Assessment of Knowledge and Attitudes Toward Digital Dentistry among Final-Year Dental Students in Southeast Iran: A Cross-Sectional StudyABSTRACT
Objective: To evaluate the knowledge and attitudes of final-year dental students in Southeast Iran regarding digital dentistry.
Material and Methods: This cross-sectional descriptive study surveyed 81 final-year dental students from Kerman and Rafsanjan using a valid questionnaire that included demographic data and questions assessing their awareness and attitudes toward digital dentistry. Statistical analyses were performed using SPSS software.
Results: 51.9% of participants were male, with mean knowledge and attitude scores of 24.56 ± 14.49 and 63.95 ± 23.11, respectively. Alarmingly, 80.2% exhibited weak knowledge, while only 38.3% had a positive attitude towards digital dentistry. No significant gender differences were found; however, students from Kerman showed higher knowledge levels, and those with greater knowledge tended to have more positive attitudes.
Conclusion: Given the increasing importance of digital technology in dental treatment, educational curricula should incorporate more content related to digital dentistry to prepare future practitioners for better modern practices.
Keywords:
Knowledge; Attitude; Digital Technology; Students; Education, Dental
Introduction
The significant growth of digital technologies in recent years has led to a crucial role for them in advanced dentistry [1]. Constantly evolving modern methods aim to deliver innovative products and systems that meet the highest standards of quality and excellence. These advancements facilitate the achievement of complete clinical restorations with high biocompatibility, minimal secondary reactions, exceptional esthetics, and improved collaboration between dentists and dental laboratories [2-4]. Digital dentistry holds the potential to make significant contributions to preventive dentistry, public health, and dental education [5].
Computer-aided design and manufacturing (CAD-CAM) technology has advanced significantly in recent years, with applications in dentistry, including new techniques for oral rehabilitation programs. These techniques differ from conventional analog methods in terms of casting (e.g., conventional castings vs. intraoral scanning) and the design and manufacture of restorations (e.g., traditional waxing vs. CAD-CAM). Digital workflows offer several general advantages, including faster treatment times, shorter appointments, reduced patient discomfort, the elimination of plaster models, and improved predictability [6]. The digital way of working, from diagnosis to final treatment provision, has been widely adopted by dental professionals [7].
In just one day, patients can receive inlays, onlays, and crowns, resulting in increased patient satisfaction [8]. Likewise, the entire process for removable prostheses achieves similar success compared to traditional methods [9]. The integration of CBC and 3D printing technology has significantly enhanced the precision and quality control of various dental procedures [10]. CBCT is utilized before dental implant surgery to assess bone volume and anatomical landmarks [11] accurately, and custom surgical guides are created to ensure the precise placement of dental implants for optimal prosthetic function [12]. Additionally, these surgical guides can aid in diagnosing blocked canals, performing root microsurgery, and guiding grafting procedures, marking a significant advancement in the field of dentistry [13].
Furthermore, the use of digital technology enables the development of clear aligners, specialized devices, and retainers in orthodontics, resulting in improved precision, reduced treatment duration, and enhanced predictability of the device [14]. In the field of maxillofacial surgery, digital technology plays a crucial role in creating custom implants for patients, producing surgical guides, and addressing skeletal reconstruction needs [15]. The impact of digitization on dental education is evident, with a focus on e-learning and web-based knowledge transfer. Additionally, digitization is involved in diagnosis through 3D imaging and digital radiography, as well as practical training in dental simulator motor skills, which includes the use of 3D printed intraoral scanners, prototyping, and digital surface mapping [16].
The reason for not using digital dentistry in 55.6% of UK dentists was the high cost [17]. In the study by Nayakar et al. [18], 96.7% of the participants were aware of CAD/CAM technology in dentistry, and 87% believed that lack of knowledge was one of the consequences of not using CAD/CAM. In Kumar et al. [19] study, 74% of dental students were unaware of the materials used to make CAD-CAM prostheses.
Results from a study in Egypt by Hall et al. [20] indicated that around half of the participants had an average level of knowledge and awareness, with prosthodontists, periodontists, and restorative dentists exhibiting significantly higher knowledge compared to general dentists. In a study conducted in Saudi Arabia by Al-Ibrahim et al. [21], it was found that 98.5% of students believed digital dentistry enhances the quality of dental procedures, and 94.7% thought it would eventually replace traditional dental services. Furthermore, a study involving US dental students revealed that most of them value CAD/CAM technology, consider it the future of dentistry, and believe it will enhance their skills as dentists [22]. The study conducted by Sri et al. [23] revealed that 95.3% of participants were aware of digital prostheses, whereas the study by Acharya et al. [24] reported a 98.9% awareness of digital technology.
The field of dentistry is experiencing a significant digital transformation, making it essential to integrate digital techniques into dental education as a core component of contemporary learning. Future dentists must develop a robust understanding of these emerging technologies to enhance their clinical skills and improve patient outcomes. As digital dentistry evolves, it influences various aspects of dental practice, including diagnostic accuracy, treatment planning, and patient communication —crucial elements in modern dental care.
Previous research has revealed inconsistencies in the awareness and knowledge of digital dentistry among dental students, indicating a critical gap that necessitates targeted educational interventions. This study aims to evaluate the understanding and attitudes of final-year dental students in Rafsanjan and Kerman, located in southeast Iran, regarding digital dentistry. By identifying potential deficiencies in current dental education, the findings can provide valuable insights for educators to enhance curricula and training programs. Ultimately, this research seeks to ensure that future dentists are well-equipped to navigate the digital landscape of dentistry effectively.
Material and Methods
Study Design and Sample
This descriptive cross-sectional study was conducted among final-year dental students at the Kerman and Rafsanjan faculties, selected through a census sampling method. Following the acquisition of the required permits, a final-year dental student, who had been thoroughly briefed on the research and trained for this specific task, presented the project.
Data Collection
The questionnaire was then distributed, and it took approximately 8-10 minutes to complete. The questionnaire consisted of three sections: 1) Demographic Information: This included gender, university of study, participation in dental familiarization courses, and willingness to participate in such classes; 2) Knowledge Questions: This section included 10 multiple-choice questions; and 3) Attitude Questions: This section also included 10 questions.
The researcher developed the questionnaire based on similar studies [20,21]. The questionnaire was prepared based on similar articles. To determine its validity, the document was provided to five experts in restorative dentistry, dental prosthetics, orthodontics, and epidemiology. To measure the validity of the content, options such as completely suitable, suitable, no opinion, unsuitable, and completely unsuitable were provided in front of all the questions. Content validity was assessed for each question, and any questions deemed inappropriate or unnecessary by the expert panel were removed. Their feedback was incorporated into the questionnaire, resulting in the approval of 10 questions. The validity coefficient of the entire questionnaire was calculated to be 0.93. To determine reliability, the test-retest method was employed. The questionnaire was administered to 10 final-year students, who completed it and then repeated the process 10 days later. The reliability coefficient of the questionnaire, based on these two rounds of answering, was calculated to be 0.89.
Scoring for the questionnaire was as follows: The knowledge section comprised 10 multiple-choice questions, with a score of zero assigned to the response "I don't know." Each correct answer received a score of one, resulting in a total awareness score range of 0 to 10. For the attitude questions, all questions except question 3 were positively framed. Scores were assigned as follows: "I agree" received a score of 1, while "I have no opinion" and "I disagree" received a score of 0. Therefore, the range of attitude scores was between 0 and 10. Data analysis was performed using SPSS version 25, employing descriptive statistics (mean and standard deviation) and analytical statistics, including Pearson's correlation, T-tests, and linear regression using the backward method. A significance level of 0.05 was considered.
Ethical Considerations
Verbal consent was obtained from all participants before their inclusion in the study. Participation was voluntary, and participants could withdraw from the study at any time. If desired, participants were provided with the correct answers to the knowledge questions. This project was approved by the Ethics Committee of Kerman University of Medical Sciences under code IR.KMU.1403.051.
Results
A total of 81 participants with an average age of 24.1 ± 1.68 years took part in this study. Among them, 42 participants (51.9%) were male, and 39 participants (48.1%) were female. Notably, 73 participants (90.1%) reported having heard about digital dentistry. The primary source of information for 64 participants (87.7%) was the Internet. Additionally, 78 participants (96.3%) had not attended workshops related to digital dentistry, while 68 participants (84%) expressed a desire to participate in such workshops (Table 1).
The frequency of responses to the knowledge questions is as follows: 72.8% (n=59) indicated that digital dentistry is only helpful at the bedside; 74.1% (n=60) stated that digital dentistry is primarily used for making crowns and bridges; 60.9% (n=49) selected digital molding as the preferred method for using CAD-CAM technology. Regarding the benefits of CAD-CAM, 37.0% (n=30) did not know, while 34.6% (n=28) mentioned time reduction as a benefit. A total of 46.9% (n=38) were unaware of the materials used in CAD-CAM; 56.8% (n=46) recognized that CAD-CAM facilitates work scheduling and improves communication with laboratories.
When asked about the types of prostheses made using CAD-CAM, 53.1% (n=43) identified fixed prostheses, while 45.7% (n=37) did not know. In response to the materials used in 3D printing technology, 19.8% (n=16) mentioned ceramics, whereas 75.3% (n=61) were unaware of the materials used in 3D printing. When asked about the types of prostheses manufactured using 3D printing technology, 52.9% (n=42) identified fixed prostheses, while 45.7% (n=37) did not know. Among the disadvantages of CAD-CAM, 85.2% (n=69) cited high costs.
The responses to the attitude questions are summarized in Table 2. Notably, 97.5% of participants agreed on the usefulness of digital technology in dentistry, and 93.8% acknowledged the positive impact of digital dentistry on the dental profession. Additionally, 51.9% believed that the predictability of treatment outcomes is higher in digital dentistry.
Total awareness scores ranged from 0 to 47, categorized as follows: scores of 0-15 indicated weak awareness, scores of 16-31 indicated average awareness, and scores of 32-47 indicated high awareness. Attitude scores ranged from 0 to 10, with scores of 0-3 indicating a negative attitude, 4-7 indicating a moderate attitude, and 8-10 indicating a good attitude. Notably, good awareness was not observed, as 80.2% of participants demonstrated poor awareness. Conversely, 51.9% exhibited an average attitude (Figure 1).
The mean and standard deviation of the knowledge and attitude scores were 24.56 ± 14.49 and 63.95 ± 23.11, respectively. Table 3 presents the mean and standard deviation of knowledge and attitudes regarding demographic variables. Students from Kerman University demonstrated significantly higher knowledge levels.
A statistically significant relationship was observed between familiarity with digital dentistry and the desire to participate in related workshops, with a more positive attitude noted in those who were familiar with digital dentistry. The ANOVA test did not reveal a significant relationship between the sources of knowledge and the variables of knowledge (p = 0.092) and attitude (p = 0.224). Multivariate analysis using backward linear regression indicated that as attitude scores increased, so did knowledge scores, particularly among students from Kerman University (Table 4).
Discussion
Dental education, like other academic fields, has undergone significant changes, and incorporating digital methods into dental education is an essential part of modern education.
In the current study, the participants' knowledge of digital dentistry was found to be insufficient. 18.5% had average knowledge. Kerman University students had significantly more knowledge. This finding is inconsistent with the findings of Hall et al. [20], in which approximately half of the dentists demonstrated average knowledge. The reason for this difference can be seen in the study population, as Hall et al. [20] studied dentists and specialists, who naturally possess more knowledge. Additionally, this finding is inconsistent with Al-Ibrahim et al. [21], which suggests that dental interns have high knowledge. The reason for this difference may be the students in this study's access to digital dental tools and devices in Saudi Arabian colleges.
A total of 38.3% of participants had a positive attitude towards digital dentistry. A positive and significant relationship was observed between people's attitude and knowledge. A previous study developed by Hall et al. [20] showed that about three-quarters of the participants had a positive attitude towards digital dentistry. Additionally, Schlenz et al. [25] found that dental students had a positive attitude towards the implementation of digital dentistry in their educational curriculum. Another research revealed the general attitude of students toward digital dentistry [22]. Additionally, Nassani et al. [26] found that Saudi dentists have a high level of satisfaction and a positive attitude towards the use and results of CAD/CAM technology in dental clinical work.
The average scores for knowledge and attitude were lower among female students, although this difference was not statistically significant. This finding is inconsistent with the results of Hall et al. [20], which found that female dentists had significantly lower knowledge. The reason for this difference may be that the training of male and female students was the same in the current study. Since these students had no prior experience and were not employed, no significant difference was observed in their knowledge. Furthermore, this finding differs from that reported by Al-Ibrahim et al. [21], who demonstrated that female interns possess significantly more knowledge.
In the current study, people who were aware of digital dentistry had a significantly more positive attitude. This suggests that with increased knowledge, the attitude becomes increasingly positive. This finding aligns with the study by Sheba et al. [27], which found a significant relationship between the intention to use technology in the future and higher knowledge scores and attitudes.
The knowledge of Kerman University students was significantly higher. The reason for this could be that Kerman is the capital of the province, and the university is larger and older, with most scientific and retraining seminars held in this faculty, providing students with more opportunities to participate. They may have gained more knowledge during these scientific events. Furthermore, the Kerman faculty has specialized departments where students can gain knowledge from assistants in specific fields.
The percentage of knowledge among the participating students was 24.56%, which is significantly lower compared to the survey by Acharya et al. [24]. The reason for this may be the difference in the study population. We found that 72.8% of respondents reported that digital dentistry is useful in clinical work. In Al-Ibrahim's study [21] in Saudi Arabia, 89.3% of respondents reported that digital dentistry is useful in diagnosis, which is consistent with the current research.
In this study, 85.2% mentioned the shortcomings of using CAD-CAM, such as high cost, which is in agreement with Nah's [28] study, in which the most common reason for not using CAD/CAM was the high cost of equipment and the lack of this technology in the workplace.
Preliminary research developed by Sri et al. [23] showed that the high cost was cited as the reason dentists did not use digital prostheses. The study by Nayakar et al. [18] in India showed that 96.7% of respondents were aware of CAD/CAM technology in dentistry, and 87% believed that a lack of knowledge was one of the consequences of not using CAD-CAM, rather than its high cost.
Our results showed that 34.6% mentioned the reduction of time spent in the office as one of the benefits of CAD-CAM [6]. Furthermore, 75.3% of participants were unaware of the materials used to make CAD-CAM prostheses, which is consistent with a study by Kumar et al. [19] in which 74% of dental students reported a similar lack of knowledge.
We observed that 60 people (74.1%) mentioned that digital dentistry is used to make crown bridges. Considering that digital technology enables the creation of clear aligners, special appliances, and retainers in orthodontics, which improves accuracy and overall treatment time, and increases the predictability of the device [29]. In the field of maxillofacial surgery, patient-specific implants, surgical guides, and skeletal reconstruction [30] are among the applications of digital technology in dentistry, as are smile design [20] and implant abutment design [31]. However, students' awareness of this matter is insufficient.
Our findings reveal that 64.2% of students believed that digital dentistry provides more accurate results than conventional dentistry. Compared to the research of Sharab et al. [32], 93.8% of students believed that digital dentistry provides more accurate results than conventional dentistry. Offers do not match and are less. Additionally, 86.4% of the participants believed that digital technology helps dental technicians. In the study by Sharab et al. [32], 42.4% of the participants believed that digital technology increases the efficiency of laboratory work.
In the current study, 59.3% of people believed that digital dentistry reduces treatment time compared to conventional treatments. In the study by Diaconu-Popa et al. [33], 97% of the respondents reported that digital technologies are helpful for most aspects of dental practice, primarily due to the significant reduction in work steps. This is achieved by increasing the sharing of patient information, reducing the number of appointments, minimizing the risk of errors, and reducing material waste.
Finally, 56.8% of people said that digital dentistry improves the quality of treatment compared to conventional treatments. Al-Ibrahim et al. [21] found that in Saudi Arabia, 98.5% of respondents believed that digital dentistry improves the quality of dental procedures.
It is important to note that since the questionnaire was self-reported by the participants, some responses may not accurately reflect reality, which is beyond the researcher's control. This study stands out as one of the few investigations conducted on the knowledge and attitudes of students regarding digital dentistry, and it is the only one of its kind in Iran. The findings from this research can serve as a foundation for more extensive studies in this area.
Conclusion
The final year students have a limited understanding of digital dentistry. Most individuals exhibited a moderately positive attitude towards it. There was no statistically significant difference in attitude and awareness based on gender. However, individuals with greater awareness demonstrated a significantly more positive attitude. Notably, students at Kerman Faculty of Dentistry showed considerably higher levels of awareness. Given the growing importance of digital technologies in dental treatment and diagnosis, it is advisable to implement courses on digital dentistry in the general dentistry curriculum.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Edited by
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Academic Editor:
Alidianne Fábia Cabral Cavalcanti
