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.
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Aaker GD, Gracia L, Myung JS, Borcherding V, Banfelder JR, D’Amico DJ, Kiss S (2011) Volumetric three-dimensional reconstruction and segmentation of spectral-domain oct. Ophthalmic Surg Lasers Imaging 42(Suppl):S116–S120
Abdelwahab MG, Cavalcanti DD, Preul MC (2010) Role of computer technology in neurosurgery. Minerva Chir 65(4):409–428
Abhari K, Baxter JS, Chen EC, Khan AR, Peters TM, de Ribaupierre S, Eagleson R (2015) Training for planning tumour resection: augmented reality and human factors. IEEE Trans Biomed Eng 62(6):1466–1477
Aebersold M, Tschannen D, Bathish M (2012) Innovative simulation strategies in education. Nurs Res Pract 2012, Article ID765212, 1–7
Aebersold M, Voepel-Lewis T, Cherara L, Weber M, Khouri C, Levine R, Tait AR (2018) Interactive anatomy-augmented virtual simulation training. Clin Simul Nurs 15:34–41
Agarwal N, Schmitt PJ, Sukul V, Prestigiacomo CJ (2012) Surgical approaches to complex vascular lesions: the use of virtual reality and stereoscopic analysis as a tool for resident and student education. BMJ Case Rep 2012:bcr0220125859
Akay M, Marsh A (2001) Information technologies in medicine, vol 1. Wiley, New York
Arikatla VS, Tyagi M, Enquobahrie A, Nguyen T, Blakey GH, White R, Paniagua B (2018) High fidelity virtual reality orthognathic surgery simulator. Proc SPIE Int Soc Opt Eng 10576
Badler N, Erignac C, Liu Y (2002) Virtual humans for validating maintenance procedures. Commun ACM 45:56–63
Becker O, Scolari N, Santos Melo MF, Avelar RL, Haas OLJ, Menenzes LM, Belle de Oliveira R (2013) Three-dimensional planning in orthognathic surgery using cone-beam computed tomography and computer software. Comput Sci Syst Biol 6(6):6
Buttussi F, Chittaro L (2017) Effects of different types of virtual reality display on presence and learning in a safety training scenario. IEEE Trans Vis Comput Graph 24(2):1063–1076
Cao C, Cerfolio RJ (2019) Virtual or augmented reality to enhance surgical education and surgical planning. Thorac Surg Clin 29(3):329–337
Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, Carlbring P, Powers MB (2019) Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. J Anxiety Disord 61:27–36
Chiarovano E, de Waele C, MacDougall HG, Rogers SJ, Burgess AM, Curthoys IS (2015) Maintaining balance when looking at a virtual reality three-dimensional display of a field of moving dots or at a virtual reality scene. Front Neurol 6:164
Dias DRC, Neto MaP, Brega JeRF, Gnecco BBG, Trevelin LC, Guimaraes MdP (2012) Design and evaluation of an advanced virtual reality system for visualization of dentistry structures. IEEE Trans Biomed Eng. https://doi.org/10.1109/VSMM.2012.6365955
Dyer E, Swartzlander BJ, Gugliucci MR (2018) Using virtual reality in medical education to teach empathy. J Med Libr Assoc 106(4):498–500
Emmelkamp P, Krijin M, Hulsbosch A, de Vries S, Schuemie M, van der Mast C (2002) Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behav Res Ther 40:509–516
Gateno J, Xia J, Teichgraeber JF, Rosen A, Hultgren B, Vadnais T (2003) The precision of computer-generated surgical splints. J Oral Maxillofac Surg 61(7):814–817
Germans DM, Spoelder HJW, Renambot L, Bal HE, van Daatselaar S, van der Stelt P (2008) Measuring in virtual reality: a case study in dentistry. IEEE Trans Instrum Meas 57(6):1177–1184
Grabowski HA, Krempien R, Munchenberg JB, Rembold U, Worn H (1999) Simulation of frontal orbital advancement. Virtual Reality 4:235–240
Gutiérrez FPJ, Vergara VM, Coulter R, Saland L, Caudell TP, Goldsmith TE, Alverson DC (2007) The effect of degree of immersion upon learning performance in virtual reality simulations for medical education. Stud Health Technol Inform 125:155–160
Izard SG, Juanes Mendez JA, Palomera PR (2017) Virtual reality educational tool for human anatomy. J Med Syst 41(5):76
Izard SG, Juanes JA, Garcia Penalvo FJ, Estella JMG, Ledesma MJS, Ruisoto P (2018) Virtual reality as an educational and training tool for medicine. J Med Syst 42(3):50
Jasinevicius TR, Landers M, Nelson S, Urbankova A (2004) An evaluation of two dental simulation systems: virtual reality versus contemporary non-computer-assisted. J Dent Educ 68(11):1151–1162
Julious SA (2005) Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 4(4):287–291
Khan R, Plahouras J, Johnston BC, Scaffidi MA, Grover SC, Walsh CM (2019) Virtual reality simulation training in endoscopy: a cochrane review and meta-analysis. Endoscopy 51(7):653–664
Krathwohl DR (2002) A revision of Bloom’s taxonomy: an overview. Theory Pract 41(4):212–218
Krokos E, Plaisant C, Varshney A (2019) Virtual memory palaces: immersion aids recall. Virtual Reality 23(1):1–15
Mallari B, Spaeth EK, Goh H, Boyd BS (2019) Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res 12:2053–2085
McMillan JH, Schumacher S (2010) Research in education : evidence-based inquiry, 7th edn. Pearson, Boston, p 511
Miller GE (1990) The assessment of clinical skills/competence/performance. Acad Med 65(9 Suppl):S63–S67
Minns S, Levihn-Coon A, Carl E, Smits JAJ, Miller W, Howard D, Papini S, Quiroz S, Lee-Furman E, Telch M et al (2018) Immersive 3d exposure-based treatment for spider fear: a randomized controlled trial. J Anxiety Disord 58:1–7
Mohammed MAA, Khalaf MH, Kesselman A, Wang DS, Kothary N (2018) A role for virtual reality in planning endovascular procedures. J Vasc Interv Radiol 29(7):971–974
Neumann PDS, Schuiz A, Fauikner G, Krauss M, Tolxdorff T (1999) Using virtual reality techniques in maxillofacial surgery planning. Virtual Reality 4:213–222
Oculus Rift CV1 Teardown (2016) https://www.ifixit.com/Teardown/Oculus+Rift+CV1+Teardown/60612. Accessed 8 Nov 2017
Oculus Rift Development Kit 2 Teardown (2014) https://www.ifixit.com/Teardown/Oculus+Rift+Development+Kit+2+Teardown/27613. Accessed 8 Nov 2017
Oculus Rift DK1 Teardown (2013) https://www.ifixit.com/Teardown/Oculus+Rift+DK1+Teardown/13682. Accessed 8 Nov 2017
Oculus Rift History—How it All Started (2015) http://riftinfo.com/oculus-rift-history-how-it-all-started. Accessed 8 Nov 2017
Orthodontics. https://www.americanboardortho.com/media/1164/bcoe-examinee-worksheet.pdf. Accessed 8 Nov 2017
Pertaub D, Slater M, Barker C (2001) An experiment on public speaking anxiety in response to three different types of types of virtual audience. Presence Teleoper Virtual Environ 11(1):68–78
Pourmand A, Davis S, Marchak A, Whiteside T, Sikka N (2018) Virtual reality as a clinical tool for pain management. Curr Pain Headache Rep 22(8):53
Proffit WR, White RP (1991) Surgical-orthodontic treatment. Mosby-Year Book, St. Louis, p 722
Robb RA (2008) Medical imaging and virtual reality: a personal perspective. Virtual Reality 12:235–237
Rothbaum B, Hodges L, Smith S, Lee J, Price L (2000) A controlled study of virtual reality exposure therapy for the fear of flying. J Consult Clin Psychol 68:1020–1026
Shu Y, Huang YZ, Chang SH, Chen MY (2018) Do virtual reality head-mounted displays make a difference? A comparison of presence and self-efficacy between head-mounted displays and desktop computer-facilitated virtual environments. Virtual Reality. https://doi.org/10.1007/s10055-018-0376-x
Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A (2019) Virtual reality-assisted pain, anxiety, and anger management in the emergency department. Telemed J E Health. https://doi.org/10.1089/tmj.2018.0273
Smith ML, Foley MR (2016) Transforming clinical education in obstetrics and gynecology: gone is the day of the sage on the stage. Obstet Gynecol 127(4):763–767
Sweta VR, Abhinav RP, Ramesh A (2019) Role of virtual reality in pain perception of patients following the administration of local anesthesia. Ann Maxillofac Surg 9(1):110–113
Triepels CPR, Smeets CFA, Notten KJB, Kruitwagen R, Futterer JJ, Vergeldt TFM, Van Kuijk SMJ (2019) Does three-dimensional anatomy improve student understanding? Clin Anat. https://doi.org/10.1002/ca.23405
UMichDent (2019) Dentistry and VR—Jaw surgery simulation [Video File]. Retrieved from https://www.youtube.com/watch?v=YCyrqmrMwPQ. Accessed 27 Aug 2018
Uppot RN, Laguna B, McCarthy CJ, De Novi G, Phelps A, Siegel E, Courtier J (2019) Implementing virtual and augmented reality tools for radiology education and training, communication, and clinical care. Radiology 291(3):570–580
Vertemati M, Cassin S, Rizzetto F, Vanzulli A, Elli M, Sampogna G, Gallieni M (2019) A virtual reality environment to visualize three-dimensional patient-specific models by a mobile head-mounted display. Surg Innov 26(3):359–370
Walther-Larsen S, Petersen T, Friis SM, Aagaard G, Drivenes B, Opstrup P (2019) Immersive virtual reality for pediatric procedural pain: a randomized clinical trial. Hosp Pediatr 9(7):501–507
Won AS, Bailey J, Bailenson J, Tataru C, Yoon IA, Golianu B (2017) Immersive virtual reality for pediatric pain. Children (Basel) 4(7):52. https://doi.org/10.3390/children4070052
Wong DT, Mehta A, Singh KP, Leong SM, Ooi A, Niazi A, You-Ten E, Okrainec A, Patel R, Singh M et al (2019) The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients: a randomised controlled trial. Eur J Anaesthesiol 36(3):227–233
Xia J, Samman N, Yeung R, Shen S, Wang D, Ip H, Tideman H (2000) Three dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery. Int J Adult Ortho Orthog Surg 15(4):265–282
Xin B, Chen G, Wang Y, Bai G, Gao X, Chu J, Xiao J, Liu T (2018) The efficacy of immersive virtual reality surgical simulator training for pedicle screw placement: a randomized double-blind controlled trial. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.12.090
Zaragoza-Siqueiros J, Medellin-Castillo HI, de la Garza-Camargo H, Lim T, Ritchie JM (2019) An integrated haptic-enabled virtual reality system for orthognathic surgery planning. Comput Methods Biomech Biomed Eng 22(5):499–517
Zawy Alsofy S, Stroop R, Fusek I, Welzel Saravia H, Sakellaropoulou I, Yavuz M, Ewelt C, Nakamura M, Fortmann T (2019) Virtual reality-based evaluation of surgical planning and outcome of monosegmental, unilateral cervical foraminal stenosis. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.06.057
Zheng C, Li J, Zeng G, Ye W, Sun J, Hong J, Li C (2019) Development of a virtual reality preoperative planning system for postlateral endoscopic lumbar discectomy surgery and its clinical application. World Neurosurg 123:e1–e8
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.
Conflict of interest
The authors declare that they have no competing interests.
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IRB exemption was obtained from the University of Michigan Health and Behavioral Sciences Institutional Review Board (#HUM00113004).
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Sakowitz, S.M., Inglehart, M.R., Ramaswamy, V. et al. 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. Virtual Reality 24, 399–409 (2020). https://doi.org/10.1007/s10055-019-00413-w
- Virtual reality
- Dental education
- Orthognathic surgical prediction
- Simulated patient
- Oral surgery