Observational studyBMC medical education2026
Educational case complexity (E‑CAT) and clinical outcomes in undergraduate endodontics: associations with procedural mishaps and postoperative pain.
Observational study in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCase allocation in undergraduate dental education must balance student learning with patient safety. The Endodontic Complexity Assessment Tool (E-CAT) provides an objective framework for categorizing non-surgical endodontic cases by difficulty. This study aimed to evaluate the predictive value of E-CAT scores for procedural complications and postoperative pain (PP) in root canal treatments performed by undergraduate dental students. MATERIALS AND
methodsThis study was a prospective observational clinical cohort study. A total of 160 patients undergoing primary RCT on mandibular or maxillary molars diagnosed with irreversible pulpitis or pulp necrosis and symptomatic/asymptomatic apical periodontitis were included. Cases were scored using the E-CAT, categorizing complexity as low, moderate, or high. RCT were performed by 5th-year dental students under supervision. Procedural complications were recorded. PP was assessed preoperatively, and at 1-, 3-, 5-, and 7-days post-treatment using a visual analog scale. Data were analyzed statistically using Spearman correlation, Cramér’s V, Chi-square, Kruskal-Wallis, Friedman tests, and Multivariable regression analyses (p < 0.05).
resultsA total of 160 patients (50.6% female; mean age: 27.8 ± 10.9 years) were included. Most of the cases (55%) were categorized as moderate complexity (E-CAT score 6–11). Higher E-CAT scores were associated with longer treatment durations (r = 0.21), more treatment sessions (r = 0.24), and increased procedural complications, particularly file separation (Cramér’s V = 0.251) and working length loss (V = 0.216). However, in adjusted count modeling, E-CAT did not independently predict the overall number of complications. Patients with higher E-CAT scores reported significantly greater PP on day 1 (p < 0.001) and required more postoperative analgesics (22.6% low vs. 73.7% high complexity, p < 0.001). PP reporting was slightly higher in complex cases, though without statistical significance (p = 0.067). Anatomical complexity, especially reduced canal visibility (V = 0.262) and apical morphology (V = 0.202), showed the strongest associations with PP.
conclusionE-CAT scores predicted both technical and patient-reported outcomes in undergraduate root canal treatments. Incorporating E-CAT into undergraduate curricula may improve case allocation, support individualized supervision, and enhance competency-based learning by aligning case complexity with student ability while reducing complications.
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