Computers can be extremely helpful in simulating patients or presenting case scenarios [19–22]. In case-based computer programs, students are presented a narrative that represents a patient encounter. The students can interact with the program that provides responses to a variety of interventions including answers to a series of questions relating to medical history, diagnostic test results, orders, possible diagnoses, and the development of appropriate treatment plans. These programs are becoming more and more interactive, allowing for more pertinent feedback to the student.

Since the early 1990s, computer simulations have been considered for dental licensure examinations or other evaluations and testing applications; however, when used for these purposes, reliability and validity are of utmost concern [23]. The goal when using simulation for education is to achieve performance improvement, whereas simulation for dental licensure examinations is used to ensure that the provider has reached competency. This requires that simulation for these high-stakes assessments must meet a higher standard in reliability and criterion validity. The advantages, however, of using simulation for dental examinations, assuming the level of reliability and validity is sufficient, are compelling. Simulation may have a greater potential validity, is safer in comparison to using live patients, and may be less expensive and easier. Some schools use simulation to assess students during their education, but advanced simulation is not currently used in any clinical examination for state licensure. As simulations in dentistry become more and more advanced, their use in dental licensure examinations will receive more consideration.

Recent advances in computer imaging have allowed for the production of very accurate 3D dental models of the oral apparatus by destructive scanning, laser scanning, or direct imaging of teeth [24–27]. Also imaging systems have been used to capture 3D images of mandibular motion [25]. The technology of computer imaging is important in the educational component of dentistry since it can dictate the relation to reality. Computer imaging is instrumental in simulations using virtual reality and/or haptics. Accurate and detailed imaging is critical because dental procedures require measurements in the tenths of millimeters; hence, virtual images must have very high resolution to order to evaluate such precise detail.

Mannequin-based simulation has become the standard of preclinical teaching in dental schools as described at the beginning of this chapter. Over a decade ago, a computerized dental simulator was developed by DenX Ltd. (presently owned by Image Navigation Ltd., Fig. 21.3). This new virtual reality simulator allows students to receive immediate, three-dimensional, audio, and written feedback of their work on artificial teeth (such as cavity, crown, and endodontic access preparations) and to review their work on video. This computerized simulator can be installed on an existing traditional mannequin, with the addition of a computer, camera, a special handpiece (dental drill), and a reference body that functions as the tracking device [2].

The DentSim tracking system technology is based on the principles of GPS (global positioning system) technology. The optical system uses a camera to track a set of light-emitting diodes (LED), located on the dental handpiece and on the simulator’s jaw. The LEDs send infrared signals that are picked up by the camera which is located above the workstation. The handpiece LEDs provide data indicating the motions of the user, while the LEDs attached to the jaw provide data regarding the location of the teeth. Once the camera has picked up the signals, the exact location of the tip of the bur (dental drill bit) in relation to the tooth may be calculated. This information is transferred to the computer and displayed through virtual simulation and as a color-coded, three-dimensional, tooth image.

Using the virtual reality simulator, the student’s work is recorded and compared to an ideal preparation that is predesigned or selected by the course director from the software database. The students can view an accurate image of the ideal preparation, the student’s preparation, and the exact measurements of each preparation in every dimension.

Several studies have been conducted to test the validity of the DentSim system. This is the only technology of its kind that has been evaluated in the scientific literature. One study demonstrated that when trained with the virtual reality simulator, starting at a minimum of 6 h dental, students learn faster than their peers in the traditional preclinical course, arrive at the same level of performance as expected of students trained in a traditional manner, accomplish more practice procedures per hour, and request more evaluations per procedure or per hour than in the traditional preclinical laboratories [28]. Another study suggested that virtual reality technology has the potential to provide an efficient and more self-directed approach for learning clinical psychomotor skills. That study showed that students using only traditional instruction received five times more instructional time from faculty than did students who used the virtual reality simulation system. There were no statistical differences in the quality of the preparations [29]. Several studies have shown an improvement in course performance through higher examination and course scores [30–32] as well as a decrease in overall course failure rate and elimination of student remediation by more than 50% [31, 32]. In addition, studies have shown the advantage of dental students using virtual reality simulators to learn psychomotor skills, as well as examined faculty members’ evaluation and expectations of employing this relatively new technology [33]. Results for other studies support the use of VRS in a preclinical dental curriculum. This virtual reality-based technology is currently being used in several dental schools around the world (Fig. 21.4). This system has many capabilities which allow specific adaptation and curricular integration based on the individual school’s requirements.

EPED stands for efficiency, professionalism, education, and dependability. EPED’s main product is the Computerized Dental Simulator (CDS-100), which ­combines a ­simulation system, an evaluation system, and 3D virtual reality technology [34]. CDS-100 system is based on exactly the same approach as the DentSim and comprised of a dental handpiece for drilling a cavity in a plastic tooth; a three-dimensional sensor with six degrees of freedom attached to the dental handpiece, which provides the system with the position and orientation of the handpiece; and a data processing and display unit for displaying the procedure [34, 35] (Fig. 21.5). There is no scientific evidence of its use at this time; however, it is expected to have similar educational benefits as the DentSim system.

Dental education has been assessing the value of distance education and the steps required to deliver technology-based learning while providing high-quality patient care teaching methods for dental and dental hygiene students. Second Life (SL) is a three-dimensional technology that provides simulation-based virtual settings. Activities in SL provide a way to combine new simulation technologies with role-plays to enhance instruction in diagnosis and treatment planning. Case studies and role-plays have been used as effective evaluation mechanisms to foster decision-making and ­problem-solving strategies in the delivery of patient care. It is a newly emerging technology and its benefits are yet to be reported in the scientific literature [36].