Web-based 3D Online Crown Preparation Course for Dental Students Heiko Spallek, DMD, PhD1; Ronald Kaiser2; Kenneth Boberick, DMD3; Daniel Boston, DMD4; Titus Schleyer, DMD, PhD5 Department of Dental Informatics (1,5) and Department of Restorative Dentistry (3,4), Temple University School of Dentistry, Philadelphia, USA; University of Applied Sciences, Dresden, Germany (2) ABSTRACT for the educational potential of the World Wide Web, Despite enthusiasm for the educational potential of empirical evidence from this study suggests that only the World Wide Web, few dental educators use the a few dental educators use the new opportunities new opportunities offered by this medium beyond the offered by this medium beyond the presentation of presentation of textual information. Based on this textual information with incorporated images. observation, we have decided to design our own Furthermore, we examined available anatomy Web interactive Web-based 3D crown preparation course. sites for content to support the process of learning The course objective is to provide dental students crown preparations. While there are excellent with fundamental didactic and technical knowledge anatomy courses available via the Web9,10, none of to begin preclinical skill development for full crown them offered enough detailed information related to preparations. The course incorporates a variety of human teeth. interactive features including images which allow These investigations about existing dental and students to examine the dimensions and contours of anatomy online resources indicated that we had to the burs in comparison to the dimensions and the design our own interactive 3D crown preparation shape of the crown preparation. QuickDraw 3D course. allows the direct manipulation of 3D graphical models by the users. METHOD This paper will relate experiences in the development In order to design an online tool to teach dental and implementation of a Web-based course with 3D students how to prepare anterior teeth for porcelain direct manipulation. An initial evaluation of the fused to metal crowns, we informally surveyed development process offers directions for further prosthodontics instructors in our school. Their major development, necessary technical support, and requirements for a crown preparation course were faculty and student preparation. - detailed, three-dimensional models of the tooth in various stages of completion, INTRODUCTION - the ability to compare models of procedural steps A rapidly increasing number of continuing medical with the actual technique of producing that step and dental education courses is available on the (on-demand video for each step), Internet1,2,3,4,5. - the ability to compare and evaluate dental bur Currently, Temple University School of Dentistry dimensions to tooth dimensions and contours, (TUSoD) integrates several of such Web-based and to actually measure and focus in on bur resources into the school’s intranet to enhance the dimensions so that the student will appreciate the opportunities for teaching and patient treatment, e.g. bur dimensions and shapes relative to the the Pulp Therapy Chapter of the Atlas of Pediatric procedural tasks, and Dentistry6 and Lexi-Comp's Clinical Reference - the ability to easily move from step to step, in Library™ 7. any order desired. While there are more online courses offered for The main objective of a crown preparation course is medicine than for dentistry, we were able to locate to provide foundation knowledge for the student to 157 online dental courses offered by 32 providers in begin preclinical skill development for full crown an earlier study by Schleyer. The result of this study preparations. This foundation knowledge and indicated that the quality and length of the currently successive skill development are necessary to begin offered courses vary significantly. For instance, most the clinical phase of learning, the objective of which courses scored very low on a preliminary quality is to become competent in full crown preparation index for educational software8. Despite enthusiasm clinically. Temple University School of Dentistry’s (TUSoD) Macromedia Authorware course editing $687.00strategic computing plan requires that every new Attain, v. 5.1 application has to be tightly integrated into our Newtek Lightwave, v. 5.0 3D model editing $742.00Macromedia Flash, v. 4.0 2D animation $97.00existing intranet11. Thus, only a Web-based Adobe Photoshop, v. 5.5 picture and icon $237.00application could be used for such a teaching tool. editing Adobe Premiere, v. 5.1 video capturing and $258.00Resource allocation editing Budget constraints and a difficult situation on the Allaire Homesite, v. 4.0 HTML and Perl $89.00editing labor market for information technology (IT) did not Complete Adult Teeth Model 3D tooth models $495.00allow us to develop an entirely proprietary Perl, v. 5.005_03 interpreting scripts freetechnology to reach our goals. In addition, it was for database planned that the new course shall function as a connection catalyst for further developments of highly Authorware Full Web Player, Web browser plug-freev. 5.1 in for the course interactive 3D direct manipulation courses covering QuickDraw 3D Viewer, v. display freevarious aspects of clinical dentistry. Thus, we 1.5.3 QuickDraw3D files focused our investigation on existing technological Windows Media Player, v. display mpeg video freesolutions, off-the-shelf 3D tooth models, and easy-to-6.0 clips use editing tools. The development team was led by * educational version one faculty member of the school’s Department of Dental Informatics. All content aspects were guided Infrastructure by two faculty members of the school’s Department During the last few years, TUSoD has allocated of Restorative Dentistry. Development and substantial resources to build a its IT infrastructure: production was handled by an intern student from the (1) hardware, software (2) faculty training, (3) German University of Applied Sciences, Dresden, support and custom application. All faculty have who worked at TUSoD for 6 months. their own networked Windows NT workstations on which they were trained to use MS-Office Technology applications, E-Mail and Internet/intranet resources. The development process started with a thorough A Web-based clinical information system which is evaluation of existing technological solutions for 3D used by all students and faculty is based on an Oracle presentation and their technical feasibility under the 8 database12. The use of a high-speed Web server to given constraints. Four main areas of decision were host the school’s intranet provides sufficient storage identified: for newly developed resources. Freshmen students - 3D tooth models complete the required course “Introduction to - development software Computing” which equips them with the necessary - delivery through the Web computer literacy to use online resources efficiently13. - tracking of individual access and progress Development From a developer’s point of view, such a highly The six-month course creation included all steps of a specialized course requires a substantial amount of software development life cycle14. programming. Because of the given constraints, we System Planning: The project team interviewed mainly focused on the use of readily available faculty who teach crown preparation and informally technologies and off-the-shelf 3D tooth models. surveyed students to develop the specifications. Technical Design: After analyzing the results of the Table 1 shows the chosen technology based on the interviews and reviewing the given constraints, the given criteria: team decided on the technology to be used (see Table - budget 1). - technical feasibility Construction and Testing: The construction process - Web-based delivery was characterized by a substantial amount of trouble - high quality graphical display of teeth shooting mainly because of incompatibilities between - modifiable 3D teeth models different 3D formats and version incompatibilities - integration of video clips between the software packages. - interactivity in terms of direct manipulation Integration: The course editing software, Authorware, per default uses an MS-Access database. However, the goal was to authenticate against our Table 1: Technology used to build 3D Course existing user database, Oracle 8. While this was Name Purpose Price* advertised as a trivial exchange of an ODBC driver, in reality the connectivity between Authorware and Oracle 8 could only be established using CGI-scripts. The database is used to store the participants’ progress and their last accessed page to allow them to re-enter the course at the same page they left. Testing: Extensive pilot testing on one of the school’s prototype servers enabled us to fine-tune the application. Documentation: A variety of programmer manuals and technical notes were created to facilitate further course developments using the same or similar technologies. Training: Training was provided to all faculty who teach prosthodontics and are likely to refer to the Figure 1: Dimension and contour of bur in course during their classroom lectures or their clinical comparison to the shape of the cut. teaching. When students and faculty access the school’s intranet remotely, online help resources In addition, students can actively measure tooth provide sufficient help on how to install the dimensions in comparison to bur dimension by using necessary Web browser plug-ins for all operating interactive rulers (see Figure 2). systems and browsers. Support: The school’s support staff was trained by members of the development team on how to install the necessary Web browser plug-ins using the remote installation capabilities via TUSoD’s network (Timbuktu Pro). In addition, all publicly available workstations inside the school were upgraded accordingly. RESULT The final course incorporates a variety of interactive features and allows individual tracking of the users’ access. All initial requirements which were stated by the prosthodontics faculty and students were fulfilled. After a login using our existing user database, the course provides various interactive tools to teach full Figure 2: Interactive ruler for dimension crown preparation. measurement of bur and tooth. Figure 1 showcases how students can evaluate dental bur dimensions in comparison to tooth dimensions Figure 3 shows a 3D model of a tooth at one stage of and contours. This feature addresses the educators’ the crown preparation. Direct manipulation via the requirement to allow students to measure and focus mouse allows users to see the model from any in on bur dimensions and shapes relative to the viewpoint and to magnify the model. The use of procedural tasks. QuickDraw 3D accomplishes the educators’ requirement for three-dimensional models of the tooth in various stages of completion. However, we experienced technical difficulties which were mainly caused by immature products and version incompatibilities. These technical problems and the need for a well established support and training infrastructure limit the usage of such technologies to organizations which can meet these preconditions. In addition, a remote usage is limited to users who are able to install several plug-ins to enhance their browsers—a procedure which requires a high level of computer literacy. The effort to overcome these technical challenges can only fully pay off if we develop further courses with the same tools or, if we share this knowledge with Figure 3: QuickDraw 3D Viewer: 3D tooth model. other institutions which plan to develop similar simulation courses. This reuse would reduce the Another key requirement was the ability to compare overall production costs per course. models of procedural steps with the actual technique In addition, some of the resources which were spent of producing that step. Small video clips for each step could be recovered by offering this or similar courses of the crown preparation can be displayed on demand as dental continuing education courses. The initial (see Figure 4). market analysis for dental online CE courses supports such a move because of the lack of high-quality multimedia offerings. ACKNOWLEDGEMENT The authors want to express their thanks for various technical support they received during the development process, especially from Marc Getty (server and network administrator) and Ray Shepherd (camera for all video clips) (both Department of Dental Informatics, TUSoD). REFERENCES 1. Coopers & Lybrand. Transformation of higher education in the digital age. 1998. Boston, MA, Figure 4: Video clips for each step of the preparation Coopers & Lybrand. 1997. 2. Hayes KA, Lehmann CU. 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