## 4 Discussion  
The study aimed to evaluate the effects of computer-aided simulation on the learning outcomes of students in terms of mandibular movement. The results showed significant improvements when 3D simulation was simultaneously used with the conventional lecture method as a teaching protocol for the determinants of guidance and mandibular movement. Thus, the null hypothesis that including computer-aided simulation in the teaching strategy for occlusion would not influence learning outcomes was rejected. The study compared the actual and expected examination scores to assess the influence of the teaching methods on learning outcomes. The actual score reflected knowledge acquisition, whereas the expected score indicated the students' self-confidence in and expectation regarding learning [14]. The results indicated that students who received the lecture-only-based teaching protocol displayed relatively low estimates of their grade outcomes, which implies that they were unsure about their understanding of the presented knowledge. As such, they may have experienced difficulty in being confident about their level of knowledge acquisition when the complicated spatial relationships of dentition were explained through text and 2D illustration. A learner's confidence in their learning knowledge influences the human cognitive processes related to learning and memory, reasoning, and problem-solving abilities [15]. Previous studies demonstrated that negative expectations and emotions can significantly decrease memorization [16,17]. Meanwhile, including computer-aid simulation in the teaching protocol for mandibular movement increased their expectation about knowledge acquisition. In 3D visualization, the use of computer software and jaw mesh models enabled the reproduction of the setting for guidance and mandibular movement in a virtual space. In this way, students could intuitively identify the relationship between tooth and condylar guidance, and the path of mandibular movement. Not only academic achievement but also confidence in knowledge acquisition was considered to increase through the application of computer-aided visualization. In this study, a significant difference was observed in the academic achievement of students in different groups despite the same 3D simulation being applied to the LtS and LwS groups. The simultaneous application of 3D simulation with conventional lecturing methods led to higher examination scores than when both methods were applied separately. This reaffirms the importance of the timing and arrangement of teaching methods for their educational impact. The simultaneous application of 3D simulation is considered acceptable for dental occlusion teaching, given the dynamic nature of the neuromuscular system in the oral cavity and the diversified functional movements of the mandible. Further experimental studies incorporating a variety of time factors are required. The authors are unaware of previous research using 3D computer image software to simulate mandibular movement for teaching occlusion. Although one study [10] investigated the effects of computer-based 3D simulation on teaching occlusion, the 3D simulation  
Figure 5: Grading of examination scores. was applied to teach occlusal adjustments in centric and eccentric positions in the mandible, and the 3D simulation protocol was not subdivided. The findings of the current study extend the application of computer modeling and design for understanding the spatial movement of the mandible. Lecture-based teaching using textbooks and 2D illustration remains mainstream in dental education. This approach is suitable for conveying core knowledge and concepts, especially to a large audience while maintaining the consistency and quality of education at relatively low costs [18].