"},{"id":89847595,"identity":"e4572a41-28e9-4b53-b00a-029e7aa9a571","added_by":"auto","created_at":"2025-08-25 16:43:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":107193432,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/10dcf944-386d-4623-82da-86630f786c1b.pdf"},{"id":84214961,"identity":"136b268d-bcb7-47cf-bedb-9f26e5d00c78","added_by":"auto","created_at":"2025-06-09 10:35:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16678,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/d28de26b7fd6a72f558a39b4.docx"},{"id":84216266,"identity":"3321342a-694a-4c12-baba-d608ec4aa335","added_by":"auto","created_at":"2025-06-09 10:43:04","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16452,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/335ca6f138ca4fc0f93a9a49.docx"},{"id":84214964,"identity":"9fa8ec8a-0d7f-40a9-a055-db4a4ef740fb","added_by":"auto","created_at":"2025-06-09 10:35:04","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":29893,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryData.docx","url":"https://assets-eu.researchsquare.com/files/rs-6701026/v1/01c3e4c2a6bed004098b916f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePerceptions of the use of a 3D-printed manufactured educational simulator for incisions and sutures\u003c/p\u003e","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003eHealth care simulation has tangible real-world impacts, including improving patient safety and care quality. \u0026ldquo;Simulation-based education\u0026rdquo; (SBE) is a teaching method that offers students and health care professionals a controlled environment to develop and refine their technical skills while ensuring that they are prepared for clinical practice [1]. Oral surgery training has traditionally relied on cadaveric dissection and, more recently, porcine models [2]. These biological specimens provide hands-on experience but present ethical concerns, high costs, and anatomical variability [3]. Despite these limitations, these methods continue to be widely used because alternative methods are still being developed.\u003c/p\u003e\n\u003cp\u003eThe fragility of oral tissues, particularly the mucosa, makes it challenging for dental students to master incision and suture techniques. Poor technique can result in torn tissue, impaired surgical access, and compromised healing. Non-animal models, such as synthetic foams, silicone-based models [4] and even fruits, lack the anatomical accuracy and haptic feedback required for realistic training. Given these challenges, there is increasing demand for standardized and reproducible models that mimic human oral tissues while providing an ethical, cost-effective alternative to animal specimens or cadaveric models [5].\u003c/p\u003e\n\u003cp\u003eIn recent years, 3D printing has facilitated the creation of anatomically accurate models for procedural training [6, 7]. Unlike biological specimens or commercial silicone models, 3D-printed simulators can closely replicate anatomical structures and tissue feedback, which can improve learning. Previous studies highlighted the benefits of 3D-printed models in dental education, particularly for teaching regional anesthesia [8] and surgical procedures such as flap design and extraction. However, existing models primarily use wax [9], silicone, or manually assembled printed resins [10-12], which limits their realism for incision and suture training.\u003c/p\u003e\n\u003cp\u003eAn effective surgical simulator must achieve a high level of anatomical and haptic realism. Integrating patient-specific data with 3D printing enables the simulation of various clinical scenarios to improve surgical training [13]. A key challenge is replicating the characteristics of soft tissue, including elasticity, tear resistance, and color differentiation.\u003c/p\u003e\n\u003cp\u003eThe Polyjet 3D printing technology addresses these challenges by enabling the simultaneous printing of multitextured, multicolored models in a single process. Unlike other technologies that require manual assembly of hard and soft components, Polyjet printing seamlessly integrates different material properties, enhancing realism and durability [9].\u003c/p\u003e\n\u003cp\u003eThis study evaluated the perceptions of undergraduate dental students, postgraduate students and expert oral surgeons regarding the educational value of this 3D-printed simulator compared with porcine jaw models for incision and suture training. By assessing user feedback, we aim to determine the effectiveness of the simulator in improving surgical competence and confidence while reducing the number of animal specimens used in dental education.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 69 participants voluntarily participated in this study, which was conducted at the Faculty of Dental Surgery of Paris-Cité University. Among the 69 participants, 27 were undergraduate students, 19 were postgraduate students,\u0026nbsp;and 23 were oral surgeons.\u003c/p\u003e\n\u003cp\u003eThe AP-HP CER institutional review board granted ethical approval (IRB: IORG0010044; REF: 2024-07-01). The patient whose data were scanned was fully informed about the use of their medical information for 3D printing and provided explicit consent for its application to the creation of the educational model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Creation and Development of the 3D-Printed Incisions and Sutures Simulator\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 3D gingival model was developed using colored surface scan data (3shape, Copenhagen, Denmark) that were obtained from a real edentulous patient and provided in .dcm format by the University of Paris-Cité. On the basis of this dataset, individual volumetric models of the gingiva, periosteum, and alveolar bone were digitally reconstructed and merged into a unified anatomical structure.\u003c/p\u003e\n\u003cp\u003eThe composite model was subsequently processed using GrabCAD Print and Dac-Creator software, and dedicated material presets were assigned to each tissue component. These presets were derived from custom blends of photopolymer resins designed to mimic the mechanical properties and tactile feedback of soft oral tissues. In total, approximately 15 different material blends were developed to accurately represent the heterogeneity of the gingival complex.\u003c/p\u003e\n\u003cp\u003eThe model was 3D printed using a Stratasys J850 Digital Anatomy Printer (Stratasys Ltd., Rehovot, Israel), which supports high-resolution, multimaterial printing with a layer thickness of 27 microns. This system utilizes a broad range of proprietary photopolymers, such as Agilus30, Vero, GelMatrix, and BoneMatrix, to reproduce soft and hard tissue structures with high anatomical and tactile fidelity.\u003c/p\u003e\n\u003cp\u003ePostprocessing involved the removal of support material using a caustic solution followed by a water rinse. The printed models then underwent a proprietary infiltration and hydration procedure designed to increase their moisture content and simulate blood-wetted soft tissue. Surface treatments were also applied to reduce surface tension and improve the realism of surgical incisions. Finally, the models were immersed in a preservation fluid to maintain structural integrity and material consistency for up to six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Evaluation of the 3D-Printed Incisions and Sutures Simulator\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 30 simulators were produced (Figures 1and 2), they were evaluated by three different groups:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;Group 1: undergraduate students (4th-, 5th- and 6th-year dental students) who had previously conducted hands-on surgery on porcine models during their 4th year and had independently managed patients (under the supervision of professors) in surgery, periodontics, restorative dentistry, prosthodontics and endodontics since the start of their 4th year.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;Group 2: postgraduate students who had their own private practice and continued their training at the university through enrollment in additional training.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;Group 3: expert surgeons in oral surgery and periodontology (full professors, associate professors).\u003c/p\u003e\n\u003cp\u003eThe simulators given to the undergraduate students, postgraduate students and experts were similar and were produced on the same day by the same operator, but they were not shared among the three groups to limit methodological bias. One simulator was tested by 2 participants in the same group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.3.1. Test Procedure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Paris Cité University (France) in February 2025.\u003c/p\u003e\n\u003cp\u003eAfter a brief oral presentation of the educational objectives and the creation of the simulator, the participants, i.e., graduate students, postgraduate students and experts who volunteered for testing, completed the following steps:\u003c/p\u003e\n\u003cp\u003e1\u0026nbsp; \u0026nbsp;\u0026nbsp;Observation of the simulator\u003c/p\u003e\n\u003cp\u003e2\u0026nbsp; \u0026nbsp;\u0026nbsp;Gingiva incision and flap of their choice using surgical instruments\u003c/p\u003e\n\u003cp\u003e3\u0026nbsp; \u0026nbsp;\u0026nbsp;Removal of the gingival flap using a detacher or a sickle-shaped syndesmotome\u003c/p\u003e\n\u003cp\u003e4\u0026nbsp; \u0026nbsp;\u0026nbsp;Sutures\u003c/p\u003e\n\u003cp\u003e5\u0026nbsp; \u0026nbsp;\u0026nbsp;Completion of a cross-sectional satisfaction questionnaire (11 questions)\u003c/p\u003e\n\u003cp\u003eFigure 4 shows some simulators after testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.3.2. Assessment Questionnaire and Statistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith respect to visual and tactile aspects, the participants compared this model to clinical reality as well as the porcine model that they had used in previous practice. Finally, they assessed the educational value of our model for integration into the university curriculum and compared it with the porcine model that was currently used. The questionnaire was inspired by a previously published article on dental education using a periodontal simulator [14]. To validate the questionnaire, we examined its dimensional structure via principal component analysis (PCA) with an eigenvalue diagram. Internal consistency was assessed by calculating Cronbach's alpha coefficient to ensure the reliability of the scale (Supplementary Data).\u003c/p\u003e\n\u003cp\u003eFor each item, the participants had five response options: strongly disagree (1), disagree (2), neither disagree nor agree (3), agree (4), and strongly agree (5) (Table 1).\u003c/p\u003e\n\u003cp\u003eA response of 3, representing a neutral value, allowed respondents to abstain from expressing an opinion if they were uncertain about their answer. A score above 3 was interpreted as an indication of the participant’s satisfaction with the simulator.\u003c/p\u003e\n\u003cp\u003eAdditionally, two final items in the questionnaire were used to evaluate the participants’ overall satisfaction with the simulator. The participants also had the opportunity to provide written comments to express any insights that were not covered by the questionnaire.\u003c/p\u003e\n\u003cp\u003eData were collected from 69 participants: 27 undergraduate students, 19 postgraduate students and 23 expert surgeons.\u003c/p\u003e\n\u003cp\u003eData management was conducted and missing data (less than 5%) were imputed using the mode corresponding to each participant's status. Descriptive statistics were presented for all scale items as well as for other questionnaire responses. Three key variables were created: visual aspect, tactile aspect, and educational interest. The visual aspect corresponded to Item 1, the tactile aspect was calculated as the mean score of Items 2 to 7, and educational interest was derived from the mean of Items 8 and 9.\u003c/p\u003e\n\u003cp\u003eThe questionnaire results are expressed as the mean and standard deviation (SD) for each group. To compare the answers of the graduate students, postgraduate students and experts, the Wilcoxon signed-rank test was performed for each question and for the three components. For the open-ended question, all frequently mentioned adjectives were recorded, allowing the creation of a word cloud in which the adjectives most commonly used by the participants appeared more prominently. In all tests, the significance level was set at α = 0.05. R software (version 4.4.1; R Foundation for Statistical Computing, Vienna, Austria) was used for all the statistical analyses.\u003c/p\u003e"},{"header":" 3. RESULTS","content":"\u003cp\u003eThe means and standard deviations (SDs) for each item of the questionnaire in each group are presented in Table 2.\u003c/p\u003e\n\u003cp\u003eWe assessed the dimensional structure of the questionnaire using principal component analysis (PCA) and an eigenvalue plot which revealed two distinct dimensions (Figure 3). A two-factor exploratory factor analysis identified the first factor as related to pedagogical value (Items 1, 2, 3, 8 and 9) and the second factor as related to comparison with animal models (Items 5, 6 and 7). The conclusive item, preference over animal models (Item 10), was present in both factors. The internal consistency of the questionnaire was confirmed with a Cronbach’s alpha of 0.84 (95% CI: [0.77–0.89]).\u003c/p\u003e\n\u003cp\u003eThe visual appearance of the model received a positive rating (4.14), with higher scores from postgraduate students (4.26) and lower scores from expert surgeons (4.04). The gum texture was rated slightly lower (4.00 on average), with a notable decrease among expert (3.78). With respect to feedback on scalpel insertion, the scores remained consistent across groups and averaged approximately 3.94.\u003c/p\u003e\n\u003cp\u003eCompared with an animal model, the realism of incision and gingival detachment in the tested model received lower scores (3.17 and 3.48, respectively) indicating a moderate perception of realism, although postgraduate students rated these aspects slightly higher (3.26 and 3.63). Suture feedback was rated 4.52 overall, with relatively consistent scores across groups. Educational interest was high (4.48), with the strongest endorsement from students (4.56). Overall appreciation of the model remained positive (3.88), although experts rated it less favorably (3.52).\u003c/p\u003e\n\u003cp\u003eAt the end of the questionnaire, the participants suggested improvements to our simulator, mainly with regard to tissue detachment, specifically the adhesion of the periosteum to the bone and the thickness of the gingiva (Figure 4a). Figure 4b presents the positive adjectives used to describe the simulator.\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis study evaluated a novel 3D-printed educational simulator for incision and suture training produced using Polyjet technology and compared its performance with that of traditional animal models. The simulator was designed to improve the quality of surgical education by providing a high-fidelity, reproducible, and ethically favorable alternative for training [7]. This study involved three distinct groups, undergraduate students, postgraduate students, and expert surgeons, which assessed the simulator in terms of visual realism, tactile feedback, and educational value. The results revealed that the simulator excelled in several key areas, particularly visual accuracy and pedagogical utility. However, some limitations remained in replicating the complex tactile properties of human tissues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1. General Discussion and Visual A\u003c/strong\u003e\u003cstrong\u003espects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, the simulator received positive feedback in terms of visual appearance and gum texture. The mean scores for visual appearance and gum texture were 4.23 ± 0.75 and 4.14 ± 0.73, respectively, indicating that the model closely replicates the anatomical details of oral tissues. These high ratings can be attributed to the advanced capabilities of Polyjet technology, which enables the simultaneous reproduction of multiple materials with distinct color and texture properties [9]. Unlike conventional 3D printing methods that require separate production and manual assembly of hard and soft components, Polyjet printing creates a monolithic structure that results in a highly realistic simulation of patient anatomy. This feature is further enhanced by the incorporation of dynamic elements such as simulated bleeding at the gum incision (Figure 5), adding an extra layer of realism [9].\u003c/p\u003e\n\u003cp\u003eThe visual fidelity of our simulator is in line with previous studies that have employed digital fabrication techniques for surgical training. For example, Antunes et al. [10] reported that 3D-printed models based on patient data offered a realistic visual representation that was comparable to that of cadaveric or animal models. Similarly, Meglioli et al. [15] highlighted the importance of high-fidelity visual models in improving surgical planning and execution in oral and maxillofacial surgery. Our study not only demonstrates the effectiveness of Polyjet technology but also shows that a carefully designed digital workflow can yield models that closely mimic clinical reality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Educational Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe educational value of the simulator was highly rated by all groups, with educational interest and overall appreciation receiving mean scores of 4.52 ± 0.68 and 4.48 ± 0.58, respectively. These results are consistent with those of Seifert et al. [5] and suggest that the simulator not only is visually accurate but also serves as a powerful teaching tool. The high score indicates that the participants believe that the simulator can enhance learning by providing a realistic and consistent platform for practicing incisions and sutures. This is particularly important because traditional training methods, such as cadaveric dissection or the use of animal models, often present ethical concerns, high costs, and variability in anatomical structures [5].\u003c/p\u003e\n\u003cp\u003eThe literature supports the integration of digital simulators in surgical education. Studies by Chae et al. [12] and Feng et al. [11] have demonstrated that digital models can significantly improve the acquisition of surgical skills by offering repeated, standardized training sessions without the ethical and logistical complications associated with animal models. The findings of this study further corroborate these reports by showing that the participants, especially undergraduate and postgraduate students, had a strong preference for simulator models, primarily due to these models’ consistent quality and ease of use. The reproducibility of digital models also allows educators to develop a standardized curriculum, which is essential for ensuring that all students receive the same high level of instruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3. Analysis of Tactile and Haptic Aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the model’s strong performance in visual realism and educational utility, tactile feedback remains the primary area for improvement [16]. Items related to tactile sensations, such as scalpel insertion (Item 3), gingival detachment (Item 6), and suturing feedback (Item 7), —showed more variability in responses. Notably, gingival detachment received a mean score of 3.17 ± 1.18, but 53% of the senior respondents reported neutral or negative experiences regarding the realism of gingival detachment and suturing feedback, indicating that while the simulator provides a reasonably tactile experience, it does not yet fully replicate the nuanced haptic properties of human soft tissues. However, the participants responded positively to the presence of a layer mimicking the periosteum (Figure 6).\u003c/p\u003e\n\u003cp\u003eThe challenges of mimicking the tactile properties of biological tissues are well documented in the literature. For example, Feng et al. [11] and Antunes et al. [10] noted that while 3D-printed models offer excellent visual realism, achieving accurate haptic feedback remains difficult owing to the limitations of current resin materials. In our study, senior surgeons with extensive experience with live tissues were critical of the tactile aspects. This finding suggests that while the simulator is highly effective for visual and educational purposes, further material innovation is needed to better mimic the elasticity, adhesion, and resistance of human tissues.\u003c/p\u003e\n\u003cp\u003eThe participants provided several constructive suggestions for improving tactile feedback. Recommendations included improving the simulation of tissue adhesion and detachment forces, refining the thickness and resistance of the simulated gum, and incorporating a visual demarcation between the attached gingiva and mucosa. These modifications are feasible given the versatility of Polyjet technology, which allows for fine-tuning of material properties during the printing process. By adjusting the formulation of the photopolymerizable resins used, future iterations of the simulator may offer improved haptic responses that more closely resemble those of animal models and actual clinical conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4. Group-Specific Feedback and Animal M\u003c/strong\u003e\u003cstrong\u003eodel Comparisons\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of66.7% of the undergraduates and 100% of the postgraduates approved of the model's visual realism, and nearly 60% and 84.3%, respectively, strongly supported its educational utility. This enthusiasm among novice learners suggests that the simulator's high visual fidelity and consistent performance make it an ideal training tool.\u003c/p\u003e\n\u003cp\u003eHowever, senior surgeons provided a more nuanced view. While they greatly appreciated the simulator's visual and educational qualities (78.3% and. 100%), they were more critical of the tactile feedback; lower mean scores reflect their higher expectations on the basis of extensive clinical experience with live tissue. In particular, the difference in preference between simulator and animal models (Item 10) was statistically significant (p = 0.03), with undergraduates giving the simulator a rating of 4.22 ± 1.12 and experts providing a rating of 3.53 ± 1.04. This discrepancy highlights the importance of refining the tactile aspects of the simulator to meet the requirements of experienced clinicians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5. Future Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe integration of 3D-printed simulators into surgical training is a growing trend, as highlighted by recent systematic reviews [15] and individual studies [10, 12]. These works collectively demonstrate that digital models can provide high levels of visual realism and reproducibility, thereby enhancing the overall quality of surgical education. However, as our study and others indicate, the challenge of replicating haptic feedback remains. The variability in tactile responses observed in our study is consistent with previous findings showing that the soft tissue components of simulators often lag behind their bony counterparts in terms of realism.\u003c/p\u003e\n\u003cp\u003eFuture research should consider a longitudinal approach that assesses the impact of the repeated use of simulators on skill retention and clinical performance. By comparing the long-term outcomes of trainees who use 3D-printed simulators with the outcomes of trainees who rely on traditional animal models, educators can better understand the practical benefits of digital simulation in surgical training, as in the study conducted by Karagkounaki et al. [7].\u003c/p\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eOverall, the 3D-printed model received positive feedback from all participants. The 3D-printed model offers a compelling alternative to animal models by significantly reducing the time required to manage pig jaws (i.e., reception, freezing, defrosting, and recycling) and allowing for streamlined medical training.\u003c/p\u003e\n\u003cp\u003eOur future objectives include the development of similar models for teaching oral mucosal pathology and biopsy techniques as well as for preprosthetic surgery, mucogingival procedures and both implant and pre-implant surgery.\u003c/p\u003e"},{"header":"ABBREVIATIONS","content":"\u003cp\u003e3 dimensional: 3D\u003c/p\u003e\n\u003cp\u003eSimulation-based education: SBE.\u003c/p\u003e\n\u003cp\u003ePrincipal component analysis: PCA.\u003c/p\u003e\n\u003cp\u003eStandard Deviations: SDs.\u003c/p\u003e"},{"header":"DECLARATIONS","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the \u0026ldquo;comit\u0026eacute; d\u0026rsquo;\u0026eacute;thique de la recherche de l\u0026rsquo;APHP Centre, Universit\u0026eacute; Paris Cit\u0026eacute;, PARIS\u0026rdquo;. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this manuscript declare that they have no conflicts of interest or other disclosures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by ARS Ile de France 2024 (C2024DOSRHS062_BIOPSIM ARS FIR 2024 BIOPSIM ODONTOLOGIE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept and design: YS, ALE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, and interpretation of data: YS, FC, ALE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting\u0026mdash;original draft preparation: YS, ALE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting\u0026mdash;review and editing: YS, ALE, JPA, AH, PF.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analyzes: FC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Arnaud Toutain from Stratasys who believed in this project from the start.\u003c/p\u003e\n\u003cp\u003eThanks to Eden Bansard and Jerome Barraco for the loan of the TRIOS 4 camera (3Shape).\u003c/p\u003e\n\u003cp\u003eThanks to Jean-Michel Lucas and Olivier Cambo from Cylaos for printer specifications.\u003c/p\u003e\n\u003cp\u003eThanks to Petronille Frenel from Medprint for the first model tests.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eCleland J, Patey R, Thomas I, Walker K, O\u0026apos;Connor P, Russ S. Supporting transitions in medical career pathways: the role of simulation-based education. Adv Simul. 2016;1:14.\u003c/li\u003e\n\u003cli\u003eGonzalez-Navarro AR, Quiroga-Garza A, Acosta-Luna AS, Salinas-Alvarez Y, Martinez-Garza JH, de la Garza-Castro O, et al. Comparison of suturing models: the effect on perception of basic surgical skills. BMC Med Educ. 2021;21:250.\u003c/li\u003e\n\u003cli\u003eEuropean Parliament and Council. Directive 2010/63/EU of the European parliament and of the council of 22 September 2010 on the protection of animals used for scientific purposes. Off J Eur Union. 2010;276:33-79.\u003c/li\u003e\n\u003cli\u003eMacluskey M, Revie G, Shepherd SD. A comparison of models for teaching suturing and surgical skills to dental students. Int J Dent. 2024;2024:3783021.\u003c/li\u003e\n\u003cli\u003eSeifert LB, Schnurr B, Herrera‐Vizcaino C, Begic A, Thieringer F, Schwarz F, et al. 3D printed patient individualised models versus cadaveric models in an undergraduate oral and maxillofacial surgery curriculum: comparison of students\u0026apos; perceptions. Eur J Dent Educ. 2020;24:809-10.\u003c/li\u003e\n\u003cli\u003eSmail Y, Dursun E, Ciers J-Y, Taleb C, Nardari C, Keosouvanh N, et al. Students\u0026apos; perceptions of knowledge reinforcement on indirect prosthetic dental material choices by a translational approach. J Dent Educ. 2024;89:514-22.\u003c/li\u003e\n\u003cli\u003eKaragkounaki A, Manoukakis T, Margariti I, Pavlou C, Hadjichristou C. 3D printing in dental education: a review of its use across disciplines. J Dent Educ. 2025:e13876. doi:10.1002/jdd.13876.\u003c/li\u003e\n\u003cli\u003eLee JS, Graham R, Bassiur JP, Lichtenthal RM. Evaluation of a local anesthesia simulation model with dental students as novice clinicians. J Dent Educ. 2015;79:1411-7.\u003c/li\u003e\n\u003cli\u003eHanisch M, Kroeger E, Dekiff M, Timme M, Kleinheinz J, Dirksen D. 3D-printed surgical training model based on real patient situations for dental education. Int J Environ Res Public Health. 2020;17:2901.\u003c/li\u003e\n\u003cli\u003eAntunes D, Mayeur O, Mauprivez C, Nicot R. 3D‐printed model for gingival flap surgery simulation: development and pilot test. Eur J Dent Educ. 2024;28:698-706.\u003c/li\u003e\n\u003cli\u003eFeng J, Qi W, Duan S, Bao C, Zhang X, Cai B, et al. Three‐dimensional printed model of impacted third molar for surgical extraction training. J Dent Educ. 2021;85:1828-36.\u003c/li\u003e\n\u003cli\u003eChae YK, Lee H, Jih MK, Lee HS, Lee JW, Kim SH, et al. Validation of a three‐dimensional printed model for training of surgical extraction of supernumerary teeth. Eur J Dent Educ. 2020;24:637-43.\u003c/li\u003e\n\u003cli\u003eChakravarthy C, Malyala SK, Aranha D, Suryadevara SS, Sunder V. Comparative evaluation of hybrid 3D-Printed models versus cadaveric animal jaws: a student\u0026apos;s perspective. J Maxillofac Oral Surg. 2022;21:1044-51.\u003c/li\u003e\n\u003cli\u003eJannot M, Attal JP, Marteleur VL, Le‐Goff S, Colombier ML, Gouze H, et al. Perceptions regarding the use of a three‐dimensionally‐printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions. J Dent Educ. 2024;88:1133-43.\u003c/li\u003e\n\u003cli\u003eMeglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med. 2020;6:30.\u003c/li\u003e\n\u003cli\u003eGund MP, Str\u0026auml;hle UT, Naim J, Waldmeyer M, Hannig M, Rupf S. Comparison of 3D‐printed patient model versus animal cadaveric model in periodontal surgery block course-what is more feasible for beginners? A pilot study. Eur J Dent Educ. 2025. doi:10.1111/eje.13090.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\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":"Simulation, Education, 3D Printing, Oral Surgery, Sutures, Incisions","lastPublishedDoi":"10.21203/rs.3.rs-6701026/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6701026/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe acquisition of clinical and surgical skills is fundamental to dental training. Traditional methods such as cadaveric dissection and porcine models face ethical, logistical, and reproducibility challenges. In this study, we evaluate a novel 3D-printed simulator produced with Polyjet technology for incision and suture training and compare its educational value to that of animal models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 69 participants—27undergraduate students, 19 postgraduate students and 23 expert oral surgeons— tested 30 identical simulators at Paris-Cité University. The simulators were created from intraoral scans using GrabCAD software and manufactured with Polyjet 3D printing. The participants observed the model, performed incisions, created gingival flaps, and sutured. They subsequently completed an 11-item satisfaction questionnaire on a 5-point Likert scale. The datawere analyzed using descriptive statistics and the Wilcoxon signed-rank test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in all groups reported a high level of overall satisfaction (mean 4.50). The simulator received particularly high ratings for visual realism (mean 4.14) and educational interest (mean 4.48), with postgraduate students providing the highest visual scores (4.26) and experts providing slightly lower scores (4.04). The participants recommended improvements in tissue adhesion, detachment, thickness, and suture resistance to better mimic human tissues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 3D-printed simulator offers a reproducible, ethically sound alternative to animal models, delivering excellent visual fidelity and strong educational value. While tactile feedback requires further refinement, this innovative tool shows promise for improving surgical training in dental education. Future work will focus on optimizing haptic properties and expanding the application of the simulator to other surgical procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Perceptions of the use of a 3D-printed manufactured educational simulator for incisions and sutures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 10:35:00","doi":"10.21203/rs.3.rs-6701026/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-07T07:39:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-05T20:35:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T02:17:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171436454017368472936679588028659683140","date":"2025-06-29T03:45:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63062524012324240582708318113369638985","date":"2025-06-27T09:46:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297039861815728207988100797012164188385","date":"2025-06-05T11:01:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63548665017219076394147194440724131149","date":"2025-06-05T06:37:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T01:56:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-04T01:50:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-02T17:54:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-30T09:41:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-05-30T09:35:24+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":"188e76ec-c382-42a0-a57f-44b4d15e3983","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:35:34+00:00","versionOfRecord":{"articleIdentity":"rs-6701026","link":"https://doi.org/10.1186/s12909-025-07779-3","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-08-19 16:29:27","publishedOnDateReadable":"August 19th, 2025"},"versionCreatedAt":"2025-06-09 10:35:00","video":"","vorDoi":"10.1186/s12909-025-07779-3","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07779-3","workflowStages":[]},"version":"v1","identity":"rs-6701026","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6701026","identity":"rs-6701026","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}