Objectives: To assess the stress level, the impact of stress factors, and discrepancies between fourth- and fifth-year undergraduate clinical students at the University of Jordan. Methods: A cross-sectional study was conducted in the academic year 2022/2023. The study group included fourth- and fifth-year dental students at the University of Jordan (n = 382) who were asked to voluntarily fill in an online dental environment stress (DES) questionnaire. Analysis was conducted using Mann-Whitney U test, independent t-test, χ² test, and Spearman ρ rank correlations. Statistical significance was inferred when P < .05. Results: Fourth-year students reported higher levels of nervousness before treating patients for the first time. Fifth-year students faced more difficulty, higher stress, and/or fear regarding the amount of assigned work, provided treatment, completed requirements, failing the course, time to finish assignments, patient comprehensive care, and financial expenses of the course. Comparison between groups revealed that the fifth-year students scored higher levels of stress on the total DES score and all partial DES scores. Furthermore, the total DES questionnaire scores were significantly correlated with grade point average (GPA) among the total study sample and the prosthodontics clinical course marks among the fourth-year students’ group. Conclusions: The stress level among students in clinical courses was influenced by their academic performance, gender, year level, and the type and time needed for the provided treatment. Completing course requirements was among the most commonly faced stressors. Future research endeavors might be considered to study each clinical factor, its impact on students’ stress level, and how to manage and positively improve these factors.

Root canal treatment (RCT) is a key dental procedure that removes inflamed or infected pulp tissue through a series of critical steps. Undergraduate students learn RCT in preclinical and clinical settings, where procedural errors may occur and affect treatment quality. Such errors can also influence students’ confidence and satisfaction with their performance. This study aims to evaluate the frequency and types of procedural errors in a preclinical setting, their effect on radiographic quality, and their influence on student satisfaction. A cross-sectional study was conducted in May 2023 among third-year pre-clinical dental students. Participants performed RCT on extracted premolars using the step-back technique for preparation and cold lateral condensation for obturation. Radiographic evaluation was conducted at: pre-operative, working length (WL), master cone fit (MC), and obturation. Data collection included radiographic assessments and structured feedback forms, with a 100% response rate. Statistical analysis involved descriptive statistics and Chi-square testing. Among 307 students (3:1 female-to-male ratio), most treated lower premolars with single canals (67%). Optimal working length and master cone fit were achieved in 84% and 74% of cases, respectively. Procedural errors occurred in 23.5%, ledges being the most common (14%). Radiographically, optimal obturation length was seen in 72%, taper in 47%, and density in only 6%; coronal extension was optimal in 29%. Students with procedural errors had significantly poorer obturation length and density (p < 0.05). Gender, tooth type, and repeated radiographs did not affect obturation quality (p > 0.05). Satisfaction was significantly lower among students with compromised obturation length or taper (p < 0.05) but not affected by coronal extension or minor voids (p > 0.05). Overall, satisfaction was higher among those without procedural errors or repeated radiographs (p < 0.05) and was not influenced by gender or tooth type. This study demonstrates a clear association between procedural errors, radiographic quality of RCT, and student satisfaction. While errors are an expected part of the preclinical learning process, it offers an important learning opportunity. A balanced approach that encourages technical skills while allowing reflection on mistakes is essential for improving student performance and clinical outcomes in endodontic training.

Aims: This study aimed to assess the decision-making of Jordanian dentists when restoring root canal-treated molars (RCTMs) and identify the tooth-related factors influencing restorative treatment decisions. Methodology: A previously validated vignette survey, adapted from a UK study, was distributed electronically to registered dentists in Jordan between August and December 2024. The survey comprised three clinical scenarios: UR7 (one remaining wall), LL7 (three remaining walls), and LL6 (one remaining wall with a crack), representing different degrees of structural tooth compromise. Associations between dentist characteristics and restorative preferences were analysed using Fisher–Freeman–Halton exact tests, Results: A total of 364 responses were analysed. Participants comprised 50.8% general dental practitioners and 49.2% specialists; 63% had ≤10 years of experience. Crowns were the preferred restoration for the more structurally compromised molars (Scenarios 1 and 3), whereas onlays predominated in Scenario 2. Zirconia was the most frequently selected material among respondents choosing indirect restorations. Remaining walls, ferrule, marginal ridge loss, and tooth position were the most influential factors, whereas skeletal/lateral guidance and periodontal status were less frequently considered. No statistically significant differences were observed between dentist groups in restorative choices or material preferences ( P > 0.05). Conclusion: Jordanian dentists demonstrated broadly consistent decision-making, with indirect restorations generally preferred across the three clinical scenarios. However, variation in consideration of some tooth-related factors suggests opportunities to better align clinical decision-making with evidence-based recommendations.

Restoring root canal treated molars (RCTMs) remains a clinical challenge due to the substantial structural compromise these teeth often exhibit. Molars, being key load-bearing teeth without successors, are particularly vulnerable to caries and fractures (1,2). Loss of marginal ridges and cusps, combined with the removal of dentin during root canal therapy, significantly reduces tooth stiffness and increases the risk of biomechanical failure (3)(4)(5). While root canal treatment addresses pulpal and periradicular pathology, long-term tooth survival is largely influenced by the quality of the coronal restoration (6). Studies indicate that treatment failure often arises from factors such as cracks and caries, emphasising the critical role of coronal restoration (3,(7)(8)(9)(10).A wide range of restorative options is available for RCTMs, including direct resin composites, indirect onlays, and full coverage crowns. Advances in restorative materials such as monolithic zirconia and lithium disilicate have expanded treatment possibilities; however, uncertainty remains regarding the most appropriate restorative approach for different clinical situations because long-term evidence remains heterogeneous (11)(12)(13)(14). Studies often differ in design, methodology, and follow-up duration, making direct comparisons difficult. Consequently, clinicians must frequently rely on their clinical judgment when selecting a restorative approach, particularly in the absence of universally accepted evidence-based guidelines, as highlighted by the European Society of Endodontology position statement (15).The long-term success of restoring root canal-treated molars depends not only on the type of restorative approach but also on comprehensive assessment of tooth-related factors such as the number of remaining walls, loss of marginal ridges, ferrule effect, occlusion, periodontal status, and tooth position (16)(17)(18)(19)(20)(21)(22). The European Society of Endodontology emphasizes that restorative treatment planning should preserve tooth structure, maintain occlusal function, minimize microleakage, and support periodontal health while considering biomechanical and aesthetic principles (15). Similarly, Bhuva et al. emphasized that restorations must preserve occlusal function, minimize microleakage, and maintain periodontal health while being guided by biomechanical and aesthetic principles (23). However, little is known about how clinicians prioritize these factors when making restorative decisions in standardized clinical scenarios, particularly among dentists particularly within the Jordanian dental community.Previous surveys conducted in Jordan have described dentists' restorative preferences for root canaltreated molars; however, they have not investigated how clinicians integrate multiple tooth-related factors into restorative decision-making using standardized clinical scenarios (24). Consequently, important questions remain regarding the relative importance clinicians assign to structural and biological factors when planning the restoration of RCTMs.The present study aimed to evaluate Jordanian dentists' clinical decision-making regarding RCTM using standardized vignette scenarios and to identify the tooth-related factors that most strongly influenced restorative treatment planning. We hypothesized that restorative decision-making and the prioritization of tooth-related factors would vary according to dentists' qualifications and clinical experience.This cross-sectional electronic vignette survey was conducted among registered dentists practicing in Jordan to evaluate clinical decision-making regarding the restoration of root canal-treated molars. Ethical approval for this study was obtained from the University of Jordan Ethics Committee (Decision No. 80-2022). The study was reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).A previously validated vignette survey, originally developed and administrated using the JISC online survey platform (Bristol, UK) (25) , was adapted to suit the Jordanian clinical context. The adaptation was limited to minor modifications in wording and terminology to ensure cultural and professional relevance, while preserving the original clinical scenarios, accompanying radiographs and intraoral scans, questionnaire structure, and study objectives. The adapted questionnaire was pilot tested with 20 practicing dentists to assess its clarity and relevance prior to dissemination. Responses obtained during the pilot phase were excluded from the original data analysis.The survey included three clinical scenarios representing common endodontically treated molar cases. Each scenario provided detailed information on tooth-related factors, such as the number of remaining walls, loss of marginal ridges, presence of a ferrule, periodontal status, and tooth position, supported by post-endodontic radiographs and intraoral scans. Where applicable, additional clinical information relating to occlusal or parafunctional considerations was also incorporated into the scenarios to reflect realistic treatment planning.Participants were instructed to to base their restorative decisions solely on these tooth-related factors, assuming successful root canal treatment and excluding patient-related factors like cost or patient preference. Occlusal and parafunctional habits were provided only when relevant to the specific clinical scenario.Participants selected their preferred restorative option for each clinical scenario using multiplechoice questions with nominal categorical response options (see Table 1). For questions exploring the tooth-related factors influencing their decision-making, respondents were permitted to select more than one applicable option where appropriate.The survey was distributed online via social media platforms (WhatsApp, Facebook) and email to registered Jordanian dentists between August to November 2024. Participation was...