Summary

Dental education has evolved through the years, and various advanced technologies are being incorporated into the curriculum to improve the quality of teaching and learning. The use of electronic devices and software programs continues to be at the forefront of e-learning modules, including in the field of Endodontology. This chapter aims to discuss current advances in dental education and applications of e-learning in Dentistry. Advances and applications of e-learning tools and virtual reality combined with more recent improvements in knowledge and clinical practice in the field of Endodontology will also be discussed.

8.1 Introduction

Dental education is ever-changing, especially with the rapid evolution of technology in Dentistry; however, predicting specific future trends and the pace of transition is challenging. New technology and modern clinical treatment modalities have propelled dentistry to a new level as specialised software and new clinical devices for treatments have been developed and introduced. Such advances in clinical care must be reflected in dental education in order that graduating dentists are competent and confident to not only work in today’s clinical environment but also be able to adapt in the future.

Common use of e-learning and the support of information and communications technology (ICT) inevitably reduce barriers for studying, teaching, and clinical practice. Technology-enhanced learning (TEL) is also another term used to describe the use of ICT in teaching and learning [1]. It includes hardware such as computers, tablets and other mobile devices, as well as software such as applications, learning management systems, event capture, and discussion boards within education and training programmes [2, 3].

Theoretical and clinical skills training in Endodontology constitute an integral part of undergraduate dental education [4]. Over the years, endodontic education has evolved in response to improvements in the understanding of endodontic diseases and therapies, new and improved endodontic materials, new devices, and evolving teaching methods. Based on a survey in the UK, there has been a significant advancement in the delivery of pre-clinical and clinical endodontic education compared to 20 years ago [5]. This is reflected with more schools having dedicated clinics for endodontics, supervisors with advanced endodontic training, use of advanced materials and equipment such as rotary/reciprocating endodontic instruments, microsurgical instruments, magnification (loupes and dental operating microscopes), and ultrasonic devices [6].

The main technologies currently used in dental education can be classified into three domains or settings: didactic, pre-clinical, and clinical [3]. This chapter discusses the technologies used with students in a classroom setting as well as the technological advances in pre-clinical and clinical settings related to the field of Endodontology.

8.2 E-learning in Dentistry

E-learning is commonly defined as the delivery of instructional content using purely Internet and digital technology [7]. Initially, e-learning was designed for working adult students who were unable to study full time for their formal education [8]. Over the years, e-learning has been referred to as online learning, Internet-based learning, computer-assisted instruction, computer-assisted learning, and web-based learning [9].

An e-learning model of instruction has the potential to transform the process from teacher-centred to learner-centred learning [10]. Although its potential as an instructional method gained recognition rapidly, concerns began to emerge about the effectiveness of e-learning, which has led to a growing field of research [11]. Educators are now able to present educational materials in a digital environment, thereby enhancing student participation. On the other hand, students will benefit from flexibility of learning at their own pace, place, and time [9].

E-learning has been increasingly used in dental curricula to support traditional teaching and learning methods in various forms, such as virtual reality-based simulations, computer or web-based tutorials, computerised patient simulations, and discussion groups [12]. Researchers have envisioned that e-learning in dental education may help meet expectations for higher quality education and at the same time save costs in an era of limited funding [13, 14] and limited availability of educators. In addition, the coronavirus disease (COVID-19) crisis has obliged most education systems to adopt e-learning as one valid alternative to face-to-face education.

8.3 Contemporary E-learning Models

Research over the years has established three different e-learning models: a) classroom learning, b) blended learning, and c) distance learning [15–17] (Figure 8.1). Classroom learning is a traditional form of education that provides face-to-face education between educators and students. Classroom learning takes place when both educators and students physically find themselves in the same space. Classroom learning is therefore not restricted to any particular form of learning content.

Distance learning is a form of education that provides education to students who are not physically present in a traditional classroom setting [7]. Distance learning is a way of bringing students, educators, and learning content together online while they are physically separated by time and/or space. Because learning content and instructions are accessible online, students have more control over the time, place, path, and pace of their programme of learning.

Blended learning is a form of education that combines face-to-face classroom learning with computer-mediated activities that take place outside the classroom. It is a combination of both classroom learning and distance learning [11].

There are two types of e-learning. The first is synchronous e-learning, which occurs when the educator and the students interact with each other in real time from different locations. The second is asynchronous e-learning, whereby the students undergo self-learning according to their own pace without the educator being there. In other words, the student and the educator are not online at the same time [18].

A variety of e-learning applications and tools have been used for teaching and learning [19]. These tools can be classified as social media tools, repositories for information and interaction, content interactive tools, and content development tools [20]. Social media tools include wikis, blogs, email, and chats, while repositories are YouTube, TED Talks, and EduwebTV. Content interactive tools include tools such as Padlet¹ and Google Earth,² while content development tools are used for video development, animation, and graphic features as well as web pages [20].

Didactic classes are the easiest to manage online. VoiceThread (VT)³ is an excellent cloud-based program that allows videos and PowerPoint to be integrated in a presentation. The features of VT allow for collaboration and peer-learning among students that can be synchronous or asynchronous [21]. EDpuzzle⁴ is another innovative tool that converts video watching into a student-centred activity. It is particularly useful for pre-clinical didactic and case-based exercises as it features embedded time-stamped questions with instant feedback in a clinical video for students to answer while watching the video.

Discussion forums are included in most learning management systems (LMS) and on some websites such as Freewebs⁵ and are used for asynchronous discussions that enable information to be archived and retrieved easily for later review [22]. Other tools that enable synchronous video interactions are Google Hangouts and Skype. These are synchronous rich-media tools that enable real-time communications. Some programs, such as Hangouts, may sometimes enable the user to represent themself using a separate identity [23]. Discussion tools that provide opportunities for synchronous discussion on mobile platforms, such as Whatsapp, are also becoming more widely used. The low cost of mobile apps over PC-based apps means that technology is available anywhere and anytime and makes them more accessible. The implication for educators is that technology apps that are accessible and convenient to use have the potential to make learning more effective and thus ensure the achievement of learning outcomes.

Additionally, collaborative workspaces and tools such Google Docs enable synchronous collaboration as users work on documents and other file types in their Google Drive. Wikis are websites are created in a collaborative environment and contribute to the creation of content [20]. Common wikis are Wikipedia and PBworks,⁶ originally PBwiki.

8.4 E-learning During the COVID-19 Pandemic

The global COVID-19 pandemic has resulted in cancellations of lectures and campus activities to avoid mass gatherings [20]. University administrators, educators, and dental school managers are facing a major challenge in trying to balance the important task of safeguarding the health of students and faculty while ensuring continuity in the education of students [21].

With this sudden shift away from the classroom in many parts of the globe, e-learning has been a necessity during the global COVID-19 crisis and is likely to continue to be a crucial component of educational delivery for some time to come. It is imperative that dental schools make appropriate modifications to their teaching and learning methods to ensure continuity of education. There has been a massive surge in usage of video conferencing tools, online learning software, and virtual tutoring since the COVID-19 pandemic.

Clearly, considerations should be given to universities and institutions in determining what modifications to the educational programme are best and most likely to be successful during this time [21]. While there is limited time to evaluate and choose between synchronous and asynchronous online teaching and learning, the teaching plan should be flexible so as to maintain the integrity of the original plan of content delivery.

Additionally, educators need to develop a strategy and practical methods to assess the knowledge and skills of students remotely [24]. This includes designing and implementing formative and summative assessments to measure the progress of students in their learning and providing effective feedback [25]. The assessment methods must also be appropriate to evaluate the achievement of the programme/module learning objectives [26]. Of critical importance is the need for educators to develop appropriate remote assessment methods, which include preventive measures to ensure assessments are free from cheating and fraud [24].

8.5 Limitations of E-learning in Dental Education

The sudden change to an e-learning environment might place students at risk of falling behind in learning if they are unable to participate with online activities. Past research on e-learning found that students struggled to adapt to the change from traditional classrooms to virtual classrooms [27]. Evidence reveals that students often lack the necessary facilities and amenities such as high-speed Internet connections [28], and computer literacy skills and motivation [29].

More recently, Crawford and colleagues [30] reviewed digital pedagogy responses compiled by higher education in 20 countries and found that most countries face tremendous challenges in transferring face-to-face teaching into online modes. Despite efforts to provide high-quality technical support for both educators and students, the key issue lies on the ability of students to gain effective and timely access to e-learning content, particularly those who have returned to their family home, which may lack a good Internet connection. This is in addition to other technical problems such as lag-time feedback interference from other microphones and potential disconnections that may result in disturbance in the flow of discussions and subsequent disappointment and dissatisfaction to students and teachers. It has to be highlighted also that the rapid shift to e-learning teaching requires proper training and preparation, which could be a challenge, especially for those unfamiliar with the technology.

A recent systematic review [31] concluded that TEL is equally effective compared to the conventional teaching methods in terms of knowledge gain and performance. This indicates that students can adapt well to either methods and the ICT and technological advancements should complement teaching and learning activities. The integration of technology will eventually become an integral component of dental education with its success dependent on the attitudes, adaptability, and interactive teaching styles of the educators, as well as the technological experience and attitudes of the students [21].

8.6 Advances in Endodontology Education

8.6.1 3D Technology for Pre-clinical Training

Dental schools commonly use simulated canals in resin blocks and plastic teeth and/or extracted teeth for pre-clinical endodontic training [32, 33]. Extracted teeth provide a close clinical simulation but difficulty in acquiring them, ethical issues, their variability, and structural characteristics can be compromised by methods of disinfection, storage, and preservation. This has led to the development of alternative tooth simulators for teaching [34], and various designs of artificial teeth have been introduced in an attempt to replicate the anatomical and physical properties of natural teeth, including their canal systems. Aseptic and standardised simulated canals in resin blocks are useful for unexperienced undergraduate dental students to visualise root canal access and instrumentation. However, the tactile sensation during cavity preparation and root canal instrumentation cannot be appreciated since the hardness and abrasion behaviour of acrylic resin differs from that of a natural tooth [35, 36]. Artificial teeth that are made of opaque resin are also commercially available and provide an alternative to natural teeth; however, they can be costly.

Rapid prototyping technologies have emerged to produce physical models of teeth and jaws from computed aided design (CAD) databases. Examples of developed technologies include stereolithography, selective laser sintering, fused deposition manufacturing, laminated object manufacturing, ballistic particle manufacturing, 3D printing, digital light processing, PolyJet printing, and multi-jet printing [37, 38]; however, the term 3D printing is widely used in medical and dental applications. This technology allows the creation of dental models based on reconstruction of actual teeth or jaws from a stereolithography language (Standard Tessellation Language [STL]) file that can be obtained from digital scanners and cone-beam commuted tomography (CBCT) scans [34]. It has been reported that modular 3D printed dental models with embedded human teeth for electronic working length determination allowed a more realistic simulation of the clinical situation for undergraduate teaching and led to reduced stress levels in root canal treatment in the subsequent clinical courses [39].

Individual tooth models with specific characteristics for various training scenarios can be produced using 3D printing technology. Various materials are now available for 3D printers, which make it possible to manufacture models of teeth rapidly with reasonable prices [40]. The technology enables printing of tooth replicas for crown preparation with a different hardness for enamel and dentine to simulate the tactile sensation of cutting a natural tooth. The distinctive discrimination in hardness was commented to be good and realistic but improvements are still required to simulate the actual difference between the two tissue types [40, 41