King’s College London The hapTEL Project A haptically enabled Virtual Reality Dental Simulator by Dr Barry F.A. Quinn

Funders UK Technology Enhanced Learning (TEL) Research Programme (within ESRC) UK Economic and Social Research Council (ESRC) UK Engineering and Physical Sciences Research Council (EPSRC) UK Joint Information Systems Committee (JISC) Award Number: RES-139-25-0387 2

hapTEL Interdisciplinary team Prof. Margaret Cox (Director, KCL) Prof. Nairn Wilson (User-Group Coordinator, KCL) Dr. Jonathan P. San Diego (Project Manager, KCL) Dr. Barry Quinn ((Lead Clinician, KCL) King’s College Staff and Post-graduate students Prof. Stephen Dunne, Prof. Tim Newton, Dr. Jon Hindmarsh, Dr. Mark Woolford, Prof. Brian Millar, Dr. Brett Robinson, Dr. Barry Quinn, Dr. Avijit Banerjee, Mr. Joe Harper, Mr. Lewis Hyland, Ms Tracy-ann Green, Mr. Arash Shahriari Rad and Mrs. Clarabella Gray University of Reading - Cybernetics team Prof. William Harwin, Dr. Alistair Barrow and Mr. Brian Tse. Consultants Mr. Bruce Elson - Engineering Prof. Patricia Reynolds – Flexible learning in Dentistry

Previous research into learning with haptic virtual dental systems Effects on transfer (Alexander et al., 2005 and Muchinsky, 1991) Fidelity Physical (Baum, Riedel, Hays, & Mirabella, 1982) Functional (Allen et al., 1986) Psychological (Kaiser & Schroeder, 2003). Levels of Immersion (Taylor, 2002) Diegetic and situated Levels of Presence (Heeter, 1992) Three types: Environmental, Social and Personal Buy-in e.g. Levels of Attitudinal beliefs ( c.f. Webb and Cox, 2004)

Why simulated practice? Smoother transition for students into the clinic Support and reinforces ergonomics, infection control etc Broaden the students’ preclinical experience by including additional models mimicking real patient Encourages autonomous and competent skills learning Improves the delivery of supporting material such as demonstrations, diagrams, manuals etc.

Goals and issues for Dental Education Undergraduate Dental Education hand-eye Co-ordination Developing the learner to become a practising professional Using tactile devices Manipulative skills Spatial reasoning skills Changing the way Professionals work: e.g. in teams with DCPs Increasing size of student cohorts Need to provide satisfactory and sufficient feedback to students

Research into developing virtual dental systems Physical Layout (Ergonomics, collocation, workspace) Physical interface (inclusion of rubber cheeks, synthetic tissues) Touch (Collision detection, DoF, workspace, etc.) Vision (3D or 2D, tissue models, colour changes, magnification, graphic scene changes) Audio (mono/stereo/3D, variants of feedback) Others (data logs and visualisation, motion representation, smell)

Requirements analysis: meeting users’ needs Physical setup of the device Ergonomics Finger-rest Foot control Oral workspace Oral cavity model First lower molar with the adjacent and opposing teeth Other tissues (but not haptic at present) Multi-sensory feedback (colour, sound, vibration etc.) Teaching aids (orientation, magnification, playback, 3D measurement, scores)

Clinical concepts and skills for undergraduate dental students Caries removal Depth of the cavity Angle of entry into the tooth Speed of the bur Different tactile sensations in cutting between different tissues( Enamel, Dentine and Pulp) Cavity design Time available for the task and the actual time taken

Phases of developing the 3D models With enough functionalities 3D VR Tooth and Jaw models

Teeth and mouth model

Beta Version I’m sure you will insert the screen capture of the system here Illustration and demo of the prototype

hapTEL Workstation (Curriculum Ver.) 3D Display Monitor Haptic handpiece Foot Controls Haptic Device Shutter glasses Audio speakers Camera Pod

hapTEL Traditional Removal of artificial decayed material on a plastic tooth Three sessions: Two attempts per session Removal of virtual decayed material on a virtual tooth located in a jaw Three sessions: as many attempts as they wish within a given time per session

Graphic models

Research design and methods to measure students‘ learning Pre and post tests Spatial reasoning; fine motor skills; 3-D perceptions Attitudes towards ICT and haptics Video observations of students’ practices in the laboratories Task performance in traditional and hapTEL laboratories Final Cavity preparation task Post-lab self assessment task

Gross, Fine Motor and 3-D Skills Assessment

Study Design (Large scale trials)

Clinical skills assessment methods Traditional methods Observation by tutors during manikin-head work Reviewing finished work at end of treatment/course Practical examination of specific clinical skills tasks TEL methods Based on logs, screen capture and live feedback Reviewing in-progress virtual clinical treatment on screen Post-evaluation of each recorded student’s task procedure Examining series of completed of tasks and peer review

Educational impact results hapTEL ‘dental chair’ provided individual feedback to each student who didn’t have to wait for the tutor to provide feedback TEL activity enabled the students to have multiple attempts to improve their practice Frasco plastic analogy teeth cost about £16 per tooth hapTEL tooth could be enlarged 6-times by the students so they could see the result of their cavity preparation, and learn about accurate self assessment hapTEL ‘dental chair’ enables the students to replay their procedure to observe their strengths and weaknesses Year 1 students who were only taught using the hapTEL virtual system and had never treated a real or plastic tooth, performed as well as the traditionally taught students when preparing a plastic tooth cavity at the end of the term

Other Systems on the market

VOXEL-MAN TempoSurg

VirtEasy by HRV Simulation

Forsslund Dental Simulator for third molar surgical extractions

Further Dental procedures Dental Injections Periodontal probing Scaling of teeth Root canal procedures Filling Dental Cavities Crown preparations Orthodontic bracket placement Implant surgery

Conclusions hapTEL trained students did equally as well as traditionally trained students University teachers need to be involved in the innovation from the beginning. TEL needs to complement the traditional teaching practices TEL needs to be seen to enhance the evolving curriculum. Extensive ongoing support for teachers is needed to maximise its potential.

Thank you for listening Barry Quinn