Digitizing Clinical Education
Dentistry has gone high-tech; now universities are mindfully adopting new tools
By Diane Peters
When Eszter Somogyi-Ganss 1T3 MSc Prostho stepped into the job of graduate program director of prosthodontics last summer, she had two goals. Firstly, the associate professor, teaching stream wanted to increase the amount of clinical experience students would receive. Secondly, she planned to start teaching digital dentistry.
“I asked myself, ‘What do I want them to have done at least once?’” she says with regards to students using technology chairside. To get there, working with a limited budget, she sourced a used intraoral scanner and 3D printer. More than a decade ago, Somogyi-Ganss wrote a master’s thesis that evaluated the accuracy of a dynamic navigation system for placing implants. So she dusted off that machine and is now updating it for clinical use.
It all took longer to get up and running than expected. She had to confirm that patient data storage was compliant with government and university regulations. Then she had to get faculty and students trained, and then ensure equal access among students. She found herself in closer touch than ever with the information technology (IT) team.
Meanwhile, Somogyi-Ganss offered input regarding the under- construction simulation lab, where technology could play an important role. “The old tech is the real deal,” she says of using mannequins and plastic teeth — but there are benefits to the Faculty’s wish list of digital alternatives for pre-clinical students.
“The reality is, everyone wants to incorporate technology, because students will leave the university and in practice they’ll encounter it,” she says. “Grads should know not just the analog way of doing things, but the digital way as well.”
Technology in clinical education has many benefits. For the university, it’s appealing to digitize patient records, including models, to save storage space and headaches. “It’s easier and faster for patients,” she notes, too.
But there are reasons not every corner of a dental faculty whirrs with tech tools. “We recognize that digital dentistry is resource intensive,” says professor Jim Yuan Lai 0T0 MSc Perio, vice-dean of education. Due to costs and logistical challenges, technology in dental education doesn’t always look as ubiquitous as it does in private practice. As well, dental school is not technology school; universities must graduate dentists with clinical and professional skills they can employ wherever they practice. That’s why schools such as U of T invest in technology, but also enable students to travel to remote locations for service rotations where compassion, strong basic skills and ingenuity come first.
“It’s difficult to go fully digital just yet,” says Somogyi-Ganss. “You can’t throw analog out of the window.”
MIXED ADOPTION
Studies show that digital dentistry is embraced in training, especially by students. A 2020 survey of dental students in Arizona showed nearly three-quarters of graduates felt prepared to practise CAD/CAM dentistry. A 2021 survey of final-year dental students found that more than half preferred using intraoral scanning over impressions, appreciating digital dentistry for identifying defects, infection control and reduced need for chairside support.
Schools in the U.S. have moved heavily into digital, with some not teaching impressions anymore. “The digital simulation labs, the digital imaging labs and technology in the clinics, certain universities have had this stuff in place for years,” says Valerie Stavro 8T4, a clinical instructor in restorative dentistry.
In Canada, the University of British Columbia opened a new simulation lab in 2022 that’s equipped with digitally powered units. Western University’s students use intraoral scanners, while professors there delve into the research and development of tech tools. Dalhousie University, meanwhile, just began using digital radiographs.
Lai says some tech functions quietly in the background. “We’re doing a lot for education and clinical care. But for some people, they see that you’re not regularly using an intraoral scanner and CAD/CAM, and that’s it.” For years, the Faculty has relied on digital patient records and digital radiographs, both of which allow for more efficient patient care.
James Fiege, associate director of clinical operations, notes that the Faculty has had a 3D scanner for decades. It’s been used, among other things, to digitally archive materials from the iconic Burlington Growth Study. Associate professor, teaching stream Marco Caminiti 9T8 Dip OMFS uses an intraoral scanner and prints surgical guides. “He was among the first to bring 3D printing to the Faculty,” says Fiege.
Indeed, chairside tools get the most notice. When students use a full CAD/CAM suite and either print an expander or surgical guide, or mill a crown, these full-circle processes directly impact patients and give learners a fulsome experience.
Stavro and husband Stephen Andrews 7T1 started training DDS students in the scan, design and milling process starting about seven years ago. Along with attending a one-day training session run by Densply Sirona for second-year students at the company’s facility, the duo uses the Faculty’s top-notch but small setup of three machines in Clinic 2 to do a six-week CAD/CAM training module for all DDS4s, supporting them in making a crown for mannequins. Stavro would like to see the suite used more outside of training sessions. “This technology is not that new, but it’s just coming of age now. It’s time for the students to be exposed to it; it’s not going away.”
HOLDING TECH BACK
Upfront and ongoing costs curb the adoption of tech in dental education. “Technology costs a lot of money, especially if you’re talking about a hundred or so students. For clinical purposes, you need a machine per person,” says Somogyi-Ganss.
While many manufacturers and distributors will offer universities a discount or make generous in-kind donations for hardware, there’s still software, additional computers (that go out of date quickly), warranties and service costs. To properly equip undergraduate and graduate clinics, schools need the ongoing support of suppliers, but also donors who appreciate the connection between equipment and education excellence.
Fiege notes that when he began working in IT for U of T Dentistry in 2013, it had 640 computers. Now, the team manages 850 desktops, with most of the growth happening in the clinics. “You really need a dedicated, full-time IT person on this. That’s a lot of money,” says Lai. That person would need to be a professional who deeply understands dental tech equipment.
Fiege works with staff, professors and IT on the intricate back-and-forth needed to install new equipment and keep old devices running. “There’s learning on both sides,” he says, plus considerable cooperation to find space, deal with glitches and make sure all data is secure. University compliance rules often add extra hurdles. Arjun Sarof, senior business development manager with Nobel Biocare, says software hosted securely on the cloud can allow more ease of use for dental schools.
Another barrier is the people involved. While about half of private practices use intraoral scanners, says Stavro, many clinical instructors are not comfortable with these and other devices. Even Somogyi-Ganss, despite her efforts to bring technology to education, considers herself a novice. “It’s a new chapter for me as well. I’m not very experienced with digital technology when it comes to scanning or printing. But I’m brave and I’m willing to learn.”
Stavro says clinical instructors need to carve out time to learn, but training sessions can come with a cost for the school. However, companies such as Nobel Biocare offer free technology days with a range of demonstrations for second-year students. “We want younger dentists to get trained on this stuff,” says Sarof. He says companies offer free webinars, so anyone can learn if they’re curious.
Importantly, dental schools need to bring in the right tech and intentionally invest in supporting it. Sometimes we get blinded by the flashing lights and thinking something is cool,” says Fiege. “We need to thoughtfully evaluate whether it’s a good or important thing to have in the school to enhance the education.”
A lack of integration across departments can be an issue for schools, says Sarof. “Gone is the closed-loop approach,” he says. To enable this, Nobel Biocare offers universities complimentary licenses to its file management system, which incorporates a wide range of administrative functions in one system and allows for a “patient journey” between departments.
PLANNING AHEAD
U of T Dentistry has two new working groups embarking on strategic planning around how to define technology and education in dentistry — both didactic and clinical — and plan investments.
The strategy is leaning toward prioritizing digital for preclinical students. The under-construction simulation lab has been designed to house a range of technology. “Ideally they’ll have two years of good, intensive training on digital workflow, and by the time they hit the clinic, they’ll know what they’re doing,” says Lai.
Pending funding, including philanthropic support, the new lab could include haptic feedback training devices, which give students a realistic feel for hands-on work, which would enhance learning. “It allows students to get faster feedback, even if they’re working on their own after hours,” says Lai. Some pre-clinical labs are using virtual reality in a variety of forms that will allow students to do the correct hand movements and watch themselves mime through a root canal that looks real.
Somogyi-Ganss hopes there will be as much digital tech in the new lab as possible, to support a wide range of learning styles and allow students to learn independently. “It might allow them to do more procedures.” Some technology could even be used at home, which would really support learners in fine-tuning challenging processes.
Upon the foundation of a more digital pre-clinical experience, Lai thinks the Faculty could continue to punctuate upper-year learning with more technology. That will satisfy the profession’s evolving standards; soon, it will be a basic expectation in residencies and private practice for grads to comfortably manage a digital workflow.
However, students will still need hand skills, which they can learn on old-school models and with conventional approaches on real patients. “Whether you use digital tools or analog tools or virtual tools, it all has to have the same goal,” says Somogyi-Ganss.
For Lai, high-tech devices aid with certain, but not all, aspects of what it means to be a proficient dentist. “Digital dentistry is a tool, but it doesn’t necessarily change how we teach someone. We still have to teach them how to be a professional, how to communicate with someone. There are many other aspects of dentistry that I don’t think digital dentistry can replace. Our mission has always been, and will remain, to train and graduate the best professionals possible.”
Top photo: Eszter Somogyi-Ganss working with the results of a scan (Jeff Comber)
Interested in more stories? Read the PDF edition of the U of T Dentistry Magazine Winter/Spring 2024 Issue