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Chapter 232added value to guarantee the quality of the treatment. However, the number of periapical radiographs taken for complex treatments (mean ± SD = 9.2 ± 3.9) was not statistically higher than those taken for less complex treatments (mean ± SD = 7.6 ± 2.6) (P=.052). It can, therefore, be considered that “unnecessary” periapical radiographs were taken. Taking those unnecessary periapical radiographs may mean that the student did not take “justification of exposure to radiation” into consideration. This may also reflect the uncertainty of the student during performing root canal treatment as well as their lack of knowledge or skills. The latter may also be an explanation for the statistically significantly higher number of failed radiographs in the molar region in comparison with the front region. The students who attended the revised programme could not be trained for the gagging reflex triggered by a phosphor plate as this cannot be simulated in the manikin head. The students who attended the former programme, however, were more “experienced” in taking periapical radiographs and performing root canal treatments in actual patients. It is, therefore, noteworthy that no statistically significant difference in the number of failed periapical radiographs was found between these two groups of students. When this finding is combined with the finding of no statistically significant difference in the quality of the root fillings made by these two groups of students, one can speculate that the revised programme was at least as effective as the former one.In the present study, when the entire cohort was evaluated, 59% of root fillings were of a good quality. This percentage, and the percentages of the evaluated subgroups (46%-88%), were in accord with the reported “acceptable” quality of root fillings made by undergraduate students of dental schools around the world (23%-79%).11-18The findings of this present study support the ESE guideline statement that students may benefit from teaching and clinical supervision by endodontists,21 at least in the less complex root canal treatments. We could not find a similar benefit in the complex treatments. The allocation of the type of supervision was mostly performed based on the occurrence of complications. If complications occurred, especially in cases that were already complex, it became difficult even for endodontists to supervise students performing root canal treatment in such a way that good quality is to be obtained. Treatments started under supervision of a general dental practitioner but finished, when a procedural error had occurred, under supervision of an endodontist were categorised in this study to the group of treatments supervised by endodontists, as the final supervisor was decisive for categorising the type of supervision. Those treatments with procedural errors Annemarie Baaij.indd 32 28-06-2023 12:26