Self-Perceived Competence and Self-Efficacy Following a Sequential Preclinical Endodontic Curriculum Combining Haptic Virtual Reality Simulation and Extracted Natural Teeth for Access Cavity Preparation: A Prospective Cohort Study.

AIM: To evaluate changes in undergraduate dental students' self-perceived competence and post-training self-efficacy in endodontic access cavity preparation following implementation of a revised preclinical course incorporating haptic virtual reality simulation (HVRS) prior to training on extracted human teeth (NT). METHODOLOGY: This prospective cohort study was conducted during the 2025-2026 academic year at ACTA. All fourth-year undergraduate dental students enrolled in the preclinical endodontics course completed a baseline questionnaire assessing self-perceived competence before HVRS training, using the Simodont dental trainer, during which students performed access cavity preparations on six virtual tooth types. Subsequently, students performed complete root canal treatments on NT mounted in simulated clinical conditions. Self-perceived competence was reassessed after completion of the training sequence, together with students' perceptions of both training modalities. Self-efficacy was measured at the end of the training using an adapted Endodontic General Self-Efficacy Scale. Pre-post differences in self-perceived competence were analysed using the Wilcoxon signed-rank test and correlations using Spearman's rank correlation coefficient, with Benjamini-Hochberg correction for multiple comparisons. Statistical significance was set at p < 0.05. RESULTS: The response rate was 100% (n = 86). Self-perceived competence scores increased significantly from a median of 17 (IQR 15-19) at baseline to 22 (IQR 20-24) after completion of the combined training sequence (Z = -7.47, p < 0.001, r = 0.81). The mean post-training self-efficacy score was 28.4 ± 4.1. Both training modalities were rated positively, although NT training was perceived as more effective than HVRS (median 4 vs. 3; Z = -7.62, p < 0.001, r = 0.82), with 84.9% of students favouring NT and none favouring HVRS. Self-efficacy showed a moderate positive correlation with post-training self-perceived competence (ρ = 0.62, 95% CI 0.48-0.74, p < 0.001). CONCLUSIONS: A preclinical curriculum where HVRS was combined with training on extracted human teeth was associated with significant improvements in students' self-perceived competence and fair levels of post-training self-efficacy in endodontic access cavity preparation. The students stated that both HVRS and training on NT contributed to their skills development in preparing endodontic access. The combination may have a cumulative effect on the students' preparedness for clinical training.