Basis of the combined training mode of CBL and digital technology

With the improvement of people’s living standards, the demand for dental implants is increasing day by day. The progress of implant technology, instruments, and materials has made it possible to implant under complex conditions. Patients have different types of tooth loss and oral soft and hard tissue conditions. Implant dentists need to master various situations. To become a qualified oral implant dentist, they cannot only limit themselves to completing implant restoration under conventional conditions, but also need to be able to handle relatively high-risk implant restoration and ensure the long-term retention of dental implants as much as possible.

The growth cycle of implant dentists is relatively long [2]. After graduating from undergraduate and above medical students majoring in oral clinical medicine, they need to complete the standardized training for resident physicians and pass the qualification examination for practicing physicians. Through one of the following four methods, they can officially independently carry out implant work:

  1. 1)

    Formal implantology courses for more than 120 h (including internships), and pass the examination;

  2. 2)

    Cumulative Class I credits of more than 40 points for continuing education courses in implantology;

  3. 3)

    Complete implantology training in domestic or foreign educational institutions (recognized by the Ministry of Education) for more than 3 months and obtain a completion certificate; 4) Work in the professional oral implant department of a medical institution for more than 3 years and be full-time engaged in the clinical diagnosis and treatment of oral implantology.

In the past, the two most commonly used surgical teaching methods were the traditional multimedia course theoretical explanation, combined with the teaching mode of chair-side demonstration or apprenticeship.

In the traditional learning, teachers hope to build a three-dimensional structural relationship in the students’ minds through two-dimensional anatomical diagrams, panoramic films, and CBCT, but the teaching process is relatively boring, and it takes some time for students to master it [3]. For the teaching of diagnosis and treatment of complex situations, there has been no systematic course carried out routinely in the past. It still stays at the stage of explaining each part of the knowledge points separately and then forming the overall plan design through the students’ own sorting and summarization. At the beginning of learning, students are extremely prone to problems such as detail omission and insufficient understanding of knowledge points, and the plan design and prognosis evaluation often do not match the actual situation. During chair-side demonstration, students have a very high dependence on teachers, and their initiative and interactivity are not strong, and the training of critical thinking is insufficient. Moreover, the clinical time is tight, and the learning effect is not ideal [4].In past research, online learning has demonstrated significant advantages in enhancing efficiency. However, students still prioritize face-to-face instruction for the development of clinical skills and meaningful interaction [5].

Therefore, it is urgent to use new teaching modes and tools to improve the teaching effect of implantology. In recent years, digital technology characterized by virtual surgery and real-time navigation has been widely used in the whole process of implantation, which is conducive to preoperative evaluation, plan formulation, surgical simulation, intraoperative navigation, and effect prediction [6,7,8]. Implantation mainly involves hard tissues such as the alveolar bone and adjacent teeth, which is very conducive to giving full play to the advantages of CT-based digital technology. Deeb [9] and Zhan [10] conducted a similar study that demonstrated computer-guided dynamic navigation training enhances implant placement efficiency and accuracy in novice dental students. Zhong [11] and Yan [12] also demonstrated that computer-assisted dynamic navigation can enhance the surgical performance and boost the confidence of dental students.

However, in teaching activities, relying solely on digital navigation cannot achieve the best teaching results because practical skill acquisition requires further support [13]. VR training improves practical performance in dental education and is best used alongside conventional methods [14]. It supports flexible learning in dentistry, but students highlight the need for authentic hands-on experiences [15].

The case-based teaching mode is a discussion-based teaching method centered on cases, based on problems, with students as the main body and teachers as the guide. It is particularly suitable for the teaching of complex cases. Through cases, teachers enable students to deepen their understanding of various knowledge points from the perspectives of anatomical and physiological theories, clinical examination, and image interpretation, exercise students’ ability to analyze and solve problems, and cultivate clinical diagnosis and treatment thinking [16].

As one of the first batch of national training bases for oral and maxillofacial surgery specialists and one of the only two bases in Zhejiang Province approved to undertake the training of national oral and maxillofacial surgery specialists, our department has started the training of oral and maxillofacial surgery specialists since 2017. In our implant center, we have a case database containing the basic information, medical history, specialist physical examination, imaging data, surgical data, and review data of patients. Using the newly introduced implant navigation system, we screened out appropriate cases from the case database and gradually tried the implant specialist training mode combining CBL with digitization.

Based on the above research findings, we attempted to integrate digital technologies with traditional teaching, combining online and face-to-face instruction through a case-based learning (CBL) approach. This blended model not only reinforces students’ understanding of theoretical knowledge but also enhances their practical skills in a clinically relevant context. It represents an effort to cultivate practice-oriented professionals and to shorten the learning curve as much as possible, without compromising educational quality.

Effect of the combined training mode of CBL and digital technology

In our study, the experimental group showed significant improvement in theoretical knowledge and practical skills after training. Despite beginning at a lower baseline compared to experienced clinicians, their post-course test and DOPS scores were comparable to those of the control group, demonstrating that the new teaching mode can rapidly elevate novice learners to a level similar to experienced practitioners.

In the training mode combined with digital technology and case-based teaching, students strengthened the concept of complete collection of clinical data and the overall view of the case by reading the case database materials. The good fidelity of the digital model can display the anatomical structure in a three-dimensional way, which is easier for students to understand and remember. Moreover, the digital system has more abundant interactivity, encourages students to try hands-on, makes up for the defects of unable to practice multiple times on the model and unable to operate in real cases, and improves students’ learning enthusiasm [17]. The cases selected by CBL are relatively more typical, containing most of the knowledge points that need to be mastered for this type, and combined with digital technology, the anatomical structure is displayed more vividly, and the surgery can be simulated and the postoperative effect can be evaluated, increasing students’ participation and enthusiasm [18].

Before the course, students often overlooked subtle details. After exposure to typical cases, they learned to systematically evaluate factors such as smile line, gingival shape, crown form, and bone volume—leading to significant score improvement. Digital design modules enabled students to visualize, modify, and repeatedly assess key anatomical structures. This not only simplified interpretation compared to conventional CBCT but also deepened understanding through spatial interaction. Though some gains were seen, students’ understanding of prevention and management of complications remained limited, highlighting a future area for emphasis.

Through the comparison before and after the teaching, we found that digital technology significantly improved students’ mastery of local anatomy, made the evaluation of the bone quality and quantity of hard tissues more accurate, and made the design of the implant position and direction more reasonable. Through the learning of typical cases, students had a more complete grasp of the details of aesthetic risk assessment in the anterior tooth area, were more familiar with the overall process of handling cases, had an intuitive understanding of possible complications in the later stage, and could trace back from complications to implant surgery and restoration design to prevent their occurrence from the source.

Under the new teaching mode, students have high participation, active classroom atmosphere, high concentration, and high learning efficiency, and have stimulated students’ learning interest during and after class. Many scholars have also put forward similar viewpoints. Additionally, the innovative teaching approach not only alleviates the workload of instructors but also diminishes students’ reliance on teachers.

Since the students in the control group are attending doctors who have completed the specialist training and carried out implantology, and have accumulated experience in many actual cases, and have a relatively better mastery of knowledge and skills, the comparison between the experimental group and the control group in some contents has no significant difference, which is not enough to show that this teaching mode is inferior to the traditional mode. The teaching mode combining digital technology with CBL is still a teaching mode worthy of promotion. Other scholars at home and abroad have also found that whether it is digital technology, case-based teaching, or the combined teaching mode of the two, it has obvious advantages in the teaching of oral and maxillofacial plastic and reconstructive surgery, trauma surgery, alveolar surgery, and temporomandibular joint surgery [19, 20]. Virtual reality simulation offers advantages over traditional jaw models in enhancing students’ skills and engagement in oral implant education [21].

Our new teaching approach aims to achieve efficient instruction while maximizing learning outcomes. The advantages of the digital platform help to address the limitations of traditional methods, particularly in areas of conceptual understanding and memory retention. Trainees were able to grasp key procedural skills effectively, while the continued use of face-to-face teaching preserved the benefits of real-time communication and feedback. The incorporation of case-based learning (CBL) brings the curriculum closer to clinical practice and supports the development of students’ clinical reasoning abilities.

In terms of hardware and software requirements, the digital implant planning platform used in this program is already installed in both the outpatient department and the Clinical Skills Center of our institution. The system can be installed on multiple workstations, enabling trainees to practice independently. The software supports data reuse and remote instruction, making it feasible and cost-effective for large-scale educational deployment in well-equipped dental hospitals or academic institutions.

Integration of artificial intelligence in future implantology education

Artificial intelligence (AI) is playing an increasingly important role in dental implantology, not only in clinical diagnosis and treatment planning, but also in education and training. According to the FDI World Dental Federation’s 2023 white paper, AI can support dental education through virtual simulation, flexable learning, and digital feedback systems, helping learners build skills more efficiently and adaptively [22].

Recent studies have reported on the applications of AI in implantology. For example, Mohammad-Rahimi et al. and Macrì et al. highlighted how deep learning can support treatment planning and error detection [23, 24]. Bayrakdar et al. demonstrated the use of AI in CBCT image analysis for implant planning [25], and Altalhi et al. (2023) summarized AI’s potential to improve standardization and provide instant guidance in clinical settings. Like these scholars, we also hope to contribute our own teaching experience to the ongoing exploration of how AI can help improve implant education in the future.

That said, these studies also pointed out current limitations of AI: the accuracy of predictions in complex cases is still uncertain, there is a lack of standardization across systems, and clinical acceptance is still in early stages [26]. In some cases, results may reflect biases from the data or differences between individual clinicians.Recent advances in CBCT and intraoral scan (IOS) registration technologies—such as those explored by Zheng et al. have significantly improved the quality of AI training data, thereby enhancing the efficiency and accuracy of 3D dental modeling [27].

Our current teaching reform did not involve real-time AI or dynamic navigation systems. we used a digital platform to guide students through pre-surgical implant design. Trainees learned to plan implant positions independently, and also observed dynamic navigation surgeries to prepare for future training that may involve real-time guidance. Although AI was not applied directly in this phase, we see this model as a useful first step toward integrating AI tools—such as automated feedback, case-based simulation, and planning support—into implant education in the future.

Here our combination of CBL with a digital platform provides unique advantages: 1)clinical decision-making rraining: CBL plays a critical role in training students to make diagnostic and treatment decisions in complex clinical cases. CBL actively engages students in reasoning, problem-solving, and structured clinical thinking, enabling them to develop judgment and decision-making skills that cannot be achieved through digital tools alone; 2)real-time instructor feedback: teachers can monitor students’ thought processes and provide immediate guidance, enhancing learning efficiency; 3)enhanced engagement and retention: repeated practice on the digital platform and case discussions increase learning motivation and comprehension. This approach not only bridges the gap between novice learners and experienced clinicians but also represents an innovative, scalable, and clinically relevant teaching method with potential for broader adoption.

Limitations of the combined training mode of CBL and digital technology

Although the combined training of CBL and digital technology has advantages in teaching, we have also found some limitations in clinical practice. First, a sufficient number of cases is needed to establish an appropriate case database for the screening of typical cases, which requires a lot of clinical time to collect data, sufficient hardware conditions to store digital data, and dedicated personnel to manage and avoid information leakage. Digital equipment is relatively expensive, and the number of equipment in the department is limited. When the number of students is large, they need to make an appointment for practice time.

The small sample size (n = 6 per group) restricts the statistical power of the study. From a statistical perspective, small samples increase the risk of Type II errors, where true differences or effects may go undetected. Second, the small sample size limits the representativeness of the findings. With only six participants per group, the diversity in learner profiles-such as clinical experience, learning preferences, and adaptability to digital tools-may not be adequately captured. Consequently, the generalizability of the conclusions to the broader population of implantology trainees is constrained.To address these limitations, we plan to expand the sample size in future studies and conduct follow-up research involving multiple training centers. Additionally, we intend to incorporate qualitative research methods, such as semi-structured interviews or thematic analysis of student reflections, to complement the quantitative data. These strategies will help validate the current findings, explore the mechanisms underlying teaching effectiveness, and enhance the overall robustness of the research conclusions.

We used a structured question bank and a standardized DOPS rubric to reduce subjectivity and ensure consistent assessment. In future studies, it will be important to check whether different evaluators score consistently and whether question difficulty remains stable over time. Additionally, the DOPS assessment was conducted without blinding, which could introduce subjective bias. Looking forward, future studies could expand to multiple centers and incorporate faculty from different institutions to provide both teaching and assessment. This would allow blinded evaluations of procedural skills, improving objectivity and providing more accurate and generalizable results.

Due to material and scheduling constraints, students were unable to perform full implant placement or receive radiographic feedback on placement accuracy after free-hand implantation in models. Implant angulation and depth were estimated using depth/direction indicator pins. In future sessions, we aim to address this limitation by securing sufficient funding for practice materials and improving coordination with the radiology department to allow for postoperative assessment and feedback.

Source link