Abstract
Objective
This study explored the potential of industrial- and medical-grade silicone phantoms as alternatives to animal models for surgical laser training in dental students.
Methods
Tongue molds with exophytic lesions were created using 3D-printed polylactic acid molds. Industrial-grade and medical-grade silicone were injected into the molds to create two distinct educational models. Forty-five sixth-year dental students participated in the study. Students first practiced with an 810-nm diode laser on a sheep tongue and then resected the lesions on the silicone models. Afterwards, they completed a questionnaire evaluating the effectiveness of silicone phantoms in surgical laser training. Data were analyzed using Kendall’s Tau and paired samples t-tests, with significance set at P < 0.05.
Results
There was no significant difference between the silicone models in terms of design and construction (P = 0.195), learners’ experience of lesion removal (P = 0.790), or effectiveness in teaching laser courses (P = 0.083). However, the medical-grade silicone was significantly more similar to animal tissues in texture (P < 0.001). Furthermore, working with the diode laser on the medical silicone phantom better simulated working on animal specimens compared to the industrial silicone phantom (P = 0.007). The overall score of the questionnaire was also in favor of medical-grade silicone (P = 0.039).
Conclusions
Both industrial- and medical-grade silicone phantoms were effective for training dental students in surgical laser applications. However, the medical-grade silicone provided a more realistic training experience and was closer in texture to animal tissue, making it a superior training model for dental students.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-026-08791-x.
Keywords: 3D printing, Dental education, Dental models, Fused deposition modelling, Hands-on-learning, Lasers, Polylactic acid, Questionnaires, Silicones, Simulation training
Introduction
The introduction of laser technology in the 1960s has led to extensive research exploring its various applications in daily dental practice [1–3]. Laser-assisted techniques have proven particularly valuable in soft tissue surgeries [4, 5], such as the removal of exophytic lesions [6, 7]. The use of lasers for soft tissue surgery offers several advantages, including reduced procedural time, limited intraoperative bleeding, a lower risk of infection, greater patient comfort, and an improved healing process compared to conventional scalpel surgery [6, 7]. While these advantages make lasers an effective tool in dental surgery, performing medical interventions with this sophisticated tool carries a certain level of risk, requiring thorough education before clinical use. For new practitioners, gaining experience is essential for developing competence, establishing a strong learning curve, and minimizing complications. This highlights the need for comprehensive training to ensure the safe and effective use of laser technology by dental students.
Conventionally, laser training in dentistry has relied on animal specimens, such as bovine or sheep tongues. These specimens offer a relatively realistic experience, but they also present several challenges, including ethical concerns, the risk of zoonotic disease transmission, and anatomical differences between animal and human tissues [8–10]. Using human cadavers for this purpose is costly, requires dedicated facilities, involves lengthy preparation, and carries a risk of contamination [9, 11]. To address these challenges, simulation-based training with phantom models has gained interest in medical and dental education. These training models can serve as a practical alternative to animal specimens, cadavers, and even the traditional master-apprentice model, where students practice skills directly on patients under the supervision of experienced clinicians. Phantoms alleviate ethical concerns and provide a controlled environment for developing technical skills, which can then be applied to real patient scenarios [12–14].
Recent advancements in 3D printing, particularly using materials such as silicone and polyvinyl alcohol (PVA), have enabled the production of training models that closely replicate the mechanical properties of human soft tissues. Silicones are versatile materials used in various industries due to their unique properties, including heat resistance, chemical stability, and flexibility. Different grades of silicone, including medical and industrial grades, are available on the market, each with distinct characteristics, performance levels, and regulatory requirements.
Industrial-grade silicones are cost-effective, durable, and easy to handle, making them suitable for general-purpose applications where strict regulatory compliance is not required [15]. However, they have lower purity and may degrade under environmental stressors, such as UV light or chemical exposure. In contrast, medical-grade silicones are formulated especially for healthcare use, offering superior biocompatibility [15], more realistic simulation of human tissues, and non-toxicity when exposed to laser energy [16]. These properties may make them safer for medical training and experimental procedures, although their higher cost reflects the additional manufacturing and quality control requirements.
In this study, two silicone-based phantoms (industrial-grade and medical-grade) were developed using molds made with 3D printing technology. The study aimed to assess the effectiveness of industrial- and medical-grade silicone phantoms as alternatives to animal models for dental students’ surgical laser training.
Materials and methods
Study design and ethical considerations
This was a cross-sectional survey-based study. The study protocol was approved by the ethics committee of Mashhad University of Medical Sciences (code: 1398.071IR.MUMS.DENTISTRY). The procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki. All participants were informed of the research goals and provided informed consent.
Participant selection
The study included 45 sixth-year dental students at Mashhad University of Medical Sciences who enrolled in the “Clinical applications of lasers” course. The study was performed at the Laser Unit of the Faculty of Dentistry from September 2021 to January 2022. Subjects who were unwilling to participate or unable to complete the training were excluded from the study.
3D Modeling and printing
A 3D tongue mold with three exophytic lesions was designed using Maya 2019.2 software (Autodesk, USA). The completed 3D model was exported in STL format and converted to G-code using Cura software (Ultimaker, Netherlands) to ensure compatibility with fused deposition modeling (FDM) 3D printers. FDM is an extrusion-based 3D printing technique in which thermoplastic filaments, like polylactic acid (PLA), are extruded through a heated printer head and form structures layer by layer [17]. The nozzle’s movement is guided by computer-controlled motors following the G-code instructions to create the desired shape [18].
In this study, the PLA mold was printed using a Creality Ender 3 printer (Creality 3D, China). The main printing parameters were: layer height of 0.2 mm, nozzle diameter of 0.4 mm, print speed of 50–60 mm/s, and 20% infill density. After printing, the molds were cleaned and lightly sanded using progressively finer grits (220 followed by 400) to reduce layer ridges. They were then wiped with isopropyl alcohol and allowed to dry completely.
Two types of silicone were used in this study: industrial-grade RTV-2 (PMP, Tehran, Iran) and medical-grade FLEX (PMP, Tehran, Iran). Red dye was added to mimic the color of a natural tongue (Figs. 1 and 2). A thin layer of Vaseline was applied to the inner surfaces of the cavities.
Fig. 1.
The industrial-grade silicone tongue phantom used in this study
Fig. 2.
The medical-grade silicone tongue phantom used in this study
before each silicone pour to facilitate demolding. The silicone base and catalyst were mixed according to the manufacturer’s ratio and poured slowly from the lowest point of the mold, allowing gravity to fill the cavities. Vents were included to prevent air bubbles from forming. Curing was done at room temperature (25 °C) for five hours. No heat curing was applied, as PLA is susceptible to deformation at around 60 °C [19].
After curing, the phantoms were carefully demolded, trimmed, and inspected. The release agent (Vaseline) was reapplied before subsequent pours. Each mold was reused multiple times until visible signs of wear appeared. Overall, two molds were sufficient to produce 30 phantoms, with 15 made from industrial-grade silicone and 15 from medical-grade silicone.
Each phantom contained three lesions, resulting in a total of 45 lesions in the medical-grade silicone phantoms and 45 lesions in the industrial-grade silicone phantoms. Three students shared one phantom of each type, with each student removing one lesion from each phantom.
Questionnaire design
A questionnaire was designed to gather participant feedback on the silicone models compared to the animal model and to identify any differences between the medical and industrial silicone models for laser training of dental students. Table 1 presents the questionnaire used in this study. The validity of the questionnaire was established using the Content Validity Index (CVI), where items with a score greater than 0.79 were considered relevant. All included questions received a score above 0.79, with a mean CVI of 0.86.
Table 1.
Frequency (N) and percentage (%) of Likert-scale responses and overall score of the questionnaire (Mean ± SD) from dental students for both medical- and industrial-grade silicone phantoms
| Questions | Type of silicone | Likert scales N (%) | P-value | ||||
|---|---|---|---|---|---|---|---|
| Excellent = 5 | Good = 4 | Average = 3 | Poor = 2 | No opinion = 1 | |||
| 1- How do you evaluate the tongue phantom’s design and construction? | Medical | 10 (22.2) | 27 (60.0) | 8 (17.8) | 0 (0) | 0 (0) | 0.195 |
| Industrial | 7 (15.6) | 25 (55.6) | 13 (28.9) | 0 (0) | 0 (0) | ||
| 2- How do you evaluate the similarity of the tongue phantom to the animal specimen in terms of texture and consistency? | Medical | 6 (13.3) | 33 (73.3) | 6 (13.3) | 0 (0) | 0 (0) | < 0.001 |
| Industrial | 4 (8.9) | 17 (37.8) | 14 (31.1) | 9 (20.0) | 1 (2.2) | ||
| 3- How do you evaluate the similarity of working with the diode laser on the phantom to working with the diode laser on the animal specimen? | Medical | 8 (17.8) | 24 (53.3) | 12 (26.7) | 1 (2.2) | 0 (0) | 0.007 |
| Industrial | 6 (13.3) | 13 (28.9) | 17 (37.8) | 8 (17.8) | 1 (2.2) | ||
| 4- Please rate your experience of lesion removal on phantoms using the diode laser. | Medical | 13 (28.9) | 24 (53.3) | 8 (17.8) | 0 (0) | 0 (0) | 0.790 |
| Industrial | 15 (33.3) | 19 (42.2) | 6 (13.3) | 5 (11.1) | 0 (0) | ||
| 5- Please rate your opinion on the effectiveness of phantoms for teaching and evaluating students in laser courses. | Medical | 17 (37.8) | 20 (44.4) | 6 (13.3) | 1 (2.2) | 1 (2.2) | 0.083 |
| Industrial | 13 (28.9) | 14 (31.1) | 16 (35.6) | 1 (2.2) | 1 (2.2) | ||
| Overall questionnaire score (Mean ± SD) | Medical | 4.03 ± 0.70 | 0.039 | ||||
| Industrial | 3.66 ± 0.96 | ||||||
Likert-scale responses are coded numerically: No opinion = 1, Poor = 2, Average = 3, Good = 4, Excellent = 5
SD Standard deviation
An expert panel of ten oral disease specialists from Mashhad Dental School evaluated the content of the questionnaire. The Content Validity Ratio (CVR) was calculated as 0.67, using the Lawshe table. This value was above the minimum acceptable level of 0.62 for CVR. Reliability was confirmed with a Cronbach’s alpha of 0.90.
Simulation and model evaluation
Each student first practiced on a sheep’s tongue with an 810-nm diode laser (Wiser, Doctor Smile, Vicenza, Italy). The laser was irradiated at a wavelength of 810 nm and operated at a setting of 1.5 W in continuous wave (CW) mode. The students then practiced on the two constructed silicone phantoms (Fig. 3). Half of the students practiced first on the medical silicone and then on the industrial silicone, while the other half practiced in the reverse order. Each student removed one lesion from the industrial-grade silicone model and one from the medical-grade silicone model. They were free to handle the phantoms in whichever manner they felt most comfortable.
Fig. 3.
A representative sample of practicing with a diode laser on industrial-grade silicone phantoms
After the hands-on training, students were asked to complete a questionnaire to rate the effectiveness of the training and the similarity of their experience on two silicon phantoms to the animal model. The questionnaire used a Likert scale for scoring, where responses were categorized as follows: excellent [5], good [4], average [3], poor [2], and no opinion [1].
Statistical analysis
The data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Kendall’s Tau test was used to compare responses to each questionnaire item between the medical and industrial silicone phantoms, as this test is appropriate for ordinal data derived from Likert-scale items.
For each participant, an overall questionnaire score was computed for both the medical-grade and industrial-grade silicone phantoms. The normality of these total scores was assessed using the Shapiro–Wilk test, which confirmed that the assumption of normality was met (P > 0.05). A paired samples t-test was subsequently performed to compare the mean overall questionnaire scores between the two phantom types. A P-value < 0.05 was considered statistically significant.
Results
A total of 45 participants, consisting of 20 males (44.4%) and 25 females (55.6%), completed the questionnaire. Table 1 presents the frequency (N) and percentage (%) of Likert-scale responses from dental students for both medical- and industrial-grade silicone phantoms. Detailed analysis of students’ responses to each questionnaire item is presented below.
Question 1. How do you evaluate the tongue phantom’s design and construction?
Over 82% of students rated the medical silicone phantom as “good” or “excellent” (Mean score = 4.04, SD = 0.66), whereas 71.2% of students rated the industrial silicone phantom as “good” or “excellent” (Mean score = 3.87, SD = 0.66). The difference between the two phantoms was not statistically significant in terms of their design and construction (P = 0.195; Table 1).
Question 2. How do you evaluate the similarity of the tongue phantom to the animal specimen in terms of texture and consistency?
About 87% of dental students rated the medical silicone phantom as “good” or “excellent” (Mean = 4.00, SD = 0.52). Only 46.7% of students rated the industrial silicone phantom as “good” or “excellent” (Mean = 3.31, SD = 0.98). The medical silicone phantom significantly outperformed the industrial silicone model in terms of similarity to the animal specimen in terms of texture and consistency (P < 0.001; Table 1).
Question 3. How do you evaluate the similarity of working with the diode laser on the phantom compared to working with the diode laser on the animal specimen?
More than 71% of students rated the medical silicone phantom as “good” or “excellent” (Mean = 3.87, SD = 0.73). Only 42.2% of students rated the industrial silicone phantom as “good” or “excellent” (Mean = 3.33, SD = 1.00). The medical-grade silicone phantom received a significantly higher score for its similarity to working with the diode laser on the animal specimen compared to the industrial-grade phantom (P = 0.007; Table 1).
Question 4. Please rate your experience of lesion removal on phantoms using the diode laser
More than 82% of students rated their experience of lesion removal on medical silicone phantom as “good” or “excellent” (Mean = 4.11, SD = 0.68), whereas 75.5% of students rated this item as “good” or “excellent” for the industrial silicone (Mean = 3.98, SD = 0.97). No significant difference was found between the two phantoms regarding the experience of lesion removal with the diode laser (P = 0.790; Table 1).
Question 5. Please rate your opinion on the effectiveness of phantoms for teaching and evaluating students in laser courses
About 82% of students rated the medical silicone phantom as “good” or “excellent” (Mean = 4.13, SD = 0.89), whereas 60% of students rated this item as “good” or “excellent” for the industrial silicone phantom (Mean = 3.82, SD = 0.96). There was no significant difference between the two phantoms in terms of their effectiveness in teaching and evaluating students in laser courses (P = 0.083; Table 1).
Overall questionnaire scores
Mean and standard deviation of the scores for the industrial silicone phantom were 3.66 ± 0.96, and for the medical silicone phantom, 4.03 ± 0.70. The statistical analysis revealed a significant difference in the overall score of the questionnaires between the two models, with the medical silicon phantom receiving the higher rating (P = 0.039; Table 1).
Discussion
This study evaluated the effectiveness of medical-grade and industrial-grade silicone phantoms as alternatives to animal specimens for surgical laser training in dental students, using feedback from a self-administered questionnaire. The questionnaire included five questions, and the two phantoms were compared based on the responses to each question and the overall scores of the questionnaire. The two phantom models were made using the same computational design and mold.
Advances in 3D printing have enabled the production of highly accurate anatomical models, improving the realism of surgical simulations [20, 21]. In this study, fused deposition modeling (FDM) was employed to fabricate the tongue phantom molds. FDM allows controlled, layer-by-layer deposition of thermoplastic filaments, effectively replicating complex anatomical structures for medical training phantoms [22]. Furthermore, FDM is compatible with Maya 2019.2 software, which was used for designing the mold. Compared to other printing techniques, FDM offers shorter printing times and a favorable cost-to-size ratio, making it suitable for producing multiple molds for a large student survey [23]. Polylactic acid (PLA) filaments were chosen for making molds due to their suitability for FDM printing and ease of handling [24].
Two types of silicone were used for making tongue phantom models in this study, including industrial-grade RTV-2 and medical-grade FLEX. Silicone is widely used in medical training models due to its ability to replicate the texture and elasticity of human soft tissues [25–28], particularly muscles, and previous studies have successfully applied it in the development of tongue phantoms [29, 30].
The analysis of the responses indicated no significant difference between the industrial-grade and medical-grade silicones for questions 1, 4, and 5. Question 1 addressed the design and overall construction of the tongue phantom. Question 4 asked students to rate their experience with lesion removal on phantoms using the diode laser, and Question 5 sought their opinions on the effectiveness of phantoms for teaching and evaluating laser courses in dental students. In all these questions, the medical-grade silicone phantom received higher scores than the industrial-grade silicone, but the differences were minor and not statistically significant. Therefore, it seems that the two phantom models were perceived as similar in terms of overall construction, learners’ experience of lesion removal, and effectiveness in teaching and evaluating laser courses.
In the present study, the medical-grade silicone phantom showed significant superiority over the industrial-grade silicone in questions 2 and 3. Question 2 assessed the similarity between the tongue phantom and the animal specimen in terms of texture and consistency. Question 3 evaluated the comparability of working with the diode laser on the phantom and the animal specimen. The results showed that the medical-grade silicone was significantly more similar to animal tissues in texture, and working with the diode laser on the medical silicone phantom better simulated working on animal specimens as compared to the industrial silicone phantom. These outcomes highlight the superior ability of medical-grade silicone to replicate the complexities of oral soft tissues for trainees.
The mean overall score for the medical silicone phantom was 4.03 ± 0.70, compared to 3.66 ± 0.96 for the industrial silicone phantom. The difference in overall scores between the two phantoms was statistically significant in favor of medical-grade silicone. This suggests that tongue phantoms made from medical-grade silicone may offer a more effective training model for dental students, highlighting the importance of high-quality materials in educational tools to enhance learning outcomes. Although the medical-grade silicone provided more realistic conditions for laser training, industrial-grade silicone can still serve as a practical alternative when resources are limited, as it is more cost-effective than medical-grade silicone.
Obtaining and preparing a fresh sheep tongue for training can cost around $50 per specimen. This cost includes not only the price of the sheep tongue but also expenses associated with cold storage, procurement, specialized shipping, sanitization, and biohazard waste disposal. Furthermore, animal tissues require careful handling, have a limited shelf life, and show natural variability in texture and structure. In contrast, producing a silicone phantom is more cost-effective compared to using animal tissue. We estimate the per-phantom cost to be approximately $3–9 using industrial-grade silicone and $6–11 when using medical-grade silicone. These estimates cover the cost of silicone material (based on volume), small amounts of coloring agent, and the cost of producing PLA molds, which can be reused many times with minimal additional expense. Moreover, silicone phantoms offer several key advantages over animal tissues, including reusability, standardization, reduced biohazard and infection control requirements, and the ability to be produced in batches for long-term use. These extra benefits enhance the cost-effectiveness of silicone phantoms, making them a more practical solution for large-group or repeated training sessions.
The overall outcomes of this study suggest that both industrial-grade and medical-grade silicone phantoms demonstrated optimal design and provided dental students with a comparable experience in lesion removal, while also achieving similar effectiveness scores for teaching and assessing laser courses. Integrating silicone phantoms into surgical laser training curricula can effectively complement the teaching process. An educational approach utilizing simulation-based training with phantom models offers distinct advantages over conventional methods. These include reduced health risks, repeatable and controlled practice environments, and frequent opportunities for skill reinforcement [14, 21]. By providing a platform for developing technical skills and enhancing trainee competence, simulation-based training with phantom models can potentially reduce the likelihood of errors in real patient scenarios [14, 21, 31]. Despite these advantages, the high costs and resource demands of simulation-based training continue to restrict its broader implementation [32].
The main limitations of this study are the relatively small sample size and the reliance on subjective student feedback, which may restrict the generalizability of the findings. Although the same pigment was used for both silicone phantoms, slight color variations occurred, likely due to differences in material properties. We believe these variations did not influence the results, as the medical-grade silicone, which appeared more brownish-dark red, was rated in Question 2 as more similar to the animal specimen than the brighter red industrial-grade silicone, even though the latter more closely resembled the natural tongue color.
It is worth noting that stereolithography (SLA) and digital light processing (DLP) can produce smoother molds with finer surface resolution compared to the FDM technique used in this study [33]. However, fine surface quality is not expected to affect the educational value of the silicone phantoms substantially. For the aims of this study, FDM was considered adequate, with light sanding applied as a simple post-processing step. Future studies should involve larger sample sizes, incorporate objective performance measures, and include direct comparisons of silicone phantoms with other training modalities. It is also suggested to evaluate whether the skills acquired using phantom models effectively translate into clinical competence and improved patient care.
Conclusions
Under the conditions used in this study.
Both industrial- and medical-grade silicone phantoms received comparable ratings for overall construction, learners’ experience with lesion removal, and effectiveness in teaching and evaluating laser courses.
The medical-grade silicone was significantly more similar to animal tissues in texture, and working with the diode laser on the medical silicone phantom better simulated working on animal specimens as compared to the industrial silicone phantom.
The overall score of the questionnaire was significantly higher for the medical-grade than for the industrial-grade silicone. This finding suggests that tongue phantoms made from medical-grade silicone may offer a more effective training model for dental students, possibly due to a more realistic simulation of oral soft tissues for trainees.
Supplementary Information
Acknowledgements
The authors sincerely appreciate the vice-chancellor for research at Mashhad University of Medical Sciences for the financial support of this project (grant number 3123). The results presented in this study are taken from a student’s thesis (thesis number 980427).
Authors’ contributions
J.S. and F.A. developed and designed the project and supervised the process. M.T. and K.M. collected and analyzed the data. F.A. and K.M. wrote the manuscript. M.V. and F.A. contributed to data collection and analysis. All authors read and approved the final manuscript.
Funding
This study was supported by a grant from the vice-chancellor for research at Mashhad University of Medical Sciences.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethical considerations
The study protocol was approved by the ethics committee of Mashhad University of Medical Sciences (code: 1398.071IR.MUMS.DENTISTRY). The procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki. All participants were informed of the research goals and provided informed consent.
Clinical trial number
Not applicable.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Farzaneh Ahrari, Email: Farzaneh.Ahrari@Gmail.com, Email: Ahrarif@mums.ac.ir.
Kiana Mazhari, Email: Kianamazhari2@gmail.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.