Virtual reality and haptic simulation in modern microsurgical endodontics: Case report and proof of concept

Aim: To highlight the development and application of a novel virtual reality (VR) haptic simulation program in endodontic microsurgery (EMS) to prepare for a clinical case performed by a resident student. Summary: Modern EMS requires adequate training and a learning curve for mastering surgical techniques and refining individual skills. VR haptic simulation is gaining attention in dentistry. Pre-clinical virtual training may enhance skills and minimize the risk of unintentional iatrogenic damage during surgery. VR simulation offers an innovative approach, allowing for the saving, reviewing and repetition of exercises without constraints. In this case report, a female patient presented with persistent apical periodontitis related to an endodontically treated maxillary right second premolar. Utilizing a validated digital workflow, cone beam-computed tomography images were converted into STL file format and optimized for VR simulation. The Virteasy Editor interface was used to generate graphics and touchable haptic solids representing different tissues (enamel, dentine, root canal filling and bone). Following the creation of the virtual patient and the simulation of the endodontic lesion, a postgraduate student in endodontics executed 10 sessions of ostectomy, root-end resection and ultrasonic retro preparation in the evaluation stage until reaching ideal standards of practice in the virtual scenario. The student then proceeded to perform supervised root-end surgery on the actual patient. A 1-year postoperative CBCT evaluated the healing outcomes.