A comparative study of standard and virtual reality training for traditional and minimal endodontic access cavity preparation

Background: Minimally invasive endodontics (MIE) emphasizes tooth preservation through conservative access designs such as the Conservative Access Cavity (ConsAC), which enhance fracture resistance but increase procedural difficulty and error risk. While phantom-head training is effective yet resource-intensive, virtual reality (VR) simulators provide cost-efficient, reusable, and feedback-driven training. This study aimed to evaluate the learning effectiveness of VR-based versus standard training for TradAC and MIECs. Method: Thirty fourth-year dental students were randomly assigned to either the standard training group (n = 15) or the VR-based training group (n = 15). All participants completed a pre-training assessment on a plastic maxillary first molar (Nissin B22X-26 Endo Typodont, Japan) using both TradAC and ConsAC techniques. Outcome measures included percentage of tooth volume loss, error scores, and preparation time. Data were analyzed using Wilcoxon signed-rank tests and split-plot ANOVA Result: Thirty dental students completed the study with almost perfect inter-examiner agreement (κ = 0.924, p < .001). Both standard and VR-based training significantly improved performance in terms of reduced tooth volume loss, lower error scores, and shorter preparation times (p < .05). ConsAC consistently resulted in less dentine and enamel removal compared with TradAC, regardless of training modality. Split-plot ANOVA confirmed that access cavity design exerted a stronger influence on performance than training method, with training modality showing limited effects except on preparation time. Conclusion: Both standard and VR training improved performance in endodontic access cavity preparation. Standard training showed a trend toward greater efficiency through shorter preparation times, while VR offered comparable accuracy in a safe environment. Access cavity design had a greater impact than training method, highlighting the value of conservative designs. VR represents a valuable adjunct to conventional training for enhancing technical accuracy in endodontic education.