Effect of Training Sequence on Learning Outcomes Using a Haptic Virtual Simulator for Endodontic Access Cavities: A Controlled Experimental Study

TL;DR

This study found that the order of using a haptic simulator versus natural teeth in dental training does not affect learning outcomes for endodontic cavity preparation.

Contribution

The novel contribution is demonstrating that training sequence does not impact skill acquisition in endodontic access cavity preparation.

Findings

No significant differences were found between training sequences in simulator metrics or natural-tooth performance.

Students showed significant improvement in simulator performance between the first and second attempts.

Learning trajectories improved overall across attempts, with no effect of training sequence.

Abstract

Background: Haptic virtual simulators are increasingly incorporated into dental education, yet it remains unclear whether the sequence of simulation-based and natural-tooth training influences early endodontic skill acquisition. Objective: The objective of this study was to compare the effect of two training sequences—haptic simulation followed by natural-teeth practice, versus natural-teeth practice followed by haptic simulation—on performance in endodontic access cavity preparation among undergraduate dental students. Methods: Thirty-eight third-year dental students were randomly assigned to two groups. All participants completed three consecutive attempts on a haptic simulator (Simodont®) and one access cavity preparation on extracted mandibular incisors. Simulator metrics included progress, precision, target volume removed, and excess volume removed. Natural-tooth preparations were scored by two blinded endodontists (ICC range = 0.75–0.88). Data were analyzed using Mann–Whitney U tests with Holm correction, Wilcoxon signed-rank tests, and a linear mixed-effects model to characterize learning trajectories. Results: No significant between-group differences were found in any simulator metric (Holm-adjusted p = 0.47–0.62; effect sizes r = 0.12–0.20, 95% CI −0.14 to 0.43) or in natural-tooth performance (all Bonferroni-adjusted p = 1.00). Students demonstrated significant improvement between the first and second simulator attempts (p < 0.05), with a clear learning plateau thereafter. Mixed-effects modelling confirmed significant overall improvement across attempts (p < 0.001), with no effect of training sequence or attempt × group interaction. Conclusions: Training sequence did not influence learning outcomes or final clinical-quality access preparations. Early performance gains suggest a rapid familiarization effect, and both modalities provide complementary—but non-hierarchical—learning affordances. Haptic simulation can therefore be integrated flexibly within preclinical endodontic curricula without compromising educational effectiveness.

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