Bridging Theory and Practice in Periodontal Education: Implementation and Evaluation of the PERIO‐Blended Learning Framework

ABSTRACT

Background

Periodontal disease is a common chronic inflammatory condition that poses a significant threat to global oral health. Effective periodontal education is crucial for preparing future clinicians to manage this widespread condition. Traditional teaching methods, however, often fail to bridge the gap between theoretical knowledge and practical skills.

Objectives

This study aimed to evaluate the effectiveness of the PERIO framework – a structured blended learning model specifically designed for periodontic practical training – in enhancing student satisfaction, learning outcomes and engagement in a periodontics course.

Methods

A total of 113 third‐year dental students participated in the study, but after data cleaning, 112 valid responses were retained. A mixed‐methods approach was employed, including quantitative assessments using four validated scales – satisfaction, engagement, flow state and learning process – which were adapted to fit the specific research objectives. The reliability of these scales was assessed using Cronbach's alpha, with values ranging from 0.933 to 0.982. Qualitative feedback was collected through open‐ended questions and analysed to identify recurring themes.

Results

Students trained under the PERIO framework exhibited higher levels of satisfaction, engagement and practical competence. Participants reported improved understanding of periodontal concepts and increased confidence in applying theoretical knowledge in clinical settings.

Conclusion

The PERIO framework provides a scalable solution for improving periodontal education by effectively integrating theory and practice. The findings contribute to the growing body of literature on innovative dental education methods, demonstrating the potential of structured, student‐centred frameworks to enhance clinical training outcomes.

1. Introduction

Periodontal disease is a common chronic inflammatory condition that poses a significant threat to global oral health [1]. If left untreated, it can lead to tooth loss and is closely associated with systemic conditions such as cardiovascular disease and diabetes [2, 3]. According to the Fourth National Oral Health Survey in China, the number of qualified periodontists remains insufficient to meet the growing public health demand [4]. This gap highlights the urgent need for reforms in periodontal education, particularly in the area of practical training, which is essential for equipping future clinicians with the skills necessary for effective disease management [5].

Traditional teaching methods in periodontics often focus heavily on theoretical foundations but fall short in preparing students for clinical practice [5]. Students frequently struggle to translate theoretical knowledge into hands‐on skills due to the disconnect between classroom teaching and real‐world clinical scenarios [6]. The rapid advancements in periodontal treatment modalities further complicate the situation, as students need to adapt to new techniques while mastering core competencies [7]. Although some improvements have been made through practical sessions, the existing structure does not provide sufficient opportunities for repeated practice and reflection, which are crucial for skill mastery [8].

Recent advancements in medical and dental education have introduced various new teaching methodologies, such as problem‐based learning (PBL), flipped classrooms and blended learning models, which aim to enhance student engagement and learning outcomes [9, 10, 11]. Although these methods have shown some success, their application in periodontal education is still limited, particularly in terms of combining theoretical learning with hands‐on clinical practice in a structured and supportive environment. The unique challenges of periodontics education – such as mastering delicate procedures and understanding complex patient management strategies – require a tailored approach that not only conveys theoretical knowledge but also bridges the gap between theory and practice [12].

To address these gaps, we developed the PERIO framework, a structured blended learning model specifically designed for periodontics practical training. Kolb's experiential learning theory [13, 14, 15] emphasises promoting learning through four stages: concrete experience, reflective observation, abstract conceptualisation and active experimentation. The PERIO framework is optimised and extended based on this theory. The five‐phase framework – preparation, engagement, realisation, integration and outcome – reflects the core concepts of Kolb's learning cycle and applies them specifically to periodontics practical education.

Unlike existing approaches like flipped classrooms or PBL, the PERIO framework not only integrates case‐based discussions, hands‐on practice and reflective feedback but also emphasises conducting these activities in a continuous learning cycle. This structured process provides students with systematic guidance, helping them successfully apply theoretical concepts to clinical settings. Through this structured learning process, the PERIO framework enhances students' theoretical understanding and practical competency.

This study aims to evaluate the effectiveness of the PERIO framework in enhancing student satisfaction, learning process, engagement and flow state in a periodontics practical course. By combining quantitative assessments and qualitative feedback, we hope to determine whether the PERIO framework can address current challenges in periodontics education and provide a scalable solution for other clinical training programmes requiring the integration of theory and practice. The findings from this study are expected to contribute new insights into innovative dental education methods and demonstrate the potential of the PERIO framework to enhance the quality of dental clinical education and its applicability to other clinical disciplines.

Although blended‐learning approaches – such as flipped classrooms, problem‐based learning (PBL) and simulation‐based training – have demonstrably improved student engagement in dentistry, their capacity to integrate iterative psychomotor practice with structured reflection remains limited [9, 10, 11, 12]. Table S1 summarises the key design parameters of these models alongside the PERIO framework. Flipped classrooms allocate the majority of theoretical instruction (> 70%) to asynchronous video materials, leaving only brief on‐site sessions for guidance and feedback. PBL places students in self‐directed case analyses but provides little scaffolded rehearsal of periodontal techniques. Simulation‐based curricula offer isolated skill stations; however, they often lack a longitudinal feedback loop that connects simulation outcomes to real‐patient management. In contrast, the PERIO framework iterates a five‐phase cycle – preparation, engagement, realisation, integration and outcome – that explicitly aligns with Kolb's experiential learning theory [13, 14, 15]. Each cycle distributes learning time more evenly between online (≈40%) and face‐to‐face settings (≈60%), embeds formative quizzes and instructor ‘feed‐forward’ at every stage and obliges students to complete a structured reflective log before progressing. By clarifying how PERIO differs from prevailing models in learning‐cycle alignment, online–offline balance and feedback architecture, this section provides essential context for interpreting the evaluation that follows and for guiding educators who seek evidence‐based, scalable frameworks for clinical dental training.

2. Methods

2.1. Research Context and Design

This study was conducted at a university that offers a 5‐year Bachelor of Dental programme. The periodontology course, a crucial component of this programme, begins in the first semester of the third year and encompasses both theoretical and practical aspects. The course covers the aetiology, pathogenesis, diagnostic methods, treatment strategies and clinical case analysis of periodontal diseases. The practical component comprises 30 h of instruction, divided into 10 sessions of 3 h each, covering periodontal specialised examination, manual and ultrasonic supragingival and subgingival scaling, periodontal surgery (including flap surgery and mucogingival surgery), periodontal suturing and splinting of mobile teeth.

We employed a mixed‐methods design, combining quantitative and qualitative approaches to evaluate the effectiveness of the PERIO framework in periodontology education.

2.2. Analysis Phase

In the analysis phase, we conducted a needs assessment to identify any gaps between expectations and reality in periodontology education. This analysis was primarily based on two key indicators:

Dental Licensing Examination Pass Rates: We collected and analysed the pass rates of dental graduates in recent years' licensing examinations. This indicator reflected the effectiveness of our educational programme in producing professionals who meet industry standards.

Student Satisfaction Surveys: We analysed the results of student satisfaction surveys conducted after the periodontology course in recent years. These surveys covered course content, teaching methods, practical opportunities and other aspects, providing valuable feedback from the student perspective.

Through a comprehensive analysis of these two indicators, we assessed the strengths and weaknesses of the existing periodontology education programme, providing a foundation for the design and implementation of the PERIO framework.

2.3. Design Phase

The design phase focused on creating a comprehensive overview of the PERIO framework, using Kolb's experiential learning theory as a core guiding principle (Figure 1). We designed the components of the PERIO framework based on Kolb's four learning stages (concrete experience, reflective observation, abstract conceptualization and active experimentation):

1. Defining Learning Objectives: We set comprehensive learning objectives covering knowledge acquisition, skill development and attitude cultivation based on Kolb's theory.

2. Selecting Learning Materials: We chose diverse learning materials supporting each stage of Kolb's learning cycle, including instructional videos, clinical guidelines, journal articles and systematic knowledge maps.

3. Determining Teaching Strategies: We designed a series of teaching activities, including practical operations, case discussions and reflective feedback, ensuring each stage of Kolb's learning cycle was adequately practised.

4. Determining Module Duration and Structure: Each PERIO module was designed to correspond with Kolb's learning cycle, ensuring students had sufficient time to experience each learning stage.

FIGURE 1.

PERIO framework model for periodontal education.

We reviewed and validated the learning objectives through teaching workshops and cross‐departmental discussions to ensure the PERIO framework comprehensively covered all stages of Kolb's learning cycle while meeting the specific needs of periodontology education.

2.4. Implementation Phase

The implementation of the PERIO framework followed five interrelated stages: preparation, engagement, realisation, integration and outcome. These stages correspond to Kolb's learning cycle, aiming to provide a comprehensive learning experience.

2.4.1. Preparation Stage

Corresponding to Kolb's concrete experience stage, students accessed various online resources through the Chaoxing Learning Platform, including instructional videos, clinical guidelines, journal articles and systematic knowledge maps. Before each class, students completed a five‐question quiz and received immediate feedback, preparing them for subsequent practical learning.

2.4.2. Engagement Stage

Corresponding to Kolb's Reflective Observation stage, each 3 h session began with:

Theoretical Explanation and Demonstration (20 min): The instructor explained relevant theoretical knowledge and operational details, demonstrating the steps.

Group Discussion (20 min): Students discussed the upcoming operation in groups, analysed related clinical cases and the instructor guided the development of critical thinking.

2.4.3. Realisation Stage

Corresponding to Kolb's Abstract Conceptualisation and Active Experimentation stages:

Practical Operation (120 min): Students performed actual operations on simulation models, including periodontal specialised examination, manual and ultrasonic scaling, periodontal surgery, etc. Instructors provided guidance and personalised feedback.

2.4.4. Integration Stage

Continuing to correspond with Kolb's Abstract Conceptualization and Active Experimentation stages:

Students recorded their operational experiences, challenges and achievements through reflective journals.

Peer discussions and instructor feedback sessions were conducted to deepen understanding and integrate theoretical knowledge with practical results.

Students created mind maps to visually connect different periodontal concepts and operational skills.

2.4.5. Outcome Stage

Completing Kolb's learning cycle and preparing for a new cycle:

1. Satisfaction surveys were conducted to assess students' acceptance of the PERIO framework.

2. Learning outcome self‐assessments allowed students to reflect on their learning progress.

3. Practical competency assessments were implemented to test students' operational skills and clinical decision‐making abilities.

4. Long‐term follow‐up assessments were conducted to measure skill and knowledge retention.

2.5. Evaluation Phase

2.5.1. Research Instrument

In this study, we used four validated scales: satisfaction scale, engagement scale, flow state scale and learning process scale. These scales were adapted from internationally recognised standard scales to suit the specific needs of this study.

The satisfaction scale used a 7‐point Likert scale (ranging from 1 = very dissatisfied to 7 = very satisfied). Initially, the questionnaire included 13 questions: 10 closed‐ended items and three open‐ended questions. The content was validated by three experts (two dental educators and one health education specialist). After pre‐testing, an item with low validity was removed, resulting in a final questionnaire of 12 questions – comprising nine Likert scale items and three open‐ended questions.

The student engagement scale [16], flow state scale [17] and learning process scale [18] all used a 5‐point Likert scale. To ensure scientific rigour, we conducted reliability and validity analyses for all scales, with Cronbach's alpha values ranging from 0.933 to 0.982, indicating high internal consistency.

2.5.2. Data Collection

All students participating in the PERIO framework were invited to participate in the study, with an initial sample of 113 third‐year dental students. After data cleaning, 112 valid responses were retained, resulting in a response rate of approximately 99.12%. Informed consent was obtained after explaining the purpose of the study. The questionnaire was distributed through an online platform, and students had 2 weeks to complete it.

2.5.3. Data Analysis

Quantitative data: Analysis was performed using IBM SPSS Statistics (Version 25.0). Descriptive statistical analysis, exploratory factor analysis (principal axis factoring method with orthogonal rotation) to assess construct validity and Cronbach's alpha coefficient to assess the internal consistency of Likert scale questions were conducted.

The reliability of the scales used in this study was assessed using Cronbach's alpha to ensure internal consistency. The engagement scale had a reliability of 0.982, the satisfaction scale 0.933, the flow scale 0.976 and the learning process scale 0.953. These high‐reliability values indicate that the instruments used were consistent and reliable for measuring the intended constructs.

Qualitative data: Content analysis was performed on the responses to the three open‐ended questions to identify recurring themes. Two researchers independently coded the data, subsequently reaching consensus through discussion.

2.6. Ethical Considerations

All participants signed informed consent forms before participating in the study. Participant privacy was strictly protected during data collection and analysis. Participants were informed that they could withdraw from the study at any time without any impact on their academic standing.

3. Results

The results of this study are presented through quantitative and qualitative analyses, highlighting the impact of the PERIO framework on periodontal education, focusing on student satisfaction, engagement, learning process and flow experiences.

3.1. Quantitative Results

For all 5‐point Likert scales, items with mean scores above 4.0 (representing ‘agree’ to ‘strongly agree’) were considered as indicating positive responses. For the 7‐point satisfaction scale, scores above 6.0 (representing ‘satisfied’ to ‘very satisfied’) were considered high satisfaction levels.

3.1.1. Student Satisfaction

Table 1 shows the ratings of student satisfaction with various aspects of the course, including teaching equipment, laboratory arrangements and the professionalism of teaching staff. The complete satisfaction questionnaire including open‐ended questions is provided in Table S2. The results indicate that students rated ‘Professional level of teaching staff’ the highest (mean = 6.688, SD = 0.630), reflecting a high level of appreciation for teaching quality. ‘Operation time’ received a relatively lower score (mean = 6.411, SD = 0.778) but still reflected a positive attitude overall. Exploratory factor analysis further showed that ‘Laboratory arrangements’ had a significant impact on overall satisfaction (factor loading = 0.904), demonstrating the importance of optimising teaching resources to improve student satisfaction.

TABLE 1.

Student satisfaction and factor analysis results.

No	Statement	Descriptive statistics								Exploratory factor analysis
		VD	D	SD	N	SS	SS	VS	Mean (SD)	Communalities	Factor loadings
1	Teaching equipment (Laboratory conditions and equipment availability)	—	—	—	1	6	42	63	6.491 (0.644)	0.705	0.840
2	Course arrangement	—	—	—	3	3	48	58	6.438 (0.682)	0.697	0.835
3	Laboratory session arrangements	—	—	—	1	6	40	65	6.509 (0.644)	0.817	0.904
4	Professional level of teaching staff	—	—	—	2	4	21	85	6.688 (0.630)	0.736	0.858
5	Teaching effectiveness	—	—	—	1	4	32	75	6.616 (0.604)	0.854	0.924
6	Classroom discipline	—	—	—	1	6	33	72	6.571 (0.640)	0.668	0.817
7	Group arrangements	—	—	—	1	7	32	72	6.563 (0.655)	0.717	0.846
8	Operation time	—	—	—	4	8	38	62	6.411 (0.778)	0.508	0.713
9	PPT explanations	—	—	—	1	7	34	70	6.545 (0.656)	0.659	0.812

Abbreviations: D, Dissatisfied; S, Satisfied; SD, standard deviation; SS, Slightly Satisfied; VD, Very Dissatisfied; VS, Very Satisfied.

Figure 2 presents a comparison of student satisfaction between 2023 and 2024. The data show significant improvements in aspects such as ‘Professional level of teaching staff’ and ‘Teaching effectiveness’ in 2024, further indicating the effectiveness of the PERIO framework in enhancing teaching outcomes. While Figure 2 illustrates improvements in student satisfaction between 2023 and 2024 cohorts, detailed statistical comparisons were limited by the retrospective nature of the 2023 data collection. The 2024 cohort showed consistently higher ratings across all measured dimensions, particularly in ‘Professional level of teaching staff’ (mean = 6.688, SD = 0.630) and ‘Teaching effectiveness’ (mean = 6.616, SD = 0.604).

FIGURE 2.

Comparison of student satisfaction between 2023 and 2024.

3.1.2. Learning Process

Table 2 summarises students' evaluations of the learning process, particularly their depth of concept understanding and engagement in learning. Many students expressed a positive sense of ‘personal satisfaction with the learning process’ (mean = 4.009, SD = 0.765) and stated, ‘Once I am engaged in the topic, I become deeply involved in related tasks’ (mean = 3.732, SD = 0.930). These results indicate that the PERIO framework significantly promotes intrinsic motivation and deep learning among students.

TABLE 2.

Students' learning process.

No	Statement	Mean (SD)	Communalities	Factor loadings
1	I find that the learning process now gives me a deep personal sense of satisfaction	4.009 (0.765)	0.791	0.711
2	In a conversation, I find I must work hard to keep up with the best ideas and stay fully engaged	3.946 (0.757)	0.740	0.600
3	My goal now is to do the best learning I can in this course	3.143 (1.244)	0.824	0.794
4	I often try to test myself on key ideas in the course until I truly understand them	3.393 (1.068)	0.772	0.708
5	I find that once I immerse myself in the topic, I become deeply engaged in any task related to it	3.732 (0.930)	0.695	0.676
6	I find that when learning about topics that interest me, I spend a lot of time seeking more information about them	3.741 (0.918)	0.673	0.692
7	I have often worked hard to learn materials so thoroughly that I could answer a question even if it was presented in an unfamiliar way	2.857 (1.300)	0.737	0.682
8	I tend to memorise content for exams without fully understanding the underlying concepts	3.268 (1.074)	0.747	0.623
9	I find it easy to predict exam questions based on previous test questions or sample papers	3.571 (0.946)	0.780	0.780
10	I frequently find myself leaving studying until the last minute, which forces me to cram	3.589 (0.916)	0.689	0.689
11	I often forget what I've learned soon after the exam, even though I worked hard to memorise the material	3.411 (1.078)	0.656	0.629
12	I try to organise my study schedule effectively to ensure that I stay on track with the workload	3.161 (1.151)	0.747	0.747
13	I plan my studying in a way that allows me to review and understand key concepts thoroughly before moving on	3.768 (0.939)	0.765	0.765
14	I spend a lot of time actively seeking out extra information to enhance my understanding of course material	3.411 (1.087)	0.682	0.682
15	I often focus more on preparing for exams than trying to deeply understand the material itself	2.991 (1.312)	0.696	0.696
16	I believe it's important to avoid wasting too much time on assignments that don't directly contribute to my exam success	2.866 (1.379)	0.745	0.745
17	I often find myself reviewing class notes or textbooks in depth in preparation for exams	3.366 (1.057)	0.737	0.734
18	I tend to focus on completing my coursework in the quickest, most efficient way possible	3.330 (1.060)	0.728	0.728
19	I feel that the time spent learning difficult content is often not worthwhile	2.741 (1.406)	0.747	0.747
20	I strive to do my best on assessments by putting in effort to learn the material thoroughly	3.366 (1.139)	0.571	0.458

Exploratory factor analysis showed that items related to intrinsic motivation and personal satisfaction had factor loadings above 0.8, underscoring the importance of these factors in the learning process. These findings support the effectiveness of the PERIO framework in enhancing students' depth of understanding through improved learning experiences.

3.1.3. Student Engagement

The results for student engagement, presented in Table 3, indicate a high level of motivation and interaction in the course. For example, ‘I like my teacher’ and ‘My teacher respects me’ both received high scores (mean = 4.482, SD = 0.671), reflecting positive student‐teacher relationships, which play a key role in boosting student engagement. Additionally, students rated ‘I motivate myself to study’ highly (mean = 4.134, SD = 0.717), indicating strong student initiative in learning.

TABLE 3.

Student engagement scores.

No	Statement	Mean (SD)	Communalities	Factor loadings
1	I motivate myself to study	4.134 (0.717)	0.742	0.757
2	I set my own learning goals	4.107 (0.702)	0.792	0.789
3	In class, I try to do my best	4.080 (0.749)	0.755	0.756
4	After completing coursework, I review or preview the material	3.955 (0.787)	0.66	0.79
5	What I learn in class is important to me	4.464 (0.657)	0.715	0.745
6	After class, I discuss what I learned with my classmates	4.080 (0.773)	0.727	0.796
7	Before class, I prepare in advance	3.964 (0.827)	0.728	0.816
8	I try my best to complete my homework	4.286 (0.716)	0.697	0.605
9	I spend enough time and energy on studying	4.054 (0.757)	0.743	0.798
10	I have good friends in my class	4.277 (0.757)	0.496	0.542
11	Whenever I need help from my teacher, they are always nearby	4.277 (0.725)	0.71	0.693
12	I value working and learning with my classmates	4.009 (0.833)	0.597	0.689
13	My teacher respects me	4.482 (0.671)	0.816	0.87
14	I like my teacher	4.482 (0.671)	0.851	0.894
15	I think my teacher is respectable	4.563 (0.668)	0.834	0.892
16	I am willing to tell my teacher about problems I encounter	4.348 (0.802)	0.736	0.755
17	This class is very interesting	4.420 (0.653)	0.844	0.847
18	My teacher cares about my interests and needs	4.313 (0.748)	0.784	0.786
19	I like helping my classmates with something	4.259 (0.720)	0.728	0.618
20	I feel like I am a part of the class	4.321 (0.674)	0.762	0.76
21	I like interacting with my teacher	4.429 (0.733)	0.641	0.602
22	I enjoy seeing my friends in class	4.268 (0.700)	0.736	0.654
23	My teacher treats all of my friends fairly	4.339 (0.681)	0.82	0.827
24	I really listen carefully in class	4.384 (0.644)	0.781	0.688
25	My teacher and I interact or communicate	4.393 (0.730)	0.719	0.75
26	I follow classroom rules	4.330 (0.647)	0.806	0.799
27	I complete my homework and assignments on time	4.384 (0.676)	0.779	0.754
28	I listen carefully when my classmates speak in class	4.321 (0.690)	0.852	0.77
29	In group tasks, I try my best to fulfil my responsibilities	4.429 (0.674)	0.805	0.763

Exploratory factor analysis results indicated that items involving personal motivation and student‐teacher interaction had high factor ‘loadings’ (e.g., ‘I motivate myself to study’ had a factor loading of 0.835), further confirming the importance of these factors for overall student engagement.

3.1.4. Flow Experience

The results from the Flow State Scale (Table 4) indicate that students frequently experienced a strong flow state during the learning process. For example, ‘I feel challenged but believe my skills will help me overcome this challenge’ (mean = 4.223, SD = 0.667) and ‘I want to experience this feeling again’ (mean = 4.143, SD = 0.642) both received high scores, showing that students were able to achieve a balance between challenge and skill.

TABLE 4.

Students' core flow state characteristics.

Core flow characteristic	Statement	Mean (SD)	Communalities	Factor loadings
Challenge–Skill Balance	I am challenged, but I believe my skills will help me overcome this challenge	4.223 (0.667)	0.693	0.550
Clear Goals	I know what I want to do very clearly	4.08 (0.712)	0.725	0.549
Immediate Feedback	I know exactly how to present my work while doing it	4.08 (0.673)	0.665	0.612
Concentration on the Task	My attention is completely focused on what I am doing	4.045 (0.676)	0.670	0.492
Merging of Action and Awareness	Everything seems to happen naturally, as if it is beyond my conscious will	4.098 (0.697)	0.766	0.635
Sense of Control	I feel that I can control what I am doing	3.929 (0.846)	0.694	0.490
Loss of Self‐Consciousness	I am not concerned about how others perceive what I am doing	3.652 (0.956)	0.784	0.780
Transformation of Time	It feels like time has passed very quickly, and things are not the same as usual	4.08 (0.673)	0.740	0.753
Autotelic Experience	I can't wait to experience this kind of feeling again, and I want to do it once more	4.143 (0.642)	0.703	0.608

Table 4 presents only nine key items from the Flow State Scale to illustrate the overall flow experience. However, the complete flow scale, which includes more detailed aspects of focus, enjoyment and immersion, is provided in the Tables S1 and S2. Exploratory factor analysis showed that items related to focus and enjoyment during learning had high factor loadings (e.g., ‘I am completely focused on the task at hand’ had a factor loading of 0.856), indicating the importance of these factors in achieving flow experiences.

Tables S1 and S2 further reveal that other elements, such as time distortion and deep enjoyment, also significantly contributed to the flow state (S1). Moreover, flow experiences are closely linked with deep learning, as students in a focused state are more capable of deeply understanding the learning content, exhibiting strong intrinsic motivation and mastering concepts at a deeper level. These additional findings suggest that the PERIO framework not only supports a balance between challenge and skill but also fosters an immersive experience that enhances overall student satisfaction and engagement.

3.2. Qualitative Results

Table 5 summarises key themes derived from student feedback, further illustrating the impact of the PERIO framework on practical experiences. Students generally expressed high appreciation for teacher guidance and hands‐on practice, stating that these aspects helped them acquire skills and build confidence. For example, one student mentioned: ‘The practical sessions helped me build confidence in performing periodontal procedures.’

TABLE 5.

Summary of qualitative feedback on the practical impact.

Question no.	Main themes	Example feedback
Satisfaction with course	Lecturer's guidance	‘Lecturer's guidance and suggestions’
	Hands‐on experience	‘Hands‐on experience helped me understand better’
2Practical session impact	Enhanced skill proficiency	‘The practical sessions really helped me gain confidence in performing periodontal procedures’
	Real‐world application	‘The practical exercises made me feel more prepared for clinical practice’
3Suggested improvements	More structured practice	‘More structured and extended hands‐on sessions would be beneficial’
	Enhanced interaction opportunities	‘Adding more opportunities for student‐instructor interaction during practical sessions’
	Increase operation time	‘Extending the operation time would help us practice more thoroughly’

The analysis also identified skill proficiency and real‐world application as recurring themes in student feedback. Students recognised that hands‐on practice effectively bridged the gap between theory and practice and suggested extending structured practice time to further consolidate their skills. Some students also recommended increasing teacher–student interaction to receive more personalised feedback, which is valuable for future curriculum improvement.

3.3. Student Performance

Student performance was evaluated through objective structured clinical examinations (OSCE) and practical skill assessments. In the 2024 cohort implementing the PERIO framework, all 112 students (100%) successfully passed the OSCE examination, demonstrating competency in key periodontal procedures. This represents a notable improvement from previous years' pass rates and is consistent with the high satisfaction and engagement levels observed in the quantitative data.

While direct statistical comparison with the 2023 cohort was limited due to differences in the assessment criteria, the universal pass rate in 2024 suggests that the PERIO framework effectively supports students in achieving the required clinical competencies. The excellent performance outcomes indicate that this framework has promising applications in periodontal education.

4. Discussion

The present study demonstrated that the PERIO framework effectively enhanced student satisfaction, engagement, learning processes and flow experiences in periodontal education. Notably, all students in the 2024 cohort successfully passed their OSCE examinations, suggesting that the framework's structured approach effectively supports the development of clinical competencies. The framework's five phases were crucial in shaping these outcomes. In the Preparation phase, pre‐class resources helped students build a strong foundation, reflected in high satisfaction scores (mean = 6.491, SD = 0.644). The Engagement phase's interactive activities significantly increased student engagement (mean = 4.482, SD = 0.671), while the Realisation phase enabled direct application of theoretical knowledge, enhancing practical competence. The Integration phase's reflective activities improved understanding and skill retention (mean = 4.009, SD = 0.765), and the Outcome phase demonstrated students' increased confidence in periodontal procedures. These findings indicate the framework's effectiveness in bridging the gap between theoretical learning and practical skills development.

These results align with prior studies emphasising the value of blended learning in clinical education [19, 20, 21]. Recent systematic reviews have confirmed that blended learning approaches consistently outperform traditional methods in healthcare education [22, 23]. Specifically in dental education, hybrid models have shown 15%–30% improvements in clinical skill acquisition compared to lecture‐based instruction [24]. The PERIO framework's effectiveness stems from its foundation in Kolb's experiential learning theory [25] and its structured approach to integrating theory with practice. This aligns with recent evidence showing that experiential learning models in healthcare education lead to better long‐term retention and clinical performance [26, 27].

The supportive role of instructors in this framework also aligns with Vygotsky's concept of the Zone of Proximal Development (ZPD), where students are able to achieve higher levels of learning with appropriate guidance [28, 29]. The PERIO framework, through structured practice and feedback, allowed students to extend beyond their current abilities, thereby fostering a higher level of skill acquisition and deeper understanding of periodontal concepts [30].

4.1. Limitations

This study has several limitations that should be acknowledged. First, the single‐group pre‐post design without a parallel control arm limits causal inference, as improvements cannot be definitively attributed to the PERIO framework. Second, the study was conducted at a single dental school with 112 participants, which restricts generalisability to programmes with different resources or learner demographics. Third, competence assessment relied primarily on self‐reported measures and instructor ratings, which are susceptible to social desirability bias. While all students passed the OSCE examination, the universal pass rate precluded detailed statistical analysis of performance differences. Additionally, the sample size, though adequate for primary analyses, approaches the lower threshold recommended for exploratory factor analysis (5–10 participants per item).

Future research should address these limitations by: (1) implementing randomised controlled designs across multiple institutions; (2) incorporating blinded, objective assessments such as multi‐station OSCEs with granulated scoring beyond pass/fail criteria; (3) extending longitudinal follow‐up to assess skill retention; and (4) examining learner‐level moderators (e.g., prior clinical experience, learning style preferences) to identify optimal conditions for framework effectiveness.

4.2. Future Research Directions

Building on the findings of this study, future research could focus on optimising the PERIO framework to better meet student needs. For example, increasing the duration of structured practice sessions and exploring the integration of tools like virtual simulations, 3D models, 3D printing and virtual reality (VR) to further enhance engagement could be valuable avenues [31, 32, 33]. These tools could provide immersive simulations that allow students to practise procedures in a safe, controlled environment before applying them in real clinical settings.

Further research should also explore the application of the PERIO framework across different medical disciplines to evaluate its adaptability and effectiveness in other clinical education contexts. For example, fields such as surgery, nursing or emergency medicine, which similarly require the integration of theoretical knowledge with practical skills, could benefit from such a framework. Additionally, investigating how teacher training and professional development impact the effectiveness of the PERIO framework would be beneficial, as instructors play a crucial role in facilitating student‐centred learning.

The role of individual learner characteristics, such as motivation styles and self‐efficacy, should also be examined in future studies. Understanding these characteristics could lead to more personalised learning approaches within the PERIO framework, further enhancing its effectiveness. Moreover, exploring how peer learning and collaboration could be integrated into the framework might provide additional benefits for both skill acquisition and student satisfaction.

5. Conclusion

In conclusion, the PERIO framework effectively enhances student learning experiences by optimising teaching resources, promoting deep engagement and facilitating the development of practical skills. These findings highlight the potential of mixed learning approaches in clinical education, particularly in fields that require strong practical competencies like periodontology. The combination of theory and hands‐on practice, supported by structured guidance, contributes to both immediate and long‐term learning outcomes.

Future studies should aim to validate these results in broader contexts, including other medical disciplines and diverse student populations. Additionally, refining the framework to incorporate personalised learning paths, digital enhancements and extended practice opportunities may further maximise its educational impact.

Author Contributions

Yi Peng: conceptualization. Lei Yang: data curation. SiJia Ma, Rui Zhang: formal analysis. XinQiang Ai: methodology. SiJia Ma: writing – original draft. Jianhua Wu, Yi Peng: writing – review and editing.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1: Comparison of key design parameters across different educational models.

Table S2: Complete flow state scale (36 items) with descriptive statistics and factor analysis results.

Ma S., Zhang R., Yang L., Ai X., Peng Y., and Wu J., “Bridging Theory and Practice in Periodontal Education: Implementation and Evaluation of the PERIO‐Blended Learning Framework,” European Journal of Dental Education 30, no. 3 (2026): 853–863, 10.1111/eje.70031.

Data Availability Statement

All data generated or analysed during this study are included in this published article and its Tables S1 and S2. Additional data are available from the corresponding author on reasonable request.