Dental Students’ Conceptual Knowledge of Fluoride-Free Remineralization Systems Assessed Through Mind Mapping

Dental Students’ Conceptual Knowledge of Fluoride-Free Remineralization Systems Assessed Through Mind Mapping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dental Students’ Conceptual Knowledge of Fluoride-Free Remineralization Systems Assessed Through Mind Mapping Esra OZGOCMEN TULA, Zeynep Ceren CELİK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8259920/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Dental education requires not only scientific and clinical knowledge but also the ability to structure concepts and establish meaningful connections. Conventional lecture-based methods often encourage linear knowledge transfer, limiting students’ capacity to integrate complex content. Mind mapping, a visual and interactive technique, supports active learning by fostering conceptual organization and critical thinking. Despite its potential, evidence on its systematic use in dental education remains limited. Methods This study involved third-year students of Bursa Uludağ University Faculty of Dentistry (2024–2025). A total of 130 mind maps (pre-test = 65; post-test = 65) on “Fluoride-Free Remineralization Systems” were collected before and after the final course examination. Two independent researchers evaluated the maps anonymously across content- and structure-related categories, including accuracy, representation of clinical agents, conceptual integration, hierarchy, cross-linking, pictorial/color use, creativity, and irrelevant content. Each criterion was rated on a 0–2 scale. Non-parametric tests compared pre- and post-test results and gender-related differences. Results Students consistently included definitions, principles, and mechanisms of action, with no gender differences. Representation of ACP-CPP, nHAp, and xylitol regressed significantly, whereas arginine, TCP, and herbal agents were preserved. Cross-linking (p = 0.039) and hierarchical structuring declined, particularly among females (22.2% vs. 25.0%; p = 0.041). From pre- to post-test, terminological accuracy decreased (0.67 ± 0.73 to 0.54 ± 0.61) and hierarchical framework declined (1.25 ± 0.84 to 0.92 ± 0.85), while conceptual integration improved (0.05 ± 0.04 to 0.15 ± 0.24) along with visual clarity (0.45 ± 0.33 to 0.57 ± 0.42). Creativity remained stable, whereas irrelevant items increased significantly (median 1.00 to 2.00; Z = − 3.196, p = 0.001). Conclusions In conclusion, this study demonstrates that mind maps are a powerful tool for reflecting students’ levels of conceptual understanding; however, their full potential may not emerge under high-stress conditions such as examinations. mind map dental student dental education flouride Figures Figure 1 Figure 2 Figure 3 Introduction Dental education is a multidimensional process to provide students with fundamental scientific and clinical knowledge, to foster the development and integration of cognitive and behavioral competencies such as information analysis, problem-solving, decision-making, and patient management [1–3]. In professional practice, the ability to make accurate and reliable clinical decisions is closely related to the extent to which students can organize the knowledge they possess and accurately construct the relationships between concepts [4]. In the health sciences, where multidimensional and interdisciplinary relationships are closely interconnected, the clear and logical establishment of conceptual connections plays an important role in enhancing the depth of learning and ensuring the effective transfer of knowledge [5]. Therefore, in dental education, assessing students’ knowledge alone is insufficient; equal emphasis should be placed on evaluating how they structure and conceptualize information throughout the learning process [1]. Traditional teaching in dental education is largely based on linear knowledge transmission [6]. In this model, the learning process is characterized by one-directional communication, where knowledge is transmitted by the instructor and the student assumes a passive role as the recipient [7]. However, such methods do not sufficiently support students in holistically structuring complex and multidimensional content or in developing meaningful relationships between concepts [6]. For these reasons, to train competent professionals capable of developing effective solutions to complex and multidimensional health problems, it is essential to adopt learner-centered approaches that promote a high level of interaction [8]. Mind mapping is a learning and expression technique that enables information to be visually organized around a central main topic in the form of branches, supported by keywords, symbols, colors, and images. Developed by Tony Buzan [9], this method allows the use of multisensory stimuli such as pictures and colors in the learning process, thereby facilitating the comprehension of intrinsic relationships between concepts, the integration of interdisciplinary knowledge, the transfer of information from short-term to long-term memory, and its retrieval [10–12]. Mind maps are an effective tool for structuring complex information, as they allow the relationships between concepts to be visually represented [12]. Studies in the field of health sciences have shown that mind mapping contributes to the integration of theoretical knowledge with clinical applications, enhances the retention of learning, and improves skills such as critical thinking, problem-solving, establishing conceptual connections, and organizing information [13–15]. The pre-test/post-test design is a research method that can objectively evaluate the effects of educational interventions on learning outcomes. This approach reveals the change in the learning process by measuring students’ knowledge and conceptual understanding of a specific topic before and after the intervention [16]. The use of this technique in combination with mind mapping provides the opportunity to evaluate not only the amount of knowledge students possess but also how they organize that knowledge, how they construct relationships between concepts, and what conceptual developments they demonstrate throughout the learning process. Criteria such as the number of concepts in the maps, the level of branching, the accuracy of linking statements, and the overall conceptual coherence can objectively reflect the depth of learning and changes in the knowledge structure [1]. There are several studies on the use of mind mapping across different disciplines in health sciences education [13, 15]. Although this technique has been noted for its potential to objectively reveal changes in the learning process and, through the analysis of the mind maps created by the same student during the pre-test and post-test phases, to uncover the dynamics of learning, to the best of our knowledge [1] studies evaluating dental students’ conceptual understanding of a specific topic using pre-test/post-test mind maps are quite limited. In this context, our study will contribute both to the evaluation of conceptual learning in a specific subject area through visual representations and to the demonstration of the educational effectiveness of mind maps. Based on the available data in the current literature, this study aims to measure dental students’ understanding of concepts related to non-fluoride remineralization agents [17] to evaluate their ability to express this knowledge through visual representations; to examine the distinctive features of their mind maps; and to retrospectively demonstrate the development reflected in the pre-test/post-test mind maps created by the same students. In this way, the potential of mind mapping for the implementation of active learning methods in dental education will be demonstrated. Materials & Methods This retrospective study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was approved by the Health Research Ethics Committee of the Faculty of Medicine at Bursa Uludağ University (Approval Number: 2025/786/14 − 5). Study Design In this study, “Fluoride-Free Remineralization Systems,” one of the important topics in preventive dentistry, was examined using the mind mapping method. The study focuses on the following research questions: (1) Do students accurately and holistically express the fundamental concepts related to fluoride-free remineralization systems through mind maps, and are there differences between genders? (2) Does the difference between students’ pre-test and post-test performances reveal whether the examination functions as a teaching tool that supports the learning process? Data Collection In this study, an evaluation was conducted on mind maps themed ‘Fluoride-Free Remineralization Systems’, prepared by third-year students of Bursa Uludağ University Faculty of Dentistry during the 2024–2025 academic year, both before and after the final assessment of the Restorative Dentistry course. A total of 130 mind maps (n pre-test =65; n post-test =65) were analyzed. The evaluation focused on the extent to which the maps reflected the definition of principles, mechanisms of action, and clinical agents, as well as their structural organization in terms of hierarchy and cross-linking, and the effective use of pictorial and color elements within the standardized framework of the mind map format (Fig. 1 ). Evaluation Criteria The STROBE flow chart outlining the sequential stages of the study is shown in Fig. 2 . The mind maps, prepared individually and independently by the students in an original manner, were evaluated anonymously. Before the mind mapping activity, the participants had completed their theoretical training on fluoride-free remineralization systems in accordance with the dental curriculum. The mind mapping activity was carried out at two different time points: before and after the final examination. The mind maps were evaluated by two independent researchers (Z.C.C. and E.O.T.) based on content and structural features. The following parameters were established as the basis for evaluation: (i) The accuracy of technical information and terminology related to fluoride-free remineralization systems (e.g., mechanism of action, fundamental principles, ozone application, ACP-CPP, bioactive glass/CSPS, nanohydroxyapatite, xylitol, arginine, TCP, and herbal agents), (ii) The appropriate and consistent representation of relationships between concepts, including the use of arrows, lines, and colors; application of text/visuals to reflect the order of importance and hierarchy of concepts; the number of subcategories; and the diversity and density of symbols, visuals, and grouping, (iii) The type of relationships between concepts (e.g., linear connections and/or cross-links), (iv) The presence of irrelevant or off-topic content. The evaluation of pre-test and post-test mind maps was carried out across both content- and structure-related sub-categories. Each sub-category was rated on a 0–2 scale, where 0 indicated the absence of the element, 1 indicated a superficial mention without elaboration, and 2 indicated a more detailed and comprehensive elaboration. To enhance the reliability of the evaluation process, the scores of both researchers were compared, and in cases where consensus could not initially be reached, a joint decision was made. Data Analysis All mind maps were collected on A5-sized paper. To ensure student anonymity, an individual not involved in the data analysis coded the mind map files with student identifier numbers, distinguishing between pre-test and post-test mind maps. To address the first research question, two independent researchers evaluated a total of 130 mind maps. The analysis of visual and textual elements was conducted from an interpretive perspective. Through this analysis, codes and themes related to the mind maps were identified, thereby revealing the extent to which students were able to express the concepts of the subject accurately, comprehensively, and in an evidence-based manner. The pre-test and post-test mind maps were analyzed independently to allow for a clear comparison of changes in students’ conceptual understanding over time. To address the second research question, each student’s pre-test and post-test mind maps were compared in terms of developmental progress. Development was defined as the presence of key elements in the post-test mind map that were not included in the pre-test. These elements included not only the presentation of technical factors (e.g., mechanisms of action of different remineralization agents, methods of application, etc.) but also the integration of biological factors (e.g., caries formation, plaque, acidic environment, the role of saliva, etc.) along with the inclusion of patient/clinical context (e.g., site of application, patient compliance, need for follow-up). Statistical analysis The normality of the data distribution was examined using the Shapiro–Wilk test. Since the data did not show a normal distribution, descriptive statistics were presented as median (min–max) values. Comparisons between independent groups were performed using the Mann–Whitney U test, while comparisons within dependent groups were conducted with the Wilcoxon signed-rank test. Categorical data were compared between groups using the chi-square test and Fisher’s exact test, and comparisons of dependent categorical variables were carried out with McNemar’s test. Categorical variables were described as frequencies and percentages. A significance level of α = 0.05 was adopted. Data analyses were performed using the SPSS v25 software package. Results Mind-map content-related and format-related parameters stratified by gender and overall totals were shown in Table 1 . Table 1 Distribution of mind-map content-related parameters and format-related parameters stratified by gender and overall totals. Unchanged Male / Female / Total n(%) Improved Male / Female / Total n(%) Regressed Male / Female / Total n(%) p-values (M; F; T) Mechanism of Action 17 (85.0%) 37 (82.2%) 54 (83.1%) 0 (0.0%) 3 (6.7%) 3 (4.6%) 3 (15.0%) 5 (11.1%) 8 (12.3%) –; 0.727; 0.227 Definition and Principles 16 (80.0%) 38 (84.5%) 54 (83.1%) 3 (15.0%) 4 (8.9%) 7 (10.8%) 1 (5.0%) 3 (6.7%) 4 (6.2%) 0.625; 1.000; 0.549 Clinical Agents Ozon 16 (80.0%) 35 (77.8%) 51 (78.4%) 1 (5.0%) 4 (8.9%) 5 (7.7%) 3 (15.0%) 6 (13.3%) 9 (13.8%) 0.625; 0.754; 0.424 ACP-CPP 13 (65.0%) 31 (68.9%) 44 (67.6%) 1 (5.0%) 4 (8.9%) 5 (7.7%) 6 (30.0%) 10 (22.2%) 16 (24.6%) 0.125; 0.180; 0.027* CSPS 14 (70.0%) 37 (82.2%) 51 (78.4%) 1 (5.0%) 5 (11.1%) 6 (9.2%) 5 (25.0%) 3 (6.7%) 8 (12.3%) 0.219; 0.727; 0.791 nHAp 16 (80.0%) 30 (66.7%) 46 (70.8%) 0 (0.0%) 3 (6.7%) 3 (4.6%) 4 (20.0%) 12 (26.7%) 16 (24.6%) 0.125; 0.035*; 0.004* Xylitol 13 (65.0%) 29 (64.4%) 42 (64.6%) 0 (0.0%) 2 (4.4%) 2 (3.1%) 7 (35.0%) 14 (31.1%) 21 (32.3%) 0.016*; 0.004*; 0.000* Arginine 18 (90.0%) 39 (86.7%) 57 (87.7%) 0 (0.0%) 3 (6.7%) 3 (4.6%) 2 (10.0%) 3 (6.7%) 5 (7.7%) 0.500; 1.000; 0.727 TCP 18 (90.0%) 31 (68.9%) 49 (75.3%) 0 (0.0%) 5 (11.1%) 5 (7.7%) 2 (10.0%) 9 (20.0%) 11 (16.9%) 0.500; 0.424; 0.210 Herbal 20 (100.0%) 43 (95.6%) 63 (96.9%) 0 (0.0%) 1 (2.2%) 1 (1.5%) 0 (0.0%) 1 (2.2%) 1 (1.5%) –; 1.000; 1.000 Mind-Map Format Picturizing 18 (90.0%) 43 (95.6%) 61 (93.8%) 1 (5.0%) 0 (0.0%) 1 (1.5%) 1 (5.0%) 2 (4.4%) 3 (4.6%) 1.000; 0.500; 0.625 Crosslinking 18 (90.0%) 38 (84.4%) 56 (86.2%) 2 (10.0%) 6 (13.3%) 8 (12.3%) 0 (0.0%) 1 (2.2%) 1 (1.5%) 0.500; 0.125; 0.039* Hierarchies 13 (65.0%) 32 (71.1%) 45 (69.2%) 2 (10.0%) 3 (6.7%) 5 (7.7%) 5 (25.0%) 10 (22.2%) 15 (23.1%) 0.453; 0.092; 0.041* Content parameters Most students, irrespective of gender, successfully included mechanism of action and definition and principles in their mind maps, with no significant differences between males and females (all p > 0.05). Regarding clinical agents, ozone and CSPS were comparably represented across genders without statistical significance. However, differences emerged for certain agents. ACP-CPP showed a higher proportion of regressed responses in the total group ( p = 0.027). nHAp demonstrated a significantly higher regression rate among females (26.7%) compared to males (20.0%), and this difference was significant both within females ( p = 0.035) and in the overall sample ( p = 0.004). Xylitol presented the most pronounced gender effect, with regression observed in 35.0% of males and 31.1% of females, reaching significance for both genders (male p = 0.016; female p = 0.004) and the overall group ( p 0.05). Format parameters For mind-map formatting techniques, picturizing and crosslinking were widely used. While picturizing did not differ significantly between groups, crosslinking showed significance in the overall sample ( p = 0.039), despite similar proportions across genders. Likewise, hierarchical structuring revealed a higher rate of regression among females (22.2%) compared to males (25.0%), reaching statistical significance in the total group ( p = 0.041). The comparison of pre-test and post-test scores demonstrated variable changes across sub-categories of Mind Map Content and Structural Features (Fig. 3 ). For terminological accuracy, the mean score decreased from 0.67 ± 0.73 in the pre-test to 0.54 ± 0.61 in the post-test. By contrast, conceptual integration showed improvement, increasing from 0.05 ± 0.04 to 0.15 ± 0.24. Within structural features, the hierarchical framework declined from 1.25 ± 0.84 at baseline to 0.92 ± 0.85 following the intervention. In contrast, visual layout and clarity improved slightly, with scores rising from 0.45 ± 0.33 to 0.57 ± 0.42. The category of creativity and originality remained stable, with a marginal decrease from 0.51 ± 0.25 to 0.46 ± 0.37. Overall, while post-test assessments indicated modest gains in conceptual integration and visual clarity, reductions were noted in terminological accuracy and hierarchical organization. Creativity and originality scores remained largely unchanged. In the comparison of irrelevant items between pre- and post-test mind maps, statistically significant differences were observed in both male (Z = -2.410, p = 0.016) and female students (Z = -2.184, p = 0.029). In the overall sample, the median score increased from 1.00 to 2.00, indicating a significant rise in irrelevant elements at post-test (Z = -3.196, p = 0.001) (Table 2 ). Table 2 Pre- and post-test comparison of irrelevant items Group N Pre-exam Median (Min-Max) Post-exam Median (Min-Max) Negative Ranks (n) Positive Ranks (n) Ties (n) Z P* Male 20 1.00 (0–2.0) 2.00 (0–3.0) 2 10 8 -2.410 0.016 Female 45 1.00 (0–2.5) 1.00 (0–3.0) 7 19 19 -2.184 0.029 Total 65 1.00 (0–2.0) 2.00 (0–3.0) 9 29 27 -3.196 0.001 * Wilcoxon Signed Ranks Discussion This study, which analyzed mind maps created by dental students before and after the final examination of the Restorative Dentistry course, provides valuable insights into students’ levels of conceptual understanding and their learning processes. Our findings revealed that the majority of students were able to express the fundamental scientific concepts of fluoride-free remineralization systems (e.g., mechanism of action, definition, and principles) accurately and holistically through mind maps. Clinical agents such as ozone and CSPS were represented at comparable rates across genders without significant differences (p > 0.05). However, certain agents demonstrated notable regression. ACP-CPP showed a significantly higher regression rate in the total sample (p = 0.027). Similarly, nHAp regression was higher among females (26.7%) compared to males (20.0%), a difference that reached significance both within females (p = 0.035) and in the overall group (p = 0.004). The most pronounced gender-related effect was observed for xylitol, with regression in 35.0% of males and 31.1% of females, which was significant for both genders (male p = 0.016; female p = 0.004) and for the total sample (p 0.05). Our findings revealed regression in hierarchical structuring (22.2% of females, 25.0% of males; p = 0.041) and significance in crosslinking (p = 0.039), indicating that while students commonly used picturizing, their ability to organize knowledge systematically declined under exam conditions. This pattern mirrors the results of Janczukowicz and Rees (2017)[18], who, in analyzing 98 mind maps from 262 medical students, observed that although learners could depict individual attributes of professionalism, many struggled to establish higher-order relationships. Together, these results suggest that while mind maps capture basic visual representation effectively, more complex structural integration requires additional scaffolding and may be especially vulnerable under high-stress contexts. Our study shows that mind mapping helped students maintain basic concepts and improve visual clarity and conceptual integration, but higher-order features like hierarchical structuring and accuracy regressed, especially for agents such as nHAp and xylitol. In line with Gao et al. ( 2022 )[19], these results suggest that mind mapping is most effective when combined with structured, problem-based learning to support deeper knowledge retention. Numerical data further support these observations. Terminological accuracy decreased from 0.67 ± 0.73 in the pre-test to 0.54 ± 0.61 in the post-test, while hierarchical structuring declined from 1.25 ± 0.84 to 0.92 ± 0.85. These declines may be explained by cognitive fatigue and overload associated with the final examination, suggesting that exams may function more as a source of stress than as a supportive learning tool. At the same time, positive developments were also observed. Conceptual integration improved from 0.05 ± 0.04 to 0.15 ± 0.24, and visual layout and clarity increased from 0.45 ± 0.33 to 0.57 ± 0.42. These improvements indicate that examinations can stimulate certain aspects of learning, particularly in terms of establishing conceptual connections and enhancing the clarity of presentation. However, the simultaneous increase in irrelevant items, along with reductions in terminological accuracy and hierarchical organization, suggests that students sometimes adopted a mindset of “the answers cannot be that straightforward” and tended to produce overcomplicated or tangential content under exam conditions.[20] Overall, these findings highlight both the potential and limitations of examinations as a learning tool. Mind maps remain a powerful method to reflect conceptual knowledge, yet their full potential may not be realized in high-stakes exam environments. Our results parallel Elsayed et al. (2022)[21], showing that mind mapping enhances recall and clarity but may regress in deeper structuring. Like their findings, its full benefit appears when applied with structured guidance. In our study, the mind map subcategories of colorizing, picturizing, and creativity were found to range between 0.4 and 0.6 out of 2 points. Some mind maps were presented in the form of technical concept maps or schematic diagrams, while artistic representations were notably limited. A possible explanation is that dental students have restricted opportunities to engage in art-based or creativity-oriented activities during their professional training. Since dental education primarily emphasizes verbal and analytical skills associated with the left hemisphere of the brain, the right hemisphere—responsible for visual and perceptual functions—may be underutilized, leading students to rely less on artistic forms of expression [22] While Grazziotin-Soares et al. ( 2021 ) reported that nearly 50% of students increased detail and artistic expression in their second mind map, our findings demonstrated a reduction in detail, likely influenced by administering the second map immediately after the examination. Conclusion In conclusion, this study provided meaningful contributions for students with different learning styles and highlighted the potential of mind mapping to support self-regulated learning. Previous research has shown that mind mapping facilitates knowledge recall and positively influences the learning process [23]. However, in our study, mind maps created immediately after the examination did not show marked improvement, suggesting that high-stakes exam environments may function more as a source of stress than as a supportive learning context. Therefore, using mind mapping more frequently and as an independent learning activity may not only facilitate knowledge recall but also help students structure their ideas in a more organized, conceptual, and holistic way. The effective realization of this potential, however, depends on providing learning-oriented and low-stakes assessment environments. Abbreviations CPP-ACP: Casein Phosphopeptide - Amorphous Calcium Phosphate– CSPS: Calcium Sodium Phosphosilicate TCP: Tricalcium Phosphate Declarations Acknowledgments The authors would like to thank all the dental students for their participation in this study. Funding The authors declare that there are no fundings regarding the publication of this article. Ethics Statements All study procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Health Sciences Research Ethics Committee of Faculty of Medicine, Bursa Uludağ University, Bursa, Türkiye (Approval Number: 2025/786/14-5). Conflict of Interest The authors declare no competing interests. Informed Consent As this was a retrospective study, the requirement for informed consent was waived according to the regulation. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Addae, J. I., Wilson, J. I., & Carrington, C. (2012). Students’ perception of a modified form of PBL using concept mapping. Medical Teacher , 34 (11). doi: 10.3109/0142159X.2012.689440 Ahmed Elsayed, A., Elgharib Mohamed Mostafa Eldiasty, N., Ahmed MohammedAbd El Salam, F., H Mohamed, S., & Mohamed Abd ElHamid Younes, M. (2022). Effect of Using Mind Mapping Learning Technique among Undergraduate Nursing Students. 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(2020). Concept mapping, an effective tool for long-term memorization of anatomy-a Quasi-experimental research carried out among 1st year general medicine students. European Journal of Investigation in Health, Psychology and Education , 10 (1), 530–543. doi: 10.3390/ejihpe10010038 Robberecht, R. (2007). Interactive Nonlinear Learning Environments. The Electronic Journal of E-Learning , 5 , 59. Ustaoğlu, S., & Akal, N. (2023). Current Approaches to Remıneralızatıon Agents. In Selcuk Dental Journal (Vol. 10, Issue 1, pp. 106–111). Selcuk University. doi: 10.15311/selcukdentj.1095382 Yan, Y., Yuehong, W., Kun, L., Hongbo, Z., Hongyu, Z., Yingming, Y., & Zhili, Z. (2023). Implementation of mind mapping with problem-based learning in prosthodontics course for Chinese dental students. BMC Medical Education , 23 (1). doi: 10.1186/s12909-023-04479-8 Additional Declarations No competing interests reported. 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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-8259920","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":565235551,"identity":"445e47c4-0186-48df-a79c-9bd91dbb2a00","order_by":0,"name":"Esra OZGOCMEN TULA","email":"","orcid":"","institution":"Bursa Uludağ University","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"OZGOCMEN","lastName":"TULA","suffix":""},{"id":565235552,"identity":"92943fb0-9bb0-43be-a484-7fb34d5891d1","order_by":1,"name":"Zeynep Ceren 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07:34:03","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81054,"visible":true,"origin":"","legend":"","description":"","filename":"4c3675b17daf4b8084cef4277bf8550b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/62dc9eb90d067e3bb962263a.xml"},{"id":99027205,"identity":"b03a8916-f854-4730-b5d5-33c9c46d51e6","added_by":"auto","created_at":"2025-12-26 07:34:04","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94342,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/5c7b643dac8e346c305339a3.html"},{"id":99027193,"identity":"f3664fb8-b79f-4834-bd7b-8f8a869e43f6","added_by":"auto","created_at":"2025-12-26 07:34:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":445119,"visible":true,"origin":"","legend":"\u003cp\u003eMind map framework of fluoride-free remineralization systems\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/44365c211c5942c133df797a.png"},{"id":99313873,"identity":"3168b5bf-820c-45e0-8502-a190ebfe900e","added_by":"auto","created_at":"2025-12-31 16:20:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":93746,"visible":true,"origin":"","legend":"\u003cp\u003eSTROBE flowchart of the mind-map study process.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/2d4198283852657c9561f2ac.png"},{"id":99027194,"identity":"62461df6-6ec1-4ebe-abe4-5fee15913529","added_by":"auto","created_at":"2025-12-26 07:34:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":48238,"visible":true,"origin":"","legend":"\u003cp\u003eThe pre-test and post-test scores across both \u003cstrong\u003econtent\u003c/strong\u003e and s\u003cstrong\u003etructural features\u003c/strong\u003esub-categories (each rated on a 0–2 scale).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/e5ad2b7d13a7cab5e97ed571.png"},{"id":99323055,"identity":"19a7465a-b5d3-4c48-a9a3-2c431dfb1fad","added_by":"auto","created_at":"2025-12-31 16:44:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1238714,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8259920/v1/2b922b0b-bc4f-4816-844a-3a9f9421ea65.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dental Students’ Conceptual Knowledge of Fluoride-Free Remineralization Systems Assessed Through Mind Mapping","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental education is a multidimensional process to provide students with fundamental scientific and clinical knowledge, to foster the development and integration of cognitive and behavioral competencies such as information analysis, problem-solving, decision-making, and patient management [1\u0026ndash;3]. In professional practice, the ability to make accurate and reliable clinical decisions is closely related to the extent to which students can organize the knowledge they possess and accurately construct the relationships between concepts [4]. In the health sciences, where multidimensional and interdisciplinary relationships are closely interconnected, the clear and logical establishment of conceptual connections plays an important role in enhancing the depth of learning and ensuring the effective transfer of knowledge [5]. Therefore, in dental education, assessing students\u0026rsquo; knowledge alone is insufficient; equal emphasis should be placed on evaluating how they structure and conceptualize information throughout the learning process [1].\u003c/p\u003e \u003cp\u003eTraditional teaching in dental education is largely based on linear knowledge transmission [6]. In this model, the learning process is characterized by one-directional communication, where knowledge is transmitted by the instructor and the student assumes a passive role as the recipient [7]. However, such methods do not sufficiently support students in holistically structuring complex and multidimensional content or in developing meaningful relationships between concepts [6]. For these reasons, to train competent professionals capable of developing effective solutions to complex and multidimensional health problems, it is essential to adopt learner-centered approaches that promote a high level of interaction [8].\u003c/p\u003e \u003cp\u003eMind mapping is a learning and expression technique that enables information to be visually organized around a central main topic in the form of branches, supported by keywords, symbols, colors, and images. Developed by Tony Buzan [9], this method allows the use of multisensory stimuli such as pictures and colors in the learning process, thereby facilitating the comprehension of intrinsic relationships between concepts, the integration of interdisciplinary knowledge, the transfer of information from short-term to long-term memory, and its retrieval [10\u0026ndash;12]. Mind maps are an effective tool for structuring complex information, as they allow the relationships between concepts to be visually represented [12]. Studies in the field of health sciences have shown that mind mapping contributes to the integration of theoretical knowledge with clinical applications, enhances the retention of learning, and improves skills such as critical thinking, problem-solving, establishing conceptual connections, and organizing information [13\u0026ndash;15].\u003c/p\u003e \u003cp\u003eThe pre-test/post-test design is a research method that can objectively evaluate the effects of educational interventions on learning outcomes. This approach reveals the change in the learning process by measuring students\u0026rsquo; knowledge and conceptual understanding of a specific topic before and after the intervention [16]. The use of this technique in combination with mind mapping provides the opportunity to evaluate not only the amount of knowledge students possess but also how they organize that knowledge, how they construct relationships between concepts, and what conceptual developments they demonstrate throughout the learning process. Criteria such as the number of concepts in the maps, the level of branching, the accuracy of linking statements, and the overall conceptual coherence can objectively reflect the depth of learning and changes in the knowledge structure [1].\u003c/p\u003e \u003cp\u003eThere are several studies on the use of mind mapping across different disciplines in health sciences education [13, 15]. Although this technique has been noted for its potential to objectively reveal changes in the learning process and, through the analysis of the mind maps created by the same student during the pre-test and post-test phases, to uncover the dynamics of learning, to the best of our knowledge [1] studies evaluating dental students\u0026rsquo; conceptual understanding of a specific topic using pre-test/post-test mind maps are quite limited. In this context, our study will contribute both to the evaluation of conceptual learning in a specific subject area through visual representations and to the demonstration of the educational effectiveness of mind maps.\u003c/p\u003e \u003cp\u003eBased on the available data in the current literature, this study aims to measure dental students\u0026rsquo; understanding of concepts related to non-fluoride remineralization agents [17] to evaluate their ability to express this knowledge through visual representations; to examine the distinctive features of their mind maps; and to retrospectively demonstrate the development reflected in the pre-test/post-test mind maps created by the same students. In this way, the potential of mind mapping for the implementation of active learning methods in dental education will be demonstrated.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e This retrospective study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was approved by the Health Research Ethics Committee of the Faculty of Medicine at Bursa Uludağ University (Approval Number: 2025/786/14\u0026thinsp;\u0026minus;\u0026thinsp;5).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eIn this study, \u0026ldquo;Fluoride-Free Remineralization Systems,\u0026rdquo; one of the important topics in preventive dentistry, was examined using the mind mapping method.\u003c/p\u003e \u003cp\u003eThe study focuses on the following research questions: (1) Do students accurately and holistically express the fundamental concepts related to fluoride-free remineralization systems through mind maps, and are there differences between genders? (2) Does the difference between students\u0026rsquo; pre-test and post-test performances reveal whether the examination functions as a teaching tool that supports the learning process?\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eIn this study, an evaluation was conducted on mind maps themed \u0026lsquo;Fluoride-Free Remineralization Systems\u0026rsquo;, prepared by third-year students of Bursa Uludağ University Faculty of Dentistry during the 2024\u0026ndash;2025 academic year, both before and after the final assessment of the Restorative Dentistry course. A total of 130 mind maps (n\u003csub\u003epre-test\u003c/sub\u003e=65; n\u003csub\u003epost-test\u003c/sub\u003e=65) were analyzed. The evaluation focused on the extent to which the maps reflected the definition of principles, mechanisms of action, and clinical agents, as well as their structural organization in terms of hierarchy and cross-linking, and the effective use of pictorial and color elements within the standardized framework of the mind map format (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eEvaluation Criteria\u003c/h3\u003e\n\u003cp\u003eThe STROBE flow chart outlining the sequential stages of the study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mind maps, prepared individually and independently by the students in an original manner, were evaluated anonymously. Before the mind mapping activity, the participants had completed their theoretical training on fluoride-free remineralization systems in accordance with the dental curriculum. The mind mapping activity was carried out at two different time points: before and after the final examination.\u003c/p\u003e \u003cp\u003eThe mind maps were evaluated by two independent researchers (Z.C.C. and E.O.T.) based on content and structural features. The following parameters were established as the basis for evaluation: (i) The accuracy of technical information and terminology related to fluoride-free remineralization systems (e.g., mechanism of action, fundamental principles, ozone application, ACP-CPP, bioactive glass/CSPS, nanohydroxyapatite, xylitol, arginine, TCP, and herbal agents), (ii) The appropriate and consistent representation of relationships between concepts, including the use of arrows, lines, and colors; application of text/visuals to reflect the order of importance and hierarchy of concepts; the number of subcategories; and the diversity and density of symbols, visuals, and grouping, (iii) The type of relationships between concepts (e.g., linear connections and/or cross-links), (iv) The presence of irrelevant or off-topic content.\u003c/p\u003e \u003cp\u003eThe evaluation of pre-test and post-test mind maps was carried out across both content- and structure-related sub-categories. Each sub-category was rated on a 0\u0026ndash;2 scale, where 0 indicated the absence of the element, 1 indicated a superficial mention without elaboration, and 2 indicated a more detailed and comprehensive elaboration. To enhance the reliability of the evaluation process, the scores of both researchers were compared, and in cases where consensus could not initially be reached, a joint decision was made.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAll mind maps were collected on A5-sized paper. To ensure student anonymity, an individual not involved in the data analysis coded the mind map files with student identifier numbers, distinguishing between pre-test and post-test mind maps.\u003c/p\u003e \u003cp\u003eTo address the first research question, two independent researchers evaluated a total of 130 mind maps. The analysis of visual and textual elements was conducted from an interpretive perspective. Through this analysis, codes and themes related to the mind maps were identified, thereby revealing the extent to which students were able to express the concepts of the subject accurately, comprehensively, and in an evidence-based manner. The pre-test and post-test mind maps were analyzed independently to allow for a clear comparison of changes in students\u0026rsquo; conceptual understanding over time.\u003c/p\u003e \u003cp\u003eTo address the second research question, each student\u0026rsquo;s pre-test and post-test mind maps were compared in terms of developmental progress. Development was defined as the presence of key elements in the post-test mind map that were not included in the pre-test. These elements included not only the presentation of technical factors (e.g., mechanisms of action of different remineralization agents, methods of application, etc.) but also the integration of biological factors (e.g., caries formation, plaque, acidic environment, the role of saliva, etc.) along with the inclusion of patient/clinical context (e.g., site of application, patient compliance, need for follow-up).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe normality of the data distribution was examined using the Shapiro\u0026ndash;Wilk test. Since the data did not show a normal distribution, descriptive statistics were presented as median (min\u0026ndash;max) values. Comparisons between independent groups were performed using the Mann\u0026ndash;Whitney U test, while comparisons within dependent groups were conducted with the Wilcoxon signed-rank test. Categorical data were compared between groups using the chi-square test and Fisher\u0026rsquo;s exact test, and comparisons of dependent categorical variables were carried out with McNemar\u0026rsquo;s test. Categorical variables were described as frequencies and percentages. A significance level of α\u0026thinsp;=\u0026thinsp;0.05 was adopted. Data analyses were performed using the SPSS v25 software package.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eMind-map content-related and format-related parameters stratified by gender and overall totals were shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of mind-map \u003cb\u003econtent-related parameters\u003c/b\u003e and \u003cb\u003eformat-related parameters\u003c/b\u003e stratified by gender and overall totals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnchanged\u003c/p\u003e \u003cp\u003eMale / Female / Total n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003cp\u003eMale / Female / Total n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRegressed\u003c/p\u003e \u003cp\u003eMale / Female / Total n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-values\u003c/p\u003e \u003cp\u003e(M; F; T)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMechanism of Action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (85.0%)\u003c/p\u003e \u003cp\u003e37 (82.2%)\u003c/p\u003e \u003cp\u003e54 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e3 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003cp\u003e8 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;; 0.727; 0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDefinition and Principles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (80.0%)\u003c/p\u003e \u003cp\u003e38 (84.5%)\u003c/p\u003e \u003cp\u003e54 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003cp\u003e4 (8.9%)\u003c/p\u003e \u003cp\u003e7 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e4 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.625; 1.000; 0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eClinical Agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOzon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (80.0%)\u003c/p\u003e \u003cp\u003e35 (77.8%)\u003c/p\u003e \u003cp\u003e51 (78.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e4 (8.9%)\u003c/p\u003e \u003cp\u003e5 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003cp\u003e6 (13.3%)\u003c/p\u003e \u003cp\u003e9 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.625; 0.754; 0.424\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eACP-CPP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0%)\u003c/p\u003e \u003cp\u003e31 (68.9%)\u003c/p\u003e \u003cp\u003e44 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e4 (8.9%)\u003c/p\u003e \u003cp\u003e5 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (30.0%)\u003c/p\u003e \u003cp\u003e10 (22.2%)\u003c/p\u003e \u003cp\u003e16 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.125; 0.180; 0.027*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCSPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (70.0%)\u003c/p\u003e \u003cp\u003e37 (82.2%)\u003c/p\u003e \u003cp\u003e51 (78.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003cp\u003e6 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e8 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.219; 0.727; 0.791\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enHAp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (80.0%)\u003c/p\u003e \u003cp\u003e30 (66.7%)\u003c/p\u003e \u003cp\u003e46 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e3 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003cp\u003e12 (26.7%)\u003c/p\u003e \u003cp\u003e16 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.125; 0.035*; 0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eXylitol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0%)\u003c/p\u003e \u003cp\u003e29 (64.4%)\u003c/p\u003e \u003cp\u003e42 (64.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (4.4%)\u003c/p\u003e \u003cp\u003e2 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (35.0%)\u003c/p\u003e \u003cp\u003e14 (31.1%)\u003c/p\u003e \u003cp\u003e21 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.016*; 0.004*; 0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArginine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90.0%)\u003c/p\u003e \u003cp\u003e39 (86.7%)\u003c/p\u003e \u003cp\u003e57 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e3 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e5 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.500; 1.000; 0.727\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90.0%)\u003c/p\u003e \u003cp\u003e31 (68.9%)\u003c/p\u003e \u003cp\u003e49 (75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003cp\u003e5 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003cp\u003e9 (20.0%)\u003c/p\u003e \u003cp\u003e11 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.500; 0.424; 0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHerbal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (100.0%)\u003c/p\u003e \u003cp\u003e43 (95.6%)\u003c/p\u003e \u003cp\u003e63 (96.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;; 1.000; 1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMind-Map Format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePicturizing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90.0%)\u003c/p\u003e \u003cp\u003e43 (95.6%)\u003c/p\u003e \u003cp\u003e61 (93.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003cp\u003e2 (4.4%)\u003c/p\u003e \u003cp\u003e3 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000; 0.500; 0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrosslinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90.0%)\u003c/p\u003e \u003cp\u003e38 (84.4%)\u003c/p\u003e \u003cp\u003e56 (86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003cp\u003e6 (13.3%)\u003c/p\u003e \u003cp\u003e8 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.500; 0.125; 0.039*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHierarchies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0%)\u003c/p\u003e \u003cp\u003e32 (71.1%)\u003c/p\u003e \u003cp\u003e45 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003cp\u003e3 (6.7%)\u003c/p\u003e \u003cp\u003e5 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003cp\u003e10 (22.2%)\u003c/p\u003e \u003cp\u003e15 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.453; 0.092; 0.041*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eContent parameters\u003c/h3\u003e\n\u003cp\u003eMost students, irrespective of gender, successfully included mechanism of action and definition and principles in their mind maps, with no significant differences between males and females (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Regarding clinical agents, ozone and CSPS were comparably represented across genders without statistical significance.\u003c/p\u003e \u003cp\u003eHowever, differences emerged for certain agents. ACP-CPP showed a higher proportion of regressed responses in the total group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027). nHAp demonstrated a significantly higher regression rate among females (26.7%) compared to males (20.0%), and this difference was significant both within females (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) and in the overall sample (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). Xylitol presented the most pronounced gender effect, with regression observed in 35.0% of males and 31.1% of females, reaching significance for both genders (male \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016; female \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and the overall group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, arginine, TCP, and herbal agents were largely maintained across both genders, with no significant differences observed (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003eFormat parameters\u003c/h3\u003e\n\u003cp\u003eFor mind-map formatting techniques, picturizing and crosslinking were widely used. While picturizing did not differ significantly between groups, crosslinking showed significance in the overall sample (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039), despite similar proportions across genders. Likewise, hierarchical structuring revealed a higher rate of regression among females (22.2%) compared to males (25.0%), reaching statistical significance in the total group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e \u003cp\u003eThe comparison of pre-test and post-test scores demonstrated variable changes across sub-categories of Mind Map Content and Structural Features (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor terminological accuracy, the mean score decreased from 0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 in the pre-test to 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61 in the post-test. By contrast, conceptual integration showed improvement, increasing from 0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04 to 0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24. Within structural features, the hierarchical framework declined from 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 at baseline to 0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85 following the intervention. In contrast, visual layout and clarity improved slightly, with scores rising from 0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 to 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42. The category of creativity and originality remained stable, with a marginal decrease from 0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 to 0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37.\u003c/p\u003e \u003cp\u003eOverall, while post-test assessments indicated modest gains in conceptual integration and visual clarity, reductions were noted in terminological accuracy and hierarchical organization. Creativity and originality scores remained largely unchanged.\u003c/p\u003e \u003cp\u003eIn the comparison of irrelevant items between pre- and post-test mind maps, statistically significant differences were observed in both male (Z = -2.410, p\u0026thinsp;=\u0026thinsp;0.016) and female students (Z = -2.184, p\u0026thinsp;=\u0026thinsp;0.029). In the overall sample, the median score increased from 1.00 to 2.00, indicating a significant rise in irrelevant elements at post-test (Z = -3.196, p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre- and post-test comparison of irrelevant items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-exam Median (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-exam Median (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNegative Ranks (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePositive Ranks (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTies (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0\u0026ndash;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00 (0\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-2.410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0\u0026ndash;2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-2.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0\u0026ndash;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00 (0\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-3.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e* Wilcoxon Signed Ranks\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, which analyzed mind maps created by dental students before and after the final examination of the Restorative Dentistry course, provides valuable insights into students\u0026rsquo; levels of conceptual understanding and their learning processes. Our findings revealed that the majority of students were able to express the fundamental scientific concepts of fluoride-free remineralization systems (e.g., mechanism of action, definition, and principles) accurately and holistically through mind maps. Clinical agents such as ozone and CSPS were represented at comparable rates across genders without significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, certain agents demonstrated notable regression. ACP-CPP showed a significantly higher regression rate in the total sample (p\u0026thinsp;=\u0026thinsp;0.027). Similarly, nHAp regression was higher among females (26.7%) compared to males (20.0%), a difference that reached significance both within females (p\u0026thinsp;=\u0026thinsp;0.035) and in the overall group (p\u0026thinsp;=\u0026thinsp;0.004). The most pronounced gender-related effect was observed for xylitol, with regression in 35.0% of males and 31.1% of females, which was significant for both genders (male p\u0026thinsp;=\u0026thinsp;0.016; female p\u0026thinsp;=\u0026thinsp;0.004) and for the total sample (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). By contrast, arginine, TCP, and herbal agents remained largely stable across groups with no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eOur findings revealed regression in hierarchical structuring (22.2% of females, 25.0% of males; p\u0026thinsp;=\u0026thinsp;0.041) and significance in crosslinking (p\u0026thinsp;=\u0026thinsp;0.039), indicating that while students commonly used picturizing, their ability to organize knowledge systematically declined under exam conditions. This pattern mirrors the results of Janczukowicz and Rees (2017)[18], who, in analyzing 98 mind maps from 262 medical students, observed that although learners could depict individual attributes of professionalism, many struggled to establish higher-order relationships. Together, these results suggest that while mind maps capture basic visual representation effectively, more complex structural integration requires additional scaffolding and may be especially vulnerable under high-stress contexts.\u003c/p\u003e \u003cp\u003eOur study shows that mind mapping helped students maintain basic concepts and improve visual clarity and conceptual integration, but higher-order features like hierarchical structuring and accuracy regressed, especially for agents such as nHAp and xylitol. In line with Gao et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)[19], these results suggest that mind mapping is most effective when combined with structured, problem-based learning to support deeper knowledge retention.\u003c/p\u003e \u003cp\u003eNumerical data further support these observations. Terminological accuracy decreased from 0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 in the pre-test to 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61 in the post-test, while hierarchical structuring declined from 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 to 0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85. These declines may be explained by cognitive fatigue and overload associated with the final examination, suggesting that exams may function more as a source of stress than as a supportive learning tool.\u003c/p\u003e \u003cp\u003eAt the same time, positive developments were also observed. Conceptual integration improved from 0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04 to 0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24, and visual layout and clarity increased from 0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 to 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42. These improvements indicate that examinations can stimulate certain aspects of learning, particularly in terms of establishing conceptual connections and enhancing the clarity of presentation. However, the simultaneous increase in irrelevant items, along with reductions in terminological accuracy and hierarchical organization, suggests that students sometimes adopted a mindset of \u003cem\u003e\u0026ldquo;the answers cannot be that straightforward\u0026rdquo;\u003c/em\u003e and tended to produce overcomplicated or tangential content under exam conditions.[20]\u003c/p\u003e \u003cp\u003eOverall, these findings highlight both the potential and limitations of examinations as a learning tool. Mind maps remain a powerful method to reflect conceptual knowledge, yet their full potential may not be realized in high-stakes exam environments. Our results parallel Elsayed et al. (2022)[21], showing that mind mapping enhances recall and clarity but may regress in deeper structuring. Like their findings, its full benefit appears when applied with structured guidance.\u003c/p\u003e \u003cp\u003eIn our study, the mind map subcategories of colorizing, picturizing, and creativity were found to range between 0.4 and 0.6 out of 2 points. Some mind maps were presented in the form of technical concept maps or schematic diagrams, while artistic representations were notably limited. A possible explanation is that dental students have restricted opportunities to engage in art-based or creativity-oriented activities during their professional training. Since dental education primarily emphasizes verbal and analytical skills associated with the left hemisphere of the brain, the right hemisphere\u0026mdash;responsible for visual and perceptual functions\u0026mdash;may be underutilized, leading students to rely less on artistic forms of expression [22]\u003c/p\u003e \u003cp\u003eWhile Grazziotin-Soares et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported that nearly 50% of students increased detail and artistic expression in their second mind map, our findings demonstrated a reduction in detail, likely influenced by administering the second map immediately after the examination.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study provided meaningful contributions for students with different learning styles and highlighted the potential of mind mapping to support self-regulated learning. Previous research has shown that mind mapping facilitates knowledge recall and positively influences the learning process [23]. However, in our study, mind maps created immediately after the examination did not show marked improvement, suggesting that high-stakes exam environments may function more as a source of stress than as a supportive learning context. Therefore, using mind mapping more frequently and as an independent learning activity may not only facilitate knowledge recall but also help students structure their ideas in a more organized, conceptual, and holistic way. The effective realization of this potential, however, depends on providing learning-oriented and low-stakes assessment environments.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCPP-ACP: Casein Phosphopeptide - Amorphous Calcium Phosphate–\u003c/p\u003e\n\u003cp\u003eCSPS: Calcium Sodium Phosphosilicate\u003c/p\u003e\n\u003cp\u003eTCP: Tricalcium Phosphate\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the dental students for their participation in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no fundings regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll study procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Health Sciences Research Ethics Committee of Faculty of Medicine, Bursa Uludağ University, Bursa, Türkiye\u0026nbsp;(Approval Number: 2025/786/14-5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this was a retrospective study, the requirement for informed consent was waived according to the regulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAddae, J. I., Wilson, J. I., \u0026amp; Carrington, C. (2012). Students\u0026rsquo; perception of a modified form of PBL using concept mapping. \u003cem\u003eMedical Teacher\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(11). doi: 10.3109/0142159X.2012.689440\u003c/li\u003e\n \u003cli\u003eAhmed Elsayed, A., Elgharib Mohamed Mostafa Eldiasty, N., Ahmed MohammedAbd El Salam, F., H Mohamed, S., \u0026amp; Mohamed Abd ElHamid Younes, M. (2022). Effect of Using Mind Mapping Learning Technique among Undergraduate Nursing Students. \u003cem\u003eEgyptian Journal of Health Care\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(4). doi: 10.21608/ejhc.2022.270425\u003c/li\u003e\n \u003cli\u003eAlessandri, G., Zuffian\u0026ograve;, A., \u0026amp; Perinelli, E. (2017). Evaluating intervention programs with a pretest-posttest design: A structural equation modeling approach. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(MAR). doi: 10.3389/fpsyg.2017.00223\u003c/li\u003e\n \u003cli\u003eBuzan T., \u0026amp; Buzan B. (1993). \u003cem\u003eZihin haritaları\u0026nbsp;\u003c/em\u003e(10th ed.). İstanbul: Alfa Yayınları.\u003c/li\u003e\n \u003cli\u003eChrismawaty, B. E., Emilia, O., Rahayu, G. R., \u0026amp; Ana, I. D. (2023). Clinical reasoning pattern used in oral health problem solving \u0026ndash; A case study in Indonesian undergraduate dental students. \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1). doi: 10.1186/s12909-022-03808-7\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;Antoni, A. V., Zipp, G. P., Olson, V. G., \u0026amp; Cahill, T. F. (2010a). Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students? \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(1). doi: 10.1186/1472-6920-10-61\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;Antoni, A. V., Zipp, G. P., Olson, V. G., \u0026amp; Cahill, T. F. (2010b). Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students? \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(1). doi: 10.1186/1472-6920-10-61\u003c/li\u003e\n \u003cli\u003eDavis, J. M., Janczukowicz, J., Stewart, J., Quinn, B., \u0026amp; Feldman, C. A. (2018). Interprofessional education in dental education: An international perspective. \u003cem\u003eEuropean Journal of Dental Education\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e, 10\u0026ndash;16. doi: 10.1111/eje.12341\u003c/li\u003e\n \u003cli\u003eDay, J. C., \u0026amp; Bellezza, F. S. (1983). The relation between visual imagery mediators and recall. \u003cem\u003eMemory \u0026amp; Cognition\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(3), 251\u0026ndash;257. doi: 10.3758/BF03196971\u003c/li\u003e\n \u003cli\u003eEdwards, B. (1981). Drawing on the Right Side of the Brain. \u003cem\u003ePlastic and Reconstructive Surgery\u003c/em\u003e, \u003cem\u003e68\u003c/em\u003e(3). doi: 10.1097/00006534-198109000-00044\u003c/li\u003e\n \u003cli\u003eEshwar Rajiv Gandhi, S., Jain, V., Manvi, S., \u0026amp; Eshwar, S. (2016). \u003cem\u003eComparison of Mind Mapping and Lecture Based Teaching Learning Method Among Dental Undergraduates Using Solo Taxonomy in Bangalore, India\u003c/em\u003e (Vol. 4). Retrieved from https://www.researchgate.net/publication/324888942\u003c/li\u003e\n \u003cli\u003eGao, X., Wang, L., Deng, J., Wan, C., \u0026amp; Mu, D. (2022). The effect of the problem based learning teaching model combined with mind mapping on nursing teaching: A meta-analysis. \u003cem\u003eNurse Education Today\u003c/em\u003e, \u003cem\u003e111\u003c/em\u003e. doi: 10.1016/j.nedt.2022.105306\u003c/li\u003e\n \u003cli\u003eGrazziotin-Soares, R., Curtis, D. A., \u0026amp; Ardenghi, D. M. (2021). Use of mind maps in dental education: An activity performed in a preclinical endodontic course. \u003cem\u003eJournal of Dental Education\u003c/em\u003e, \u003cem\u003e85\u003c/em\u003e(5), 623\u0026ndash;633. doi: 10.1002/jdd.12510\u003c/li\u003e\n \u003cli\u003eJanczukowicz, J., \u0026amp; Rees, C. E. (2017a). Preclinical medical students\u0026rsquo; understandings of academic and medical professionalism: Visual analysis of mind maps. \u003cem\u003eBMJ Open\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(8). doi: 10.1136/bmjopen-2017-015897\u003c/li\u003e\n \u003cli\u003eJanczukowicz, J., \u0026amp; Rees, C. E. (2017b). Preclinical medical students\u0026rsquo; understandings of academic and medical professionalism: Visual analysis of mind maps. \u003cem\u003eBMJ Open\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(8). doi: 10.1136/bmjopen-2017-015897\u003c/li\u003e\n \u003cli\u003eKahlke, R., \u0026amp; Eva, K. (2018). Constructing critical thinking in health professional education. \u003cem\u003ePerspectives on Medical Education\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3). doi: 10.1007/s40037-018-0415-z\u003c/li\u003e\n \u003cli\u003eKalyanasundaram, M., Abraham, S., Ramachandran, D., Jayaseelan, V., Bazroy, J., Singh, Z., \u0026amp; Purty, A. (2017). Effectiveness of mind mapping technique in information retrieval among medical college students in Puducherry-A pilot study. \u003cem\u003eIndian Journal of Community Medicine\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(1), 19\u0026ndash;23. doi: 10.4103/0970-0218.199793\u003c/li\u003e\n \u003cli\u003eKotcherlakota, S., Zimmerman, L., \u0026amp; Berger, A. M. (2013). Developing scholarly thinking using mind maps in graduate nursing education. \u003cem\u003eNurse Educator\u003c/em\u003e, \u003cem\u003e38\u003c/em\u003e(6), 252\u0026ndash;255. doi: 10.1097/01.NNE.0000435264.15495.51\u003c/li\u003e\n \u003cli\u003eMuchhal, M., Patthi, B., Singla, A., Gupta, R., Malhi, R., \u0026amp; Chaudhary, D. (2018). Effectiveness of mind mapping as a learning tool among dental students. \u003cem\u003eJournal of Indian Association of Public Health Dentistry\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2), 122. doi: 10.4103/jiaphd.jiaphd_23_18\u003c/li\u003e\n \u003cli\u003eNicoara, S. M., Szamoskozi, S. E., Mitrea, D. A., \u0026amp; Leucuta, D. C. (2020). Concept mapping, an effective tool for long-term memorization of anatomy-a Quasi-experimental research carried out among 1st year general medicine students. \u003cem\u003eEuropean Journal of Investigation in Health, Psychology and Education\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(1), 530\u0026ndash;543. doi: 10.3390/ejihpe10010038\u003c/li\u003e\n \u003cli\u003eRobberecht, R. (2007). Interactive Nonlinear Learning Environments. \u003cem\u003eThe Electronic Journal of E-Learning\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e, 59.\u003c/li\u003e\n \u003cli\u003eUstaoğlu, S., \u0026amp; Akal, N. (2023). Current Approaches to Remıneralızatıon Agents. In Selcuk Dental Journal (Vol. 10, Issue 1, pp. 106\u0026ndash;111). Selcuk University. doi: 10.15311/selcukdentj.1095382\u003c/li\u003e\n \u003cli\u003eYan, Y., Yuehong, W., Kun, L., Hongbo, Z., Hongyu, Z., Yingming, Y., \u0026amp; Zhili, Z. (2023). Implementation of mind mapping with problem-based learning in prosthodontics course for Chinese dental students. \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1). doi: 10.1186/s12909-023-04479-8\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"mind map, dental student, dental education, flouride","lastPublishedDoi":"10.21203/rs.3.rs-8259920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8259920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDental education requires not only scientific and clinical knowledge but also the ability to structure concepts and establish meaningful connections. Conventional lecture-based methods often encourage linear knowledge transfer, limiting students\u0026rsquo; capacity to integrate complex content. Mind mapping, a visual and interactive technique, supports active learning by fostering conceptual organization and critical thinking. Despite its potential, evidence on its systematic use in dental education remains limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study involved third-year students of Bursa Uludağ University Faculty of Dentistry (2024\u0026ndash;2025). A total of 130 mind maps (pre-test\u0026thinsp;=\u0026thinsp;65; post-test\u0026thinsp;=\u0026thinsp;65) on \u0026ldquo;Fluoride-Free Remineralization Systems\u0026rdquo; were collected before and after the final course examination. Two independent researchers evaluated the maps anonymously across content- and structure-related categories, including accuracy, representation of clinical agents, conceptual integration, hierarchy, cross-linking, pictorial/color use, creativity, and irrelevant content. Each criterion was rated on a 0\u0026ndash;2 scale. Non-parametric tests compared pre- and post-test results and gender-related differences.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eStudents consistently included definitions, principles, and mechanisms of action, with no gender differences. Representation of ACP-CPP, nHAp, and xylitol regressed significantly, whereas arginine, TCP, and herbal agents were preserved. Cross-linking (p\u0026thinsp;=\u0026thinsp;0.039) and hierarchical structuring declined, particularly among females (22.2% vs. 25.0%; p\u0026thinsp;=\u0026thinsp;0.041). From pre- to post-test, terminological accuracy decreased (0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 to 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61) and hierarchical framework declined (1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 to 0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85), while conceptual integration improved (0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04 to 0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24) along with visual clarity (0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 to 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42). Creativity remained stable, whereas irrelevant items increased significantly (median 1.00 to 2.00; Z = \u0026minus;\u0026thinsp;3.196, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn conclusion, this study demonstrates that mind maps are a powerful tool for reflecting students\u0026rsquo; levels of conceptual understanding; however, their full potential may not emerge under high-stress conditions such as examinations.\u003c/p\u003e","manuscriptTitle":"Dental Students’ Conceptual Knowledge of Fluoride-Free Remineralization Systems Assessed Through Mind Mapping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-26 07:33:58","doi":"10.21203/rs.3.rs-8259920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-13T15:26:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259913784531639016243562016536297277424","date":"2026-01-06T16:02:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T10:48:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-03T06:19:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T00:32:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-03T00:29:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-02T11:12:45+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":"ee736e5b-7e8c-4689-bf76-f8a9cd2a11c3","owner":[],"postedDate":"December 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-26T07:33:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-26 07:33:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8259920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8259920","identity":"rs-8259920","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}