Innovative 3D-printed educational models for vital pulp treatments and local anesthesia training in pediatric dentistry

Abstract

Background

Preclinical training is essential across all areas of dental education. In pediatric dentistry, it is particularly valuable due to the unique challenges of working with young patients, and it provides a safe environment for students to gain confidence before transitioning to clinical care. Procedures such as local anesthesia administration and vital pulp therapy require specific skills that are best developed through simulation-based education. Recent advancements in three-dimensional (3D) printing technology offer innovative solutions to enhance dental education by providing realistic and patient-specific educational models. This study aimed to develop and evaluate two distinct 3D-printed educational models for pediatric dentistry training.

Methods

A patient-derived cone beam computed tomography dataset was processed to create anatomically accurate models replicating primary molar structures, pulp chambers, and surrounding hard tissues. Sixty-six dental students (third-year, fifth-year, and postgraduate) participated in hands-on training using these models. Participants assessed the models’ educational value, realism, and effectiveness using a structured survey.

Results

68.2% of students strongly agreed, and 28.8% agreed that the local anesthesia model enhanced their understanding of anatomical structures and injection sites. Additionally, 81.8% strongly agreed, and 18.2% agreed that visualizing anesthetized nerves enhanced their understanding of how anesthesia spreads within the tissue. In vital pulp therapy training, 71.8% of participants strongly agreed, and 27.3% agreed that the 3D-printed teeth provided a realistic simulation for pulp therapy procedures. 83.3% of students desired to use these models for more advanced methods, and 100% of third-year students strongly agreed that practicing 3D-printed models before treating actual patients would be beneficial. Compared to phantom and extracted teeth, 3D-printed models were perceived as more engaging and accessible, though extracted teeth remained superior in tactile authenticity.

Conclusions

3D-printed models contribute to a more structured and comprehensive educational process by bridging the gap between theoretical knowledge and hands-on experience. Integrating 3D printing technology into the dental curriculum has excellent potential to improve the quality of pediatric dentistry education and clinical preparation.

Clinical trial number

Not applicable.

Introduction

The undergraduate dental curriculum comprises basic sciences, preclinical training, and clinical training to equip students with the necessary competencies for professional practice. Preclinical training prepares students for safe and effective patient care by improving their hand skills and helping them turn theoretical knowledge into practical experience [1, 2]. Utilizing dental simulations before patient interactions can improve dental students’ readiness for clinical practice [3]. Educational models have been shown to provide a safe environment where students can practice repeatedly, enhance technical skills, and build confidence by allowing students to receive immediate feedback and practice until they achieve proficiency [4, 5].

Dental education has traditionally relied on typodont models and extracted natural teeth to facilitate the acquisition of practical skills. However, these methods present several limitations, including restricted standardization, ethical considerations, and limited availability of anatomically varied samples [6]. Moreover, such models often fail to reflect the complexity of real-life clinical cases [7, 8]. Several digital technologies, such as haptic simulators and virtual/augmented reality systems, have been developed to enhance operative training. While these approaches offer benefits in procedural repetition, they still fall short in replicating tactile feedback and ergonomic realism, which are critical for developing fine motor skills and clinical decision-making [9].

Three-dimensional (3D) printing has emerged as one of the most transformative technologies in modern dentistry, with increasingly diverse applications across nearly all dental specialties. According to recent reviews by Balhaddad et al. [10] and Chen and Wei [11], this technology has been extensively applied in prosthodontics, implantology, orthodontics, maxillofacial surgery, and regenerative procedures. Its use has been reported in the fabrication of accurate anatomical models, surgical guides, dental prostheses, and scaffolds for tissue engineering applications. With its high precision, time efficiency, and wide material compatibility, 3D printing has become an essential tool in modern dental practice and education [10, 11]. As this technology continues to evolve and become more accessible, it is anticipated to become an integral part of dental education [12]. 3D-printed models in dental education have gained widespread recognition for improving dental student training and advancing practitioners’ practical skills [13, 14]. 3D-printed models have been shown to have significant potential in providing a learning experience for dental students and improving their proficiency in different dental procedures, such as teaching caries removal, endodontic procedures, restorative techniques, dental trauma, oral surgery, periodontics, and prosthodontics [14,15,16,17,18,19,20,21,22,23,24,25,26,27]. Integrating 3D-printed models into dental education is essential to enhance hands-on learning experiences and improve students’ confidence in clinical procedures and education to stay at the forefront of technological innovation [28, 29].

Dental students frequently face high-stress levels when transitioning from preclinical to clinical education, mainly due to limited hands-on experience, low self-confidence, and the challenges of handling diverse anatomical and clinical conditions [30]. Managing pediatric patients, a unique patient group, adds to these challenges, making clinical training even more demanding and stressful for students. Studies on stress levels among dental students and practitioners in pediatric dentistry have highlighted local anesthesia administration, especially in the mandible, and pulp treatments in children as the most anxiety-inducing procedures [31,32,33,34,35]. To mitigate these challenges, implementing 3D-printed educational models, particularly those tailored to replicate patient-specific anatomy, has shown promise in improving students’ preparedness and reducing procedural anxiety [15, 28]. These models help students develop technical skills, understand clinical workflows, and gain confidence in patient care [15, 16]. However, there is a need for more realistic and anatomically detailed tools that bridge the gap between theory and clinical application in pediatric dentistry.

Therefore, this study aimed to evaluate the educational effectiveness of anatomically accurate, patient-specific 3D-printed models designed for training dental students in vital pulp treatments and local anesthesia administration in pediatric patients.

Methods

Ethical approval

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Gazi University Faculty of Dentistry (Approval Date: 11.09.2023, Decision No: GÜDHKAEK.2023.17/3).

Design and development of 3D-printed educational models

This study aimed to manufacture two distinct 3D-printed training models to enhance students’ skills in local anesthesia and vital pulp treatment applications (including indirect/direct pulp therapy and pulpotomy) in primary teeth.

For developing the 3D-printed training models, a pediatric patient who already required cone beam computed tomography (CBCT) imaging in the clinic and whose mandibular first and second primary molars were free of caries was selected. Written informed consent was obtained from the patient’s legal guardian (parent). The CBCT scan was indicated as part of a clinical diagnostic procedure following the detection of a lesion with suspected maxillary bone destruction on a routine panoramic radiograph. The scan was acquired using a DENTRI-C (HDXWILL, Korea) CBCT scanner. The imaging protocol included the following parameters: voxel size of 0.2 mm, field of view of 160 mm, kilovoltage (kVp) of 90, tube current of 10 mA, and exposure time of 0.10 s. The scan resolution was set at 800 × 800 pixels with a slice thickness of 0.2 mm. Pixel spacing was 0.20 mm in both vertical and horizontal dimensions. The patient’s CBCT data were consolidated and digitized into a single DICOM (Digital Imaging and Communications in Medicine) file for further processing. The CBCT scan was taken from an 8-year-old child, representing typical anatomical features of the mixed dentition phase suitable for simulation purposes (Fig. 1).

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For 3D planning and modeling, Mimics Innovation Suite 25.0 (Materialise, Leuven, Belgium) was used to import DICOM data and generate axial, coronal, and sagittal projections from individual slices. All DICOM files were anonymized prior to segmentation using Mimics’ anonymization tool, including removal of personal identifiers from metadata and file names. The dataset contained no personal health information and was used solely for model design purposes, in accordance with ethical guidelines. Threshold values were applied for gray-scale segmentation, and anatomical boundaries were defined using the segmentation module. Key structures were segmented, including the mandible, mandibular foramen, inferior alveolar, mental, and lingual nerves (Fig. 2).

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Additionally, all teeth and surrounding anatomical structures were isolated using the segmentation module. In total, twelve teeth were segmented in the mandible, including teeth 46, 85, 84, 83, 82, 81, 71, 72, 73, 74, 75, and 36. The pulp chambers of all segmented teeth were identified. For teeth #74 and #75, both the enamel and dentin layers were also segmented. During the 3D reconstruction process, the enamel, dentin, and pulp were distinctly identified (Fig. 3). The finalized models were then converted into the Standard Triangulation Language (STL) format, a widely recognized standard file type for 3D printing. The STL files were subsequently imported into 3-matic 17.0 (Materialise, Leuven, Belgium) software for further refinement and optimization of anatomical structures to ensure accuracy in manufacturing. Moreover, various clinical case scenarios for vital pulp treatments were conceptually designed based on typical pediatric treatment needs and then digitally implemented within the software environment for model development.

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Caries simulations of varying depths were incorporated into the model, providing a realistic educational tool for clinical training. A deep dentin caries was designed to simulate carious lesions in the occlusal and mesial surfaces of the mandibular second primary molar (tooth #75), closely approximating the pulp. An occlusal and distal cavity was also created on the mandibular first primary molar (tooth #74), establishing direct contact with the distal pulp horn. The STL model with simulated carious lesions of varying depths and locations is presented in Fig. 4. The segmented mandibular CBCT data and the intraoral scan were digitally aligned to ensure anatomical accuracy, generating a realistic 3D model that closely replicates patient anatomy.

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Production of 3D-printed educational models

After completing the 3D design in the digital environment, the finalized STL files (master files) were imported into PreForm (Formlabs Inc., Somerville, MA, USA) software. In PreForm, support structures required for printing were added, material parameters were configured, and the master files were converted into form files, preparing them for production. The models were then printed using a 3D printer with SLA (stereolithography) technology (Form 3B, Formlabs Inc., Somerville, MA, USA).

For the local anesthesia model, the models were printed using transparent photopolymer resin (Formlabs Inc.), and the teeth were printed using A2 shade permanent crown resin (Formlabs Inc.). In contrast, the inferior alveolar, mental, and lingual nerves were printed using flexible photopolymer resin (Formlabs Inc.) to replicate anatomical flexibility. To enable the visualization of anesthetic diffusion during participant practice, the mandibular canal and associated nerve pathways were digitally modeled and fabricated as anatomically accurate hollow channels. This structural design was intended to allow the colored saline solution to travel visibly along the nerve paths upon injection, thereby observing the expected anesthetic distribution pattern. After printing, all parts underwent post-processing steps in accordance with the manufacturer’s instructions, including washing and post-curing procedures. Then, the separate components, including the transparent mandibular base and the permanent crown resin teeth, were assembled using a bonding method involving uncured liquid photopolymer resin. A thin layer of the resin was applied between the contact surfaces, and the assembled model was post-cured according to the manufacturer’s recommendations to achieve adequate bonding. The spaces corresponding to the permanent tooth germs on the transparent model were filled with flowable composite material (Nova Compo-HF, Imicryl, Türkiye) through an access hole created on the lingual surface. This technique ensured the visibility of the permanent tooth germs on the model, accurately replicating their anatomical positioning. 3D-printed nerves were stained with yellow dye (Fig. 5).

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The base model for the vital pulp therapy model was printed using transparent photopolymer resin. In primary first and second molars, where vital pulp treatment scenarios were designed, dentin and cement layers were printed using A2 shade permanent crown resin.

All other teeth, in which enamel and dentin were not segmented, were printed using A2 shade permanent crown resin. After printing, all parts were produced following the manufacturer’s post-printing process instructions. The enamel layer was created using A1 shade universal composite resin (Charisma Smart, Kulzer, GmbH, Hanau, Germany). Molds were prepared using polyvinyl siloxane impression material to achieve a standardized enamel thickness and morphology on the tooth surfaces. These molds were obtained from primary molars #74 and #75, which were produced without segmentation of the enamel layer, ensuring accurate replication of natural enamel surfaces. To simulate artificial caries, digitally created cavities with varying depths in the software were restored using light-cured glass ionomer cement (Nova Glass LC, Imicryl, Türkiye). Brown food coloring was mixed with the liquid component of the glass ionomer cement to simulate typical dentin caries for educational purposes. Although the color of natural caries can vary depending on lesion type and progression, the selected shade was chosen to provide sufficient visual contrast and facilitate clear differentiation during training. Subsequently, the pulp chamber of the designed teeth was filled with Penta Duosoft Light Body (3 M Espe, Seefeld, Germany), a polyether impression material, to simulate the color and consistency of the pulp. A small access hole was created on the pulp chamber floor using a dental bur to place the impression material. The light body impression material was injected into the pulp chamber using a dental syringe through this cavity. Once the chamber was filled, the access cavity was sealed with a composite resin material to ensure proper closure (Fig. 6). Then, all teeth were placed on the 3D-printed model.

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A silicone gingival mask (Gingifast Rigid, Zhermack, Badia Polesine) was applied to replicate gingival tissue, mimicking the natural soft tissue anatomy surrounding the teeth (Fig. 7). Based on previously clinical measurements of gingival thickness in the mandibular posterior region, the gingival mask was manually applied with an approximate thickness of 1.5 mm to simulate physiologically relevant dimensions [36, 37]. Unlike the other digitally designed components of the model, the gingival mask and the enamel layers of teeth #74 and #75 were not produced via 3D printing. Instead, these structures were manually fabricated using conventional dental materials—silicone for the gingival tissue and composite resin for enamel surfaces.

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Training and survey implementation on 3D-printed educational models

This part of the study was conducted with third-year and fifth-year dental students and postgraduate dental students in the Department of Pediatric Dentistry at Gazi University, Faculty of Dentistry. Participation was voluntary, and students who agreed to participate were informed about the study’s purpose, reliability, and confidentiality. Written informed consent was obtained from all participants. It was explicitly stated that the decision to participate or not participate and the survey results would not impact the student’s academic performance or grades.

Based on a literature review of similar methodologies, the sample size was calculated using the G-POWER program. With an effect size of 0.4, 80% power, and a significance level of 0.005, the total sample size was 66. Accordingly, the study was conducted with 22 students in each group (third-year, fifth-year, and postgraduate students). Third-, fifth-year, and postgraduate students were selected to represent different stages of clinical training and competence, with the aim of gaining insight into how varying levels of experience influence the perception and effectiveness of simulation-based education. Previously, all participants had training experience with phantom teeth and extracted natural teeth during their preclinical and clinical education. Third-year students were included as they had no prior clinical experience; fifth-year students represented those transitioning toward clinical autonomy; and postgraduate students reflected a group with substantial clinical experience, particularly in pediatric procedures.

Before the application phase, all participants received structured instruction from two experienced faculty members—an associate professor (N.A.) and a professor (D.A.)—each with over 15 years of clinical and academic experience in pediatric dentistry. These sessions included theoretical instruction and live demonstrations of both the local anesthesia and vital pulp therapy procedures, ensuring clarity, consistency, and procedural accuracy across participants. Following this preparatory training, the hands-on component of the study began. Participants practiced inferior alveolar nerve block (IANB) administration using the 3D-printed local anesthesia training model, followed by vital pulp therapy procedures on a separate 3D-printed model. All student procedures were directly observed and verified by N.A. and D.A. to ensure adherence to standardized techniques.

Inferior alveolar nerve block anesthesia application on the local anesthesia training model

The hands-on training began with the local anesthesia model. During the practice, a dental syringe (Beybi Dental Syringe, İstanbul, Türkiye) was filled with saline solution mixed with yellow food coloring to visually represent the anesthetic solution. The purpose of this colored solution was to enhance the visibility of nerve branches in the transparent resin model, allowing students to observe the expected distribution pathway of the injection. The colored solution was injected near the mandibular foramen and traveled through the mandibular canal, staining the areas corresponding to the inferior alveolar nerve, its terminal branch, and the mental nerve. This visualization allowed students to observe the anesthetized regions. Following the demonstration, all students first practiced mandibular anesthesia using the local anesthesia training model and dental syringe provided, allowing them to visually observe the nerve branching and the distribution of the anesthetic. Subsequently, students applied mandibular anesthesia on the vital pulp therapy training model, which was covered with gingival tissue. This allowed them to experience the tactile sensation of injecting anesthesia through soft tissue, closely simulating a real clinical scenario.

Removing caries and cavity preparation on the vital pulp therapy training model

Following the anesthesia procedure, students proceeded to caries removal on the vital pulp therapy model. Cavities were prepared in the teeth according to their different treatment requirements, and students were instructed to perform indirect pulp capping, direct pulp capping, and pulpotomy. In the first scenario, the carious lesion in the mandibular first primary molar was intentionally designed to be in close proximity to the distal pulp horn, leading to pulp chamber perforation during cavity preparation. At this stage, students were expected to identify the need for pulpotomy and prepare the cavity accordingly. In this scenario, students were not given prior instructions and were expected to recognize the clinical need for pulpotomy based on spontaneous pulp exposure during caries removal. In contrast, the second scenario, based on the mandibular second primary molar, was initially designed for indirect pulp capping. The carious lesion was located on the mesial and occlusal surfaces, in close proximity to the pulp. During cavity preparation, the reddish reflection of the pulp became visible, indicating an indirect pulp capping situation. At this point, students were instructed to extend the cavity on the occlusal surface using a bur to intentionally expose the pulp. This controlled exposure allowed them to perceive the remaining dentin thickness and differentiate between indirect and direct pulp capping procedures. The hands-on experience was designed to improve their understanding of the clinical indications for different pulp therapy approaches. Faculty members provided guidance and clarification when students faced challenges in making diagnostic decisions. In cases where necessary, students were allowed to repeat the procedures to reinforce their understanding of the treatment differences.

Survey implementation

A survey was administered to evaluate the educational models after the training sessions. To assess the effectiveness of the local anesthesia training model, the survey was adapted from the studies conducted by Wong et al. [4] and Lee et al. [31]. For the vital pulp therapy training model, the survey was modified from the questionnaires used in the studies by Höhne et al. [20] and Höhne & Schmitter [21]. Prior to its use in the main study, the survey was pilot tested with fifteen students who were not part of the main study population (five third-year, five fifth-year, and five postgraduate students) to ensure reliability and enhance data quality. After completing the pilot test, students were asked for feedback on the survey, and any unclear questions were revised. Based on the results of the pilot study, the survey was refined and finalized. The final survey consisted of 6 sections and 28 questions (Q). The English version of the survey used in this study is available as Supplementary Material [see Additional file 1].

Statistical analysis

Statistical analyses were performed using IBM SPSS V23 (IBM Corp., Armonk, NY, USA). The normality of data distribution was assessed using the Shapiro-Wilk test. The Chi-square test, Fisher’s Exact Test, and Monte Carlo corrected Fisher’s Exact Test were used to compare categorical variables across groups. Bonferroni-corrected Z tests were conducted for multiple comparisons of proportions. For comparing non-normally distributed age data across three or more groups, the Kruskal-Wallis test was applied, followed by Dunn’s test for post-hoc multiple comparisons. Within-group comparisons by method were analyzed using the Friedman test, with Dunn’s test for post-hoc multiple comparisons. Cochran’s Q test was used to compare dichotomous variables across three methods, with Bonferroni correction applied for multiple comparisons. Descriptive statistics were presented as mean ± standard deviation and median (minimum-maximum) for quantitative data and as frequency (percentage) for categorical data. The level of significance was set at p < 0.05.

Results

The demographic data of the study participants are summarized in Table 1. Among the participants, 60.6% were female and 39.4% were male. The mean age of the participants was 23.71 ± 2.79 years, with an age range of 20 to 32 years.

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The distribution of participants’ responses regarding their experiences with the training models is presented in Table 2. Most participants found the model beneficial for understanding anatomical structures and identifying the correct injection site for n. alveolaris inferior anesthesia in the local anesthesia training model, with 68.2% strongly agreeing and 28.8% agreeing. Additionally, 81.8% of participants strongly agreed, and 18.2% agreed that visualizing anesthetized nerves enhanced their understanding of the anesthetized regions following n. alveolaris inferior anesthesia. A statistically significant difference was observed in Q3, where third-year students reported the highest rate of strongly agreeing (95.5%), while postgraduates had a lower rate (59.1%) (p < 0.05). There was also a significant interest (84.1% strongly agree and 13.6% agree) in having prior experience with the 3D model before performing the first local anesthesia procedure. Although not statistically significant, there was a noticeable trend in Q5, where third-year and fifth-year students showed high confidence levels (77.3% strongly agreed), while postgraduates were less confident (42.9% strongly agreed).

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The overall responses about vital pulp treatment training models were highly positive; no statistically significant differences were observed among the educational groups (p > 0.05). In experiences with these models, most participants found the 3D-printed teeth helpful in understanding the differences between indirect and direct pulp therapies, with 59.1% strongly agreeing and 37.9% agreeing (Q8). Regarding realistic application, 71.8% of participants strongly agreed, and 27.3% agreed that the 3D-printed teeth provided a realistic approach to performing indirect/direct pulp therapies and pulpotomy procedures (Q10).

The evaluation of learning outcomes using 3D-printed teeth showed positive feedback, emphasizing their effectiveness in enhancing practical skills and educational engagement. Most participants found the models exciting for skill development (75.8% strongly agreed, 21.2% agreed) (Q12) and highly beneficial for improving fine motor skills (78.8% strongly agreed, 19.7% agreed) (Q13). A statistically significant difference was observed in the perceived benefit of these models in actual patient care (p = 0.047), with postgraduates showing the highest level of agreement (90.9%) (Q14). Interest in further practice was exceptionally high (81.8% strongly agreed), especially among third-year students (100% strongly agreed (Q15). Additionally, 83.3% desired to use the models for advanced procedures (Q16).

The evaluation of 3D-printed teeth and models showed positive feedback, especially for their realistic design and educational value. Most participants agreed that the models were realistic (54.5% agreed, 39.4% strongly agreed) (Q18). However, it should be noted that third-year students had not yet performed dental procedures on real patients. Their perceptions of realism were therefore based on comparisons with conventional preclinical training tools, such as phantom models, and on indirect clinical observation. Regarding the color difference between enamel and dentin, the caries simulation, and the soft tissue simulation, perceptions varied significantly by educational level (p = 0.008, p = 0.001, p = 0.031). The comparison of 3D-printed teeth, phantom teeth, and extracted teeth across different educational levels is presented in Table 3; Fig. 8. The evaluated parameters included hardness of dental tissue, educational value, ease of use, accessibility, level of interest, tactile feedback, and suitability for practical application. No statistically significant differences were found between groups for any of these characteristics. However, significant differences were found within each educational level when comparing the different types of teeth. Extracted teeth were consistently rated as the hardest among all groups, while 3D-printed teeth were generally rated as medium in hardness, and phantom teeth were rated as low in hardness (p = 0.191) (Q23). 3D-printed teeth were consistently rated as having the highest educational value across all groups (Q24). Extracted teeth were also rated positively but slightly lower, while phantom teeth were rated the lowest (p = 1.000). 3D-printed teeth generated the highest interest across all groups, while phantom teeth received the least interest (p = 0.314) (Q26). Extracted teeth were rated the highest for realistic tactile feedback, followed by 3D-printed teeth, while phantom teeth were rated the lowest (p = 0.651) (Q27).

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Discussion

This study aimed to evaluate anatomically accurate 3D-printed educational models that simulate pediatric dental scenarios for vital pulp therapy and local anesthesia training, using a structured questionnaire administered to students after hands-on sessions. The findings demonstrated that these models significantly improved students’ understanding of anatomical structures, procedural accuracy, and confidence in performing pediatric dental treatments. Participants highly rated the models for their educational value, realism, and ability to enhance hands-on learning.

Although 3D printing is widely used in dental education, its application in pediatric dentistry is still limited. A recent scoping review showed that most studies using 3D-printed models focus on areas such as prosthodontics, endodontics, and maxillofacial surgery [38]. Pediatric dentistry was represented in only a single study [16]. This may be due to the relatively recent shift toward age-specific simulations, which are particularly important in pediatric dentistry because of anatomical and behavioral differences in children. The strong positive responses from participants at different educational levels in our study emphasize the importance of integrating pediatric-focused 3D-printed models into dental curricula to address existing gaps in simulation-based education and to facilitate a smoother transition from theory to clinical practice in pediatric patient care.

The application of the IANB poses a challenge to local anesthetic injections due to the delicate injection technique [28, 39]. Various educational approaches have been explored to enhance students’ competence and confidence in local anesthesia administration. These include student-to-student training, simulation models, virtual and augmented reality, and digital educational tools [4, 28, 30, 39, 40]. Simulation models, in particular, have shown promising results in providing a safe, controlled, and low-stress environment where students can practice injection techniques repeatedly [4, 31]. Lee et al. [31] reported that students who trained with local anesthesia simulators expressed higher levels of preparedness and confidence before administering local anesthesia in a clinical setting. In a recent pilot study, Lamira et al. [41] developed an innovative simulation model for IANB training that combined 3D printing with mixed reality and haptic feedback features. Their findings revealed that students who practiced with the simulator prior to clinical laboratory sessions achieved significantly higher rates of successful anesthesia application (52.6%) and reported markedly improved self-confidence compared to those who did not receive simulator training. Garcia-Blanco et al. [28] conducted a study to evaluate the effectiveness of 3D-printed simulation models in administering IANB. The results indicated that students who practiced with the simulator model demonstrated significantly better instrument-handling skills and showed a trend toward improved identification of anatomical landmarks compared to those who received only theoretical instruction [28]. These studies have demonstrated that simulation-based training, including local anesthesia and 3D-printed models, enhances students’ confidence, instrument-handling skills, and anatomical landmark identification, suggesting its effectiveness in improving clinical preparedness. To the best of our knowledge, no studies have investigated the use of 3D-printed models for local anesthesia training in pediatric dentistry.

The goal of this study was not to quantitatively validate the anatomical accuracy of anesthetic delivery but to demonstrate the feasibility and educational potential of a 3D-printed model for training purposes. The effectiveness of the model was assessed based on participants’ perceptions during hands-on use and their survey responses. When the participants’ experiences with the local anesthesia training model were evaluated, it was revealed that most of them found the model helpful in determining anatomical structures and the correct entry point for IANB (68.2% strongly agreed, 28.8% agreed). In agreement with the current study, Garcia Blanco et al. [28] reported that nearly all students agreed strongly that training with the 3D simulation model for local anesthesia education was helpful. Third-year students reported the highest rate of strongly agreeing (95.5%) with the subject of experiencing bone contact from the model while performing anesthesia. In comparison, postgraduates had a lower rate (59.1%). This suggests that third-year students, having limited clinical exposure, were more sensitive to tactile feedback, whereas postgraduates, with more real-world experience, found the simulation less realistic. Additionally, a strong retrospective desire for prior experience with the 3D model before administering the first local anesthesia among fifth-year and postgraduate students underscored the perceived value of the model as a preparatory tool in clinical education. These findings indicated that the 3D-printed local anesthesia model was highly effective in enhancing anatomical knowledge, confidence, and clinical preparedness, particularly for less experienced students.

Phantom or extracted teeth have been available for students’ education in preclinical and clinical courses in pediatric dentistry. Phantom teeth, commonly provided by manufacturers such as KaVo Dental GmbH or Frasaco GmbH in Germany, are widely used in dental education. While these teeth are ideal and standardized, they are typically made from a single hard plastic material, lacking realism. They fail to replicate the complexity of individual dental arch configurations encountered in real patient scenarios [14,15,16, 24, 42]. These teeth have neither a pulp cavity nor carious lesion, and students must prepare intact teeth [21]. Certain manufacturers produce specialized model caries teeth, but their high cost makes them less feasible for widespread dental education use [24, 43]. Extracted teeth have been used in dental education to provide students with a realistic training experience, helping them better understand teeth’ anatomical and tactile properties [42]. However, their use has been associated with significant challenges, including ethical concerns regarding patient consent, difficulties in obtaining sufficient numbers, hygienic risks due to potential infection, and a lack of standardization, leading to inconsistent assessments and learning outcomes [1, 6, 39]. It has been reported that 3D-printed teeth offer a practical solution to overcome these existing difficulties in many studies [15, 16, 21, 23, 44,45,46,47]. Compared with traditional training methods such as extracted teeth and phantom teeth, 3D-printed training models offer a reproducible, safe, and customizable learning environment that simulates clinical conditions more effectively. Their ability to incorporate patient-specific anatomical variations makes them especially effective for preparing students for complex real-life scenarios [46, 48]. While Marty et al. [16] and Kröger et al. [15] developed their 3D-printed models using patient-derived CBCT data, Höhne and Schmitter [21] used a standardized KaVo tooth model. In the present study, the 3D-printed teeth were generated from pediatric patient CBCT scans by segmenting anatomical structures such as the pulp chamber and carious lesions, allowing the fabrication of patient-specific training models that closely mimic real clinical anatomy.

Several digital technologies, such as haptic simulators and virtual/augmented reality systems, have been developed to improve procedural training in dentistry. While these platforms offer advantages such as repeatability, immersive environments, and objective performance tracking, they still lack the tactile fidelity and ergonomic realism required for developing fine motor skills. In contrast, 3D-printed models have been reported to enable physical manipulation with real instruments, providing a more authentic hands-on experience [9, 47]. Duan et al. (2024) reported that although students appreciated the virtual simulation for its structured practice and safety, a majority still favored integrating 3D-printed models for realistic drill sensations and clinical applicability [47].

In this study, extracted teeth were consistently rated as the most challenging and realistic regarding tactile feedback. In contrast, 3D-printed teeth were perceived as the most educationally valuable, engaging, and versatile for hands-on practice. Phantom teeth were rated the least realistic and the easiest to use. However, while 3D-printed models outperformed traditional phantom models in terms of engagement and simulation quality, they still fell short of replicating the tactile realism provided by extracted teeth. In our study, extracted teeth received the highest scores for both material hardness and tactile feedback. Petre et al. [48] reported that 91.7% of undergraduate students perceived the hardness of the printed material as notably different from natural dentition. Their study, which employed SLA printing and Formlabs White Resin, also highlighted that despite the pedagogical advantages of 3D-printed models, the discrepancy in tactile sensation remains a limitation. Similarly, Ballester et al. [49] developed layered 3D-printed tooth models incorporating carious lesions and found that although students rated the simulation as effective for caries training, 26% expressed dissatisfaction with the tactile distinction between enamel and dentin. Students also emphasized a desire for greater hardness, particularly in the enamel, to better match the resistance encountered during clinical drilling. However, Cresswell-Boyes et al. [50] developed 3D printed typodont teeth using composite materials such as hydroxyapatite and carbonated hydroxyapatite incorporated into a methacrylate-based photopolymer resin. Although several material compositions achieved cutting force values closely matching extracted enamel and dentine, the tactile realism of these printed teeth still fell short. These results emphasize that true tactile fidelity in dental simulation depends not only on replicating morphology and cutting resistance but also on mimicking the heterogeneous material behavior of natural teeth. These insights highlight the critical importance of material selection and composite design in the future development of 3D printed dental simulation tools. Similar to our study, positive results were observed in studies evaluating the use of 3D-printed teeth in preclinical dental education [21, 23, 44,45,46]. Mahrous et al. [44] evaluated students’ perceptions of learning dental anatomy using extracted natural teeth, 3D-printed models, and augmented reality technology. Among these methods, extracted teeth were rated highest in educational value, whereas 3D-printed models were rated the easiest to use. Höhne and Schmitter [21] reported that, in a comparative evaluation, natural teeth were rated slightly higher than 3D-printed models in terms of educational effectiveness. Reymus et al. [45] developed a workflow for creating 3D-printed resin teeth for endodontic education. They found that students rated them higher than extracted teeth regarding usability, fairness due to standardization, convenience in endodontic practice, and hygiene. However, the study did not report specific data on students’ tactile perception or preferences related to cutting realism, anatomical accuracy, or comparisons with extracted and typodont teeth [45]. The findings of our study highlight the effectiveness of 3D-printed teeth as educational tools, particularly for improving learning engagement and practical skills, while indicating that extracted teeth remain the gold standard for tactile authenticity.

In our study, most students found 3D-printed teeth helpful in understanding the differences between indirect and direct pulp therapies. Students reported that practicing on 3D-printed teeth provided valuable insights into the amount of remaining dental tissue during cavity preparation and offered a realistic experience for performing indirect pulp capping, direct pulp capping, and pulpotomy procedures. The models were particularly effective in enhancing understanding of pulp therapy concepts, procedural realism, and skill acquisition, demonstrating their value as an educational tool across different educational levels [14, 21]. Marty et al. [16] conducted the first study in the literature to develop, evaluate, and compare a 3D-printed model for pediatric dentistry education. Using computed tomography data from a patient, they created a 3D-printed tooth with an artificial pulp chamber and model. Students performed primary molar pulpotomy and stainless steel crown preparation on the 3D-printed and industrial (Frasaco) models. Students reported that the model effectively simulated carious lesions and the proximity of the pulp, offering pedagogical advantages for understanding pulpal involvement. The simulation of the pulp chamber received high ratings, and the 3D-printed model was generally perceived as providing a more realistic experience compared to the industrial Frasaco model. However, students found the uniform color of the model and teeth and the simulation of the proximal area to be inadequate [16]. Höhne and Schmitter [21] designed a 3D-printed single-tooth model compatible with KaVo typodont systems, incorporating detailed anatomical features such as carious lesions, a pulp chamber, and artificial pulp tissue. This model enabled students to simulate a complete restorative procedure, including caries excavation, direct pulp capping, core build-up, and crown preparation. Notably, students expressed strong interest in the simulation of the pulp capping step, which was rated highly. These findings suggest that anatomically and functionally enhanced 3D-printed models can significantly improve students’ understanding and execution of vital pulp therapies, reinforcing the results observed in our study.

In a study by Höhne et al. [20], a 3D-printed tooth with different enamel and dentin layers was designed and manufactured for training in crown preparation to gain experience with realistic differences in the hardness and color of the model tooth. Both students and experts evaluated the learning effectiveness of this model positively [20]. In our study, postgraduate students found the simulation more realistic than other groups regarding the color difference between enamel and dentin. This suggests that advanced students, possibly due to their clinical experience, were more perceptive to subtle color variations. Postgraduate students, who had more clinical training than undergraduate participants, perceived the model as less realistic. Their prior experience with real patient cases may have led to higher expectations regarding tactile feedback and anatomical accuracy, resulting in a more critical evaluation of the 3D-printed simulation. In contrast, less experienced students, who had limited or no clinical exposure, perceived the models as highly realistic and helpful. These findings highlight that educational level influences the perception of realism in 3D printed models, suggesting a need for continued refinement to meet the expectations of more advanced learners. These findings are consistent with the results reported by Petre et al. [48], who evaluated the combined use of modular digital and 3D-printed models in prosthodontic education. In their study, fourth-year dental students, who had more advanced theoretical knowledge and clinical experience, were better able to appreciate the educational value of the proposed models. Statistical analysis revealed that student perceptions varied significantly by academic year.

The ability to realistically simulate carious lesions is critical for enhancing operative training in dental education. However, only a limited number of studies have successfully integrated caries simulation into 3D-printed tooth models. Kröger et al. [15] developed 3D-printed models with decayed teeth using PolyJet technology and softer resins to simulate carious dentin. Marty et al. [16] later created a pediatric dental model by manually incorporating self-curing resin into the pulp chamber of a 3D-printed tooth. Ballester et al. [49] developed a 3D-printed tooth model designed for caries assessment and removal training. The tooth was constructed using SLA technology (Formlabs Form 3), and a carious lesion cavity was simulated by injecting composite material tinted with custom pigments to achieve a visually and tactilely realistic texture. Students reported high levels of satisfaction with the texture and shade of the caries simulation. Panpisut et al. [51] developed a 3D-printed model combining wax and resin-modified glass ionomer with color modifiers to simulate pulp and deep caries layers, offering a more realistic tactile experience during selective caries removal training. Their results showed high student satisfaction. In our study, the caries simulation was achieved by resin-modified glass ionomer with color dye and was well-received by participants across all educational levels. These findings, supported by prior research, underscore the importance of improving the material composition of 3D-printed caries models to enhance tactile fidelity. While current simulations demonstrate educational value, the use of materials that better replicate the mechanical behavior and visual appearance of natural lesions could significantly improve realism.

Most participants noted that 3D-printed models significantly motivated students and increased their interest in hands-on learning. Moreover, interest in further practice on 3D-printed teeth was exceptionally high. 83.3% of participants strongly agreed they would like to use the models for advanced procedures such as dental trauma management, splint treatment, root canal therapy, and regenerative treatments. These model’s high motivational impact and broad applicability in dental procedures demonstrate their potential as an essential educational tool in dental training. Variations provided by educational models obtained with current technology will improve the diagnosis and decision-making process and provide experience with different treatment methods [15, 21]. Additionally, Chevalier et al. [52] found that preclinical simulation of caries using 3D-printed models significantly reduced student anxiety and stress while increasing knowledge and self-efficacy in vital pulp therapy. A recent study by Lin et al. [9] demonstrated that students trained with 3D-printed caries models showed significant increases in confidence, reduced reliance on faculty guidance, and enhanced ability to differentiate carious from sound tissues. These outcomes suggest that targeted preclinical experiences not only build technical proficiency but also improve decision-making and psychological readiness, factors known to influence clinical outcomes such as error rates, patient safety, and treatment efficiency. Incorporating such models into dental curricula may thus support a smoother and more confident transition into patient care [48, 52].

While 3D-printed models offer anatomically accurate and customizable simulation tools for dental education, their affordability and scalability remain essential considerations. Traditional typodont models are often commercially priced at around €320 for a full maxillary-mandibular set, with individual teeth costing approximately €2.50 per unit, totaling over €400 for complete replacements [38]. In contrast, 3D-printed teeth and typodont components represent a significantly more economical alternative. Karagkounaki et al. [38] reported that individual 3D-printed teeth can be produced for no more than €2.70, while entire typodonts range from €1.20 to €3.60 depending on complexity and material. Other studies have reported even lower production costs, with unit prices for 3D-printed teeth ranging from €0.20 [53] to €0.31 [54], and full models between €0.90 [53] and €3.30 [14], depending on printer type and material used. Similarly, Klink et al. [14] calculated the average material cost for mounting components (e.g., plates and spacers) as only €2.37 per case using fused deposition modeling. Moreover, Garcia-Blanco et al. [28] emphasized that digital 3D printers enable resin-based anatomical models to be produced at approximately one-tenth the cost of conventional simulators. As 3D printing technologies evolve to support multi-material and tissue-mimicking outputs, cost and manufacturing complexity are expected to further decline. Taken together, these developments suggest that 3D-printed educational models offer a cost-effective and scalable solution suitable for integration into preclinical dental education worldwide.

Limitations and future directions

This study has several limitations that should be considered when interpreting the results. First, it was conducted at a single institution with a relatively small sample size, which limits the generalizability of the findings. Future studies should involve more diverse and larger student populations across multiple dental schools to validate and extend these results. Second, although the models were positively received in terms of educational value and realism, the study relied solely on self-reported questionnaire data. No objective performance evaluations, such as expert scoring, inter-rater reliability analysis, or proficiency-based assessments, were included. Incorporating standardized evaluation tools in future studies would enhance methodological rigor. Third, the study did not compare the 3D-printed models to traditional teaching methods. This lack of comparison limits the strength of the conclusions regarding the model’s relative effectiveness. Future research should include comparative analyses against conventional methods to better evaluate the model’s educational impact. Fourth, the models were not benchmarked against real clinical cases or validated simulators, such as extracted teeth or clinical success rates, which limits the verification of the model’s realism and educational efficacy. Benchmarking the model against established clinical practices and simulators in future studies would provide more robust validation. Fifth, although postgraduate student feedback was collected, no evaluations from faculty or clinical experts were included. Incorporating expert feedback and objective scoring rubrics in future studies would provide stronger evidence of the model’s realism and educational utility. Sixth, the models were created based on CBCT data from an 8-year-old patient, and therefore reflect anatomical features specific to that age group. This limits their applicability to broader pediatric populations, as anatomical structures such as mandibular foramen position and nerve pathways vary significantly with age. These models should not be generalized to all pediatric age groups without further validation. Future research should focus on designing and evaluating a range of age-specific models. Additionally, some model components, such as carious lesions and gingival tissue, were manually simulated rather than 3D-printed, due to current technical limitations. While extracted natural teeth have traditionally been used in dental education to provide superior tactile realism, they pose limitations in terms of ethical sourcing, variability, and infection control. In this study, although the printed materials realistically simulated anatomical structures, some postgraduate students reported a lack of tactile authenticity compared to extracted teeth. Enhancing the haptic feedback and optimizing material hardness may enhance the model's tactile realism and overall educational utility. As 3D printing technologies evolve, it may become feasible to fabricate more integrated, multi- material models that mimic both hard and soft tissues with enhanced anatomical and tactile fidelity.

The Formlabs Form 3B printer was selected for its large build volume, material versatility, and suitability for producing high-resolution dental models [26]. Although using Formlabs printers and readily available resins makes this workflow technically accessible to many faculties of dentistry, the production process still requires technical expertise in segmentation and CAD software. These requirements may pose challenges for dental schools without engineering or digital design support. Therefore, interdisciplinary collaboration between dental educators and biomedical engineers will be essential for such educational tools’ broader adoption and standardization [28, 29].

Conclusions

This study demonstrates the effectiveness of 3D-printed educational models in pediatric dentistry for both local anesthesia training and vital pulp treatments. By incorporating patient-specific anatomical details, these models provide a realistic and standardized platform for students to enhance their technical skills and confidence before engaging in clinical practice. As digital fabrication technologies evolve, integrating these models into the curriculum can further improve the quality of dental education and clinical training.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

3D:

Three-dimensional

CBCT:

Cone beam computed tomography

DICOM:

Digital imaging and communications in medicine

STL:

Standard triangulation language

SLA:

Stereolithography

IANB:

Inferior alveolar nerve block

Q:

Question

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