Management of Ledge Formation and Perforations in Endodontics: A Survey of Knowledge, Attitudes, Practices, and...

This study compared knowledge, attitudes, and perceptions of endodontists and general practitioners regarding ledge formation and root perforation.

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.

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.

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.