The ability to perform local anesthesia on dental patients is an important clinical skill for a dental hygienist. When learning this procedure in an academic situation, students often practice on their peers to build their skills. There are multiple reasons why the peer practice is not ideal; consequently, educators have sought the means to simulate the practice of local anesthetic procedures without endangering others. Mixed-reality technologies offer a potential solution to the simulated procedure problem. The purpose of this research was to determine if students could learn the techniques for providing local anesthesia using a mixed-reality system that allows them to manipulate 3D objects in virtual space. Guiding research questions were: In what ways do using 3D objects allow for a greater understanding of anatomical, spatial, and dimensional acuity? Will students develop conceptual understandings regarding the application of anatomical and technical concepts through iteration? Will students demonstrate the proper technique and verbalize a level of confidence for administering local anesthesia after using the mixed-reality system? Design-based research methods allowed for multiple iterations of design, enactment, analysis, and redesign. The first iteration focused on building a knowledge base for designing and developing virtual reality technologies for use in dental hygiene education. The second phase of research increased in technical sophistication and involved a virtual system that allowed for student interaction and manipulation of 3D objects. The interactions supported students' learning through the association of anatomical, spatial, and dimensional acuity. Built-in learner prompts promoted the understanding and identification of anatomical landmarks for performing an injection for the lower jaw. Further, the system promoted self-controlled practice and iterative learning processes. Redesign and development in the final iteration focused on design improvements of the system that included an output metric for assessing student performance, a data glove, and a marker to assist in following student interactions. Results support that students learned "while doing" in a specific immersive environment designed for dental hygiene education and they increased their level of confidence for performing a specific procedure. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]