Non-Cochrane · intervention · PM41825435
The Impact of Early Clinical Exposure on Competency Development in Dental Students: A Systematic Review and Meta-Analysis.
Pang Xuefei, Wang Huilin, Li Jinggui, et al. · International dental journal · 2026 · PubMed · doi:10.1016/j.identj.2026.109483
Findings
20 findings
| Population | ||||
|---|---|---|---|---|
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Self-efficacy | SMD 1.62 [0.92, 2.32] GRADE not reported Studies not reported |
| Dental students without prior clinical experience | Early clinical exposure (ECE) | Traditional lecture-based teaching | Competency score (examinations) Dental schools (preclinical education) · Assessment method: examinations | SMD 1.19 [0.81, 1.58] GRADE not reported 24 studies |
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Overall competency (student scores) NRSIs (non-randomized) | SMD 1.37 [0.78, 1.97] GRADE not reported 14 studies |
| Dental students without prior clinical experience | Early clinical exposure (ECE) | Traditional lecture-based teaching | Competency score (questionnaires) Dental schools (preclinical education) · Assessment method: questionnaires | SMD 1.55 [0.66, 2.45] GRADE not reported 7 studies |
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Theoretical knowledge | SMD 1.02 [0.58, 1.46] GRADE not reported Studies not reported |
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Overall competency (student scores) RCTs | SMD 1.06 [0.53, 1.58] GRADE not reported 13 studies |
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Clinical practice performance | SMD 1.47 [0.98, 1.96] GRADE not reported Studies not reported |
| Dental students without prior clinical experience | Early clinical exposure (real, simulated or virtual) | Traditional lecture-based teaching without clinical contact | Overall competency (student scores) | SMD 1.25 [0.83, 1.66] Low Downgraded: imprecision, inconsistency 27 studies · 2995 participants |
| Dental students without prior clinical experience | Early clinical exposure in real clinical settings | Traditional lecture-based teaching without clinical contact | Overall competency (student scores) ECE type: real clinical interactions | SMD 1.74 [0.83, 2.66] GRADE not reported 8 studies |
| Dental students without prior clinical experience | Early clinical exposure with simulated patients or simulators | Traditional lecture-based teaching without clinical contact | Overall competency (student scores) ECE type: simulated clinical interactions | SMD 1.06 [0.46, 1.67] GRADE not reported 13 studies |
| Dental students without prior clinical experience | ECE: virtual environment learning | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · ECE type: virtual environment learning | SMD 0.93 [0.29, 1.58] GRADE not reported 7 studies |
| Junior preclinical dental students (second year and below) | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Student type: junior preclinical (second year and below) | SMD 1.58 [0.79, 2.37] GRADE not reported 11 studies |
| Senior preclinical dental students (third year and above) | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Student type: senior preclinical (third year and above) | SMD 0.82 [0.44, 1.21] GRADE not reported 10 studies |
| Dental students in Europe | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Region: Europe | SMD 0.49 [0.19, 0.80] GRADE not reported 4 studies |
| Dental students in Asia | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Region: Asia | SMD 1.30 [0.82, 1.79] GRADE not reported 20 studies |
| Dental students in the Americas | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Region: Americas | SMD 1.82 [-0.24, 3.88] GRADE not reported 3 studies |
| Dental students in general stomatology | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Discipline: general stomatology | SMD 1.64 [0.42, 2.87] GRADE not reported 5 studies |
| Dental students in oral medicine | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Discipline: oral medicine | SMD 1.33 [0.74, 1.93] GRADE not reported 13 studies |
| Dental students in prosthodontics | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Discipline: prosthodontics | SMD 1.16 [0.33, 1.99] GRADE not reported 9 studies |
| Dental students in oral and maxillofacial surgery | Early clinical exposure (ECE) | Traditional lecture-based teaching | Overall competency score Dental schools (preclinical education) · Discipline: oral and maxillofacial surgery | SMD 0.92 [0.58, 1.25] GRADE not reported 2 studies |
Included primary studies 27
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ales 2009 matched by author and year (probable) | NR | this review only | Overall competency (student scores) | not extracted yet |
| Ales 2009 A clinically oriented complete denture program for second-year dental students. PMID:19805784 | 2009 | this review only | Overall competency (student scores) | not extracted yet |
| Aript 2025 An Analysis of Student's Perspective of an Early Team‐Based Denture Clinical Experience DOI:10.1002/jdd.13883 | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Benedikt 2025 Smartphone application-based augmented reality for pre-clinical dental implant placement training: a pilot study DOI:10.1007/s10006-024-01317-z | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Elizabeth 2023 Comparing two whole task patient simulations for two different dental education topics DOI:10.1016/j.learninstruc.2022.101690 | 2023 | this review only | Overall competency (student scores) | not extracted yet |
| Esra 2025 Effects of virtual reality and layered tooth model training on manual dexterity in preclinical dental education DOI:10.1186/s12909-025-07622-9 | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Harish 2022 Early Clinical Exposure: An Adjunct Teaching–Learning Tool in Dental Discipline DOI:10.4103/jdmimsu.jdmimsu_231_21 | 2022 | this review only | Overall competency (student scores) | not extracted yet |
| Kamal 2017 matched by author and year (probable) | NR | this review only | Overall competency (student scores) | not extracted yet |
| Komal 2024 Introduction and Effectiveness of Early Clinical Exposure Among Dental Students in Pre-clinical Prosthodontics. PMID:39229438 | 2024 | this review only | Overall competency (student scores) | not extracted yet |
| Li 2025 DOI:10.15956/j.cnki.chin.j.conserv.dent.2025.09.007 | NR | this review only | Overall competency (student scores) | not extracted yet |
| Liu 2016 DOI:10.3969/j.issn.1003-1634.2016.12.008 | NR | this review only | Overall competency (student scores) | not extracted yet |
| Liu 2025 From anatomy to surgery: Effectiveness of virtual simulation adjuvant to traditional methods in the preclinical training of apicoectomy DOI:10.1002/ase.2538 | 2024 | this review only | Overall competency (student scores) | not extracted yet |
| Marco 2025 Bridging the gap to clinical practice: a concept for virtual patients in preclinical education in prosthetic dentistry DOI:10.1186/s12909-025-08097-4 | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Musab 2023 Comparative Analysis of Manual Dexterity of Dental Students at Ajman University following One Academic Year of Preclinical Training… DOI:10.1055/s-0042-1758793 | 2022 | this review only | Overall competency (student scores) | not extracted yet |
| Nebu 2023 Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric… DOI:10.3390/ijerph20054226 | 2023 | this review only | Overall competency (student scores) | not extracted yet |
| Pravinkumar 2016 Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot… PMID:27621550 | 2016 | this review only | Overall competency (student scores) | not extracted yet |
| Sarah 2025 Impact of Early Preclinical Exposure on Academic Performance, Clinical Skills, and Confidence Among BDS Students at Private Dental College DOI:10.1155/sci5/5178600 | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Sukhdeep 2020 Evaluation of the introduction of a dental virtual simulator on the performance of undergraduate dental students in the pre‐clinical… DOI:10.1111/eje.12453 | 2020 | this review only | Overall competency (student scores) | not extracted yet |
| Tong 2024 DOI:10.3969/j.issn.1002-1701.2024.11.018 | NR | this review only | Overall competency (student scores) | not extracted yet |
| Valerie 2022 Preclinical <scp>3D</scp>‐printed laboratory simulation of deep caries and the exposed pulp reduced student anxiety and stress, while… DOI:10.1111/iej.13780 | 2022 | this review only | Overall competency (student scores) | not extracted yet |
| Wang 2017 DOI:10.26914/c.cnkihy.2017.005416 | NR | this review only | Overall competency (student scores) | not extracted yet |
| Wang 2025 DOI:10.13566/j.cnki.cmet.cn61-1317/g4.202505018 | NR | this review only | Overall competency (student scores) | not extracted yet |
| Zain 2023 Assessment of quality improvement of simulation‐based learning using an evidence‐based framework in dental education DOI:10.1111/eje.12957 | 2023 | this review only | Overall competency (student scores) | not extracted yet |
| Zeng 2023 <scp>3D</scp> ‐printed coloured tooth model for inlay preparation in pre‐clinical dental education DOI:10.1111/eje.12972 | 2023 | this review only | Overall competency (student scores) | not extracted yet |
| Zhao 2021 matched by author and year (probable) | NR | this review only | Overall competency (student scores) | not extracted yet |
| Zou 2025 Three-dimensional printed apical barrier model technology for pre-clinical dental education DOI:10.3233/thc-241483 | 2025 | this review only | Overall competency (student scores) | not extracted yet |
| Zulema 2023 DOI:10.18926/amo/65144 | NR | this review only | Overall competency (student scores) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Dental students without prior clinical experience | Dental students (n=2995) |
| Intervention | Early clinical exposure (real, simulated or virtual clinical learning) | ECE: 8 real clinical, 13 simulated, 6 virtual environment studies (n=1787) |
| Comparison | Traditional lecture-based teaching | Traditional teaching (n=1211) |
| Outcomes | Student competency scores (theoretical knowledge, practical assessments, self-efficacy) | Overall competency (27 studies); theoretical knowledge; clinical practice; self-efficacy |
| Study designs | RCTs and NRSIs | 13 RCTs and 14 NRSIs |
| Timing | Not specified | ECE duration from hours to one academic year |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |