How is Endodontics taught? A survey to evaluate undergraduate endodontic teaching in dental schools within the United Kingdom

A multi-national survey-based evaluation of undergraduate/predoctoral endodontic education

AIM

To evaluate the current status of endodontic education and assessment at an undergraduate/predoctoral level in dental schools worldwide.

METHODOLOGY

The current survey comprised a 50-item online questionnaire related to undergraduate endodontic education. The project leaders emailed the survey's details to faculty members responsible for endodontic teaching at one dental school in every country to seek their willingness to participate in the survey. After the faculty members accepted, the survey details were sent to participants along with the survey link. Simple descriptive statistics were used to represent the data.

RESULTS

Amongst the 44 faculty members from different countries who agreed to participate, 36 completed the survey. Endodontic training starts in 50% of dental schools from the third year of the curriculum. Each dental school employs a diverse range of educational methods. During pre-clinical training, 19.4% of the participating dental schools used only natural teeth. Stainless-steel hand instruments, syringe irrigation with a needle, resin-based sealer and the cold lateral compaction technique are the most frequently used in pre-clinical and clinical training. A significant percentage of dental institutions necessitate that students treat a predetermined quantity of canals or teeth throughout their pre-clinical and clinical education. Dental institutions conduct formative, summative or a combination of the formative and summative throughout the clinical and pre-clinical phases of endodontic training.

CONCLUSIONS

According to the data collected from this survey, there are considerable variations in the curriculum for undergraduate/predoctoral endodontic programmes amongst the surveyed dental schools. Pre-clinical and clinical education should integrate a larger array of modern tools and procedures.

Teaching of magnification in the undergraduate curriculum: A position statement from the British Endodontic Society Teachers of Endodontology Group

This position statement on undergraduate teaching on the use of magnification in endodontics represents the consensus of the British Endodontic Society Teachers of Endodontology Group. Current clinical and scientific evidence, as well as the expertise of the committee, has been used to develop this statement. The contributors to this position statement consider, as a minimum requirement, the use of dental loupes in non-surgical endodontics at undergraduate level. It is recommended that the use of dental loupes should be integrated into endodontic clinical skills training and the performance of endodontic treatment in the undergraduate curriculum.

Undergraduate endodontic curricula across Canadian Dental Schools: A cross-sectional analysis

INTRODUCTION

This study aimed to evaluate and assess the degree of uniformity in endodontics education at the undergraduate level among Canadian dental schools. The objective is to enhance Canadian dental education programs to meet societal oral health needs while incorporating advancements in the field of endodontics.

METHODS

An online survey comprising 36 multiple-choice questions targeting the nature of endodontic teaching was conducted as our methodology. Participation was sought from directors of the undergraduate endodontics program at all ten Canadian dental schools in 2021 and 2022.

RESULTS

A remarkable 100% response rate and the findings revealed a certain level of consistency among Canadian schools concerning pedagogical and assessment methods, as well as the endodontic topics taught to undergraduate students. However, notable variations were observed in the equipment and materials utilized. This study serves as a fundamental reference for identifying future modifications to the undergraduate endodontics curriculum in Canada.

Teaching a New Obturation Technique in Preclinical Endodontic Training: Assessment of Student Learning Experience, Performance, and Self-Evaluation

INTRODUCTION

This study investigated the impact of implementing hydraulic condensation (HC) as a second obturation technique in the Endodontic Preclinical course for dental students trained in warm vertical compaction (WVC).

METHODS

A total of 70 students performed root canal treatment of 2 extracted molars; they performed the HC technique for the first time after a demonstration. The combination of the obturation technique (WVC or HC) and the type of molar (maxillary or mandibular) was randomly assigned, resulting in 4 groups (n = 35). The students answered a questionnaire appraising their learning experience and completed a self-evaluation rubric. Masked instructors graded projects. Data were statistically analyzed (significance set at 5%).

RESULTS

Most of the students (91%) considered learning 2 obturation techniques relevant and considered it difficult to perform the downpack in molars (P < .05). About half of the students (45.7%) responded that HC resulted in fewer errors and disagreed that WVC derives in a more homogeneous obturation; accordingly, 52.9% of the students selected the highest self-grading for HC obturations, while only 38.6% for WVC. No significant difference was found in the distribution of grades attributed by students and instructors (P > .05). Students reported significantly higher levels of confidence for HC and difficulty for WVC (P < .05). No difference was found between the techniques regarding the presence of voids. The presence of multiple errors was more frequent for WVC (P < .05).

CONCLUSION

The findings indicate a positive learning experience and comparable performance among preclinical dental students in implementing HC as an alternative obturation technique.

EUROPEAN SOCIETY OF ENDODONTOLOGY Undergraduate Curriculum Guidelines for Endodontology

Undergraduate education should accomplish graduates who are skilled to provide quality care for patients, who are aware of their scope of practice, competency level and limits and who are open to referring patients whose needs are beyond their own skills and experience. They should also become self-efficacious. Quality performance begins with good diagnosis and decision-making. Graduates should understand when to treat, why to treat, what to treat and how to treat. These guidelines include a list of capabilities that the graduating student will be expected to have achieved to provide a minimum level of competency in endodontics. Theoretical knowledge, practical skills, understanding and insight should be assessed, with both formative and summative assessment procedures, making use of reflection and feedback. Endodontic procedures should be undertaken within the context of comprehensive patient care and should be evidence based. Students should not perform treatments on patients until they have demonstrated in a pre-clinical setting that they possess the required skills. Only if it is not possible to simulate a specific procedure sufficiently in a pre-clinical setting should students learn this procedure by performing it clinically under close supervision. Clinical endodontics should ideally be supervised by endodontists or by staff with special knowledge, interest and self-efficacy in endodontics. It is advised to ensure that students apply their knowledge and practice their skills periodically throughout the continuum of endodontic education until graduation. A philosophy of lifelong learning and evidence-based practice should be instilled in all dental undergraduates.

Influence of the incorporation of small-group practical seminars to a traditional lecture for the understanding of root canal morphology classification systems

INTRODUCTION

This study aimed to assess if the incorporation of small-group practical seminars into a traditional lecture format improved the understanding and learning of the root canal classification systems in undergraduate students.

MATERIALS AND METHODS

A small-group practical seminar was designed for 3rd year undergraduate students. The seminar consisted of the analysis of a guided summary of root canal morphology classifications, a participative discussion of several cases and drawing exercises of several internal anatomies based on the different classifications in templates presenting the external anatomy of different dental groups. Students were inquired about their perspectives on the different classifications and the learning strategies with an anonymous questionnaire. The knowledge acquired was assessed in an exam. The scores obtained were compared using the Mann-Whitney U-test with those obtained in the cohort of the previous year in which only the traditional lecture was delivered.

RESULTS

Students' scores (mean = 7.7; SD = 2.5) were significantly higher (p = .006) than those from the previous cohort (mean = 6.9; SD = 2.3). Most students agreed that Ahmed's classification system was the most complete (98.8%) and intuitive (84%), but also the most difficult to understand (67%). All the students believed that the learning activity helped them understand the new classification system.

CONCLUSION

The incorporation of small-group practical seminars into traditional lecture improved the understanding and learning of root canal configurations in undergraduate students. Students rated the classification system suggested by Ahmed et al. as the most complete and intuitive out of the three systems, but also the most difficult to learn.

Assessment of the quality of root canal fillings performed on extracted teeth by undergraduate dental students in a sample from Saudi Arabia

BACKGROUND

The educational process in the field of endodontics commences with preclinical exercises to enhance students' proficiency in cleaning, shaping, and performing root canal fillings. Therefore, this study aimed to radiographically evaluate the technical quality of root canal fillings performed by preclinical students on extracted teeth at the College of Dentistry, University of Ha'il, Saudi Arabia.

METHODS

A total of 788 extracted human teeth received root canal treatment by undergraduate students. The samples were then gathered and radiographically assessed using the three quality criteria of length, density, and taper. The category of root canal fillings was classified as either acceptable or unacceptable. The criteria for evaluating the acceptability of filling quality were defined based on the presence of adequate length, density, and taper. The effectiveness of root canal fillings was also evaluated in relation to the tooth type, sex, and treatment year. The agreement between the examiners was evaluated using Cohen's kappa test, and the relationship between the research variables was determined using the chi-squared test. The significance threshold was set at 0. 05.

RESULTS

The overall quality of root filling was determined to be satisfactory in 532 (67.5%) of 788 endodontically treated extracted teeth. The majority of the research sample (88.1%) had enough length, 89.6% had adequate density, and 86.4% had acceptable taper. The quality of anterior teeth was substantially better than that of posterior teeth (p < 0.001). Our findings showed that the quality of root canals was better in 2022 than it had been in earlier years (p = 0.001). The three RCT quality criteria differed significantly when compared between sexes (p = 0.002).

CONCLUSIONS

The quality of the root canal fillings completed by undergraduate students was rated as acceptable. The findings of the research suggest that the implementation of routine assessments to evaluate the technical competence of undergraduate dental students performing root canal treatments could provide significant insights into the efficacy of the curriculum requirements.

Difficulties Faced by Undergraduates While Conducting Endodontic Therapy

BACKGROUND

Dentistry is a complex field that utilizes both theoretical and practical knowledge along with a distinct coordination of the hand, brain, and eye of an individual, forming a major part of endodontic therapy. Assessing the understanding and practical knowledge of undergraduates from time to time is essential in evaluating the success of the undergraduate education system. Therefore, the purpose of this study was to evaluate the challenges that are associated with endodontic therapy and are faced by undergraduate students at College of Dentistry, Qassim University.  Methodology: Ninety-seven undergraduates who had completed their preclinical training and had done endodontic treatments were included in this questionnaire-based study. The Chi square test and Fisher's exact test have been used to determine whether or not there is a significant difference on a categorical scale between two or more groups of study parameters.

RESULTS

According to our results, de-roofing of the pulp chamber and recognizing the canal orifices are the two areas that need more consideration. The gender-wise difference in the challenges faced by the students while performing the majority of steps during endodontic treatment was found to be insignificant. However, a significant difference was noted in relation to the complete deroofing of the pulp chamber (p-value=0.04) and locating the canal orifices (p-value=0.04). Moreover, fifth year students rarely faced difficulties in performing anesthesia and rubber dam placement, whereas fourth year students faced difficulties in both procedures.

CONCLUSION

The study concludes that de-roofing the pulp chamber and identifying the orifices of canals are two areas where more attention should be given while training undergraduate dental students.

Parallel endodontic education via social media: An exploratory survey study

There is insufficient research to evaluate social media's influence on endodontic education. Therefore, this study assessed the percentage of students utilising Facebook in their education and the factors influencing their engagement. A survey was conducted on dental students, interns and dentists undertaking specialist programmes. Categorical data were analysed using Fisher's Exact test and multiple pairwise comparisons. The significance level was set at p < 0.05. Responses were received from 801 participants, with 98.4% using Facebook for endodontic knowledge. Although most students knew that scientific evidence is not always provided, they still deemed such information valuable as it was a practical demonstration of clinical cases. Most students turn to Facebook for endodontic education to compensate for the gap between their academic education and clinical practice. The utilisation of social media for education can be a concerning phenomenon and should not be ignored by academic institutes.

Endodontic access cavities: Fears and difficulties of Moroccan dental students related to teachers, self-confidence and technical protocol

Fears and difficulties of Moroccan dental students regarding endodontic access cavity were evaluated among 3 items: (i) teachers, (ii) student confidence and (iii) access cavity protocol. A three Likert scale was used to rate 24 statements. Specific scores between 1 and 3 and mean scores between 0 and 1 were used to assess statements and items, respectively. Among 116 students, the mean score of difficulty related to teachers (0.48 ± 0.14) was significantly low (p < 0.001) compared to student confidence (0.69 ± 0.12) and cavity protocol (0.68 ± 0.08). The number of teachers was esteemed insufficient, additional training sessions were requested and maxillary teeth and molars were rated the most difficult with specific scores of 1.91 ± 0.80, 2.72 ± 0.61, 2.22 ± 0.67 and 2.47 ± 0.74, respectively. The highest specific score referred to the risk of making ledges (2.8 ± 0.56) or perforations (2.76 ± 0.59). Students expressed a lack of confidence, difficulty with upper molars and fears of making procedural errors.

Teaching rotary root canal instrumentation using a Peyton teaching approach

INTRODUCTION

The aim of the study was two evaluate the effectiveness of a Peyton teaching approach for rotary root canal instrumentation, in comparison to the traditional "see one-do one" method.

MATERIAL AND METHODS

Forty undergraduate students were randomly divided into two groups (n = 20). Students of the first group (G1) were taught how to use rotary instrumentation using a modified Peyton method, whilst the second group (G2) watched a teaching video (30 min) on the same subject. Both groups instrumented a plastic block and subsequently both mesial canals of an extracted lower molar. The quality of the root canal instrumentation was analysed by 2 blinded observers on video recordings and x-rays.

RESULTS

Interobserver correlation was 0.917 (p < .0005; Pearson) for the assessment of the video recordings; students of G1 received significantly more total points (83.55 ± 6.82 points) compared to G2 (69.76 ± 13.82) (p = .001; t-test), the gender had no significant effect on the overall results (p = .444; two-way ANOVA). Significant differences were detected for the categories "initial scouting," "coronal enlargement," "glide path preparation," "preparation using X2 file," "preparation using X3 file" (p < .05; t-test) as well as for the subcategories "sequence of rinse, recapitulation, rinse" (p = .001; t-test) and "recapitulation" (p < .002; t-test). No differences between groups were observed for the radiographic evaluation with respect to working length and canal straightening.

CONCLUSION

Teaching rotary instrumentation by using the Peyton approach resulted in improved performance of undergraduate students assessed with a checklist-based process analysis. Enhanced implementation of rotary instrumentation could result in better long-term results of students' root canal treatment.

A Novel Self-Assessment Method for Training Access Cavity on 3D Printed Endodontic Models

BACKGROUND

New technologies can facilitate the transition from pre-clinical to clinical settings. We investigate students' satisfaction with a novel learning method adopted in access cavity exercises.

METHODS

Students performed their access cavity on inexpensive, in-house 3D printed teeth. Their performances were evaluated by scanning the prepared teeth with an intraoral scanner and visualized using a mesh processing software. Then, the same software was used to align the tooth prepared by the student and the teacher's one for self-assessment purposes. Students were asked to answer a questionnaire about their experiences with this new learning method.

RESULTS

From the teacher's perspective, this novel learning approach was easy, straightforward and affordable. Overall, student feedback was positive: 73% found that access cavity assessment by scanning was more useful compared to a visual inspection under magnification and 57% reported that they had a better understanding of errors and mishaps. On the other hand, students pointed out that the material used to print teeth was too soft.

CONCLUSION

The use of in-house 3D printed teeth in pre-clinical training is a simple way to overcome some of the drawbacks associated with extracted teeth, such as limited availability, variability, cross-infection control, and ethical constraints. The use of intraoral scanners and mesh processing software could improve student self-assessment.

Differential attitudes and outcomes of endodontics education between mainland and non-mainland chinese students during COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has changed the learning style and campus life of dental students. This study aimed to evaluate the learning attitudes and outcomes of endodontics among mainland Chinese students and non-mainland Chinese students (students from Hong Kong, Macao, and Taiwan) during the pandemic.

METHODS

A cross-sectional survey was conducted in November 2022 at the School of Stomatology, Jinan University, utilizing a self-report online questionnaire, including demographic characteristics and attitudes toward the endodontic course and the COVID-19 pandemic. The endodontics scores were collected from recruited students for further analysis. The collected data were analyzed using SPSS 22.0 software, with independent two-sample t-tests to compare continuous variables and chi-square tests for categorical variables.

RESULTS

A total of 215 dental students completed the survey, with 126 (58.6%) of them being non-mainland Chinese students. Compared to mainland Chinese students, non-mainland Chinese students had lower scores in both theoretical (63.6 ± 13.5 vs. 83.2 ± 8.00) and skill (88.4 ± 5.38 vs. 90.0 ± 4.91) endodontic assessments. Non-mainland Chinese students reported significantly greater impacts of the COVID-19 pandemic on their learning emotions, personal hygiene, and future career choices compared to mainland Chinese students.

CONCLUSIONS

Non-mainland Chinese students had poorer academic performance in endodontics and experienced a greater impact from the COVID-19 pandemic in terms of their studies and lives. Dental educators should consider the diversity of students and take necessary measures to support their mental health and enhance learning outcomes in the post-COVID-19 era.

Perception of Dental House Officers regarding Endodontic File Separation during Endodontic Treatment

Background

Despite of having improved endodontic file designs as well as the reinforced metal alloy file structure, intracanal endodontic file separation (EFS) is still a very problematic and worrisome dental incident, which usually occurs without any visible signs of permanent deformation. Further, there have been conflicting reports regarding the clinical significance of leaving separated files within root canals.

Aims

The aim of this study was to look into the current perceptions and awareness about file separation during endodontic treatment among the dental house officers (DHOs).

Materials and Methods

A novel validated questionnaire comprising of 15 close-ended questions was distributed anonymously via Google Forms through email to 1100 DHOs across Pakistan. The questionnaire consisted of two parts: the first component (Section I) collected demographic data and the second component (Section II) investigated the causes of EFS during root canal treatment. Following the completion of socioeconomic information, including age and gender, the DHOs were asked to answer a few questions about the various reasons for endodontic instrument fracture.

Results

A total of 800 responses were recorded, with an effective rate of 72.8%. The majority of the DHOs (p value < 0.001) perceived that endodontic instrument fracture occurred in the posterior (61.5%) and apical third of the canal (50.5%) and in older permanent dentition (67.3%), possibly due to patient anxiety (62%). Better choice of instrument (61.15%), operators' experience (95.3%), knowledge (87.5%), and proper root canal cleaning (91.1%) are believed to be the vital steps in reducing endodontic file separation/fracture. Furthermore, majority of them (p value < 0.001) perceived that stainless steel was a superior alloy for filing instruments. Manual files tend to be more prone to fractures due to repeated use than rotary files.

Conclusion

This study demonstrated that young DHOs had adequate knowledge and awareness regarding the potential predisposing factors and handling techniques for EFS. This study thereby provides an evaluating tool to access the insights of the current perceptions and awareness of DHOs concerning EFS.

Undergraduate Endodontic Training and Its Relation to Contemporary Practice: Multicenter Cross-Sectional Study in Saudi Arabia

Materials and Methods

An online questionnaire was developed and emailed to all dental schools in Saudi Arabia. This questionnaire was answered by the endodontic undergraduate program director. The data collected were analysed using descriptive statistics.

Results

The response rate was 96.15%, which means twenty-five out of twenty-six dental schools participated in the study. The majority of the academic supervisors was endodontists (92%). The use of magnification and ultrasonic tips was not required by 84% and 76% of the dental schools, respectively. The main endodontic treatment techniques were the step-back technique and gates glidden for cleaning and shaping (76%) and cold lateral compaction for obturation (92%).

Conclusions

The dental students were supervised by endodontic specialists and trained to use traditional endodontic methods. Encouraging dental educators to train students to use modern technology and equipment would probably improve their graduate clinical skills and performance.

How Is Endodontics Taught in Italy? A Survey of Italian Dental Schools

The aim of our study was to investigate how endodontics is taught in Italian universities. An online survey was conducted from August to December 2021. A comparison between courses led by full or associate professors (Group 1) versus courses led by other figures, such as researchers or temporary lecturers (Group 2), was made. A total of 28 out of 36 schools participated (78%). In most schools, endodontics is taught in the fifth year to 15-29 students. All schools planned pre-clinical endodontic training, and in 25/28 schools (89.3%), clinical endodontic training was also provided. The course programs varied among schools, and significantly more hours were allocated to teaching nonsurgical root canal treatment in Group 1 schools than in Group 2 schools. The average numbers of hours of preclinical and clinical training were 34.3 ± 23.6 and 84.1 ± 76.7, respectively. All schools used rotary NiTi files in their clinical training, and the vertical condensation of hot gutta-percha was the most frequently taught obturation technique. As expected, the scenario of endodontic education in Italian universities was variable and needs harmonization. Courses led by full or associate professors seem to be better structured.

A Critical Evaluation of the Undergraduate Endodontic Teaching in Dental Colleges of Saudi Arabia

BACKGROUND

The purpose of the research was to evaluate the content and delivery of the undergraduate endodontic curriculum.

METHODS

A needs assessment survey was distributed among the Deans of all the dental colleges in Saudi Arabia.

RESULTS

The response rate was 72%. All the colleges include foundational and advanced topics in their curriculum. Didactic lectures, clinical cases, self-directed learning assignments and projects, and videos are the most common teaching methods, whereas virtual learning and reading list are the least popular methods. The average staff-to-student ratio for preclinical and clinical training is 1:6 and 1:7, respectively. Eighty-six percent of colleges utilize dedicated endodontic clinics supervised by specialized endodontists. Eighty percent of colleges use simple cases for canal preparation and obturation. Most colleges do not use magnification and ultrasonic instruments. Saline and sodium hypochlorite are preferred irrigation solutions, whereas calcium hydroxide is the preferred inter-visit medicament. Many use MTA as an advanced material, calcium hydroxide as an inter-visit medicament, and provisional restoration after RCT.

CONCLUSION

The content and delivery of the endodontic undergraduate curriculum are primarily uniform. The use of specialist endodontists dedicated endodontic clinics, rotary instruments, and advanced materials have emerged as curricular strengths. However, diversification of teaching strategies, use of magnification instruments, and an increase in the minimum number of endodontically treated teeth are leading areas demanding curricular improvement.

The Assessment of Quality of the Root Canal Filling and the Number of Visits Needed for Completing Primary Root Canal Treatment by Operators with Different Experience

The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed, obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.

Radiographic assessment of endodontic mishaps in an undergraduate student clinic: a 2-year retrospective study

Objectives

The aim of this study was to compare the occurrence of instrumentation and obturation related endodontic procedural mishaps following the use of either, stainless steel hand or engine-driven rotary instrumentation techniques.

Methods

From a computerized hospital database, a total of 730 dental patient records who had received endodontic treatment by undergraduate dental students between August 2018 to September 2020 were retrieved. The inclusion criteria were primary (non-surgical) endodontic treatment on permanent teeth with complete radiographic records. Following record screening, a final sample of n = 475 dental records were included. Radiographic records were evaluated for both instrumentation and obturation related mishaps. The data was analysed using multiple logistic regression analysis (α = 0.05).

Results

Engine-driven rotary instrumentation resulted in a significant decrease in the overall occurrence of instrumentation related endodontic mishaps by 40% compared to hand instrumentation (Odds Ratio = 0.59 [0.36-0.97], p = 0.04). In particular, rotary instrumentation decreased ledge formation, perforation and obturation related mishaps, with minimal effect on the limitation of zipping.

Conclusion

The use of rotary instrumentation techniques may reduce the incidence of instrumentation and obturation endodontic mishaps in the undergraduate dental clinic.

How is working length determination taught? A survey to assess what is recommended in undergraduate Schools of Dentistry in Brazil

INTRODUCTION

To analyse what are the methods for working length (WLD) determination taught for undergraduate students in Brazilian Dental Schools and the perception of professors about the use of electronic WL determination in the clinical practice.

METHODS

An online questionnaire with eighteen closed questions was sent to 209 Schools of Dentistry in Brazil using the Google Forms Platform. The questionnaire was structured to analyse the perception of professors in the department of endodontics about the method of working length determination taught in undergraduate courses in Dentistry. The data collected in the questionnaires were transferred to an Excel^® spreadsheet and analysed using absolute and relative frequencies. The non-parametric Mann-Whitney test was used to compare groups.

RESULTS

Of the 209 schools contacted, 41 (19.61%) returned answers to the questionnaire. According to professors, electronic working length (WL) determination had a shorter length of time to perform it (p < .001), WL measurement accuracy (p < .001) and ease of performance (p < .001). Professors felt safer when maintaining patency when using electronic WL determination (p = .0020).

CONCLUSIONS

Both radiographic and electronic methods of WL determination are taught in Brazilian Schools of Dentistry. The electronic method was used more frequently, especially in undergraduate clinical courses.

Dental students' observations about teaching of endodontic access cavities in a French dental school

INTRODUCTION

Teaching in French universities has undergone deep changes for several years. Dental studies are no exception to the rule. Endodontics is one of the most difficult fields requiring good knowledge of anatomy before performing clinical procedures. The access cavity is the key step of endodontic therapy. The aim of this study was to collect and understand what students feel and expect from theoretical and practical training on endodontic access cavity.

MATERIALS AND METHODS

A questionnaire survey on the teaching and learning of endodontic access cavities in a French dental school was sent by e-mail to the 4th-year students (n = 66). The questionnaire consisted of 13 questions of different formats. Qualitative variables were analysed using a word cloud according to the words of the participants. Students were also asked how to improve teaching with new educational tools.

RESULTS

60 students answered the questionnaire (response rate of 90.9%). When students were asked which stage of endodontic treatment they feared the most, performing access cavity came in 3rd place. Upper molar (71%) and lower molar (58%) appeared to have the most difficult endodontic access cavities. Within the word cloud gathered after students' answers analysis, the words "fear," "perforation," "cavity" and "axis" were highlighted. Amongst the 3 new educational tools proposed to students, most were in favour of realistic models of teeth with their ideal endodontic access cavity (79%).

DISCUSSION

This study highlighted the feelings of students during their hands-on training on endodontic access cavities. Although they seemed satisfied with practical classes on endodontic access cavities, this step seemed to be stressful for students especially because of the great internal anatomical variabilities of teeth. To help them better understand the root canal anatomy and improve their training, students asked for new educational resources, especially macro-models of teeth with their optimal access cavities.

CONCLUSION

This study showed that students are seeking for innovative resources in addition to traditional resources that would make it easier for them to visualise the root canal system and help them feel more comfortable and facilitate learning when performing endodontic access cavities.

Factors affecting the quality of endodontic treatment in general dental practice in Scotland: a qualitative focus group study

Introduction The quality of endodontic treatment worldwide is variable despite clear clinical guidelines being available.

Aims Identify the factors that affect the quality of endodontic treatment in general dental practice in Scotland and how to overcome the barriers identified.

Methods Four online focus group interview sessions were conducted in which a total of 16 participants were recruited, including general dental practitioners, endodontic specialists and educationalists. Topics for facilitated discussion were based on healthcare system theory and included education/training, patient factors, resources and equipment factors; themes were identified via template analysis.

Results A number of themes and subthemes affecting the quality of care are reported, including aspects to do with remuneration, time, education, training, support from secondary care and the impact of COVID-19.

Conclusion Findings support: increase practical experience for undergraduates; access to postgraduate mentoring and training; development of a managed clinical network to facilitate access to appropriately trained specialists; and increased remuneration to allow sufficient time and adequate equipment to achieve clinical standards.

Despite available clinical guidelines, the quality of root canal treatment in NHS general dental practices is suboptimal.

A variety of factors influence the quality of treatment in general dental practices, such as cost of treatment and equipment, a lack of training or education, inadequate support from secondary care and the impact of COVID-19.

Adequate funding and support for clinicians could allow them to invest appropriately in treatment and equipment to improve the quality of care in NHS.

Continuing professional education is frequently seen as a tool to improve the quality of care.

The objectives and instructional design of undergraduate endodontic program: multicenter cross-sectional study in Saudi Arabia

BACKGROUND

Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.

METHODS

The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher's exact tests.

RESULTS

The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students' performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).

CONCLUSION

The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.

Effect of an endodontic e-learning application on students' performance during their first root canal treatment on real patients: a pilot study

BACKGROUND

E-learning has found its way into dental teaching in general and endodontic teaching in particular. The present study aimed to implement a newly developed multimedia learning application and assess its effect on students' first root canal treatment on real patients. With the COVID-19 outbreak, the application's performance was investigated during the pandemic.

METHODS

A total of 138 students in the initial clinical endodontic course participated in this study. The control group (n = 49) followed the traditional curriculum, including practice on artificial teeth and face-to-face teaching events. In addition to the traditional curriculum, test group 1 (n = 54) had access to an endodontic e-learning application containing videos demonstrating artificial teeth and patient cases. With the COVID-19 outbreak, test group 2 (n = 35) had no face-to-face teaching; however, endodontic patient treatments were included. The quality of students' first root canal treatment on real patients was compared using performance and radiographic assessment items. Statistical analysis was done using Kruskal-Wallis and chi-squared tests. Test groups received a questionnaire to assess the learning application. Test group 2 also completed a COVID-19-specific survey to measure students' perceptions of how the pandemic affected their endodontic education.

RESULTS

The results of endodontic treatments were significantly better for test group 1 (P < 0.001) and 2 (P < 0.001) than for the control group. Likewise, there were significantly fewer treatment errors in test group 1 (P < 0.001) and 2 (P < 0.001). No significant differences were found between test groups 1 and 2. Students of the test groups positively evaluated the e-learning application. Students of test group 2 expressed their fear of negative impacts on their course performance.

CONCLUSION

The e-learning application was well-received and seemed to improve endodontic education. The results imply that the quality of education may be maintained by implementing e-learning to compensate for face-to-face teaching. As no difference was found between online and face-to-face teaching, students' and lecturers' concerns that endodontic education is suffering because of the pandemic may be eased.

Preclinical 3D-printed laboratory simulation of deep caries and the exposed pulp reduced student anxiety and stress, while increasing confidence and knowledge in vital pulp treatment

Aim

To evaluate the impact of a preclinical laboratory session using 3D printed teeth on dental student stress, anxiety, confidence and knowledge when treating deep caries and pulp exposure.

Methodology

This was a two‐centre controlled study, with randomized distribution of students into two groups: a vital pulp treatment (VPT) lecture‐only (control) group and a VPT‐lecture combined with a VPT‐laboratory (experimental) group. In both universities, preclinical students with endodontic or operative dentistry laboratory sessions could participate. All students were invited to the lecture. Two weeks later (timepoint‐T1), both groups completed validated and bespoke questionnaires and scales to evaluate their stress (Stress‐VAS), anxiety (STAI Trait [T] and State [S]), self‐confidence and knowledge. Thereafter, only the experimental group attended the hands‐on laboratory session demonstrating the techniques of selective caries removal and partial pulpotomy on a commercial 3D‐printed tooth. Two weeks later (timepoint‐T2), the participants from both groups repopulated the same questionnaires and VAS. The control group had the laboratory session after the completion of the study. The statistical analysis was performed with Statistica® (significance p = .05). The homogeneity between the two samples was checked by Khi² and Student tests. Stress‐VAS, STAI‐S, confidence and knowledge scores were compared within each group, and between the two groups, at T1 and T2, with a repeated measures anova test (+/−Tukey post‐hoc test).

Results

The groups comprised 54 students each, with no statistical difference between the groups regarding demographic, academic data and STAI‐T score. The two groups had no significant difference of Stress‐VAS, STAI‐S, confidence and knowledge scores at T1 while they presented a significant difference in stress, anxiety and confidence scores at T2, but with no significant difference in knowledge score. However, knowledge score, as other parameters, improved significantly between T1 and T2 in the experimental group.

Conclusions

The addition of a laboratory session using 3D‐printed teeth that simulated deep caries and pulp exposure management, significantly reduced the stress and anxiety of students and increased their confidence. Within the limitations of this study, the benefit of introducing new technology in increasing student confidence and reducing stress offers opportunity for educational improvement in the VPT and cariology areas.

A multicentric survey to evaluate preclinical education in Endodontology in German-speaking countries

AIM

To evaluate preclinical education in Endodontology at Austrian, German and Swiss dental schools using an online survey.

METHODOLOGY

An online survey divided into nine categories was sent using SurveyMonkey software to 37 dental schools, before the spread of the COVID-19 pandemic. The questionnaire included 50 questions to evaluate preclinical endodontic education, such as faculty-to-student ratios, topics taught and materials used, in preclinical phantom head courses. Seven and 14 days after the first e-mail contact, dental schools received a reminder e-mail. After four and six weeks, the dental schools were contacted by telephone and asked to participate in the online survey. The processing time was eight weeks in total.

RESULTS

The response rate was 89%. Preclinical endodontic education at the participating dental schools differs considerably. Theory classes ranged from 1 to 70 h (15 h mean), and practical classes ranged from 3 to 78 h (39 h mean). The faculty-to-student ratio varied between 1:4 and 1:38 (1:15 mean). Forty-five per cent of the dental schools had a specialist in endodontics teaching theory. Several dental microscopes were available for preclinical teaching purposes at 82% of the dental schools. The majority (82%) taught root canal preparation with rotary or reciprocating NiTi instruments. Overall, 85% of the dental schools taught lateral compaction, amongst other methods, for canal filling.

CONCLUSION

A substantial divergence amongst the dental schools regarding the time dedicated to theory and practical instruction in Endodontology was reported. However, convergence in the use of root canal treatment techniques and materials was reported.

Influence of Preclinical Training on Root Canal Treatment Technical Quality and Confidence Level of Undergraduate Dental Students

Objectives

The aim of this study was to investigate the influence of exposure to additional preclinical endodontic training on undergraduate students' technical quality of root canal treatment and overall confidence levels in endodontics.

Methods

Technical quality of root canal treatment performed clinically by fifth-year undergraduate students was evaluated and divided into two groups: Group 1, teeth treated by students who had attended both a preclinical endodontic block course and an elective preclinical course. Group 2: teeth treated by students who had not attended the elective preclinical course. All students were also invited to participate in a survey to rate their undergraduate endodontic training and confidence levels performing endodontic treatment. Statistical analysis of data was performed using Person chi-square test, Fisher Freeman Halton exact test, and t-test. A p-value <0.05 was considered statistically significant.

Results

There was no significant difference between the two groups in overall obturation quality (p=0.619). However, more teeth treated by attendees were of adequate obturation length (p=0.015) and lacked procedural errors (p=0.004). Significantly more elective course attendees rated their undergraduate endodontic training as adequate (p=0.002), but there was no significant difference in the level of confidence between the attendees and the non-attendees.

Conclusion

Within the limitations of this study, additional preclinical training showed minimal effect on overall quality of root canal treatment performed clinically by undergraduate students and did not enhance their confidence levels; however, it was associated with more satisfaction with their undergraduate endodontic education.

Use of technology in endodontics by undergraduate dental students in a south-eastern state of Brazil

INTRODUCTION

This study aimed to determine the level of incorporation of current technologies for endodontic treatment in undergraduate dentistry courses in a south-eastern state of Brazil.

METHODS

For data collection, a self-assessment-based online questionnaire was created using the "Google Forms" platform, consisting of 12 multiple-choice and a few open-ended questions. The questions were related to the use of current technologies for diagnosis, imaging, use of ultrasonics in endodontics, instrumentation, use of apex locator, microscopy, photodynamic therapy and thermoplastic techniques during endodontic treatment. The questionnaire was sent to 54 dental schools in Minas Gerais.

RESULTS

The results show low technological incorporation during the various stages of endodontic treatment by undergraduate students in dentistry courses in Minas Gerais.

CONCLUSION

Despite the availability of several technologies to help perform different stages of endodontic treatment, it was observed that most universities do not teach the use of these technologies. Additional studies are needed to correlate how the lack of incorporation of these technologies could impact on the quality of the endodontic learning for undergraduate students.

Use of contemporary technologies and new materials in undergraduate Endodontics teaching

Background

This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain.

Material and Methods

The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics.

Results

The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta-percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).

Conclusions

Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools.

Key words:Bioceramic materials, dental schools, endodontic curriculum, magnification, online survey, rotary instrumentation, ultrasonic devices.

Undergraduate endodontic clinical training in Malaysia: A National survey

AIM

Online survey was conducted to investigate the state of undergraduate endodontic clinical training in Malaysian dental schools.

METHODS

An online questionnaire and a cover letter were emailed to the deans of 13 Malaysian dental schools. The questionnaire covers various aspects of endodontic clinical training including teaching methods, endodontic clinical procedures, minimum requirements, clinical sessions and teaching staff.

RESULTS

The response rate was 69%. Similarities in teaching methods were observed in all responding schools. All schools taught contemporary root canal treatment procedures, including the utilisation of radiograph and electronic apex locator for working length determination, the crown-down approach for canal preparation and the cold lateral compaction for obturation. Sodium hypochlorite solution and non-setting calcium hydroxide medicament were used in most dental schools. Variations were observed in terms of the number of clinical requirements, supervisor: student ratio, and availability of endodontic specialists. The use of engine-driven instruments was observed mainly in government-funded dental schools.

CONCLUSIONS

The majority of dental schools in Malaysia are adopting the European Society Endodontology recommendation for undergraduate endodontic training, particularly in relation to the surveyed aspects. Most of the government-funded dental schools have progressed towards engaging contemporary endodontics with their increasing application of engine-driven Ni-Ti instruments and 3D imaging techniques. Appointments of full-time endodontic specialists would further enhance the quality of endodontic teaching and permit the utilisation of contemporary endodontic materials.

Evaluation of undergraduate Endodontic teaching in dental schools within Spain

AIM

To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools.

METHODOLOGY

An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools.

RESULTS

The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full-time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P = 0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate-based endodontic cements, irrigating solutions, inter-visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P = 0.041), spend significantly more hours in clinical training (P = 0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P = 0.010).

CONCLUSIONS

Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed.

How is paediatric dentistry taught? A survey to evaluate undergraduate dental teaching in dental schools in the United Kingdom

INTRODUCTION

The quality assurance of undergraduate dental education in the UK is regulated by the General Dental Council who describe the competencies expected of the newly qualified dentist or "safe beginner." Whilst the literature has explored the level of undergraduate training in a number of dental specialties within the UK, there is a paucity of information on the UK curriculum for undergraduate paediatric dental teaching.

AIMS

This study aimed to assess the undergraduate teaching of paediatric dentistry within dental schools in the UK.

METHODS

An anonymous questionnaire was distributed to all 16 UK dental schools via email.

RESULTS

Twelve questionnaires were completed, giving a response rate of 75%. First exposure to both academic teaching and clinical teaching in paediatric dentistry ranged from years 1-4. Whilst there were broad similarities between units with regard to core components of the curricula, there were notable differences including the teaching of regenerative endodontics (75%) and the use of the titanium trauma splint (58%). Silver diamine fluoride was only used clinically in one unit (8%), and non-vital pulpotomy was taught by two units (16%). There was also considerable heterogeneity in assessment methods between universities.

CONCLUSION

The undergraduate paediatric dental curriculum is broadly similar between UK dental schools. However, there are discrepancies in assessment methods and the teaching of new advances.

Self-Reported Effectiveness of e-Learning Classes during COVID-19 Pandemic: A Nation-Wide Survey of Pakistani Undergraduate Dentistry Students

OBJECTIVES

 The main aim of this study was to determine the undergraduate dental students' self-reported effectiveness of online classes offered by various dental institutes of Pakistan.

MATERIALS AND METHODS

 A cross-sectional study was conducted using an online survey. A pretested and validated questionnaire comprising of 31 questions was circulated among dental students. The study participants were inquired about the perceived level of accessibility of resources and the effectiveness of online teaching. The data was analyzed using SPSS version 24. Mann-Whitney U test and Kruskal-Wallis test were used for statistical analysis at p ≤0.05.

RESULTS

 A total of 1,207 students from all over Pakistan responded. The majority of students was dissatisfied with the institutional learning management system and quality of learning resources available. Students were also dissatisfied with the level of training of teachers for online lectures. The worst rating was reported for questions related to the effectiveness of online classes (average rating: 3.83 and 3.781/5). First-year students reported poor interaction with teachers (p < 0.001) and strongly disagreed with the effectiveness of online classes (mean rating: 4.14 ± 0.935).

CONCLUSIONS

 The results from the present survey showed that dental students of Pakistan unanimously voiced dissatisfaction toward various elements of online teaching sessions. Findings from this survey will aid the academic institutes to establish proficient learning platforms focused on improving students` learning experience.

Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey

Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.

Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia

AIM

To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice.

METHODS

One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05).

RESULTS

A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P < 0.001). Overall, 97% of students reported the new system helped their understanding of root and canal morphology compared with the Vertucci classification (P < 0.001). Over 97% of students recommended the use of the new system in teaching, pre-clinical courses and clinical practice (P < 0.001). Except for two schools, no significant difference was detected between the responses of students for all questions at the different schools (P > 0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05).

CONCLUSIONS

The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.

Perception of Undergraduate Students at the Faculty of Medicine in Hradec Králové Regarding Their Endodontic Education and Suggested Improvements

AIM

The aim of this study was to assess the perception of undergraduate dentistry students at Charles University, Faculty of Medicine in Hradec Králové, the Czech Republic regarding their endodontic education within the context of the Undergraduate Curriculum Guidelines for Endodontology by the European Society of Endodontology (ESE). The secondary aim was to compare this perception among students in the Czech and English groups.

METHODOLOGY

A questionnaire survey was conducted among fifth year students at the very end of their studies.

RESULTS

The students returned 60 filled questionnaires, making the response rate of 75.9%. More than two thirds of the respondents declared that they were competent at or had knowledge of most of the major competencies defined by the ESE. Eighty seven percent of respondents felt competent to perform a root canal treatment on anterior teeth; 86.7% on premolars; and 48.3% on molars. Nearly all respondents (98.3%) recommended more opportunities to practice on patients.

CONCLUSIONS

The overall perception of the students was that their endodontic education was sufficient and largely conformed to the guidelines. Insufficient exposure to endodontic practice on patients was identified as a deficiency. There were no significant differences in perceptions between the two study groups.