Does 3D simulation impact clinical reasoning for orthodontic treatment planning of impacted maxillary canines?

Clinical reasoning is an essential competence to develop in the diagnosis and treatment planning of impacted maxillary canines to ensure good treatment outcomes. It involves skills of radiographic interpretation and mental visualization. To master these, postgraduate students learn to interpret 2D and 3D X-rays to locate these canines accurately. This process demands the creation of mental models of the impaction and resolving it either by envisioning the canine's movement to its correct position or considering its removal. To facilitate this cognitive exercise, a 3D-printed simulator, derived from Cone Beam Computed Tomography scans, serves as a tool to allow students to experiment with various movement simulations, helping them select the most viable treatment approach.This project aimed to assess the differences in expert and novice orthodontists’ clinical reasoning for impacted maxillary canines, and whether the addition of a 3D simulator would affect their reasoning. Thirteen (13) novices randomly assigned to a control and intervention group and three (3) experts took part in a Think-Aloud exercise to diagnose and treatment plan a case of bilaterally impacted maxillary canines. Experts and intervention group novices had the 3D simulator in addition to standardized patient records. Their responses were recorded and analyzed according to a coding scheme reflecting the clinical reasoning process. While experts demonstrated quick clinical judgment and found the 3D simulator redundant, novices were more uncertain and required additional cues. Novices using the 3D simulator described more elaborate treatment plans and had increased awareness of potential complications as compared to the control group.