Effect of centring rings and an educational intervention on intraoral radiographic quality among dental students

Intraoral radiography is a core diagnostic skill in dental practice. However, technical errors, such as cone cuts and positioning inaccuracies, remain common among undergraduate dental students, leading to image retakes and unnecessary radiation exposure. This study aimed to evaluate the impact of centering rings combined with a structured educational package on intraoral radiographic quality, technical errors, and student confidence. A quasi-experimental pre–post study was conducted among 109 dental students and interns at the College of Dentistry, University of Ha’il, Saudi Arabia. Baseline assessments included radiographic performance, technical errors, retakes, image quality, and self-reported confidence. Participants then received a standardized educational intervention on intraoral radiography and centering ring use. Post-training assessments were performed using identical evaluation criteria. Pre- and post-intervention outcomes were compared using appropriate paired statistical tests, and correlation analyses were performed to examine associations between confidence, image quality, and retake frequency. Chi-square, Wilcoxon signed-rank tests, and Spearman’s correlation were used to assess group differences, training effects, and associations, with p < 0.05 considered significant. Among 109 dental students (52.3% female), baseline cone cuts were observed in 15.6% of periapical and 26.6% of bitewing radiographs. Following the intervention, cone cuts decreased significantly (periapical: Z = − 3.300, p = 0.001; bitewing: Z = − 2.629, p = 0.009), with a marked improvement in image quality (periapical: Z = − 2.753, p = 0.006; bitewing: Z = − 5.506, p < 0.001). Retake frequency decreased and self-reported confidence increased significantly (Z = − 7.446, p < 0.001). Gains were observed across all academic levels, particularly for technique-sensitive bitewing imaging. Higher post-training image quality was associated with fewer retakes (r = − 0.278, p = 0.003), indicating improved technical proficiency and radiation safety. Observed improvements in image quality, reduced cone cuts, fewer retakes, and increased student confidence were noted following the introduction of centering rings and a focused educational intervention. These findings suggest a positive association between the intervention and radiographic performance in undergraduate training.