Management of Ledge Formation and Perforations in Endodontics: A Survey of Knowledge, Attitudes, Practices, and Perceptions Among General Dental Practitioners and Endodontists.

Background: This study compared knowledge, attitudes, and perceptions of endodontists and general practitioners regarding ledge formation and root perforation. Materials and Methods: A 15-item questionnaire assessed knowledge, attitudes, perceptions, and practices on ledge formation and root perforation. It was pilot-tested on 20 endodontists, revised for clarity and validity, and finalized for data collection. Results: A total of 202 responses (65%) were analyzed, including 51% academicians and 49% private practitioners. Most participants (82%) identified stiff instruments in curved canals as the primary cause of ledge formation, while 80% recognized sudden loss of working length as a key sign; 59% identified causes of apical perforation. Mineral trioxide aggregate was preferred by 98% for perforation repair, and CBCT by 72% for diagnosis. Additionally, 95% agreed that Ni-Ti instruments help prevent ledge formation, 84% practiced pre-curving of files, and 72% prioritized sealing, while 98% supported referral of perforation cases. Despite strong knowledge, clinical gaps were evident, with only 46% consistently using apex locators and 60% adhering to recommended protocols. Significant associations by experience involved causes, Ni-Ti use, apex locator use, management goals, and tip design. By professional status, differences included causes, Ni-Ti use, pre-curving, apex locator use, techniques, and rake angle. By practice type, causes, pre-curving, and rake angle varied. The Chi-square (²) test was used, with p < 0.05 considered statistically significant. Conclusions: While practitioners demonstrate strong knowledge and positive attitudes, gaps in clinical implementation persist, particularly in the use of apex locators, adherence to protocols, and consistency in understanding causative factors.