Simulator practice of temporary anchorage device (TAD) insertion on inter-radicular sites improves learning and confidence in dental residency

Purpose: This exploratory study elicited the procedural considerations and inter-radicular site placement techniques of experts and investigated how the use of a simulator, with and without feedback, influenced novice learners' procedural considerations, placement techniques, and confidence.

Methods: Three orthodontic/oral maxillofacial surgery expert clinicians participated in a temporary anchorage device (TAD) insertion assessment accompanied by a think-aloud protocol. Expert transcripts were coded according to a coding scheme to analyze clinicians' (N = 18) procedural considerations and placement techniques. Residents were randomly allocated to control and intervention groups. Two placement sessions were conducted at two inter-radicular sites with audio recordings. The intervention group received real-time feedback on root contact from the simulator's sensor and postoperative radiographs for self-assessed feedback. Residents' confidence levels were compared before and after placements, and subjective feedback about the simulator was obtained.

Results: This study utilized the think-aloud protocol to capture experts' procedural considerations and placement techniques during TAD insertion and revealed a disparity between residents' and experts' thought processes. Only four out of 15 expert themes were mentioned by more than 50% of the residents. The use of the TAD insertion simulator in combination with feedback broadened residents' procedural considerations after one round of placement. Residents' confidence increased significantly in both groups (p < 0.05), but there was no significant difference between them (p > 0.482).

Conclusion: When used in conjunction with feedback, simulator practice of TAD insertion broadened residents' procedural considerations after one round of placement. It improved residents' confidence level and was well received as a learning tool.