Radiology · Medical Literature
Assessment of classification accuracy in endodontics by dental students: a comparative study of holographic imaging and conventional radiography.
Abstract
Dental students must master endodontic anatomy, radiographic diagnostics, and treatment strategies early in their clinical training-yet traditional teaching methods, including two-dimensional radiographs, often fail to effectively convey complex spatial structures. Hologram technology has emerged as a promising tool for three-dimensional visualization in dental education. The aim of the study was to compare the classification accuracy of dental students using holograms versus conventional periapical radiographs in identifying endodontic structures. This randomized single center-controlled trial included 79 dental students (years 4-6). After a calibration seminar and pre-test each of the 79 students assessed six tooth cases-three presented as holograms and three as periapical radiographs. Holograms were created from cone-beam computed tomography data, annotated by two calibrated examiners to establish reference points regarding the number of canals, Vertucci classification, and treatment complexity. Students evaluated each case for these parameters; responses were compared to the reference points to assess classification accuracy. The final evaluation form captured their subjective perceptions of the new hologram system. Primary binary outcomes were analyzed using logistic mixed-effects models. P-values were adjusted for multiple testing using the Benjamini-Hochberg procedure. Statistical significance was set at p < 0.05. After Benjamini-Hochberg correction, holography significantly improved root-canal number identification in three multi-rooted cases (adjusted p ≤ 0.007). For Vertucci classification, only the maxillary anterior tooth remained significant (adjusted p = 0.044). Treatment-complexity assessment showed case-dependent results, favoring radiography in two cases (adjusted p = 0.045 and p = 0.006) and holography in one case (adjusted p = 0.013). Holographic visualization demonstrated case- and task-specific effects in endodontic training. Holograms were able to improve classification accuracy in certain endodontic tasks. However, they did not outperform conventional periapical radiographs in all outcomes. Holography could be an effective, supplementary tool for teaching certain endodontic tasks, but its application requires further investigation. The study was prospectively registered in the German Clinical Trials Register (DRKS-ID: DRKS00035000) on 13.09.2024.
Clinical relevance
Traditional two-dimensional periapical radiography remains the standard for teaching endodontic anatomy, yet it inadequately conveys complex three-dimensional canal morphology to novice clinicians, contributing to diagnostic errors early in training. This randomized controlled trial addresses a critical pedagogical gap by evaluating whether holographic imaging derived from CBCT data can improve dental students' classification accuracy for endodontic structures. As hologram technology becomes increasingly accessible in academic dental centers, educators and program directors need evidence-based guidance on when and how to integrate it into preclinical and clinical curricula.
Key findings
1. Holographic visualization significantly improved root-canal number identification in three multi-rooted tooth cases compared to conventional periapical radiography (adjusted p ≤ 0.007 after Benjamini-Hochberg correction for multiple comparisons). 2. For Vertucci classification accuracy, holography demonstrated a statistically significant advantage only in the maxillary anterior tooth case (adjusted p = 0.044); no significant benefit was observed in remaining cases after correction. 3. Treatment-complexity assessment was case-dependent: conventional periapical radiography outperformed holography in two cases (adjusted p = 0.045 and p = 0.006), while holography was superior in one case (adjusted p = 0.013). 4. The study enrolled 79 dental students in years 4–6 in a randomized single-center controlled trial, with each student evaluating six tooth cases (three per modality), providing a within-subject comparative design with logistic mixed-effects modeling. 5. Holograms were constructed from cone-beam computed tomography (CBCT) data and annotated by two calibrated examiners to establish reference standards for canal number, Vertucci classification, and treatment complexity. 6. Holography did not demonstrate uniform superiority over conventional radiography across all outcomes or all tooth types, indicating that its educational benefit is task-specific and case-specific rather than globally generalizable.
Practice implications
Dental educators should consider incorporating holographic imaging derived from CBCT data as a supplementary—rather than replacement—tool in endodontic training, particularly for multi-rooted tooth cases where three-dimensional canal number identification is the learning objective. Holography should not be substituted for conventional periapical radiograph interpretation training, especially for treatment-complexity assessment, where radiography retained equivalent or superior performance in the majority of cases. Future curriculum integration should be selective and task-targeted, and further multicenter trials with larger cohorts are warranted before broad implementation can be recommended.