Enhancing dental education: integrating online learning in complete denture rehabilitation

Abstract

This study investigated the integration of online learning into complete denture rehabilitation (CDR) training for dental interns, highlighting its impact on their education and readiness for clinical practice. Given that CDR poses significant challenges due to its technical complexity and profound influence on patient well-being, online learning has emerged as a strategic educational tool to enhance interns’ knowledge and skills. This research included the administration of a comprehensive questionnaire to 63 dental interns to assess their backgrounds, experiences with online learning, and attitudes toward its application in CDR education. The results revealed strong engagement with online learning, with a majority valuing its flexibility, accessibility, and capacity to facilitate self-paced, individualized learning. Despite the enthusiasm for online modalities, the results identified notable gaps in interns’ confidence in and preparedness for performing CDR, highlighting the need for targeted improvements in online curriculum development. By emphasizing the essential role of innovative teaching methods, including virtual reality (VR), this study underscores the need for a balanced educational approach that combines traditional and digital platforms. This strategy aims to prepare future dental professionals for the complexities of modern clinical environments, ensuring that they are well equipped to meet the diverse needs of the edentulous population.

Introduction

Complete denture rehabilitation (CDR) is a traditional prosthodontic treatment option for edentulous patients experiencing systemic, anatomic, or financial limitations [1]. CDR is challenging for dental interns (fifth-year dental students) because of its patient-centered nature, the many factors influencing treatment planning, the need for technical precision, and the profound impact on patients’ functional and psychosocial well-being [2]. Mastering CDR is crucial for dental interns because it not only meets the clinical needs of patients but also contributes to the intern’s professional growth, reputation, and overall success in their dental practice. It aligns to provide comprehensive and patient-centric care and prepare interns for the challenges and responsibilities of modern dentistry. Dental students in CDR navigate through a challenging and rewarding field that requires a comprehensive understanding of dental science and a commitment to ongoing education and skill development.

Online learning refers to the application of information and communication technologies to support and enhance learning and teaching between students and teachers [3]. Integrating online learning into CDR education during the internship year offers several advantages specific to this critical period’s unique challenges and requirements [4]. First, interns often have demanding clinical schedules during their internship year. Online learning provides flexibility, allowing interns to access CDR education conveniently and avoiding conflicts with clinical responsibilities. It is a resilient alternative, allowing interns to continue their CDR education even when physical attendance is not feasible. The self-paced nature of online learning enables interns to revisit and review CDR concepts until mastery is achieved. This flexibility supports individualized learning and ensures that interns are well prepared for clinical applications. For example, Subramani et al. reported that 90.4% of preclinical students, and 80.4% of clinical students, used smartphones with various learning apps to enhance their learning online [5]. Moreover, online learning opens doors to expertise worldwide, and online platforms enable the efficient use of educational resources. Online platforms facilitate the incorporation of diverse learning resources, such as videos, interactive simulations, and multimedia presentations. Interns can collaborate with peers in ways that are not constrained by the limitations of physical boundaries. Online learning platforms can accommodate various learning styles, catering to the diverse preferences of interns. Online learning eliminates costs associated with commuting, accommodations, and physical textbooks. This can be particularly advantageous for interns facing financial constraints during their internship year. Finally, in prosthodontics, CDR in particular, it is not easy to visualize and correlate theory with practice. Therefore, exceptional knowledge and training are necessary for students to master CDR skills. A study conducted by Gilmour et al. [6], and a national study conducted by Ali et al. [7], investigated the preparedness and confidence levels of undergraduate dental students in the United Kingdom. These studies provide insight into the challenges that dental interns may face during their training, especially in complex procedures such as CDR. Lack of clinical experience and traditional teaching methods can lead to students lacking the confidence to complete CDR. Familiarity with online learning platforms equips interns with the technological skills that are essential for modern dental practice. Online assessments and quizzes provide immediate feedback, allowing interns to gauge their understanding and identify areas for improvement. This timely feedback contributes to ongoing skill enhancement. Bahanan et al. evaluated dental students’ perceptions and overall experiences with e-learning and found that most students considered e-learning a positive experience [8]. Furthermore, substantial progress has been made in educational methodologies, especially in the integration of virtual reality (VR) technologies and artificial intelligence (AI). These innovations are proving transformative in online education, especially in specialized areas such as CDR [9].

Loka et al. studied the effect of reflective thinking on academic performance among undergraduate dental students [10]. They recognized that self-directed learning is a vital principle promoted in health professions education, particularly with the increasing use of online learning methods. Furthermore, Linjawi et al. conducted a cohort study in Saudi Arabia to assess students’ perceptions, attitudes, and readiness toward online learning in dental education. The results indicated that the attitude and understanding of interns towards online education are crucial to its development and effectiveness [11]. When online learning is incorporated into CDR education during the internship year, dental interns can benefit from a comprehensive and adaptable learning environment that addresses their unique needs, supports continuous skill development, and prepares them for successful clinical practice in CDR. Therefore, this study aims to evaluate dental interns’ background in CDR and assess their attitudes toward the online learning of CDR.

Methods

Participants and questionnaire

The study conducted a questionnaire-based online survey via the Universal Questionnaire Designer platform (www.wjx.cn) to assess dental internship students’ backgrounds in and attitudes toward online learning of CDR. The survey comprised three parts and 20 structured questions, including students’ online learning experiences, knowledge background about CDR, and attitudes toward online learning for CDR. The elements of the questionnaire are illustrated in Table 1. The study received ethical approval from the Academic Affairs Office of the West China School of Stomatology, Sichuan University (WCHSIRB-NR-2022-005). A total of 63 dental interns (19 male and 44 female undergraduate dental students) participated, and their privacy was safeguarded, with personally identifiable information kept confidential. The interns who participated in this survey were all fifth-year dental students who had just started their clinical internship. They had relevant theoretical knowledge but lacked practical clinical experience. The participants were required to respond to all the questions to ensure the completion of the electronic forms. Informed consent was obtained from all the participants involved in the study.

Table 1 Questionnaire about the online learning of complete denture restoration

Data analysis

The data analysis involved descriptive statistics, with the findings presented as percentages. The response percentages were calculated based on the number of respondents for a specific response compared with the total number of answers to a question. This approach allowed for a comprehensive understanding of the participants’ experiences, knowledge, and attitudes related to online learning of CDR.

Results

Students’ experience with online learning

In this survey, 63 undergraduate dental students participated, with a gender distribution of 19 males (30.2%) and 44 females (69.8%). The findings revealed that 22.22% of the students preferred online learning, whereas the majority (60.32%) favored traditional face-to-face teaching. In addition, 17.46% of the students expressed uncertainty about their preferences (Fig. 1a). The survey indicated a high participation rate in online learning, with 93.65% of the students engaging in online educational activities and only 6.35% who did not participate (Fig. 1b). In terms of the perceived necessity of online learning, 76.19% of the students believed that it is essential, whereas 6.35% held different opinions (Fig. 1c). Furthermore, 80.95% of the students were willing to participate in online learning, whereas only 4.76% strongly indicated an unwillingness (Fig. 1d). With respect to readiness for online learning of CDR, 71.42% of the students considered themselves prepared, whereas 12.70% felt unprepared for such learning (Fig. 1e).

Fig. 1

Students’ experience with online learning. (a) Do you prefer face-to-face teaching or online learning? (b) Have you ever participated in online learning before? (c) Do you think it is necessary to carry out online learning? (d) Would you like to participate in online learning? (e) Are you ready for online learning on complete denture restoration?

Students’ knowledge background about CDR

The evaluation of the students’ knowledge background about CDR yielded noteworthy insights. Only 7.94% considered their knowledge of CDR to be good, with a substantial 63.49% rating it as average and 28.57% rating it as poor (Fig. 2a). With respect to confidence in clinical performance, a mere 11.1% expressed confidence, 65.08% lacked confidence, and 23.81% were uncertain (Fig. 2b). In terms of readiness for participation, 44.4% felt prepared, 28.57% believed they were not ready, and 26.98% were unsure (Fig. 2c). In terms of familiarity with the CDR treatment plan, 26.98% claimed to be familiar with it, an equivalent percentage did not know, and 46.03% were uncertain (Fig. 2d). Significant disparities in students’ perceptions of appointment management for CDR patients existed, with 22.22% feeling confident, 46.03% feeling uncertain, and 31.75% having no idea (Fig. 2e). The level of communication confidence varied; 34.92% of the participants felt confident, 28.57% lacked confidence, and 36.51% were unsure (Fig. 2f). These findings indicate diverse levels of knowledge, confidence, and readiness, indicating potential areas for targeted educational interventions and support to enhance students’ understanding and skills in this critical aspect of dentistry.

Fig. 2

Students’ knowledge background and attitude about complete denture restorations. (a) Can you access your level of knowledge of complete denture restoration? (b) Do you have the confidence to perform complete denture restoration in the clinic? (c) Are you ready to participate in the treatment process of complete denture restoration? (d) Do you know the treatment plan for complete denture restoration? (e) Do you know the appointment management for patients with complete denture restoration? (f) Do you have the confidence to communicate effectively with patients with complete denture restorations?

In specific clinical tasks related to CDR, students exhibited varying levels of self-confidence and uncertainty. Notably, 30.16% believed that they could handle impression-taking independently, 38.10% thought that they could not, and 31.75% were unsure (Fig. 3a). Similarly, only 15.87% of the students felt confident in achieving occlusal relationships alone, whereas 50.79% believed they could not, and 33.33% were unsure (Fig. 3b). With respect to the selection of correct artificial teeth for patients, only 7.94% felt capable, 53.97% believed they could not, and 38.1% were unsure (Fig. 3c). In the CDR try-in stage, 31.75% thought that they could perform the task independently, while 46.03% believed they could not, and 22.22% were uncertain (Fig. 3d). In addition, 39.68% believed that they knew how to instruct patients on wearing complete dentures, while 30.16% did not, and 30.16% were unsure (Fig. 3e). Finally, approximately 31.75% thought they knew how to provide postoperative guidance, 36.51% did not, and 31.75% were unclear (Fig. 3f). These findings indicate the diverse self-perceptions and potential areas for targeted educational support in specific clinical competencies related to CDR.

Fig. 3

Students’ knowledge background and practical ability about complete denture restorations. (a) Can you independently perform impression-taking for complete denture restorations? (b) Can you operate independently to obtain the occlusal relationship for the patient? (c) Can you independently choose the correct artificial teeth for your patients? (d) Can you perform the try-in stage of complete denture prosthesis for patients independently? (e) Do you know how to instruct patients to properly wear full removable dentures? (f) Do you know how to give postoperative guidance to patients after complete denture restoration?

Students’ attitude about online learning CDR

When we explored students’ attitudes toward the online learning for CDR, significant insights emerged. A substantial percentage (60.90%) of the students enjoyed participating in online CDR learning, with only 6.35% expressing dislike, and 31.7% being unaware (Fig. 4a). In addition, a majority (71.43%) expressed a strong desire to continue online learning for CDR, only 7.94% declined, and 20.63% remained undecided (Fig. 4b). When assessing attitudes toward online learning in general, 82.54% of the students believed it was helpful, 6.35% held a contrary view, and 11.11% were uncertain (Fig. 4c). These findings underscore a positive inclination toward online learning for CDR among students, suggesting its perceived effectiveness and acceptance within the academic context.

Fig. 4

Students’ attitude about online learning complete denture restorations. (a) Do you like to participate in the online learning of complete denture restoration? (b) Do you want to continue the online learning of complete denture restoration? (c) Do you think online learning is helpful to you?

Discussion

Ensuring that dental students master CDR during their internship is crucial because this stage is pivotal in the transition to clinical practice. The internship provides a vital opportunity for students to apply their theoretical knowledge in real-world settings, refine their technical skills, and gain practical experience. Effective mentoring, hands-on training, and exposure to a variety of cases are essential in building confidence and competence in CDR. Integrating both traditional and innovative teaching methods, including online learning tools, can enhance this learning process. The flexibility of online platforms, which are accessible through smart devices and apps, enables students to review lessons at their convenience, making them a viable choice. Despite challenges, some scholars predict that online learning for dentures will become mainstream by 2025 [12]. Thus, the active promotion and participation in online learning for CDR have become imperative in the current circumstances.

The original purpose of this study was to assess dental students’ knowledge and attitudes toward online learning in CDR, with the aim of enhancing their understanding and clinical practice. The data indicated high engagement in online learning among students, with a majority recognizing its necessity and planning future participation. This inclination may be attributed to the increased emphasis on digital education and the use of online platforms during the COVID-19 pandemic, as supported by Wang et al.’s findings on the widespread adoption of online courses in dental education [13, 14]. However, it is important to point out that the data showing that more students prefer face-to-face teaching do not conflict with the popularity of online learning. The prevalence of online learning is not a substitute for face-to-face learning but rather a necessary auxiliary means of learning. Through online learning, conflicts between time arrangement and low personal learning efficiency can be easily solved, and thus it is more suitable for students who wish to personalize intensive learning so they can fully master the relevant knowledge. Moreover, the low efficiency of teacher‒student interactions can also be effectively solved via traditional face-to-face learning. This study also revealed gaps in students’ readiness and confidence with respect to CDR. Although a significant proportion felt prepared for online CDR learning, only a small percentage rated their CDR knowledge as good, and even fewer felt confident in performing CDR clinically. This may be due to the complexity of oral rehabilitation with complete dentures, which requires extensive theoretical and practical knowledge [15, 16]. Nonetheless, the literature suggests that students’ practical abilities and confidence can improve significantly during their internship, emphasizing the importance of clinical experience [17]. The survey also explored students’ familiarity with various aspects of CDR, such as treatment planning, appointment scheduling, patient communication, and specific procedural skills. The results revealed that students had limited confidence in these areas, highlighting the need for targeted improvements in online CDR education to address these gaps. This necessity is highlighted by the ongoing relevance of CDR, especially for older patient populations [18]. Overall, this study highlights the potential of online learning to improve dental students’ proficiency in CDR while also identifying specific areas for educational focus.

In higher education, the acceptance of online learning is primarily due to its time and cost efficiency. As physical and online classrooms increasingly merge, dental students must adapt to online learning environments [19]. Prosthodontics, a comprehensive subject, necessitates internships for dental graduates to develop clinical, communication, and teamwork competencies [20]. Internships are pivotal in cultivating patient-centered attitudes and behaviors, thus significantly enhancing students’ future clinical performance. Therefore, assessing students’ attitudes and performance is crucial in evaluating the success and value of online learning [21]. Our survey revealed interns’ strong optimism about online learning for complete dentures: 61.90% enjoyed online learning, 71.43% were motivated to continue, and 82.54% found it beneficial for CDR (Fig. 4a-c).

However, dental students still require hands-on training and opportunities to apply their skills clinically [22]. We advocate early clinical exposure and active preclinical prosthodontic teaching methods. Sole reliance on the internship year for the acquisition of procedural skills is inadequate. Dental students across all specialties need efficient access to educational materials. Research has indicated that the effectiveness of online learning is on par with, or exceeds, that of face-to-face methods [14]. Chang et al. reported a 5–10% improvement in learning efficiency when blended learning was used compared with traditional methods [23]. The positive perception of online learning among students and lecturers suggests its potential integration into post-COVID-19 curricula [24]. However, given that stomatology focuses on clinical practice, the lack of practical experience may impede the enhancement of clinical skills [25], necessitating further research to evaluate the effectiveness of online learning in such practical subjects.

In the field of dental education, online learning can leverage advanced digital resources to significantly enrich the learning experience, in particular in CDR techniques. For example, the application of on-demand, enhanced videos equipped with real-time subtitles that capture the presenter’s dialogue, along with concise text bullet points and summary pages, offers a robust platform for augmenting knowledge acquisition, enhancing perceptual skills, and improving clinical performance in dentistry [26]. In addition, the integration of custom-built simulation models for impression-taking and tooth arrangement exercises can substantially improve online learning outcomes for dental students, fostering practical skills in complete denture impression creation and tooth positioning [27]. Furthermore, the adoption of multimedia learning applications, such as video demonstrations of artificial teeth placement and patient case studies, serves to uphold or even increase the quality of dental education, effectively bridging the gap left by the absence of face-to-face instruction [28]. Finally, the deployment of AI-driven e-learning tools, such as the Generative Pre-trained Transformer 4 (GPT-4) model by OpenAI, exemplifies a forward-thinking approach to training [29]. This model facilitates an immersive learning environment that allows students to engage in realistic diagnostic conversations with virtual patients, thereby honing their diagnostic capabilities in a controlled yet lifelike setting.

Furthermore, virtual reality (VR) has emerged as a transformative force in dental education, heralding a new era characterized by immersive training environments and immediate feedback mechanisms [30]. This innovation facilitates the acquisition of standardized skills among students, bridging the gap between theoretical knowledge and practical expertise. The advent of VR simulation-based pedagogy marks a significant shift in educational paradigms, encompassing both undergraduate and postgraduate realms [31]. It acts as a complement—or, in certain contexts, an alternative—to conventional training methodologies across various dental specialties [32]. Although VR simulators cannot entirely supplant traditional hands-on training, their utility and effectiveness in specific educational scenarios are undeniable. In particular, VR technologies, in conjunction with three-dimensional computer models and simulators, are proving to be invaluable assets in the comprehensive management of edentulous patients. Research conducted by Mansoory et al. highlights the efficacy and utility of VR in facilitating the learning process related to the neutral zone and teeth arrangement for edentulous patients, thereby fostering a dynamic, engaging, and successful educational experience [33]. The integration of VR simulators with advanced technological frameworks, such as big data analytics, cloud computing, the proliferation of 5G networks, and deep learning algorithms, promises to further revolutionize preclinical dental training. Numerous dental colleges and universities have already embarked on integrating VR-based experimental teaching into their curricula, highlighting the feasibility and adaptability of such innovative teaching modalities [34,35,36,37]. Educational researchers now have a responsibility to rigorously evaluate this novel online and VR-assisted teaching methodologies. Their objective is to ascertain the efficacy of these methods in comparison with traditional educational approaches, ensuring that the quality and efficiency of dental education are not only maintained but also significantly enhanced.

Virtual reality (VR) technologies provide immersive and interactive experiences that are particularly beneficial for dental education, where hands-on practice is essential [38]. In complete denture rehabilitation, VR can re-create clinical environments, enabling students to practice crucial techniques such as impression-taking, jaw relation recording, and denture fitting in a controlled and highly realistic setting. This immersive experience allows students to hone their motor skills and decision-making abilities in a safe environment where mistakes can be made without compromising patient safety. VR also enhances the visualization of complex anatomical structures and the interaction of dentures with oral tissues, deepening students’ understanding of denture design and function [39]. This critical aspect is often challenging to master through traditional methods. Artificial intelligence (AI) complements VR by offering personalized learning experiences, assessing student performance in real time, and providing instant feedback [40]. AI-driven platforms can identify areas where students struggle, such as achieving proper occlusion or understanding material properties, and offer tailored resources to address these gaps. AI also enhances the accessibility and scalability of education by adapting content to different learning styles and paces, which is particularly valuable in online education environments. Integrating VR and AI in complete denture rehabilitation education also offers new opportunities for dynamic and interactive assessments of practical skills and clinical decision making; however, adopting these technologies requires significant investment and careful planning to ensure effective integration into educational curricula [30]. Despite these challenges, VR and AI hold promise for revolutionizing dental education by making it more immersive, personalized, and effective in preparing students for clinical practice.

Conclusion

The manuscript discusses the importance of CDR training for dental interns, emphasizing the role of online learning in enhancing education. This highlights the need for comprehensive understanding, skill development, and the integration of innovative teaching methods. The study explores dental students’ attitudes toward and knowledge of online learning of CDR, revealing not only engagement but also gaps in readiness and confidence. The results suggest the necessity of improving online CDR education. This study also highlights the ongoing relevance of CDR, in particular for older populations, and the need to integrate theoretical knowledge with innovative technologies such as virtual reality into dental education. The results suggest that a balanced approach to online and traditional learning is crucial for equipping future dental professionals with the necessary skills and confidence to succeed in clinical practice.