AIM: This study aimed to evaluate the compliance of dentists in Croatia and the Czech Republic with endodontic recommendations and identify the subjective and objective factors influencing their adherence to them. METHODOLOGY: A total of 1386 dentists from Croatia and the Czech Republic participated in an online survey through a self-administered, author-designed questionnaire. After excluding those who did not perform root canal treatments (RCT), 1376 responses (394 from Croatia and 982 from the Czech Republic) were statistically analysed. RESULTS: The median age of respondents was 40 years, with a higher proportion of females in both countries. Croatian dentists treated fewer patients weekly but performed more RCTs and placed more composite fillings than their Czech counterparts. Czech dentists more frequently employed magnification devices, rubber dam (RD), pre-endodontic build-ups, nickel-titanium (NiTi) instruments, irrigant activation, bioceramic sealers, indirect post-endodontic restoration of lateral teeth, and single-visit treatments. These practices were also more common among endodontists than general dental practitioners and other specialists in both countries. Croatian dentists adhered more consistently to the recommended irrigation protocol. In the Czech group, adherence to recommended procedures, such as magnification, RD usage, and irrigation protocol correlated with younger age, smaller weekly number of patients, and preference for treating patients in the supine position. No such correlations were observed among the Croatian dentists. CONCLUSIONS: Despite notable improvements in recent years, dentists still do not fully comply with the recommended RCT working procedures in Croatia and the Czech Republic.

Department of Dentistry Faculty of Medicine in Hradec Králové Charles University Hradec Králové Czech Republic

Department of Dentistry University Hospital Hradec Králové Hradec Kralove Czech Republic

Department of Endodontics and Restorative Dentistry Faculty of Dental Medicine University of Rijeka Rijeka Croatia

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Abt, E., Weyant, R.J., Frantsve‐Hawley, J. & Carrasco‐Labra, A. (2023) The potential harm of not following clinical practice guideline recommendations. Journal of the American Dental Association (1939), 154(8), 760–765. Available from: https://doi.org/10.1016/j.adaj.2023.05.002

Alhejailan, A., Aldahman, B. & Sadan, P. (2022) The standard protocols used for endodontic treatment among dental interns and general dental practitioners in the central region of Saudi Arabia. International Journal of Medicine in Developing Countries, 6(9), 1083–1089. Available from: https://doi.org/10.24911/IJMDC.51‐1633147587

Alrahabi, M., Zafar, M.S. & Adanir, N. (2019) Aspects of clinical malpractice in endodontics. European Journal of Dentistry, 13, 450–458. Available from: https://doi.org/10.1055/s‐0039‐1700767

American Association of Endodontists. (2017) Dental dams AAE position statement [WWW Document]. https://www.aae.org/specialty/wp‐content/uploads/sites/2/2017/06/dentaldamstatement.pdf

American Association of Endodontists. (2019) Treatment standards: executive summary [WWW Document]. https://www.aae.org/specialty/wp‐content/uploads/sites/2/2019/11/TreatmentStandards_2019.pdf

American Association of Endodontists. (2020a) Treatment standards [WWW Document]. Treat. Stand. https://www.aae.org/specialty/wp‐content/uploads/sites/2/2018/04/TreatmentStandards_Whitepaper.pdf

American Association of Endodontists. (2020b) Use of microscopes and other magnification devices [WWW Document]. https://www.aae.org/specialty/wp‐content/uploads/sites/2/2020/04/MicroscopesPositionStatement2020_v2.pdf

American Medical Association. (2024) Medical ethics [WWW Document]. https://www.ama‐assn.org/topics/medical‐ethics

Anabtawi, M.F., Gilbert, G.H., Bauer, M.R., Reams, G., Makhija, S.K., Benjamin, P.L. et al. (2013) Rubber dam use during root canal treatment: findings from the dental practice‐based research network. Journal of the American Dental Association (1939), 144, 179–186. Available from: https://doi.org/10.14219/jada.archive.2013.0097

Aysal, Z., Demirturk Kocasarac, H., Orhan, K. & Helvacioglu‐Yigit, D. (2022) Radiological assessment of prevalance and quality of periapical status of endodontic treatments. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 28, e936569. Available from: https://doi.org/10.12659/MSM.936569

Beauchamp, T.L. (2019) Principles of biomedical ethics, 8th edition. New York: Oxford University Press.

Buchanan, G.D., Gamieldien, M.Y., Tredoux, S. & Bhayat, A. (2019) Endodontic trends by south african dental association members: an online survey. Saudi Endodontic Journal, 9, 198–204. Available from: https://doi.org/10.4103/sej.sej‐1‐19

Coric, A., Grgic, S., Kostic, S., Vukojevic, K., Zovko, R., Radica, N. et al. (2020) Attitudes of dental practitioners towards antimicrobial therapy in Croatia and Bosnia and Herzegovina. European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe, 24, 88–94. Available from: https://doi.org/10.1111/eje.12471

Czech Dental Chamber (Ed.). (2024) Yearbook 2023, 1st edition. Prague, Czech Republic: Czech Dental Chamber.

Duncan, H.F., Kirkevang, L.‐L., Peters, O.A., El‐Karim, I., Krastl, G., Del Fabbro, M. et al. (2023) Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3‐level clinical practice guideline. International Endodontic Journal, 56(Suppl 3), 238–295. Available from: https://doi.org/10.1111/iej.13974

European Society of Endodontology. (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International Endodontic Journal, 39, 921–930.

European Society of Endodontology, Mannocci, F., Bhuva, B., Roig, M., Zarow, M. & Bitter, K. (2021) European Society of Endodontology position statement: the restoration of root filled teeth. International Endodontic Journal, 54, 1974–1981. Available from: https://doi.org/10.1111/iej.13607

Fonseca, G., Mira, K., Beltrán, H., Peña, K. & Yendreka, V. (2018) Adverse events and malpractice claims in endodontics. International Journal of Medical and Surgical Sciences, 2, 367–375. Available from: https://doi.org/10.32457/ijmss.2015.002

Fransson, H. & Dawson, V. (2023) Tooth survival after endodontic treatment. International Endodontic Journal, 56(Suppl 2), 140–153. Available from: https://doi.org/10.1111/iej.13835

Haapasalo, M., Endal, U., Zandi, H. & Coil, J.M. (2005) Eradication of endodontic infection by instrumentation and irrigation solutions. Endodontic Topics, 10, 77–102. Available from: https://doi.org/10.1111/j.1601‐1546.2005.00135.x

Haapasalo, M., Shen, Y., Wang, Z. & Gao, Y. (2014) Irrigation in endodontics. British Dental Journal, 216, 299–303. Available from: https://doi.org/10.1038/sj.bdj.2014.204

Kaliaperumal, K., Hidoussi Sakly, E., Cavalcanti, A.L., Gayathri, A., Subramanian, K., Nasraoui, N. et al. (2024) General dentist's knowledge and attitude towards non‐surgical endodontic retreatment in Tunisia: a cross‐sectional study. Clinical, Cosmetic and Investigational Dentistry, 16, 349–357. Available from: https://doi.org/10.2147/CCIDE.S479284

Kapitán, M. & Šustová, Z. (2011) The use of rubber dam among Czech dental practitioners. Acta Medica (Hradec Kralove), 54, 144–148.

Lietz, J., Ulusoy, N. & Nienhaus, A. (2020) Prevention of musculoskeletal diseases and pain among dental professionals through ergonomic interventions: a systematic literature review. International Journal of Environmental Research and Public Health, 17, 3482. Available from: https://doi.org/10.3390/ijerph17103482

Lopes, R.M.V., Marins, F.C., Belladonna, F.G., Souza, E.M., De‐Deus, G., Lopes, R.T. et al. (2018) Untouched canal areas and debris accumulation after root canal preparation with rotary and adaptive systems. Australian Endodontic Journal: The Journal of the Australian Society of Endodontology Inc, 44, 260–266. Available from: https://doi.org/10.1111/aej.12237

López‐Valverde, I., Vignoletti, F., Vignoletti, G., Martin, C. & Sanz, M. (2023) Long‐term tooth survival and success following primary root canal treatment: a 5‐ to 37‐year retrospective observation. Clinical Oral Investigations, 27, 3233–3244. Available from: https://doi.org/10.1007/s00784‐023‐04938‐y

Manandhar, A., Kunwar, D. & Shrestha, S. (2020) Assessment of practice of endodontic treatment protocols among general dental practitioners in Pokhara, Nepal. Medical Journal of Pokhara Academy of Health Sciences, 3, 298–304. Available from: https://doi.org/10.3126/mjpahs.v3i2.35616

Markvart, M., Fransson, H., EndoReCo & Bjørndal, L. (2018) Ten‐year follow‐up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners. Acta Odontologica Scandinavica, 76, 515–519. Available from: https://doi.org/10.1080/00016357.2018.1447684

Matijević, J., Cizmeković Dadić, T., Prpic Mehicic, G., Ani, I., Slaj, M. & Jukić Krmek, S. (2011) Prevalence of apical periodontitis and quality of root canal fillings in population of Zagreb, Croatia: a cross‐sectional study. Croatian Medical Journal, 52, 679–687. Available from: https://doi.org/10.3325/cmj.2011.52.679

Matijević, J., Jukić Krmek, S., Simeon, P., Prpić Mehičić, G. & Medvedec, I. (2011) Root canal treatment protocols, materials and attitudes employed in endodontic treatment by dentists in Croatia. International Endodontic Journal, 44, 1221. Available from: https://doi.org/10.1111/j.1365‐2591.2011.01914.x

McGovern, C. (2015) Medical ethics: principles of medical ethics. In: Encyclopedia of forensic and legal medicine. Amsterdam: Elsevier Ltd, pp. 330–334. Available from: https://doi.org/10.1016/B978‐0‐12‐800034‐2.00245‐7

Mohanty, A., Patro, S., Barman, D. & Jnaneswar, A. (2020) Modern endodontic practices among dentists in India: a comparative cross‐sectional nation‐based survey. Journal of Conservative Dentistry: JCD, 23, 441–446. Available from: https://doi.org/10.4103/JCD.JCD_408_20

Morozova, Y., Míšová, E., Holík, P. & Voborná, I. (2019) Názor pacientů a souboru zubních lékařů mladší věkové kategorie na ošetření s použitím kofferdamu. Česká stomatologie a praktické zubní lékařství, 119, 36–43. Available from: https://doi.org/10.51479/cspzl.2019.011

Mustafa, M., Almuhaiza, M., Alamri, H.M., Abdulwahed, A., Alghomlas, Z.I., Alothman, T.A. et al. (2021) Evaluation of the causes of failure of root canal treatment among patients in the City of Al‐Kharj, Saudi Arabia. Nigerian Journal of Clinical Practice, 24, 621–628. Available from: https://doi.org/10.4103/njcp.njcp_290_20

Ng, Y.‐L., Mann, V. & Gulabivala, K. (2010) Tooth survival following non‐surgical root canal treatment: a systematic review of the literature. International Endodontic Journal, 43, 171–189. Available from: https://doi.org/10.1111/j.1365‐2591.2009.01671.x

Ng, Y.‐L., Mann, V. & Gulabivala, K. (2011) A prospective study of the factors affecting outcomes of non‐surgical root canal treatment: part 2: tooth survival. International Endodontic Journal, 44, 610–625. Available from: https://doi.org/10.1111/j.1365‐2591.2011.01873.x

Ng, Y.‐L., Mann, V., Rahbaran, S., Lewsey, J. & Gulabivala, K. (2007) Outcome of primary root canal treatment: systematic review of the literature—part 1. Effects of study characteristics on probability of success. International Endodontic Journal, 40, 921–939. Available from: https://doi.org/10.1111/j.1365‐2591.2007.01322.x

Ng, Y.‐L., Mann, V., Rahbaran, S., Lewsey, J. & Gulabivala, K. (2008) Outcome of primary root canal treatment: systematic review of the literature—Part 2. Influence of clinical factors. International Endodontic Journal, 41, 6–31. Available from: https://doi.org/10.1111/j.1365‐2591.2007.01323.x

Pantaleo, G., Amato, A., Iandolo, A., Abdellatif, D., Di Spirito, F., Caggiano, M. et al. (2022) Two‐year healing success rates after endodontic treatment using 3D cleaning technique: a prospective multicenter clinical study. Journal of Clinical Medicine, 11, 6213. Available from: https://doi.org/10.3390/jcm11206213

Persic Bukmir, R., Paljevic, E., Vidas, J., Glazar, I., Pezelj‐Ribaric, S. & Brekalo Prso, I. (2022) Is coronal restoration a predictor of posttreatment apical periodontitis? European Journal of Dentistry, 16, 386–395. Available from: https://doi.org/10.1055/s‐0041‐1735909

Peters, O.A., Schönenberger, K. & Laib, A. (2001) Effects of four Ni‐Ti preparation techniques on root canal geometry assessed by micro computed tomography. International Endodontic Journal, 34, 221–230. Available from: https://doi.org/10.1046/j.1365‐2591.2001.00373.x

Rao, S., Nilker, V., Telikapalli, M. & Gala, K. (2023) Incidence of endodontic failure cases in the department of conservative dentistry and endodontics, DY Patil School of Dentistry, Navi Mumbai. Cureus, 15, e38841. Available from: https://doi.org/10.7759/cureus.38841

Sedani, S., Thakkar, A. & Nikhade, P. (2020) Ongoing trends in endodontic practice. Journal of Research in Medical and Dental Science, 8(3), 110–117.

Shashirekha, G., Jena, A., Maity, A.B. & Panda, P.K. (2014) Prevalence of rubber dam usage during endodontic procedure: a questionnaire survey. Journal of Clinical and Diagnostic Research: JCDR, 8, ZC01‐03. Available from: https://doi.org/10.7860/JCDR/2014/9011.4425

Siqueira Junior, J.F., Rôças, I., Das, N., Marceliano‐Alves, M.F., Pérez, A.R. & Ricucci, D. (2018) Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Brazilian Oral Research, 32, e65. Available from: https://doi.org/10.1590/1807‐3107bor‐2018.vol32.0065

Słowik, J., Jurczak, A. & Zarow, M. (2011) The application of quality guidelines of the European Society of Endodontology in dental practice in Poland. Annales Academiae Medicae Stetinensis, 57, 110–114.

Sović, J., Šegović, S., Tomasić, I., Pavelić, B., Šutej, I. & Anić, I. (2020) Antibiotic administration along with endodontic therapy in the Republic of Croatia: a pilot study. Acta Stomatologica Croatica, 54, 314–321. Available from: https://doi.org/10.15644/asc54/3/9

Šutej, I., Par, M., Lepur, D., Peroš, K., Pintarić, H., Alajbeg, I. et al. (2021) Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis‐ national survey study. Journal of Clinical and Experimental Dentistry, 13, e648–e652. Available from: https://doi.org/10.4317/jced.58054

Toia, C.C., Khoury, R.D., Corazza, B.J.M., Orozco, E.I.F. & Valera, M.C. (2022) Effectiveness of 1‐visit and 2‐visit endodontic retreatment of teeth with persistent/secondary endodontic infection: a randomized clinical trial with 18 months of follow‐up. Journal of Endodontia, 48, 4–14. Available from: https://doi.org/10.1016/j.joen.2021.09.004

Vera, J., Siqueira, J.F., Ricucci, D., Loghin, S., Fernández, N., Flores, B. et al. (2012) One‐ versus two‐visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study. Journal of Endodontia, 38, 1040–1052. Available from: https://doi.org/10.1016/j.joen.2012.04.010

Virdee, S.S., Seymour, D.W., Farnell, D., Bhamra, G. & Bhakta, S. (2018) Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta‐analysis. International Endodontic Journal, 51, 605–621. Available from: https://doi.org/10.1111/iej.12877

Wigler, R., Herteanu, M., Wilchfort, Y. & Kfir, A. (2023) Efficacy of different irrigant activation systems on debris and smear layer removal: a scanning electron microscopy evaluation. International Journal of Dentistry, 2023, 9933524. Available from: https://doi.org/10.1155/2023/9933524

Working Party of the Royal College of Physicians. (2005) Doctors in society. Medical professionalism in a changing world. Clinical Medicine (London, England), 5, S5–S40.

Yancheshmeh, S.S.Y. (2020) Examining the factors affecting endodontic therapy failure. Journal of Molecular Biology Research, 10, 1. Available from: https://doi.org/10.5539/jmbr.v10n1p1