Dental teachers perspectives on Extended Reality in dental education: an international survey

This international survey reveals that while dental educators hold positive views on the educational value of Extended Reality for enhancing anatomy understanding and clinical skills, its widespread integration is currently hindered by structural barriers such as high costs, limited technical support, and time constraints.

The Gist

Imagine dental school as a high-stakes cooking school. Traditionally, students learn to chop onions and sear steaks by standing over a real stove with a real knife, guided by a chef. It's the best way to learn, but there's a problem: you can't practice on a real steak every day without wasting expensive food, and you can't make a mistake without burning the kitchen down (or hurting a patient).

Enter Extended Reality (XR). Think of XR as a super-powered, magical video game that lets students practice chopping and searing in a virtual kitchen. They can make a million mistakes, burn a thousand virtual steaks, and learn the perfect technique without ever wasting a real ingredient or hurting a real person.

This paper is like a report card from the head chefs (the dental teachers) around the world. The researchers asked these teachers: "Do you think this magical video game is a good idea for your students? Do you use it? And what's stopping you?"

Here is the breakdown of what the teachers said, translated into everyday language:

1. The Verdict: "We love the idea, but we aren't playing the game yet."

The teachers are very positive about the concept. They agree that this "magical video game" is amazing for:

• Understanding the Map: It helps students visualize the complex "terrain" of the mouth (nerves, bones, roots) better than looking at a flat textbook picture.
• Building Muscle Memory: It lets students practice their hand movements over and over until they get it right.
• Boosting Confidence: It's like a flight simulator for pilots. Students can practice before they ever touch a real patient, so they feel less nervous and more ready.

However, the teachers are not ready to throw away the real stove. They see XR as a sidekick, not a replacement. They believe it's perfect for training, but it can't fully replace the feeling of working with a real human patient.

2. The Problem: "We want to use it, but our pockets and schedules are empty."

Even though the teachers think the tool is great, they aren't using it much. Why? Three big walls are blocking the door:

• The Price Tag (Cost): Buying the VR headsets and the software is expensive. It's like trying to buy a Ferrari for a school bus fleet.
• The Tech Support Gap: If the virtual kitchen glitches, who fixes it? Teachers feel they don't have a "tech wizard" on speed dial to help them when things go wrong.
• The Time Crunch: Learning how to use new technology takes time. Teachers are already busy cooking (teaching) and don't have hours to spare to learn how to code a new game.

3. The "Experience Gap"

Here is a funny twist: The teachers who know the most about this technology are the ones who actually use it the most.

• Most teachers have only dipped their toes in the water. They know XR exists, but they haven't jumped in.
• The study found that if you just tell a teacher about XR, they might nod and say, "Cool." But if you actually put the headset on their hands and let them play for an hour, they are much more likely to want to use it in class.

4. The Bottom Line

The paper concludes that dental teachers are open-minded and excited. They aren't stubborn old chefs refusing to use a new oven; they are just waiting for the right tools and the right support.

To make this work, schools need to:

1. Pay for the gear: Stop making teachers buy their own VR headsets.
2. Hire the tech support: Have someone ready to fix the glitches instantly.
3. Give them time: Let teachers take a break from their regular duties to learn how to use the new tools without feeling rushed.

In short: The teachers have the desire to use this magical training tool, but they need the keys (money, support, and time) to unlock the door. Once they get those keys, the students will be better, safer, and more confident dentists.

Technical Summary

1. Problem Statement

Dental education faces structural challenges, including limited access to real patients, infrastructure constraints, and discrepancies between student self-assessment and faculty evaluations of clinical readiness. While Extended Reality (XR)—encompassing Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR)—offers potential solutions for immersive, low-risk skill acquisition, its integration into curricula remains slow.

Existing literature on XR in dentistry is predominantly limited to:

• Single-site studies.
• Focus on specific modalities (e.g., VR only) rather than the broader XR spectrum.
• Student-centric perspectives, with a lack of comprehensive data on educators' perceptions, readiness, and the structural barriers they face.

The study addresses the gap in understanding how dental educators view the educational value of XR, what barriers limit its adoption, and how their familiarity with the technology correlates with their willingness to integrate it.

2. Methodology

• Study Design: Cross-sectional, web-based survey.
• Participants: Dental educators (faculty, clinicians, and health professionals actively involved in dental student education) from 15 countries (including Australia, Denmark, USA, and various European nations).
• Sampling: Convenience and snowball sampling via email invitations, professional mailing lists, and social media.
• Instrument: A 26-question survey adapted from validated tools (Khukalenk et al. and Wozney et al.).
  • Section 1: Demographics (gender, age, experience, specialty, location).
  • Section 2: Familiarity and frequency of XR use (VR, AR, MR).
  • Section 3: Perceptions of XR (19 Likert-scale items, 1–7 scale) covering educational value, teaching impact, barriers, and curriculum integration.
• Data Analysis:
  • Software: GraphPad Prism (v10.6.1).
  • Metrics: Descriptive statistics (means, SD), Standardized Cronbach's alpha for reliability, and Spearman correlation coefficients ($R$) to analyze associations between familiarity, usage, and perceived benefits.
  • Significance: $p < 0.05$ with Holm-Bonferroni correction.

3. Key Contributions

• International Scope: Provides one of the first global snapshots of dental faculty perspectives on XR, moving beyond single-institution case studies.
• Barrier Identification: Systematically categorizes the specific structural and organizational hurdles (cost, time, technical support) preventing XR adoption, distinguishing them from a lack of pedagogical interest.
• Correlation Analysis: Investigates the relationship between an educator's familiarity with XR and their perception of its utility, revealing that familiarity does not automatically equate to high-frequency usage.
• Pedagogical Positioning: Clarifies that educators largely view XR as a complement to traditional teaching rather than a replacement, specifically for anatomy and preclinical skills.

4. Results

Demographics:

• Sample: 40 valid responses from 15 countries.
• Experience: 46.3% female; 53.7% male. The largest age group was 45–54 years. 29.3% had >20 years of teaching experience.
• Specialties: Highest representation from oral radiology, endodontics, periodontology, and restorative dentistry.

Perceived Educational Value:

• High Agreement: Educators strongly agreed that XR improves understanding of complex anatomy (Mean = 6.02/7) and skill development (Mean = 5.68/7).
• Confidence: XR was seen as effective for building student confidence and clinical preparedness (Mean ~5.1–5.2/7).
• Role: XR is viewed primarily as a complement to traditional methods (Mean = 3.77/7 for "better alternative than lectures," indicating disagreement).
• Correlations: Strong positive correlations were found between perceived improvements in confidence, skills, and clinical readiness ($R = 0.71 - 0.89, p < 0.0001$).

Barriers to Implementation:

• Cost: The most significant barrier (Mean = 5.28/7).
• Technical Support: Lack of institutional technical support was a major concern (Mean = 4.85/7).
• Time & Competence: Educators reported time constraints and low self-perceived technological competence (Mean = 3.55/7 for having sufficient skills).
• Usage Frequency: Despite positive attitudes, actual usage is low. >66% of respondents never use XR; 24.4% use it rarely.

Familiarity vs. Usage:

• Familiarity levels were low-to-moderate (VR: 2.65/5; AR: 2.29/5; MR: 2.10/5).
• Male educators reported significantly higher familiarity with AR than females ($p = 0.035$).
• Crucial Finding: No significant association was found between an educator's current use/experience and their perceived teaching benefits. This suggests that positive attitudes exist even among those with little practical experience, but structural barriers prevent translation into practice.

5. Significance and Conclusion

The study concludes that dental educators are pedagogically receptive to XR but are structurally constrained. The primary impediments to adoption are not skepticism regarding educational value, but rather:

1. High implementation costs.
2. Insufficient technical infrastructure and support.
3. Time constraints for faculty training and curriculum development.

Implications for Practice:

• Faculty Development: Successful integration requires hands-on training and workshops to bridge the gap between awareness and competence.
• Institutional Support: Universities must provide dedicated technical support and financial resources to overcome cost barriers.
• Strategic Implementation: XR should be positioned as a tool to enhance clinical readiness and individualize learning (e.g., for students struggling with psychomotor skills) rather than replacing traditional lectures.

The authors suggest that without addressing these organizational factors, the positive attitudes of educators will not translate into sustained, meaningful integration of immersive technologies in dental curricula. Future work should focus on establishing international collaborative networks to share best practices and conduct qualitative studies on implementation strategies.