Virtual reality simulation for learning minimally invasive endodontics: a randomized controlled trial

Learning minimally invasive endodontic techniques presents unique challenges, requiring precise tooth structure preservation and strong spatial awareness. This study evaluated a clinically realistic virtual reality (VR) simulator, featuring eye-tracking feedback and automated outcome scoring, as an innovative tool to support student learning in minimally invasive endodontics. A prospective randomized controlled trial was conducted with 30 fourth-year preclinical dental students assigned to either a VR group (n = 15) or a standard phantom head (PH) group (n = 15). The VR system featured high-fidelity dental arch modeling, dual haptic devices, a head-mounted display with eye-gaze and tool trajectory tracking (mirror and handpiece), and automated outcome scoring. All students completed three 1-hour training sessions and performed both Traditional Access Cavity (TradAC) and Conservative Access Cavity (ConsAC) techniques. The primary outcome was tooth volume loss assessed via micro-computed tomography (micro-CT). Secondary outcomes included procedural error scores (rated by blinded experts) and task completion time. Wilcoxon signed-rank tests evaluated pre–post differences. A split-plot ANOVA analyzed training method (between-subjects) and access technique (within-subjects). Significant improvements were observed across all outcomes in both groups (p < 0.05). There was no significant main effect of training method or interaction. A significant main effect of access technique was found for tooth volume loss (F(1,28) = 10.46, p = 0.003) and task completion time (F(1,28) = 6.86, p = 0.014), favoring ConsAC. This study supports the feasibility of automated virtual reality (VR) simulation as a scalable and effective tool to support student learning in minimally invasive endodontic procedures within preclinical dental education. This randomized controlled trial was registered on 29 April 2025, at the TCTR registry with the study registration number TCTR20250502004.