Endodontic training: Study call for standardisation

Dental Tribune International

Fri. 11 April 2025

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DOHA, Qatar: In the past, studies showed that the technical quality of root canal treatments performed by general dental practitioners and students often fell below accepted standards. In response, the European Society of Endodontology (ESE) issued guidelines to strengthen undergraduate endodontic curricula and has continued to update these. Improvements in training in some countries have been noted, and researchers from Qatar, Jordan and Portugal have now conducted a global survey of undergraduate endodontic training. They concluded that investment in modern tools and standardised integration of evidence-based practice in curricula could help to improve the global delivery of endodontic therapy.

The researchers surveyed 38 dental schools across six continents regarding endodontic training and assessments in undergraduate curricula. They found that preclinical endodontic training was generally provided as a key part of other courses at dental schools in Australia and South America and as a separate course at schools in Asia, Africa and North America. Most colleges had dedicated clinical areas for endodontic training, and over half of those surveyed in Europe offered clinical training in dental clinic settings.

Regarding the type of simulators and teeth employed in preclinical training, all of the schools surveyed in Europe and North America and the vast majority of those in Africa, Asia and Australia used phantom heads. Schools in South America largely employed virtual reality simulators instead. The majority of the schools surveyed employed extracted human teeth in preclinical training, besides schools in Australia, which used commercial plastic teeth and 3D-printed teeth. The majority of schools in North America used commercial plastic teeth in addition.

The researchers found that endodontic topics are taught over one or more academic years at different times across dental schools, and the schools in Africa and Asia generally introduce preclinical training later, owing to varying programme duration (four to six years). The study authors pointed out that introducing these topics earlier in the curriculum can help students build a stronger knowledge base, which may enhance their postgraduate clinical performance.

Dr Raidan Ba-Hattab is a researcher at the College of Dental Medicine at Qatar University. (Image: Raidan Ba-Hattab)

Mean staff–student ratios in preclinical training were also found to vary. The lowest (1:9) were at schools in Asia, Australia and Europe, and the highest (1:7) at those in South America. At 1:6, schools in Asia, Australia and Europe had the highest staff–student ratio in clinical training and were thus closer to meeting the new ESE recommendation that a staff member should supervise a maximum of four endodontic treatments simultaneously.

Regarding advanced endodontic technologies, the researchers observed that many schools had adopted instruments such as electronic apex locators, modern rotary instruments and bioceramic cements. However, they found that adoption of the latest root filling techniques, magnification and ultrasonic instruments in curricula remained limited.

Targeted investment needed

Discussing the findings in an interview with Dental Tribune International (DTI), lead author Dr Raidan Ba-Hattab, associate professor of endodontics at the College of Dental Medicine at Qatar University, pointed out that effective endodontic training hinges on several factors, including maintaining optimal student–staff ratios. Dr Ba-Hattab commented: “When clinical training is overseen by specialists, students are more likely to develop stronger diagnostic, technical and decision-making skills, which can directly enhance their self-efficacy and readiness for independent practice. Our study found that dental schools in Asia, Europe and Australia approached this ideal, while those in other regions often exceeded limits recommended by the ESE.”

“Even when the equipment is available, there is often a lack of trained instructors comfortable with teaching these technologies.”

Given the global reliance on traditional techniques identified in the study, the findings alluded to barriers preventing global adoption of more advanced endodontic technologies. Dr Ba-Hattab identified three key factors limiting the integration of more advanced technologies into undergraduate curricula: financial constraints, faculty preparedness and institutional prioritisation. She explained: “Many dental schools, particularly in developing countries, face budget limitations that make it difficult to procure expensive tools such as microscopes, CBCT units and ultrasonic systems. Even when the equipment is available, there is often a lack of trained instructors comfortable with teaching these technologies, which limits their use in both preclinical and clinical training. Additionally, educational institutions may be hesitant to shift from well-established traditional methods that are simpler, less costly and logistically easier to implement.” Dr Ba-Hattab emphasised that targeted investments were needed to close the technology gaps identified in the study.

The study identified a divergence in obturation techniques taught at North American dental schools from those taught elsewhere, and Dr Ba-Hattab commented that this trend hinted at a pedagogical emphasis on evidence-based practice and early adoption of contemporary clinical methods. She told DTI: “Establishing greater standardisation in undergraduate endodontic education could offer meaningful benefits—most notably, by ensuring a consistent baseline of clinical competency among dental graduates globally.” She emphasised that calls for standardisation should be viewed not as a call for uniformity but as a framework supporting the integration of evolving clinical practice. “Incorporating modern endodontic tools into this standardised framework would not only raise global clinical standards but also better equip students for the technological demands of modern dental practice. Updating curricula to reflect advancements in endodontics requires strong collaboration between educators and policymakers, along with strategic investments in infrastructure, faculty development and academic research. Ultimately, the goal is to design a curriculum that balances consistency with adaptability—encouraging both competence and innovation,” Dr Ba-Hattab concluded.

The study, titled “Global trends in preclinical and clinical undergraduate endodontic education: A worldwide survey”, was published online on 24 March 2025 in Scientific Reports.

Topics:

Endodontics

Tags:

Dental education Digital dentistry Endodontic treatment

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