# A Review of Training and Guidance Systems in Medical Surgery
## 3 Methods
### Synthesis of the Selected Works
#### 3.8.2 Dentistry  
TEL techniques have been gaining terrain in all fields of science, where simulators and collaborative environment can be appointed as its most representative approaches. In dentistry, dental cavities treatment is one of the most common procedures that dentists face. Therefore, [PERSON] and [PERSON] implemented a collaborative simulator with guidance [55]. The simulator was created using IntelligentBox, a framework previously developed by the authors [114]. In this dental simulator, actionssuch as drilling and touch were programmed. The simulator uses a Geomagic Touch haptic device to provide force feedback. Collaborative training is deployed thanks to modules called _RoomBoxes_, which share user-operations between simulators. In this mode, the simulator is continuously collecting and propagating actions to other _RoomBoxes_. This feature lets the simulator apply all activities in the simulator at the moment they occur, enabling a user to proceed with real-time guidance and collaboration in a procedure. Even though collaborative techniques guide training, they still need a user's presence, which can range from a resident to an expert. In the case of students, they still lack expertise during tasks, and for doctors, this type of approach is time-consuming. Consequently, researches should focus on developing automated or computer-assisted resources to provide quality and feasible training in education. Another simulator found in this area is the one described by [PERSON] et al. [56]. They created a haptic-enabled virtual simulator called Orthognathic Surgery System (OSSys). OSSys can be used for training, evaluation, or even planning of orthognathic procedures. The system displays three types of visualization--2D, 2.5D, and 3D. The simulator was developed using Microsoft Foundation Classes (MFC) of Visual Studio 2010, the Visualization Toolkit libraries (VTK) for graphical rendering, and the H3 DAPI for haptic rendering. In this study, a Falcon, manufactured by Novint Technologies, or a Geomagic Touch haptic device can be used. For planning, OSSys calculates the distance between user-defined markers, which helps surgeons to generate a possible layout of the procedure. It also provides orthogonal views to consider all possible angles in the surgery. On the other hand, a simulation of six procedures was implemented for training, and evaluation reports are given as feedback. The reports are generated using the completed task times, and the Steiner methodology [115]. On dentistry, CA techniques are also found in the area of implantology [48]. [PERSON] et al. used a CA system for edentulous maxilla implantology. The test subject in this study was a 78 years old man. The CA system Simplant was used. It is developed by DENTSPLY Implants. Impressions of the maxilla and mandible were made. Implant planning, position, and angles were calculated by the software considering the final position of the titanium bar. This data was transferred to a master model, and the authors proceeded with the implantology. During operation, only minimal corrections were needed to achieve complete contact. Post-implantology results showed a mean apical deviation of 2.31 mm and a mean angular deviation of 3.72 degrees. This approach also provided an immediate rehabilitation of the mandible and maxilla on the same day of the surgery. On the virtual simulations side, [PERSON] et at. evaluated a ceramic crown preparation training system developed by Affiliated Stomatological Hospital of Nanjing Medical University, the Virtual Learning Network Platform [57]. The simulator provides visual aids for the user to understand the procedure (operational essentials, pre-defined criteria, and videos). Moreover, the system provides guidance using the Real-time Dental Training and Evaluation System (RDTES) and collects learning data to assess users' performance [116]. Fifty-seven dental students participated in this study, and results showed that there was a significant improvement in their clinical skills. Lastly, [PERSON] et al.