Knowledge, Attitudes, and Practices of the Tug-Back Technique: A Cross-Sectional Survey in Endodontics

This study aimed to assess the knowledge, attitudes, practices, and challenges faced by dental practitioners regarding the tug-back technique in endodontics, a method used to ensure an effective apical seal during root canal therapy. A structured cross-sectional survey was conducted among 154 dental practitioners, including general dentists and endodontic specialists. The questionnaire comprised sections on demographic information, knowledge and attitudes toward the tug-back technique, and current practices and challenges. Data were analyzed using descriptive statistics and Fisher’s Exact Test to evaluate associations between practitioner demographics and aspects of the tug-back technique. The survey achieved a response rate of 60%, with the majority of respondents being female (77.3%) and early-career practitioners (66.9% had less than five years of experience). Most participants were familiar with the tug-back technique (57.1% reported being very familiar) and considered it essential for achieving a hermetic apical seal. Commonly used methods for confirming tug-back included tactile feedback (68.8%) and radiographic verification (63.6%). Key challenges included difficulty distinguishing between true and false tug-back and inadequate canal shaping. Fisher’s Exact Test revealed a significant association between practice type and confidence in distinguishing true versus false tug-back (p = 0.0108), suggesting higher confidence levels among specialists and academic practitioners. However, no significant association was found between years of experience and the choice of method or tool used to confirm tug-back (p = 0.9019). The findings highlight a need for targeted training in distinguishing true versus false tug-back, particularly for practitioners in general practice settings. Enhanced access to advanced diagnostic tools and hands-on workshops could help bridge knowledge gaps and improve clinical outcomes. Future research should explore the impact of training interventions on practitioners' proficiency in using the tug-back technique and achieving effective apical seals.