Table 1.

Summary of the studies included in the systematic review.

Author Year	Country	Aim	Participants	Methods	Feedback Measurement	Traditional Method	Effectiveness and Acceptability
Nurko and Profitt (2005) [91]	USA	Effectiveness of Web-based self-instruction/small-group seminars for an orthodontics predoctoral course	Not mentioned	10 self-learning teaching modules (Macromedia Directors) 4 seminars for discussion	Final questionnaire; Likert scale	Yes	Effectiveness: web-based seminars were effective as traditional methods Acceptability: web-based seminars and small-group discussions are well accepted by students
Bednar et al. (2007) [92]	USA	Effectiveness and acceptability of Web-based instructor	45 residents and 4 faculty	(A) seminars of basic concepts and clinical underlying principles (B) clinical conferences and treatment plans evaluation (C) clinical theme seminars and treatment plans	Effectiveness: pre- and post-test scores Acceptability: Likert scale; open questions	No	Effectiveness: A statistically significant increase in test scores for participants in all groups and interactive groups. Acceptability: high scores in all groups and interactive group
Peterson et al. (2007) [93]	USA	Evaluate the dental student perceptions regarding Web-based education in paediatric dentistry	55 third-year undergraduate dental students	Students were surveyed regarding their use of the Atlas of paediatric dentistry as the textbook resource during a paediatric dentistry course.	Acceptability: questions regarded the students’ attitude toward the Atlas and online education	Yes	Acceptability: students preferred the online textbook to traditional textbooks. The complaints resulted from the use of home computers with slower connection speeds and a programming problem that made it difficult to access the quiz part of the book
Miller et al. (2007) [94]	USA	Evaluate the effectiveness of 3 methods of pre-recorded seminars in orthodontics	First-year residents from three universities	Recorded seminars and follow-up interaction for residents and practicing orthodontists via video conferencing, telephone, and internet chat with Net Meeting software (Microsoft, Bellevue, Wash)	Acceptability: closed- and open-ended questions	No	Acceptability: the use of distance learning methods mediated by recorded seminars and monitoring interactions is an accepted method for teaching orthodontics. Residents agreed that the overall experience was an effective and efficient way to learn. Videoconferencing received the highest ratings
Kleinert et al. (2007) [95]	USA	Examine the effectiveness of a CD-ROM virtual patient learning module	51 students	An interactive, multimedia, virtual patient module was designed and developed on compact disc (CD-ROM) to increase students’ competence in caring for children’s disabilities.	Effectiveness: pre- and post-test of knowledge Acceptability: Usability Scale	No	Effectiveness: significant results were obtained in knowledge Acceptability: participants reported overall satisfaction with the module
Linjawi et al. (2009) [96]	UK	To develop an online undergraduate orthodontic e-course and assess its success as a learning resource from the student’s perspective	64 third-year undergraduate students	E-course composed of modules, photo gallery, clinical consultations, glossary, list of readings and resources	Acceptability: feedback questionnaire (Likert scale)	No	High acceptability by the students that responded ‘positive’ for course design, course delivery, and course outcome. Web-based material as supplemental for traditional teaching methods
Mulgrew et al. (2009) [97]	UK	Evaluate the effects of a web-based modular teaching programme, housed with a virtual learning environment on orthodontic training	9 trainees (postgraduates) and 14 trainers	Modular teaching programme, housed with a VLE	Effectiveness and acceptability: semi-structured interviews and focus group	No	Effectiveness: Positive effects on postgraduate orthodontic teaching and learning. Travel commitments for trainees have been reduced, but not as expected and demands on academic staff have not reduced but have changed Acceptability: Improvements in the flexibility and efficiency of learning. Trainees continue to value the opportunity to interact face-to-face with their teachers
Al-Riyami et al. (2010) [98]	UK	Compare the instructional efficacy of an internet-based temporomandibular joint (TMJ) tutorial with a traditional seminar	30 orthodontic graduate students	Group 1: Moodle VLE tutorial followed by the face-to-face seminar Group 2: Face-to-face seminar followed by Moodle VLE tutorial	Effectiveness: at the end of the course students were required to examine a patient and diagnose their TMJ condition Acceptability: anonymous questionnaire based on the learning experiences	Yes	Effectiveness: no differences were found between either teaching modes, and both are equally effective at delivering information to students Acceptability: students had positive perceptions of VLE learning, and the feedback to this mode of teaching was comparable with more traditional methods of teaching
Bains et al. (2011) [99]	UK	Compare e-learning, face-to-face (F2FL) learning, and blended learning (BL) with respect to their effectiveness and students’ attitudes toward them	157 fourth-year undergraduate students (90 completed the study)	F2FL: teacher-led tutorial EL: online tutorial developed by a Senior Orthodontic Register using WebCT® version 3.8 BL1: EL first then F2FL BL2: F2FL first then EL	Effectiveness and acceptability were immediately assessed with an MCQ.	Yes	Effectiveness: no statistically significant difference between F2FL and BL. EL alone was less effective Acceptability: students are generally positive about all three methods but BL is the most and F2FL the least accepted, while EL is the least preferred
Jackson et al. (2011) [100]	USA	Evaluate the effectiveness of self-texts as a component of web-based self-instruction in predoctoral orthodontics and paediatric dentistry	157 postgraduate students	Online teaching modules, seminar for discussion, and self-texts.	Effectiveness: free-response, multiple-choice tests and seminar participation, and exercises related to the course material.	No	Effectiveness: The correlations between frequency of self-test access and course average were positive but not statistically significant. Increased use of web-based self-tests may be correlated with more effective learning in predoctoral dental education and that dental students’ usage of resources for learning changes significantly over the course of their education
Miller et al. (2011) [101]	USA	Evaluate the effectiveness and acceptability of various forms of post-seminar feedback after distant residents viewed recorded interactive seminars	Orthodontic residents	25 seminars organised into 4 sequences: Sequences 1 and 3 (UNC): growth and development of the face and biomechanics Sequences 2 and 4 (OSU): diagnosis, treatment plan, and treatment of sequelae Four different methods of post-seminar interaction: local follow-up discussion, videoconference, teleconference, and no discussion.	Effectiveness: pre- and post-tests Acceptability: satisfaction questionnaire at the end of the course	No	Effectiveness: post-test scores improved in each seminars sequence Acceptability: residents agreed that the videos helped them understand the material better than the readings alone and improved their educational experience. Residents preferred real-time interaction and local follow-up discussion regarding the videoconference and teleconference
Klein et al. (2011) [102]	USA	Test the acceptability and perceived effectiveness of using recorded interactive seminars and video conference (through WebEx or Elluminate software) follow-up discussions for in-office continuing education	23 orthodontists in private practice	Four groups of practitioners were asked to prepare for view and then discuss previously recorded interactive seminars; a fifth group (5 previous participants) had live discussions of 3 topics without viewing a pre-recorded seminar.	Acceptability: Likert scale and open-ended responses	No	Acceptability: Some participants reported difficulties using the videoconference system the private practitioners enjoyed their experience with this in-office (or home) version of continuing education and found it an effective way to learn
Klein et al. (2012) [103]	USA	Determine programmatic interest in using distance learning, resident and faculty interest, and the seminars’ perceived usefulness	253 residents and 42 teachers	25 interactive orthodontic seminars in 4 topic sequences and post seminars discussions with faculty	Acceptability: survey, Likert scale	No	Acceptability: the blended approach to distance learning was judged to be effective and enjoyable; faculty members were somewhat more enthusiastic about the experience than residents. Both were close to neutral about whether residents about interactive seminars as vs. traditional classroom. The post-seminar discussions were rated highly positive by both faculty and residents
Klein et al.(2012) [104]	USA	Discuss the problems that are likely to be encountered in the use of blended distance learning in postdoctoral health science education and possible solutions	253 residents and 42 teachers	Discussion of the problems and solutions of the previous study 25 interactive orthodontic seminars in 4 topic sequences and post seminars discussions with faculty		No	Acceptability: the biggest problem was lack of remote-based resident preparation and expectation of a lecture rather than a seminar. The logistics of scheduling distant seminars and uneven quality of the audio and video recordings were the major concerns of both residents and faculty members
Ireland et al. (2013) [105]	UK	Evaluate Wiki topic teaching in postgraduate orthodontists	9 postgraduate orthodontists	Students were divided into three groups and wrote and presented a Wiki on three interrelated topics using Blackboard platform.	Acceptability: feedback questionnaires	No	Acceptability: students felt writing the Wikis was useful for teamwork, provided a more learner-centred approach, and was a welcome variation on traditional teaching methods
Papadopoulos et al. (2013) [106]	Greece	Design and evaluate a virtual patient as a supplemental teaching tool for paediatric dentistry	130 undergraduate students	Simulation group: virtual patient Control group	Effectiveness: knowledge questionnaire Acceptability: evaluation questionnaire	Yes	Effectiveness: a statistically significant difference between the two groups was found showing a gain in knowledge in the simulation group Acceptability: the majority of participants evaluated the simulation very positively
Camargo et al. (2014) [107]	Brazil	Evaluate e-learning strategy in teaching ART to undergraduate and graduate students	76 participants (38 undergraduate students and 38 paediatric dentistry students in specialisation course)	DVD training course in ART. These e-learning courses combined many resources, such as the ‘Virtual Man project’, clinical videos, interviews with ART experts, clinical pictures, and radiographs	Effectiveness: tests performed before and after the course	No	Effectiveness: all students significantly improved their performances after the e-learning course. The comparison of the final evaluation grades between the two groups showed a statistically significant difference, indicating that graduate students finished the course with better performance than undergraduate students
Luz et al. (2015) [108]	Brazil	Evaluate the effect of a digital learning tool on undergraduate students’ performance in detecting dental caries using ICDAS	39 undergraduate students	Group 1: ICDAS e-learning programme Group 2: ICDAS e-learning programme plus digital learning tool (DLT) Group 3: traditional learning	Effectiveness: twelve paediatric patients were examined by the students before and after the training sessions	Yes	Effectiveness: sensitivity was statistically significantly higher for G1 and G2. G2 showed a significant increase in sensitivity at the D2 and D3 thresholds
Naser-ud-Din (2015) [109]	Australia	To investigate learning styles and the acceptance of e-modules as part of postgraduate training	9 postgraduate orthodontists	Nine interactive modules on Software SBLi® for orthodontics postgraduate training Acceptability: post- SBLi open-ended questionnaire		Yes	Acceptability: high acceptance rate. E-modules demonstrated high compatibility with the learning styles of the participants
Schorn-Borgmann et al. (2015) [110]	Germany	Evaluate the effect of online demonstrations concerning the quality of orthodontic appliances manufactured by undergraduate dental students	55 undergraduate students	Group I: conventional lectures and live demonstrations Group II conventional lectures and access to an online blog Group III: access to all the materials of Group I and II, plus access to the online video material	Effectiveness: at the end of the course three orthodontic appliances made by the students were scored by tutors	Yes	Effectiveness: concerning the different appliances made, there was no significant difference in the outcome scores between groups
Ludwig et al. (2016) [111]	Germany	Assess whether e-learning improves learning efficiency and compare an opposite programme to commercially available software	30 fifth-year undergraduate students	Group 1 (control): traditional teaching method on 10 cephalometric radiographs; 6 weeks of training Group 2: PowerPoint created by the authors for the study; study of 10 cephalometric radiographs Group 3: commercial software for cephalometric study on 10 radiographs	Effectiveness: identification of 30 anatomical points on two radiographs in 5 min Acceptability: the students were interviewed	Yes	Effectiveness: the best improvement of scores was achieved by group 2 (8.6 points) compared to group 1 (four points) and group 3 (2.8 points) Acceptability: students preferred the PPT created by the authors to the commercial software, which the students found difficult to manage
Mehta et al. (2016) [112]	UK	Assess the impact of e-learning on student learning experience and orthodontic knowledge	63 fourth-year undergraduate students	Intervention group: Six Orthodontic modules of videos and multiple-choice questions with feedback. The E-learning resource was available to the test group through the student Virtual Learning Environment (VLE), namely QMPlus Control group: traditional teaching method	Effectiveness: quizzes before and after the course (6 weeks) Acceptability: satisfaction questionnaire at the end of the course	Yes	Effectiveness: no significant difference was observed between the test group and the control group Acceptability: user satisfaction with the resource was very high
Asiry(2017) [113]	Saudi Arabia	Identify the readiness of students for online learning and measure the quality of online tutorials	70 students (57 completed the study)	Online flash lectures, procedural video illustrating laboratory steps in addition to traditional face-to-face lectures, and laboratory demonstrations during the preclinical orthodontic course. Online tutorial links we received through Twitter. Twitter and Google Moderator were used.	Acceptability: satisfaction questionnaire at the end of the course	Yes	Acceptability: few students preferred online flash lectures (31.5%) and procedural videos (17.1%). Fewer students (11.1% agree and 3.7% strongly agree) agreed to replace traditional lectures and live demonstrations by online tutorials. Most students (38.9% agree and 31.5% strongly agree) preferred a combination of the methods
Bavarescoet al. (2018) [114]	Brazil	Develop a distance learning course in paediatric dentistry	430 dentists working in PHC (220 completed the study)	Distance learning course of paediatric dentistry composed of five modules that were made available to participants weekly. Every video class was also recorded and edited and made available to participants of the course through the Moodle Platform used as a virtual learning environment	Effectiveness: pre- and post-course quizzes. Participants were also invited to respond to a quiz about their personal and professional profiles. The software and online research tool Survey-Monkey® was used to deliver the quizzes	No	Effectiveness: from pre- to post-course, there was a significant improvement in participant quiz performance. The variables age, time since graduation, and time working at PHC presented a statistically significant difference when correlated the grade with the pre-test average, while this difference was not observed when these variables were correlated with the post-test average
Stamm et al. (2019) [115]	Germany	Assess the impact of a one-to-one tablet PC programme by analysing students’ learning skills	108 students attended a clinical orthodontic course	One-to-one Tablet PC (TPC) programme. The NDE scores of students who participated in the TPC programme (n = 53) were compared with the scores of 64 students who attended the orthodontic scores before TPC deployment	Effectiveness: National Dental Examination (NDE) in orthodontics that evaluated theoretical knowledge and motor skills. Acceptability: survey	No	Effectiveness: the NDE scores of theoretical knowledge increased significantly after TPC deployment, whereas the scores for manual skills remained on the same level Acceptability: students expectations concerning the TPC benefit in the orthodontic curriculum improved significantly by using these devices
Bavaresco et al. (2019) [116]	Brazil	Evaluate the performance of dentists working in primary healthcare (PHC) in a paediatric dentistry distance learning course	430 Dentists working in PHC (201 completed the study)	Distance learning course of paediatric dentistry composed of five modules that were made available to participants weekly through the Moodle Platform used as a virtual learning environment	Effectiveness: Post-module questionnaire Participants were also invited to respond to a quiz about their personal and professional profiles.	No	Effectiveness: high rates of correct answers were observed after the course. It was observed that training in a public institution and a longer time since graduation positively influenced the grades earned on the restorative dentistry and dental trauma questionnaires, respectively
Bavaresco et al. (2019) [117]	Brazil	Assess the level of satisfaction of dentists working in primary healthcare with a distance learning course in paediatric dentistry	430 Dentists working in PHC	Distance learning course of paediatric dentistry composed of five modules that were made available to participants weekly through the Moodle Platform used as a virtual learning environment	Acceptability: satisfaction questionnaire (Likert scale); (40 answered the satisfaction questionnaire; 31 completed the satisfaction and personal/professional profile questionnaires)	No	The participants were satisfied with the course and attributed positive values to the variables evaluated. However, no statistically significant association was found between student satisfaction and the grades they earned on the pre- and post-course questionnaires
Isherwood et al. (2020) [118]	UK	Compare the ‘flipped classroom’ method and traditional lecture-based teaching for undergraduate students orthodontic emergencies	61 undergraduate students	Conventional group: lectures Flipped group: videos via VLE	Effectiveness: 20 questions Acceptability: semi-structured, open-ended focus group interviews	Yes	Effectiveness: there was no significant difference between the groups Acceptability: students were very positive about flipped classroom method of teaching and there was a general consensus that it should be incorporated into the undergraduate curriculum
Zafar et al. (2020) [119]	Australia	Compare students’ perception of the preclinical paediatric dentistry training gained in Simodont and conventional simulation environment	100 undergraduates	Lectures followed by practice sessions on the Simodont and conventional pre-clinical simulation. The Moog Simodont Dental Trainer provides a virtual reality-based dental simulation environment for training students.	Acceptability: Likert scale	Yes	Acceptability: participants felt Simodont training facilitated their understanding of paediatric dentistry tasks but the majority of the students disagreed that Simodont should replace conventional simulation.
Jeganathan and Fleming (2020) [120]	UK	Describe the use of blended learning as a method of undergraduate orthodontic teaching delivery and assess its effectiveness.	70 fifth-year undergraduate students	Intervention group: blending learning. The E-learning resource was developed using proprietary E-learning software. Clinical cases with diagnostic, in-treatment and final photographs and radiographs were included. Interactive features included questions on radiographs and flow diagrams. Control group: traditional seminar teaching	Effectiveness: tests both before (T0) and after(T1) the study period Acceptability: post-intervention student satisfaction survey	Yes	Effectiveness: no differences in short-term knowledge gain between two groups of students randomly allocated to teachings using either a blended or traditional seminar teaching was identified Acceptability: high levels of learner satisfaction common to both approaches
Golshah et al. (2020) [121]	Iran	Compare the efficacy of smartphone-based mobile learning versus lecture-based learning for instruction of cephalometric landmark identification	53 undergraduate students (4th year)	Intervention group: smartphone application instruction Control group: traditional lecture-based instruction Effectiveness: two weeks after the instruction, dental students were asked to identify four cephalometric landmarks		Yes	Effectiveness: no significant difference was noted between the two groups
Zafar et al. (2021) [122]	Australia	Investigate dental student’s perception of dental local anaesthesia (LA) virtual reality (VR) simulation on a paediatric patient and determine whether this can improve students learning experience	71 students	LA VR simulator software Acceptability: pre- and post-training survey containing open-ended and Likert-scale questions		Yes	Acceptability: most of participants agreed that LA VR simulator improved their knowledge of anatomical landmarks and added value compared with traditional LA teaching method