A 3D-printed vanperio educative dental model – A review report of its chairside evaluation

Abstract

Background: 

Patient education and demonstration of osseous defects by teachers and clinicians are difficult even though there are different models made up of metal, plastic, plaster, stone, and acrylic. To overcome such difficulty, 3D printed Vanperio model was printed for multifunctional activity.

Aims and Objective: 

The aim of this article was to provide information on the 3D printed VANPERIO model and its implications in the field of periodontics and general dentistry.

Conclusion: 

Vanperio model proves to be a promising model for teachers, students, and clinicians in the field of periodontics and general dentistry as it helps in patient education, student learning and also for various demonstrations which is not possible to achieve in other available expensive models.

INTRODUCTION

Three-dimensional printing (3DP), also called rapid prototyping (RP) is a process of producing 3D objects by joining, bonding, sintering, or polymerizing small-volume elements.^[1] 3DP models support preclinical and surgical steps in the medical field and dentistry. In oral surgery, construction of maxillofacial prosthesis, 3D-printed wafers for mandibular reconstruction and orthognathic surgery, prosthodontics: fixed and removal partial denture frameworks, wax patterns for fixed denture prosthesis, metal casting molds, zirconia prosthesis, implant dentistry: implant surgical guide fabrication, and in periodontics, fabrication of scaffold for periodontal regeneration and making of models for the educational purposes as it is in case of vanperio model using 3DP. However, a skilled operator is a must for printing using expensive materials to create a variety of utility models to apply in daily life.

The multifunctional tasks such as patient education in terms of oral hygiene method (interdental aids); student learning at undergraduate and graduate levels in terms of preclinical and clinical work and demonstration of osseous defects due to periodontal disease have been the main attraction provided in Vanperio model even though there existed different models made up of natural bone, metal, plastic, plaster, stone, and acrylic. The journey of 3DP, vanperio model began with the natural mandible [Figure 1] in which all the purposes were designed by the experienced author.

Figure 1: Natural mandible versus Vanperio model

Medline search using keywords such as RP model patient education, student activity, the aim of this article was to provide information on the 3D printed VANPERIO model and its implications in the field of periodontics and general dentistry., three dimensional and osseous defects didn’t reveal any literature. Hence, the clinical impression of the vanperio model:

The dental models that are so far available were made of materials and sizes which don’t resemble the actual anatomical size of the jaw. However, the availability of human jaws with intact dentition and its maintenance is always compromised. To overcome these issues, a 3DP model of the lower jaw which is a replica of human mandible with intact dentition was printed. In the field of periodontics, the bone defects caused by periodontics are printed for the first time, so that there is a clear view of those defects three dimensionally. This feature is unique to the model which is made available for the first time in Vanperio model. The evaluation of this model in terms of patient education, student learning, and demonstration of osseous defects by teachers and clinicians is very encouraging and supportive.

PURPOSES SERVED BY VANPERIO MODEL

The various purposes served by the Vanperio model include patient education and motivation, student activity, and demonstration which are presented in Table 1.

Table 1: Purposes served by the Vanperio model

Patient education and motivation is the main cornerstone in the dental treatment by the maintenance of oral hygiene. The brushing demonstration is made possible in all the models without facilitating the demonstration of interdental aid due to tight contacts. The challenge is passing of the floss across the tight contact point during the demonstration. The sudden snapping of the floss across the contact point will injure delicate interdental tissue causing the tear in the gingiva. Hence, there remains a need for the model to demonstrate the flossing technique easily so as to motivate the patient to use dental floss. To fulfill this requirement, the 3DP Vanperio model allows to perform the demonstration effectively [Figure 2a and b]. The next issue is with demonstration of interdental brushing which was again easily demonstrable in the Vanperio model [Figure 3a and b] and the regular brushing method demonstration as the norm possible in the model. The interdental brushing and flossing demonstration are not available on other models and remained the priority for the demonstration on the Vanperio model. As interdental brushing and flossing demonstration are difficult to be demonstrated on other models, they are the priority for the demonstration on the Vanperio model.

Figure 2: (a and b) Demonstration of flossing on the Vanperio model versus plaster model

Figure 3: (a and b) Demonstration of interdental brushing on the Vanperio model versus plaster model

Most often the clinician uses radiographs to show the bone loss and describes it as the black and white areas representing bone loss and no bone loss respectively. The willingness to undergo gum surgery after seeing the radiograph is either a forced issue by the clinician or the clinician’s preference of periodontal surgery as required. To create awareness regarding bone loss to the patient, the bone defects were created in the Vanperio model around teeth instead of radiographic demonstration of bone loss. This feature mainly supports general dentist as well the periodontist. The extreme bone loss which can lead to tooth mobility is easily demonstrated in the model because generally patient agrees for extraction which is due to severe bone loss and has been depicted in the edentulous area in the model [Figure 4].

Figure 4: Edentulous area irt 34, 35, and 37 on the Vanperio model

The demonstration of various diagnostic techniques has been made feasible on the VANPERIO model. In addition, the demonstration of various periodontal diagnostic and surgical techniques has been made possible meticulously with adaptation of soft material simulating the gum-like tissues.

Gingival sulcus probing is demonstrated as depicted in Figure 5a. Similarly, the difference in probing depth differentiating deep pocket and normal gingival sulcus is demonstrated in Figure 5b.

Figure 5: Probing techniques (a) Gingival sulcus probing on the Vanperio model irt 43; (b) Demonstration of deep and shallow pocket irt 44 and 43, respectively; (c) Transgingival probing in the region of 44

Gingival thickness being a diagnostic factor owing to its therapeutic importance has also grabbed significant attention and has been demonstrated On the VANPERIO model by means of transgingival probing technique^[2] as depicted in Figure 5c.

Grade I, II, and III furcation involvement as per Glickman’s classification has been simulated on the model also efficiently for the purpose of student demonstration which is presented in Figure 6a Grade 1, Figure 6b-Grade II and Figures 6c and 6d-Grade III.

Figure 6: Furcation defects on Vanperio model (a) Grade I Furcation Involvement on 48; (b) Grade II Furcation Involvement on 47; (c and d) Grade III Furcation Involvement on 46

Apart from the various diagnostic methods, demonstration of the various surgical and clinical activities on the Vanperio model has been attempted as part of student learning activities which is otherwise not efficiently possible to be reproduced by means of other educational tools. Various procedures like the basic pocket elimination procedures, and perioplastic procedures have been attempted on the model for the demonstrative purpose for the easy understanding among postgraduates and undergraduates.

1. Local anesthesia nerve block demonstration [Figure 7]
2. Gingivectomy procedure with all the steps [Figure 8a-c]
3. Modified flap operation [Figure 9 a and b]
4. Modified Widman flap with all steps in sequence [Figure 10a-e]
5. Root coverage procedure with all steps in sequence [Figure 11a-e]
6. GTR procedure demonstration with all steps in sequence [Figure 12a-i].

Figure 7: Local anesthesia nerve block demonstration

Figure 8: Gingivectomy (a) Pocket marking; (b) External bevel incision; (c) Excised tissue

Figure 9: Modified flap operation (a) Crevicular incision; (b) Flap reflection

Figure 10: Modified Widman flap (a) First incision/Internal bevel incision; (b and c) Flap elevation and reflection; (d) Second incision/Crevicular incision; (e) Third incision/Interdental incision

Figure 11: Root coverage procedure using coronally advanced flap (a) Recession depth measurement with mucogingival junction as reference irt 33; (b) Vertical incision; (c) Flap reflection; (d) Flap coronally advanced; (e) Suturing

Figure 12: Guided tissue regeneration demonstration; (a) Probing pocket depth of 10 mm distal to 36; (b) Osseous defect distal to 36 visualized upon flap reflection; (c) Defect debridement distal to 36; (d, e) Placement of bone graft simulating material into the osseous defect; (f) GTR membrane placement; (g) GTR membrane adaptation; (h) Primary closure with simple interrupted sutures; (i) Periodontal dressing placement irt the surgical site

The simulation of a novel regeneration technique termed, stem cell assistance in periodontal regeneration technique^[3] has also been demonstrated on the Vanperio model and is depicted in Figure 13a-j.

Figure 13: Simulation of SAIPRT On Vanperio model; (a) Crevicular incision demonstrated in the third quadrant; (b) Flap reflection irt 36,37; (c) Osseous defect visualized irt 36,37 (d) Osseous defect debridement; (e) Presuturing irt to the site indicated for regeneration; (f) Extraction of indicated tooth on opposite arch for preparation of autologous stem cell niche transplant; (g) Preparation of autologous transplant by combining Pdl tissue and angel; (h) Placement of autologous stem cell niche transplant into defect site; (i) Primary closure using simple interrupted suture; (j) Periodontal dressing placement. SAIPRT - Stem cell assisted periodontal regenerative technique

An attempt has been made with the present short communication to demonstrate most of the periodontal diagnostic and surgical procedures however not all techniques have been demonstrated which are easily understood by undergraduates and postgraduates.

The effective training for undergraduate and graduate students in the university or in a private setup depends upon the preclinical exposure of the bare minimum procedure to treat the patient confidentially. The confidence derived from the preclinical training is enormous as the apprehension toward unknown to known is better understood. The students are of various attitudes in acquiring knowledge and the merit component of each student matters in learning. Hence, the need of a preclinical model in terms of preclinical learning is well supported by the Vanperio model. The various student activities are demonstration of scaling and root planing (using Sticky wax to simulate calculus deposit), demonstration of Splinting, demonstration of probing technique, demonstration of surgical steps (after placement of gingiva using cotton cloth/mackintosh/others) such as local anesthesia administration, placement of incision, reflection of flap, debridement, placement of osseous graft (plaster/stone can be used), placement of GTR, suture placement, and closure of flap.

Evaluation of the Vanperio model by the clinical faculty and students is shown in Tables 2-5.

Table 2: Vanperio model for patient education and motivation

Table 3: Vanperio model for student activity

Table 4: Vanperio model for periodontal osseous defects demonstration

Table 5: Vanperio model with its overall presentation

The success of periodontal treatment and overall dental health depends on patient education and motivation. The routinely used Plaster of Paris, stone, and acrylic models have shortcoming in not providing the interdental space for the demonstration of interdental aids. The evaluation by clinical faculty concluded that the 3D-printed vanperio model was able to elicit response such as excellent (52.3%) for the demonstration of regular brushing and interdental aids. No time there was a poor response for patient motivation and demonstration. About 9.7% of the Vanperio model users felt that the patient demonstration was not possible as two instructions provided in the brochure were not considered by them.

For the success of any dental or periodontal treatment, patient education and motivation are important modes of reaching them for awareness and compliance. The demonstration of use of interdental aids such as flossing and interdental brush was not possible with other routinely used models made of Plaster of Paris, dental stone, or acrylic which was made possible in 3D-printed Vanperio model. The response for the demonstration of brushing and interdental aid was excellent (52.3%).

The preclinical work for undergraduate and postgraduates are generally recommended by the universities. The student activity was found to be satisfactory. The periodontal osseous defects were created as 3D view for most of the osseous defects in the VanPerio model. Till now, students relied in textbooks or atlas to understand them theoretically. The actual visualization of osseous defects was possible after the surgical exposure. The shortcomings of 2D images in textbooks were overcome by the Vanperio model before the clinical exposure. The overall presentation for the four purposes was found to be excellent and discussed the clinical recommendation.

The added advantages of the vanperio model are: It is economical, lightweight, and easily washable, and the anatomical structures can also be painted if required. The drawback is material is breakable, so proper care has to be taken while handling it. 3DP is cost-effective, the maintenance of material and need for a skilled operator to print are part of the shortcomings. A recent review by Vandana and Savitha, have mentioned about the various techniques and applications of 3DP in dentistry and periodontics and also a recent study done from the data collected by the purchasers of the model have shown positive responses. Further improvements required are the use of silcone gums for perclinical work and modifying the current model for mannequin purpose.

As a general note, the medical model with voids, undercuts, complete internal geometrics due to sinuses and neurovascular canals can be created using 3DP. However, a skilled operator is a must for printing by using expensive materials to create a variety of utility models to apply in day-to-day life.

CONCLUSION

Vanperio model proves to be a promising model for teachers, students, and clinicians in the field of periodontics and general dentistry as it helps in providing patient education in terms of oral hygiene methods (interdental aids and flossing), student learning and demonstration of osseous defects which is not possible to achieve in other available expensive models.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.