Virtual reality simulation for learning minimally invasive endodontics: a randomized controlled trial

Abstract

Background: Learning minimally invasive endodontic techniques presents unique challenges, requiring precise tooth structure preservation and strong spatial awareness. This study evaluated a clinically realistic virtual reality (VR) simulator, featuring eye-tracking feedback and automated outcome scoring, as an innovative tool to support student learning in minimally invasive endodontics. Methods: A prospective randomized controlled trial was conducted with 30 fourth-year preclinical dental students assigned to either a VR group (n = 15) or a standard phantom head (PH) group (n = 15). The VR system featured high-fidelity dental arch modeling, dual haptic devices, a head-mounted display with eye-gaze and tool trajectory tracking (mirror and handpiece), and automated outcome scoring. All students completed three 1-hour training sessions and performed both Traditional Access Cavity (TradAC) and Conservative Access Cavity (ConsAC) techniques. The primary outcome was tooth volume loss assessed via micro-computed tomography (micro-CT). Secondary outcomes included procedural error scores (rated by blinded experts) and task completion time. Wilcoxon signed-rank tests evaluated pre–post differences. A split-plot ANOVA analyzed training method (between-subjects) and access technique (within-subjects). Results: Significant improvements were observed across all outcomes in both groups (p < 0.05). There was no significant main effect of training method or interaction. A significant main effect of access technique was found for tooth volume loss (F(1,28) = 10.46, p = 0.003) and task completion time (F(1,28) = 6.86, p = 0.014), favoring ConsAC. Conclusion : This study supports the feasibility of automated virtual reality (VR) simulation as a scalable and effective tool to support student learning in minimally invasive endodontic procedures within preclinical dental education. Trial registration: This randomized controlled trial was registered on 29 April 2025, at the TCTR registry with the study registration number TCTR20250502004.