Evaluation and Perception of Digital Technologies in Endodontic Practice by Specialists in Ecuador

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 5, September – 2025, Page No. : 138 - 146 Corresponding Author: Joseline Carolina Delgado Delgado, ijdsir, Volume – 8 Issue - 5, Page No. : 138 - 146 Page138 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Evaluation and Perception of Digital Technologies in Endodontic Practice by Specialists in Ecuador 1Joseline Carolina Delgado Delgado, 1Maria Cristina Miranda Rosero 1Faculty of Dentistry, Universidad Hemisferios, Quito-Ecuador Corresponding Author: Joseline Carolina Delgado Delgado, Faculty of Dentistry, Universidad Hemisferios, QuitoEcuador. Citation of this Article: Joseline Carolina Delgado Delgado, Maria Cristina Miranda Rosero, “Evaluation and Perception of Digital Technologies in Endodontic Practice by Specialists in Ecuador”, IJDSIRSeptember – 2025, Volume – 8, Issue – 5, P. No. 138 – 146. Copyright: © 2025, Joseline Carolina Delgado Delgado, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract To analyze the implementation and perception of digital technologies in endodontic practice among specialists in Ecuador through a structured and validated survey, evaluating their impact, level of knowledge, frequency of use, and factors influencing their integration into clinical practice. Three hundred eighty-three endodontic specialists were surveyed using a validated questionnaire previously used by The American Association of Endodontists and the Royal Dutch Dental Association. The survey was distributed electronically and analyzed using descriptive statistics. The results showed that 98.7% of professionals use digital radiography, 72.3% use apex locators with radiographic confirmation, 71.3% use ultrasonic irrigation systems, and 46.48% use CBCT frequently. High acceptance was reported for surgical microscopy and CAD/3D printing technologies. Most professionals (77.26%) believe digital technologies significantly reduce clinical errors, 71.28% consider treatments more predictable, and 74.15% believe these technologies increase positive patient perception. The analysis revealed significant associations between age groups and microscope use (χ² = 18.34, p = 0.005) and between experience level and modern obturation techniques (χ² = 22.78, p = 0.001). This research concludes that endodontic practice in Ecuador is transitioning toward sustained digitalization with significant levels of knowledge and technological tool usage. However, challenges persist regarding equitable access, continuous training, and implementation standardization. These results suggest that digital technology integration effectiveness depends on professional training and infrastructure availability, being more beneficial when accompanied by systematic education programs. Keywords: Digital Technologies, Endodontics, CBCT, Surgical Microscopy, Digital Radiography, Ecuador Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Page139 Introduction The integration of advanced digital technologies has enabled endodontics to undergo profound transformation in recent decades, giving rise to what is known as digital endodontics 1. This specialty, concerned with the detection and treatment of dental pulp diseases and periapical tissues, has benefited significantly from advances in visualization methods that allow adequate diagnosis of root canal anatomy and periradicular structures 2. The digital workflow in endodontics refers to the integration of digital tools in all stages of the clinical process: diagnosis, planning, execution, and evaluation of treatments 3. This transformation has been driven by technologies such as cone-beam computed tomography (CBCT), digital radiography, optical microscopes, mechanized rotary systems, 3D printing, and surgical planning software 4. CBCT has become particularly valuable for accurate diagnosis of complex anatomical variations and periapical pathologies, with studies showing superior diagnostic accuracy compared to conventional radiography 19,20. Tools such as CBCT, digital radiography, computerassisted design (CAD), 3D printing, mechanized instrumentation systems, optical microscopy, and surgical planning software are included in various stages of endodontic processing. This digital technology enables more precise images of dental anatomy, more efficient surgical planning, facilitates access to root canals—even in cases of obliterations—and allows less invasive procedures, increasing clinical success rates 5. Through specialized software, the possibility of simulating treatments before performing them improves clinical decision-making and reduces risks 6. Recent studies have demonstrated the effectiveness of dedicated endodontic software for CBCT analysis in evaluating root canal anatomy with high precision 23. Electronic apex locators (EALs) provide greater accuracy by measuring electrical resistance between the root canal and surrounding tissues, making them safer and more reliable than conventional methods 7. EALs can be used as essential diagnostic tools to identify fractures, cracks, and root canal resorptions 8. Several factors can affect electronic measurements, including the diameter of the apical constriction, instrument gauge, cervical preflaring, and the irrigating solution used during the procedure 9. Modern apex locators have shown excellent accuracy when validated against micro-computed tomography, particularly in complex anatomical situations 22. The development of nickel-titanium rotary instrumentation has revolutionized root canal preparation, with extensive research on cyclic fatigue resistance and optimal preparation protocols 20,25. Surface treatments and metallurgical properties of these instruments continue to evolve, improving their clinical performance and safety 26,30. Additionally, advances in irrigation protocols and activation systems have enhanced debridement efficacy and treatment outcomes 25. The adoption of digital technologies in endodontics, despite these benefits, is not uniform across all geographical contexts. In developing countries like Ecuador, implementation is conditioned by multiple factors, including access to technological infrastructure, operational costs, professional training, and attitudes or perceptions of dentists toward these tools 10. Although various studies on digitalization in dentistry have been published internationally, there is a clear lack of systematic research on how this transformation is being applied in the Ecuadorian context, especially in endodontics. Recent reviews emphasize that digital Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 Page140 dentistry can be either disruptive or destructive, depending on proper implementation and training 29. Current research guidelines, such as the PRILE 2021 recommendations, emphasize the importance of standardized reporting in endodontic research to ensure reproducibility and clinical relevance 27. This is particularly important when evaluating new digital technologies and their clinical applications. The objective of this study was to evaluate the implementation and perception of digital technologies in endodontic practice among specialists in Ecuador, assessing their impact, level of knowledge, frequency of use, and conditioning factors for their integration. Materials and Methods This study was quantitative, descriptive, and crosssectional, aimed at analyzing the perception, knowledge, use, and barriers related to the adoption of digital technologies by endodontic specialists in Ecuador. The target population consisted of all endodontic specialists actively practicing in Ecuador, considering available records and databases from professional associations and national dental organizations. Since an exact number of active professionals in this area is not available, a probabilistic sampling strategy with an infinite population approach was chosen, widely accepted in studies with large undefined universes. The minimum sample size was calculated using the formula for infinite populations, with a 95% confidence level, 5% margin of error, and an expected proportion of 0.5, yielding a minimum of 383 participants. This size ensures adequate representation and allows for valid statistical analyses. For data collection, a survey previously validated by The American Association of Endodontists and the Royal Dutch Dental Association (KNMT), adapted by Marieke et al. (2021), was used 11. The survey was translated into Spanish through a direct and reverse translation process to ensure conceptual equivalence. The instrument was divided into three sections: demographic data including age, sex, and work sector, use of digital technologies comprising 11 items about frequency and type of technology used such as digital radiography, CBCT, intraoral scanner, and planning software, and perception and attitude evaluated through 7 items using a 5-point Likert scale ranging from 1 (Totally agree) to 5 (Totally disagree). In total, the questionnaire consisted of 21 structured questions. The survey was distributed electronically through the Google Forms platform, directed to endodontic specialists in the main cities of the country. It was shared by email and professional networks including WhatsApp, institutional email, and professional association social networks over a 4-week period. Participation was voluntary, and confidentiality and anonymity of responses were guaranteed. The inclusion criteria comprised being an endodontic specialist with a recognized degree in Ecuador, actively practicing clinically at the time of the study, having used at least one digital technology mentioned in the questionnaire, and signing virtual informed consent. The exclusion criteria included inactive or retired professionals, those who had not performed endodontic procedures in the last six months, specialists who had not used digital technologies in their practice, and those who did not agree to participate through informed consent. Statistical Analysis Data were exported from Google Forms to Microsoft Excel, where initial cleaning and coding were performed. Subsequently, they were processed for descriptive and inferential analysis using statistical software. To analyze and compare the adoption of digital technologies among endodontic specialists, measures of central tendency and Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 dispersion including median, interquartile range, mean, and standard deviation were calculated for all quantitative variables. Since some variables did not show normal distribution according to the Shapiro-Wilk test (p < 0.05), non-parametric tests were applied when appropriate. For categorical variables, absolute and relative frequencies were calculated and presented as percentages. To evaluate associations between sociodemographic variables and technology adoption patterns, chi-square tests of independence were performed. The significance level was set at p < 0.05 for all statistical tests. Pearson correlation coefficients were calculated to assess relationships between continuous variables such as experience level and frequency of technology use. To analyze the impact of demographic factors on technology perception, responses from the 5-point Likert scale were grouped into favorable (strongly agree + agree) and unfavorable (disagree + strongly disagree) categories, with neutral responses analyzed separately. Cross-tabulation analysis was performed to identify patterns in technology adoption based on age groups, work sector, and years of experience. The accuracy of digital technology perception was evaluated by calculating mean scores for each perception item, with lower scores indicating more positive attitudes toward technology integration. Comparison of mean perception scores between different demographic groups was performed using appropriate statistical tests based on data distribution characteristics. The research followed ethical principles established by the Declaration of Helsinki. A virtual informed consent was presented at the beginning of the survey, which had to be accepted to access the questionnaire. The information collected was treated confidentially, for research purposes exclusively, and no identifiable personal data were stored. The research had authorization from the ethics committee of Universidad Hemisferios. Data were processed using descriptive statistics with frequencies and percentages. Chi-square tests of independence (χ²) were applied to explore relationships between sociodemographic variables and perception or use of digital technologies. Pearson correlation coefficients were calculated to assess relationships between continuous variables. Results The sample consisted of 383 endodontic The sample consisted of 383 endodontic specialists, with 63.97% women (n=245) and 36.03% men (n=138). The age distribution showed predominance of the 25-34 years group with 48.56% (n=186), followed by 35-44 years with 28.98% (n=111) (Figure 1). Most respondents (87.47%) work in the private sector. Figure 1: Distribution by age groups. Regarding digital technology use, 98.69% of respondents use digital radiography. For clinical magnification, 41.51% use surgical microscopes, 30.81% use loupes, and 27.68% use no magnification system (Figure 2). Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Figure 2: Use of magnification in endodontics. In working length determination, 72.33% use apex locators with radiographic confirmation, 26.37% use only electronic locators, and 1.31% rely solely on radiographs. Regarding irrigation systems, 95.56% report using complementary systems, with ultrasonic being most used (71.28%), followed by Endo Activator (19.06%). CBCT use frequency showed 46.48% use it frequently, 31.07% occasionally, 19.06% always, and 3.39% never (Figure 3). For surgical microscope experience, 34.47% self-evaluate as high level, 36.03% medium, 21.68% low, and 7.83% have no experience. Figure 3: CBCT use frequency In root canal preparation, 48.56% use hybrid methods (combining rotary and manual), 35.25% use pure rotary instrumentation, 12.01% reciprocating, and 4.18% manual techniques. For obturation, gutta-percha injection technique is most used (43.08%), followed by lateral condensation (34.99%). Regarding perceptions of digital technologies: 77.26% consider they significantly reduce clinical errors, 71.28% believe they allow more predictable treatments, 68.67% think they improve quality in complex cases, and 74.15% believe they increase positive patient perception. Statistical analysis revealed significant associations between age groups and surgical microscope use (χ² = 18.34, df = 6, p = 0.005), with 25-44 year-old professionals reporting greater use. A significant relationship was detected between microscope experience level and preference for modern obturation techniques (χ² = 22.78, df = 6, p = 0.001). The Pearson correlation between "CBCT use frequency" and "experience level" was r = 0.62, indicating moderate positive correlation. Table 1: Chi-Cuadrado Table 2: Correlación de Pearson Adicional Discussion The results demonstrate a clear trend toward adoption and integration of digital technologies in Ecuadorian endodontic practice, aligning with current scientific literature trends. The high frequency of digital radiography, apex locators, and CBCT use reflects a paradigm shift in how professionals approach endodontic diagnosis, planning, and treatment 12. This widespread adoption of CBCT is consistent with international studies Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 showing its superior diagnostic capabilities for detecting complex root anatomies and periapical pathologies 19,21. The frequent use of CBCT in Ecuadorian endodontic practice aligns with recent findings highlighting this tool's value in detecting complex root anatomies, resorptions, fractures, and other endodontic pathologies that may go unnoticed in conventional radiographic studies 13,24. Systematic reviews and meta-analyses have consistently demonstrated the diagnostic superiority of CBCT over conventional radiography for root fracture detection and periapical lesion assessment 21,24. The predominance of surgical microscopy use, although not universal, reflects evolving technical training consistent with evidence showing that surgical microscopes significantly improve operative field visualization 14. Professional experience plays an important role in technology use. Most professionals report medium to high microscope proficiency levels, suggesting an ongoing learning curve and highlighting continuous training needs. This becomes relevant in the Ecuadorian context, where resource availability varies significantly between public and private sectors 15. The correlation between experience and technology adoption aligns with findings from comparative studies using different methodological approaches including clearing techniques, CBCT, and micro-CT analysis 28. Regarding professional perception, respondents agreed that digital technologies improve diagnostic precision, reduce errors, and increase treatment efficiency. These perceptions are supported by scientific evidence indicating that incorporating artificial intelligence, augmented reality, and other digital developments contribute not only to improving clinical outcomes but also to facilitating decision-making in highly complex cases 16. Recent advances in metallurgical testing and instrumentation design have further enhanced the reliability and safety of endodontic procedures 30. The demographic finding that a large percentage of respondents are aged 25-34 years may explain the high acceptance of digital tools, as younger dentists show greater openness toward technological adoption 17. This finding aligns with reports that Ecuador is experiencing transformation in oral health services due to digital advancement, although challenges persist related to access inequality and technological infrastructure gaps 18. The integration of digital workflows requires careful consideration of both technical capabilities and educational requirements, as emphasized in recent comprehensive reviews of digital dentistry evolution 29. The high adoption rates of modern irrigation systems and activation protocols observed in this study reflect current evidence-based practices that emphasize the importance of effective debridement and disinfection 25. The preference for hybrid instrumentation techniques combining rotary and manual methods suggests a thoughtful approach to treatment planning that considers individual case requirements while incorporating technological advances in NiTi instrumentation 20,26. It is important to note that this research followed current guidelines for endodontic research reporting to ensure methodological rigor and reproducibility 27. The findings contribute to the growing body of evidence supporting digital technology integration in endodontic practice while highlighting the importance of adequate training and infrastructure support for successful implementation. Conclusions The results revealed variable effects of digital technology integration depending on the professional and institutional context evaluated. Most Ecuadorian endodontic specialists demonstrate high acceptance and frequent use of digital technologies, with statistically Joseline Carolina Delgado Delgado, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 significant differences in adoption patterns related to age, experience, and work sector. Digital radiography, CBCT, and apex locators showed highest integration rates, while surgical microscopy and CAD/3D printing technologies showed growing but not universal adoption. Professional perception is highly favorable toward digital technologies, with most specialists recognizing their benefits in reducing clinical errors, improving treatment predictability, and enhancing patient experience. However, significant challenges remain regarding equitable access, continuous professional education, and implementation standardization across different practice settings. 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