Plascencia H, Contreras-Preciado M A, Brito-Ortiz J F, Díaz M, Solis R, Gascón G
Endodontic Postgraduate Program, University Centre of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
Universidad Centro Panamericano de Estudios Superiores (UNICEPES), Zitácuaro, Michoacán, Mexico.
Int Endod J. 2025 Jul 17. doi: 10.1111/iej.70002.
Patient-specific 3D-printed dental models present innovative opportunities in endodontic education, offering a bridge between theoretical learning and clinical practice. This study aimed to compare the effectiveness of such models versus extracted natural teeth for training postgraduate residents in the MTA apexification technique, focusing on procedural accuracy and perception.
This mixed in vitro study (QUAL-quant) involved 21 postgraduate endodontic residents who were randomly assigned to two groups: The control group (CG), using 63 extracted natural teeth, and the experimental group (EG), using 63 patient-specific 3D-printed open-apex models derived from in vivo CBCT scans. After proper calibration, the participants performed the training sessions including identical procedural steps. Subsequently, the residents completed two Likert scale surveys: Academic Satisfaction Scale and Open-Apex Model Questionnaire. Additionally, an observer reviewed the radiographs of all practices and rated the executed procedures. Statistical analyses included descriptive statistics, Spearman's correlation, confirmatory factor analysis (CFA), chi-square and Fisher's exact tests (p ≤ 0.05).
Patient-specific 3D-printed teeth achieved high acceptance rates among residents, with approval scores of 96.6% on the Academic Satisfaction Scale and 70.79% on the Open-Apex Model Questionnaire. Procedural accuracy was comparable across groups, with 86.14% of treatments free of errors in both. Significant correlations were identified among key procedural variables, such as dental radiographic aspect, access and negotiation of the root canal, determination of working length, and creation of the apical barrier with MTA, highlighting the internal consistency of performance patterns of the 3D model. Inferential analyses revealed significant differences in specific procedural steps: the CG outperformed the EG in determining working length (p = 0.043) and achieving a homogeneous apical barrier (p = 0.004). Minor concerns regarding the tactile sensation and radiographic properties of the artificial prototypes were noted but considered addressable.
Patient-specific 3D-printed open-apex teeth demonstrated high acceptance and supported technically proficient treatments during MTA apexification training. Although overall performance was comparable to that with natural teeth, specific procedural differences suggest that further refinement of the artificial models may enhance their effectiveness as alternative training tools in postgraduate endodontic education.
患者特异性3D打印牙齿模型为牙髓病学教育带来了创新机遇，在理论学习和临床实践之间架起了一座桥梁。本研究旨在比较此类模型与拔除的天然牙在培训研究生住院医师进行MTA根尖诱导成形术方面的有效性，重点关注操作准确性和认知情况。
这项混合体外研究（质量-数量研究）纳入了21名牙髓病学研究生住院医师，他们被随机分为两组：对照组（CG），使用63颗拔除的天然牙；实验组（EG），使用63个从体内CBCT扫描获得的患者特异性3D打印开放根尖模型。经过适当校准后，参与者进行了包括相同操作步骤的培训课程。随后，住院医师完成了两项李克特量表调查：学术满意度量表和开放根尖模型问卷。此外，一名观察者查看了所有操作的X线片并对执行的操作进行评分。统计分析包括描述性统计、斯皮尔曼相关性分析、验证性因子分析（CFA）、卡方检验和费舍尔精确检验（p≤0.05）。
患者特异性3D打印牙齿在住院医师中获得了较高的接受率，在学术满意度量表上的认可得分是96.6%，在开放根尖模型问卷上的认可得分是70.79%。两组的操作准确性相当，两组中86.14%的治疗均无差错。在关键操作变量之间发现了显著相关性，如牙齿X线表现、根管入口和疏通、工作长度的确定以及使用MTA创建根尖屏障，突出了3D模型操作模式的内部一致性。推断性分析显示在特定操作步骤上存在显著差异：对照组在确定工作长度（p=0.043）和实现均匀的根尖屏障（p=0.004）方面优于实验组。对人工模型的触觉感受和X线特性存在一些小问题，但认为是可以解决的。
患者特异性3D打印开放根尖牙齿在MTA根尖诱导成形术培训期间表现出较高的接受度，并支持技术熟练的治疗。虽然总体表现与天然牙相当，但特定的操作差异表明，进一步完善人工模型可能会提高其作为牙髓病学研究生教育中替代培训工具的有效性。
