A comparison of two-dimensional prediction tracing and a virtual reality patient methods for diagnosis and treatment planning of orthognathic cases in dental students: a randomized preliminary study

  • Scott M. Sakowitz
  • Marita R. Inglehart
  • Vidya Ramaswamy
  • Sean Edwards
  • Brandon Shoukri
  • Stephen Sachs
  • Hera Kim-BermanEmail author
Original Article


Virtual reality patient (VR patient), a simulated patient module in a virtual reality environment allowing manipulation of the upper and lower jaws and chin in three planes of space, was developed to help students understand diagnosis and treatment planning of orthognathic surgical procedures. The objective was to compare student understanding in diagnosing and treatment planning complex orthognathic cases using the VR patient versus a conventional 2D prediction tracing method and to determine feasibility of utilizing VR methods. Thirty third year dental students were assigned randomly to an experimental (VR patient) or control (2D tracing) group. The dependent variables were a multiple choice question (MCQ) examination, baseline and exit surveys, and written case analysis of two cases. Student–teacher interactions were recorded for both length and type of interaction. Data were evaluated using descriptive and inferential statistics. The students’ performance on the MCQ examinations improved immediately following the educational intervention (p < .05). However, no significant difference was found between the 2 groups on the written case analysis and pre-test, post-test, and follow-up MCQ examinations. The effect size of the intervention ranged from .14 to .90 and differed greatly between the written responses to the two cases. Intra- and inter-rater reliability of the written response scoring was found to be reliable and reproducible (> .928). Dental students were able to improve their understanding of diagnosis and treatment planning of orthognathic cases using both 2D prediction tracing and the VR patient methods. The method of scoring the written responses was reliable and reproducible and should be used for future full-scale studies.


Virtual reality Dental education Orthognathic surgical prediction Simulated patient Orthodontics Oral surgery 



We thank Theodore Hall, Sean Petty, Stephanie O’Malley, Eric Maslowski, and Shawn O’Grady for developing the VR Patient module; Jason Sherbel and Justin Kammo for assisting with the research sessions; and Erin Walker for scheduling the study participants.


This study was funded in part by The University of Michigan Le Gro Fund and University of Michigan Center for Research on Learning and Teaching, Faculty Development.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

IRB exemption was obtained from the University of Michigan Health and Behavioral Sciences Institutional Review Board (#HUM00113004).


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthodontics and Pediatric Dentistry, School of DentistryUniversity of MichiganAnn ArborUSA
  2. 2.Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborUSA
  3. 3.School of DentistryUniversity of MichiganAnn ArborUSA
  4. 4.Department of Oral and Maxillofacial Surgery, School of DentistryUniversity of MichiganAnn ArborUSA
  5. 5.New York Center for Orthognathic and Maxillofacial SurgeryLake SuccessUSA

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