Does preoperative anxiety influence endodontic skill performance and students' subjective perceptions in an observational simulation-based study?

backgroundPreoperative state anxiety is known to influence student performance across diverse dental educational contexts. Yet, its specific impact on root canal treatment outcomes in simulation-based environments remains insufficiently explored. This study investigated the association between preoperative anxiety and students' technical performance and subjective outcomes during their first root canal treatment on extracted molars.

methodsNinety-three dental students performed root canal treatments on extracted permanent mandibular and maxillary molars. Prior to each procedure, students completed the State-Trait Anxiety Inventory-State (STAI-S) to assess preoperative state anxiety levels. Scores were recorded before the procedure and grouped during the analysis as low (< 44) or high (≥ 45) anxiety. Preclinical performance was evaluated based on total procedure score (access, shaping, obturation, apical accuracy, and cleanliness), treatment duration, distance to the apex, and occurrence of procedural errors. Post-procedure measures included STAI-S, perceived procedural difficulty, self-confidence, and self-reported comprehension. Statistical comparisons were conducted using appropriate parametric or nonparametric tests (t-test, Mann-Whitney U, Wilcoxon signed-rank, chi-square/Fisher's exact), correlations were examined with Spearman's rank test, and inter-rater reliability was assessed with Cohen's Kappa (α = 0.05).

resultsNo statistically significant differences were observed between low- and high-anxiety groups in total root canal treatment performance scores for either mandibular or maxillary molars (p > 0.05). Treatment duration also showed no meaningful variation between groups (p > 0.05). However, during mandibular procedures, the incidence of over-instrumentation was higher in the low-anxiety group (p = 0.040), whereas a non-significant trend toward increased instrument separation was noted in the high-anxiety group (p = 0.060). High-anxiety groups showed a significant post-procedure decline in anxiety, though scores stayed above the clinical threshold. For subjective outcomes, high-anxiety students reported lower self-confidence during mandibular procedures and lower comprehension ratings during maxillary procedures (p < 0.05). Correlation analyses further indicated that higher anxiety was weakly associated with lower self-confidence in mandibular procedures, and with reduced comprehension and greater perceived obturation difficulty in maxillary procedures.

conclusionPreoperative state anxiety did not compromise technical performance outcomes, though limited associations were noted in subjective measures. Anxiety at the preclinical stage may influence perceptions more than procedural skills.