3D Tooth Atlas 7 Free Download

Educational Methodologies
Evaluation of a 3-D Interactive Tooth Atlas by Dental Students in Dental Anatomy and Endodontics Courses Edward F. Wright, D.D.S., M.S.; William D. Hendricson, M.S., M.A. Abstract: Advances in information and communication technology continually offer innovations to assist faculty in their efforts to help students learn new information or develop new skills. However, faculty members are often hesitant to incorporate these innovations into their courses out of fear that these new methods may not provide the anticipated outcomes. Hence, students are often the subjects of educational trials to evaluate curriculum innovations by comparing a new teaching/learning method to traditional lecture-based instruction. The most typical finding is that students can learn equally well by either method. However, two questions that have not been studied extensively in dental education are whether dental students will actually use computer-based educational resources made available to them and whether students perceive these materials to provide a value-added learning experience. Accordingly, the goals of this study were to determine whether first-year dental students (D1), second-year dental students (D2), and third-year dental students (D3) would 1) use an interactive tooth atlas, available on a DVD, as a study aid and 2) perceive that the atlas provided sufficient value-added benefit for their dental anatomy (D1), preclinical laboratory endodontics (D2), and clinical endodontics (D3) courses to recommend adding it to their school’s comprehensive electronic resources. A low percentage of the students (14 percent; 40/289) voluntarily downloaded the atlas from a DVD to their laptops prior to the addition of incentives in the form of atlas-related examination questions. Even after incentives were added, only 43 percent of the students (126/289) downloaded the DVD. After using the atlas, students responded to the statement “Using the 3D Interactive Tooth Atlas was beneficial for me” on a 0 to 10 scale with 0 representing strongly disagree, 5 representing unsure, and 10 representing strongly agree. The mean rankings were 5.34 for D1s, 6.79 for D2s, and 7.28 for D3s. Students also responded to the statement “The atlas should be added to our school’s VitalBook” (digital library of curriculum materials). The mean rankings for this statement, using the same 0–10 scale, were 5.15 for the D1s, 6.63 for the D2s, and 7.26 for the D3s. Based upon these findings, the course directors decided not to add this atlas to the students’ electronic resources. Dr. Wright is Associate Professor, Department of Restorative Dentistry; and Prof. Hendricson is Assistant Dean, Educational and Faculty Development—both at the Dental School, University of Texas Health Science Center at San Antonio. Direct correspondence and requests for reprints to Dr. Edward Wright, Department of Restorative Dentistry, Dental School, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229; 210-567-3697 phone; 210-567-6354 fax; [email protected] Keywords: dental education, teaching methods, curriculum, information and communications technology, DVD, dental anatomy, prospective study Submitted for publication 2/14/09; accepted 11/13/09
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lectronic curriculum (e-curriculum or elearning) refers to computer-assisted learning including educational materials available to students by CD or DVD; online courses and web mechanisms used to search the literature; electronic systems used to enhance academic programs such as e-mail; online testing and course evaluations; and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible, wireless classrooms.1 Figure 1 provides a summary of the proposed advantages of e-curriculum.2-4
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A study of dental school curriculum innovation conducted during the 2002–03 academic year by Kassebaum et al. found a high level of interest among dental educators in e-curriculum.5 Kassebaum et al. reported that 86 percent of North American dental schools had expanded use of instructional technology during the past three years for implementation of core curriculum and 82 percent of schools desired to increase their use of computer-based technology even further during the next three years. In 2004, Hendricson et al. found that virtually all North American dental schools had made substantial efforts to provide
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• Enhances student enthusiasm and motivation • Enhances anytime, anywhere access to educational materials by students • Improves learning outcomes • Increases speed of learning • Increases efficiency and effectiveness of students’ study habits • Increases student control over the pace and sequencing of learning • Stimulates teachers to make courses less lecture-based and more problem- or issue-centered • Improves communication and sharing between teachers and students and among students • Provides students with a portal to all materials in one interactive system • Provides students with better imagery and visualization • Allows high-fidelity simulations • Allows students to actively engage with module content by making decisions and receiving feedback on the accuracy and consequences of these decisions
Figure 1. Proposed educational benefits of e-curriculum Sources: Hendricson WD, Eisenberg E, Guest G, Jones P, Panagakos F, Johnson L, Cintron L. What do dental students think about mandatory laptop programs? J Dent Educ 2006;70(5):480–99; Kinzie MB. Requirements and benefits of effective interaction instruction: learner control, self-regulation, and continuing motivation. Educ Technol Res Dev 1990:38:5–21; Clark R, Mayer RE. E-learning and the science of instruction. San Francisco: Pfeiffer, 2003.
instructional technology resources to their faculty in the past several years, collectively investing millions of dollars, but also found use of twenty-two components and capacities of e-curriculum was limited except at schools that required students to purchase a laptop with bundled curriculum support software.6 This article focuses on one component common to e-curriculum: the use of DVDs by dental students to assist their acquisition of biomedical knowledge and skills. In health professions education, DVDs are typically designed to allow students to interact with the educational materials by image selection and manipulation. Many DVDs also allow students to make decisions in simulations, analyze the outcomes of these decisions, and respond accordingly much as “gamers” do with PlayStation, Xbox, and Wii. The use of DVDs as an educational tool has received considerable attention in dental education over the decade as more and more schools require students to matriculate with a laptop and associated curriculum-support software. To explore whether an interactive DVD was a valuable study aid, we investigated dental students’ perceptions of the benefits of an interactive threedimensional tooth atlas, accessible by DVD, and their utilization of this educational resource in a
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freshman dental anatomy course, a sophomore endodontics preclinical course, and a junior year clinical endodontics course at one U.S. dental school in the 2007–08 academic year.
Description of 3D Interactive Tooth Atlas The 3D Interactive Tooth Atlas, Version 4.0, was created by Brown and Herbranson Imaging (http://ehuman.com/) as a teaching tool to provide a comprehensive database of human dentition. Users can access four types of images of every tooth: photographs, radiographs, serial cross-sections, and micro-CT scans. Photographs, cross-sectional views, and CT scans can be fully rotated and tilted 360 degrees in any direction and also enlarged for better visualization. The CT scans also allow users to peel away anatomical structure to view internal anatomy; users can literally navigate canals and roam around inside the tooth to explore structures in fine-grain detail. For example, external structures can be completely stripped away to reveal only the canals. Internal structures are highlighted in color to trace their pathway, and popup labels can be accessed
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on demand to identify and describe all structures and features, both internal and external. Users can compare side by side photographic, radiographic, and CT scan views of the same tooth and rotate them in sequence. In addition, users can request and view tooth-skull relationships and request various 3D images to review anatomical considerations for periapical surgery and implant placement. The 3D tooth atlas contains an x-ray database of dozens of images of each tooth demonstrating numerous anatomic variations and an extensive collection of case studies showing numerous dental pathologies and anatomic variations for each tooth. These cases were submitted to Brown and Herbranson by dentists from all over the United States and internationally. For in-depth study of endodontics, the DVD includes examples and explanations of pulpal pathology that illustrate the pathway from normal to pulpal degeneration to periapical involvement. Students can review pulpal anatomy by rotating images and literally drill down through the tooth via the cross-sectional images. To produce the cross-sectional views, teeth were sliced into fifty to seventy sections and photographed. Other modules illustrate and label pulpal anatomy using the CT scans and allow exploration of periapical anatomy via cut-away techniques controlled by the user. Split screens combining photographs, radiographs, and CT scans visualize instrumentation and canal anatomy that create challenges for dentists. The tooth atlas DVD also contains self-assessment quizzes that allow users to review correct and incorrect responses and an extensive glossary of terms, definitions, and concepts. Dentists and staff at Brown and Herbranson assisted the authors in development of the protocol described in the methods section.
Methods This was a prospective study performed at the University of Texas Health Science Center at San Antonio (UTHSCSA) in 2007–08. The research proposal was approved by the UTHSCSA Institutional Review Board. The research hypotheses explored in this study were that dental students 1) will utilize a three-dimensional interactive tooth atlas accessible via a DVD as a study aid when provided an opportunity to do so and 2) will perceive that the atlas is a beneficial educational resource. To test these hypotheses, we sought answers to four questions using
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an investigator-developed survey as the primary data collection method. Question 1 addressed the first hypothesis, and questions 2, 3, and 4 addressed the second hypothesis: 1. What percentage of first-year dental students (D1), second-year dental students (D2), and third-year dental students (D3) voluntarily used the 3D Interactive Tooth Atlas? 2. Did D1s, D2s, and D3s perceive that the atlas was beneficial? 3. To what extent did D1s, D2s, and D3s perceive that the atlas provided information, perspectives, radiographic images, and other learning opportunities that were otherwise not available? 4. Did D1s, D2s, and D3s recommend adding the atlas to a comprehensive electronic resource at this dental school that includes all textbooks and course manuals, plus many other instructional materials, for their entire curriculum? Dental students in the freshman, sophomore, and junior years at the UTHSCSA Dental School participated in this study on a voluntary basis. The total enrollments for each class at the time of the study were ninety-five, ninety-three, and 101, respectively, although not all students elected to participate as indicated in the results section. The surveys used in this study are displayed in the Appendix. Survey questions were developed by the authors based on the hypotheses to be explored. Several other faculty members reviewed the questions for clarity and appropriateness, given the purposes of the study, and provided suggestions for wording that were incorporated. The surveys were not validated. An educational specialist received a copy of Brown and Herbranson’s 3D Interactive Tooth Atlas DVD and participated in several hours of training by one of the atlas marketers, as well as one of the dentists who participated in atlas development, about how to use the DVD to present the atlas to dental students in the dental anatomy and endodontics courses. Ten DVDs containing the tooth atlas were provided by Brown and Herbranson to the dental school to lend to requesting students. Students acquired the DVD by requesting it from an administrative assistant in the Department of Restorative Dentistry. The names of requesting students and request dates were recorded. All UTHSCSA students purchase either a Macintosh laptop computer (Mac) or personal laptop computer (PC) at the time of their matriculation into dental school as part of their tuition. Requesting students installed the tooth atlas DVD onto their laptop computers in the immediate vicinity and im-
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mediately returned the DVD to the administrative assistant, who observed the students as they loaded the DVD onto the laptops. Consequently, we have a high level of confidence that the recorded students were the only ones who placed the atlas on their computers, although more than one student could view the atlas from one student’s computer. Students were not provided registration numbers for the atlas, but it was programmed to allow computers to run it for a two-week period without being registered. Students could uninstall and reinstall the program to obtain another two-week viewing period. Near the beginning of the freshman year dental anatomy and occlusion course, the educational specialist demonstrated the tooth atlas DVD to show these students the purposes of this study; the components, features, and potential advantages of the atlas to assist their learning of external tooth anatomy; and how to access this educational resource. After two months, only eleven of the ninety-five D1s had requested the DVD from the administrative assistant,
so the students were informed that four questions about the atlas would be placed on their next examination. These questions appear in Figure 2 with the correct answers highlighted in bold. Students were informed that these four questions would be included in calculation of their test score and were equal in value to all other items on their examination. After receiving notification about these four questions and prior to the examination, seventy-three of ninety-five D1s (77 percent) requested the DVD to install on their computers. Near the beginning of the sophomore year preclinical (laboratory) endodontics course, the educational specialist also oriented students in this course about the research study and the atlas. Students were informed that the four atlas-related questions would be included in calculation of their test score and were equal in value to all other items on their examination. Prior to the examination, twenty-six of the ninetythree D2s (28 percent) requested the DVD from the administrative assistant.
1. When entering the 3D Interactive Tooth Atlas, you are requested to select one of three choices. These three choices are A. B. C. D.
Photography, tomography, and x-ray Crown anatomy, root anatomy, and internal anatomy Dental anatomy, supportive tissues anatomy, and oral anatomy Enamel structures, dentinal structures, and pulpal structures
2. From the options below, what is the best answer to this question: which of the following were NOT in the 3D Interactive Tooth Atlas? A. B. C. D. E.
Third molars Primary teeth Palmer and international nomenclature None of the above were in the atlas A, B, and C all were in the atlas
3. Which of the following options indicates how you select a tooth to view on the 3D Interactive Tooth Atlas? A. B. C. D.
Table of listed teeth Maxillary pie chart and mandibular pie chart Teeth over a picture of the lower face Typodont identical to the one our students have
4. Which of the following were on the 3D Interactive Tooth Atlas? A. B. C. D.
View of skulls A quiz that assessed understanding of information communicated in the atlas A quiz with sample National Board Dental Examination Part I dental anatomy questions All of the above
Figure 2. Questions related to the 3D Interactive Tooth Atlas DVD that were added to the dental anatomy examination (correct answers in bold)
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Near the beginning of the year-long D3 clinical endodontics course, the educational specialist also oriented third-year students about the research study and the atlas. The students were informed that prior to appointing a patient to the endodontic clinic to perform their first endodontic procedure, their course director required that they use the atlas to review the internal tooth anatomy of the tooth to be treated. During the fall semester, three of the 101 D3s requested the DVD. To encourage installation and review of the atlas, junior students were informed that the four previously described questions (Figure 2) about the atlas would be placed on their first examination in this course during the spring semester. Prior to the examination, twenty-seven D3s (27 percent) requested the DVD from the administrative assistant. Near the end of the freshman dental anatomy course, all D1s (n=95) received a survey titled “Dental Anatomy and 3D Interactive Tooth Atlas” (see Appendix) to evaluate the atlas as an added benefit to their current course material, which consisted of a 315-page manual developed by the course director and two dental anatomy textbooks. Near the end of the sophomore preclinical endodontics course, all D2s (n=93) received a survey titled “Endodontics and 3D Interactive Tooth Atlas” (see Appendix) to evaluate the atlas as an added benefit to their current course material, which consisted of a manual developed by the course faculty and two endodontics textbooks. Near the end of the junior clinical endodontics course, all D3s (n=101) received the same survey as the sophomores to evaluate the atlas as an added benefit to their current course material (two clinical endodontics textbooks). Students in each class were provided time to complete the survey in a paper and pencil format during regularly scheduled class time. The nonparametric Mann-Whitney procedure was used to perform pairwise statistical comparisons among the three groups for each question. All testing was two-sided with null hypotheses rejected at the 0.05 level of statistical significance. The reported p-values were adjusted by the Bonferroni method to control for inflation of the Type 1 error rate due to multiple comparisons.
Results A total of 235 students (eighty-four D1s, seventy-one D2s, and eighty D3s) completed surveys for response rates of 88 percent, 76 percent, and 80 percent respectively. The total number of students
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who responded to each question varied. Findings for each of the four questions that framed the study are reported in this section. 1. What percentage of first-year dental students (D1), second-year dental students (D2), and third-year dental students (D3) voluntarily used the 3D Interactive Tooth Atlas? Two sources of data were available to answer this question: the number of students who acquired the DVD for laptop installation and the students’ self-reported use of the atlas on the survey. For actual checkout, departmental records indicate that eleven D1s (12 percent; 11/95) requested the DVD prior to the addition of the four atlasrelated examination questions in the dental anatomy course, and a total of seventy-three D1s (77 percent) obtained the DVD by the time of the examination. For the D2s, twenty-six (28 percent; 26/93) requested the DVD for laptop installation. Among the D3s, three of the 101 students (3 percent) requested the DVD prior to the addition of the four atlas-related questions on the clinical endodontics examination, and a total of twenty-seven (27 percent) obtained the DVD by the time of the examination. A summary of the students who acquired or reported viewing the DVD appears in Table 1. Among the students who completed the survey, seventy-four of eighty-four D1s (88 percent), forty-nine of seventy-one D2s (69 percent), and thirty-eight of eighty D3s (47 percent) reported that they had viewed the 3D Interactive Tooth Atlas. The self-reported usage of the atlas by the D1s is consistent with the DVD checkout records, but the self-reported usage by D2s and D3s is substantially higher than indicated by the checkout roster for these classes. The primary reasons students reported for not viewing the atlas were problems running it on their computers (especially with Macintosh laptops) and being too busy with other schoolwork. Among the students who attempted to utilize the atlas on their computer, 19 percent (30/154) indicated they could not run it. 2. Did D1s, D2s, and D3s perceive that the atlas was beneficial? Only those students who viewed the DVD were asked to respond to the survey item designed to elicit their perceptions of benefit, which was stated as “Using the 3D Interactive Tooth Atlas was beneficial for me.” Students responded to this item using an elevenpoint scale ranging from 0 to 10 with the anchors of 0 representing strongly disagree with the statement, 5 representing unsure, and 10 representing
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Table 1. Students who checked out or reported viewing the atlas D1 D2 D3 n % n % n % Checked out atlas prior to knowing questions would be on examination (95 D1s and 101 D3s)
11 12%
– –
3 3%
Checked out atlas after knowing questions would be on examination (95 D1s, 93 D2s, and 101 D3s)
73 77%
26 28%
27 27%
Self-reported viewing of atlas among students completing survey (84 D1s, 71 D2s, and 80 D3s)
74 88%
49 69%
38 47%
strongly agree. A summary of the D1 students’ assessment of the atlas’s helpfulness for their dental anatomy course is in Table 2. Summaries of the D2 and D3 assessments of the atlas’s helpfulness for their preclinical laboratory endodontic course and clinical endodontic course are in Table 3. For D1s, the weighted mean ranking for this statement was 5.34 with a standard deviation (SD) of 2.24, while the mean scores were 6.79 (SD=1.64) for D2s and 7.28 (SD=1.56) for D3s. The weighted mean rankings of the D1 and D2 classes were significantly different from each other (p=0.002) and the rankings of the D1 and D3 classes were also significantly different (p