Adherence to endodontic treatment protocols in the clinical practice of Lithuanian dentists and...

To evaluate contemporary endodontic practice patterns among general dental practitioners and endodontists in Lithuania, compare the clinical protocols used, and assess their adherence to international endodontic guidelines.

A cross-sectional survey was conducted among Lithuanian general dental practitioners and endodontists. The questionnaire addressed major stages of endodontic treatment, from isolation and canal preparation to obturation and post-treatment restoration. A total of 470 participants completed the survey (372 general dental practitioners, 77 endodontists, and 20 "other" (did not specify their professional category) responses), of whom 450 were included in the final analysis. Data were analyzed using descriptive and inferential statistics. Descriptive statistics were calculated for categorical variables and presented as frequencies and percentages. Associations between groups were assessed using the chi-square (χ²) test, logistic regression and Spearman correlation analysis. Degrees of freedom (df) and corresponding p-values were reported, with statistical significance set at p < 0.05.

Rubber dam was used in all endodontic procedures by 101 (34.4%) of general practitioners and 65 (84.4%) of endodontists. An electronic apex locator was used by the vast majority of both general practitioners and endodontists for working length determination. Sodium hypochlorite was the most commonly used irrigant; general practitioners favored passive irrigation activation, whereas endodontists more frequently employed ultrasonic and sonic activation methods. Calcium hydroxide was the most frequently used intracanal medicament. Cold lateral condensation was more commonly used by general practitioners, while endodontists preferred warm vertical compaction and single-cone obturation techniques. Private practice was associated with higher odds of bioceramic cement use. Direct composite restorations were the most common post-endodontic restorations, with crowns used less frequently.

Compared to data from 2010, endodontic practice in Lithuania has shown greater adherence to European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) guidelines. Endodontists consistently apply evidence-based methods more rigorously than general practitioners. However, insufficient rubber dam usage and variable implementation of the latest clinical protocols indicate that guideline adherence is still not routine. These findings underscore the importance of continuous professional development and application of updated recommendations in clinical practice to ensure high-quality endodontic care and patient safety.