Perceptions and Procedural Errors in the Use of a Patient-Specific 3D-Printed Model for MTA Apexification Technique Training.

Abstract

Aim: 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.

Methodology: 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).

Results: 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.

Conclusion: 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.