Paper Example on Exploring the World of Virtual Reality

Introduction

Virtual reality is a three dimensional (3D) environment that is stimulated to provide the user with a sensation of being inside, controlling, and interact with it (1). Simply put, it is an immersive, interactive, multi-sensory, viewer-centered, 3D computer-generated environments, and the mixture of technologies needed to create these environments. According to Joda (4), virtual reality allows the user to navigate and view a world of three dimensions in real-time. Essentially, it is a clone of physical reality that establishes a virtual habitat to replace the environment of the real world (1), (12). In prosthetic and restorative dentistry, the virtual dental articulator integrates the use of virtual reality to the clinical dental practice for the evaluation of multifaceted static and dynamic occlusal relations. The virtual articulator refers to software that integrates virtual reality technology to improve clinical outcomes (10). It should be noted that the virtual articulator needs digital 3D representations of the jaws and particular data of the patients regarding the movements of jaws. This device then stimulates the movements of jaws and gives a quick visualization of the occlusal contacts.

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Applications of VR in Removable Prosthodontics

Virtual Articulator

The Glossary of Prosthodontics terms eighth edition defines an articulator is a mechanical device that represents the temporomandibular joints and jaws that attaches the maxillary and mandibular casts to simulate the movements of mandibular (11). With the application of semi-adjustable mechanical articulators, it is difficult for a person to reproduce the mandibular movements with related timeframes (10), (11). The solution to these dilemmas involves the replacement of mechanical articulator with its computerized replication such as virtual articulator. This instrument can indicate and quantify the effects of soft tissue resilience on a time-dependent basis during muscular movements. That is why virtual articulator can demonstrate the actual time dynamics of the occlusion. Its primary function is to generate mandibular movements according to the input data and calculate the occlusion points (6). This device is important in removable prosthodontics because it provides effective communication between the dental technician and the dentist; acts as a 3D navigator; simulates specific data of the real patient; and evaluates static and dynamic occlusions (5), (6),(7)

Simulation of Tooth Reduction

Although the simulation systems of VR are used in various aspects of clinical training like laparoscopic surgery, their application in removable prosthodontics is not an easy task. It is due to the complexity of the type, shape, and speed of the dental instruments, as well as the diversity of oral tissues, including gingiva, multilayer teeth, and bone (3). To simulate the reduction of the tooth in dental VR systems, the operator uses a stylus. With the assistance of worn goggles, the stylus appears as the intended tool in the 3D displaying stereoscopic monitor (5), (6). The process assures accurate computerized models of the device, tissues of the oral cavity, and complex graphic programs for indicating tooth reduction. VR systems also help in the modeling of different tooth layers such as dentin, enamel, and dental pulp (7). This helps a prosthodontist to avoid accidental exposure of dental pulp while operating the patient.

The differentiation between structures and the speed of the instrument is possible with the help of haptic. Haptic is a sensing and manipulating technology that stimulates the senses of touch and motion. (7), (8) It enables the user to touch and feel the force needed for each practice (force feedback) and provide a realistic tactile sense (8). In dental surgery, haptic devices allow prosthodontics to touch and feel objects like surgical tools and human organs in a virtual environment. They also will enable the surgeon to conduct operations such as pulling, pushing, and cutting soft or hard tissues with the force feedback. (9)

A 3D haptic technology of VR has introduced dental simulators that provide a reliable mechanism to efficiently teach dental students about dental procedures while improving their hand-skills. (10) Repetitive procedures like instrument usage and placement and proper hand are the primary targets that students must learn on dental simulators. There are two types of dental simulators that are presently available. They include manikin-based simulators and haptic-based simulators (4), (6). Manikin-based simulators provide a physical model of the head and mouth of the patient where specific dental can be carried out using real dental instruments such as DentSim (8). In contrast, haptic-based simulators utilize a PHANToM haptic device and virtual models of the tooth or mouth of a person to facilitate dental practices.

Instead of using real dental devices, the student holds the haptic instrument to manipulate virtual instruments displayed on the monitor screen. The tactile feedback generates clinical sensations in the operator's hand (11). VR simulators are also programmed to detect errors and evaluate performance quality. As such, prosthodontists use them to determine the mistakes and the best performances, which form the foundation for the comparison and analysis. The system can record and replay the user's performances, thus, enabling them to identify their weaknesses and fix them. (3), (5)

VR is also used in dental implantation, temporomandibular joint motion analysis, maxillofacial surgery, and prosthetic surgery. Its application in oral and maxillofacial surgery is in the visualization of deep masked structures (2). Before surgery, the operator maps the surgical plan on the 3D image of the site and determine any significant modification. During operation, the prosthodontist views and follows the mapped model using specialized glasses. (3)

Pain and Anxiety Management

The pain and anxiety experienced by patients in removable prosthodontics are undesirable side effects of the procedure, which can affect the willingness of the patients to undergo treatment. (12) Clinical interventions to minimize pain during the procedure are often used. However, they are expensive and present with additional side effects. For that reason, simple, non-invasive alternatives like distraction therapy are applicable with the assistance of VR (11), (12). As a distraction tool, the use of VR is gaining momentum in medical contexts, particularly in the field of prosthodontics. Several researchers have found that distraction helps patients cope with pain and other aversive experiences that are likely to deter them from seeking treatment (12). During aversive experiences, VR distraction improves dealing with pain, reduces the level of itching for patients with chronic pruritis, and lower the duration of the procedure.

A present systematic review of eleven studies examined the use of VR distraction on the reduction of pain. The studies concluded that more improved VR techniques that immerse the patient are connected with pain relief. According to Ogawa et al., 9 VR offers a dynamic means of modifying effect due to its immersive nature. Other studies have considered the impact of VR distraction on pain and anxiety during the procedure. Jung and Kim (5), in particular, found that distraction can have a long-term effect based on more positive treatment memories, increasing the willingness of the patients to seek dental treatment.

Padmaja (10) noted that VR researchers pay little attention to its application in dental prosthodontics, yet it is rated as one of the significant encounters in dental care. As Tanja-Dijkstra et al. (12) puts, dental anxiety and pain is a collective experience, and anxious patients have reduced possibility of maintaining their appointments. Prosthodontists are also likely to take an extended time to perform on them. In addition, these individuals are more likely to feel less satisfied with the operations or treatments they receive (11). This implies that patients with high dental fear delay treatment, which can result in additional dental problems and regular visiting patterns that, in turn, intensifies a real dental fear. With VR distraction, the treatment experience in removable prosthodontics is improved and, by doing so, breaks the cycle of negative experiences that leads to negative memories and expectations regarding future procedures. (8), (9)

Dental Training

During dental training, students learn how to examine dental patients, make a diagnosis, draft treatment plans, and conduct dental procedures efficiently. Nonetheless, improvement in computer-based technologies such as virtual reality simulators has led to new modalities for instruction and practice in removable prosthodontics. (5), (7) VR simulators allow continual, objective, and measurable practice in multiple controlled situations. Superimposition of3D virtual images on actual images in VR enables operators to visualize the surgical sites simultaneously and overlay instructive 3D representations of physical regions on the site to act as a guide. According to Jung (5), the most common application of VR in student training is 3D dental patients. This system allows the trainees to understand the anatomy of the teeth and mouth. It is offered in the form of a haptic system which directs the virtual drilling of the teeth (6), (9). The continuous process increases the trainee's familiarity with the anatomy of the teeth. This familiarity gives them the knowledge, experience, and trust required to treat the real patients.

Conclusion

Virtual reality is a useful technology for prosthodontists as it helps them to successfully diagnose and treat dental patients with the help of virtual articulator. The virtual articulator is specific software that deals with the operational aspects of occlusion to avoid errors in dental care. In removable prosthodontics, virtual reality is used to manage pain and anxiety during the procedure, simulate tooth reduction, and simulate the movements of mandibular using virtual articulator.

Reference List

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Jung HS, K. H. (2018). Virtual reality training simulator for tooth preparation techniques. Oral Biology Research, 42(4), 235-240.

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Tanja-Dijkstra, K, P. S. (2014). Improving denta...