Date Published: February 1, 2019
Publisher: Public Library of Science
Author(s): Diva Lugassy, Yafi Levanon, Nir Shpack, Shifra Levartovsky, Raphael Pilo, Tamar Brosh, Rafael Sarkis-Onofre.
Traditionally, the acquisition of manual skills in most dental schools worldwide is based on exercises on plastic teeth placed in a “phantom head simulator”. No manual trainings are done at home. Studies revealed that preliminary training of one motoric task leads to significant improvement in performance of the required motoric task that has similar components. Performing tasks indirectly via a dental mirror are complicated for the young dental students. We hypothesized that instructed training of basic skills required in dentistry at home on a tool simulating the phantom laboratory will improve the capabilities of the students and will be reflected by their clinical grades.
We developed a portable tool PhantHome which is composed of jaws, gingival tissue, rubber cover and a compatible stand. Specific teeth produced by a 3D printer with drills in different directions were placed in both jaws. Students were requested to insert pins by using tweezers and dental mirror according to instructions initiating with easy tasks and continue to ones that are more complicated. 106 first clinical year dental students participated in the study; 65 trained only in the traditional phantom lab (control). 41 trained at home by the PhantHome tool two weeks before and 2 months during the initial stage of phantom lab. The students grades routinely provided in the phantom laboratory at different stages were compared.
Students who trained with the portable tool performed better than the control group in the first direct and second indirect preparations (p<0.05). These exams were taken when the PhantHome was available to the students. Then, the tool was returned and the phantom course continued regularly. We believe that this is why no differences between the grades of the groups were observed further on. Training by the PhantHome improves motor skills and consequently the clinical performances.
Most medical professions require manual capabilities, in particular surgeons, including dental surgeons that have to demonstrate a high ability of manual dexterity skills and high level of proprioception recognition in every treatment. Therefore, dental students have to acquire comprehensive theoretical knowledge as well as specific manual skills during their early dental education. This capability is developed by training on artificial plastic teeth placed in a “phantom head simulator”. This training includes clinical tasks using direct vision and indirect vision via a dental mouth mirror.
In this study, a novel portable tool, named “PhantHome” was developed for the purpose of home training for dentistry students in basic skills required in the phantom course. Training with a tool that simulates a patient’s mouth is based on the transfer of learning theory, according to which repeated training of one motoric task leads to significant improvement in performance of another motoric task that has similar components [24,25]. It has long been recognized that the extent of transfer of training between one learning task to another depends on the similarity of the tasks . Therefore, to assure a high degree of transfer from a motoric activity learned in the PhantHome tool to motoric tasks required in the phantom course, both tasks must have comparable components. Although this home training, that includes the insertion of small pins by using tweezers and dental mirrors on similar artificial jaws, doesn’t simulate cavity preparation, it trains some of the components needed in cavity preparation such as orientation in the oral cavity, manipulation of instruments in direct vision and especially in indirect vision and grip control. The results of our study prove our hypothesis that practice at home on a portable tool that has general principles and similar elements as the phantom laboratory indeed lead to improve performances in the phantom laboratory (transfer of learning).