Teaching Clinical Decision-Making in Endodontics Using Case-Based Learning: a Questionnaire-Based Study

Abstract

Background: Clinical decision-making is an essential competency in endodontic education, requiring students to integrate clinical findings, diagnostic information, prognosis, and treatment alternatives. Case-based learning (CBL) may facilitate the application of theoretical knowledge to realistic clinical situations and strengthen clinical reasoning.

Objective: To evaluate the effectiveness of case-based learning in improving clinical decision-making, confidence, and perceptions among undergraduate dental students in endodontics.

Methods: This single-center, questionnaire-based, quasi-experimental pretest–posttest study was conducted at the Department of Operative Dentistry and Endodontics, de’Montmorency College of Dentistry, Lahore, Pakistan, from November 2025 to April 2026. Eighty final-year BDS students participated in structured faculty-facilitated CBL sessions covering six major endodontic decision-making domains. Clinical decision-making performance and confidence were assessed before and after the intervention, while students’ perceptions of CBL were evaluated after completion of the sessions. Paired statistical tests were applied, with p<0.05 considered statistically significant.

Results: The mean age of participants was 23.2±1.1 years, and 57 (71.3%) were female. The mean clinical decision-making score increased significantly from 3.35±1.10 before CBL to 5.01±0.84 after CBL, with a mean improvement of 1.66 points (95% CI: 1.43–1.89; p<0.001; Cohen’s dz=1.60). Overall correct responses increased from 55.8% to 83.5%. Significant improvements were observed across all six assessed clinical domains. Confidence also increased significantly in diagnosis, radiographic interpretation, treatment planning, management of complex cases, and evidence-based decision-making (all p<0.001). The overall perception score was 4.38±0.49, and 75 (93.8%) students supported routine incorporation of CBL into undergraduate endodontic teaching.

Conclusion: Case-based learning was associated with substantial improvement in endodontic clinical decision-making and self-reported confidence among final-year dental students. The high level of student acceptance further supports its integration as a complementary teaching strategy in undergraduate endodontic education.