Sequential Radiographic Decision‐Making in Traumatic Dental Injuries Among Final‐Year Dental Students: A Scenario‐Based Single‐Center Cross‐Sectional Study

BACKGROUND: Radiographic decision-making is an important component of traumatic dental injury (TDI) management. It requires clinicians to select an appropriate baseline examination, determine whether complementary imaging is needed, choose the most suitable additional modality, and consider advanced imaging only when clinically justified. This study evaluated final-year dental students' sequential radiographic decision-making performance in TDI scenarios using the 2020 International Association of Dental Traumatology (IADT) guidelines and an expert-consensus scoring framework as references. METHODS: This cross-sectional survey study was conducted among final-year dental students at the Faculty of Dentistry of Afyonkarahisar Health Sciences University. All 114 eligible students were invited to participate; 110 completed the survey, yielding a participation rate of 96.5%. The instrument included eight clinical trauma scenarios. Each scenario contained four scored decision-making questions addressing the preferred baseline radiographic examination, the need for complementary imaging, selection of the complementary modality, and selective CBCT consideration. The total scenario-based radiographic decision-making score ranged from 0 to 32. Four domain scores, each ranging from 0 to 8, were also calculated for the sequential decision stages. Scenario-level performance and exploratory subgroup comparisons according to gender and self-reported IADT guideline awareness were evaluated. RESULTS: Of the 114 eligible final-year dental students invited to participate, 110 completed the survey, corresponding to a participation rate of 96.5%. The mean total scenario-based radiographic decision-making score was 21.62 ± 2.92 out of 32 (95% CI: 21.07-22.17), equivalent to 67.6% of the maximum possible score. The lowest mean domain scores were observed for baseline examination selection (5.04 ± 1.05 out of 8) and complementary modality selection (5.05 ± 1.22), whereas selective CBCT consideration had the highest mean score (6.10 ± 1.18). Scenario-level performance was lowest for suspected root fracture and multiple-tooth displacement with segmental mobility. In the three scenarios in which CBCT could be considered selectively, correct CBCT-related responses were 54.5%, 52.7%, and 84.5% in S5, S6, and S7, respectively. Students reporting awareness of the IADT guidelines had higher total scores than those reporting no awareness (23.24 ± 2.29 vs. 19.81 ± 2.46; unadjusted mean difference: 3.43, 95% CI: 2.53-4.33; p < 0.001; Cohen's d = 1.45). No gender-related difference was detected. CONCLUSIONS: Final-year dental students demonstrated moderate performance in sequential radiographic decision-making for TDIs, with greater difficulty in selecting the baseline examination and complementary modality and in managing more complex trauma scenarios. Although the overall selective CBCT domain score was comparatively high, recognition of situations in which CBCT could be justified was inconsistent across the three relevant scenarios. Self-reported IADT guideline awareness was associated with higher performance, but this exploratory cross-sectional association should not be interpreted causally. The findings identify potential educational needs in guideline-based imaging selection, staged clinical reasoning, and case-specific CBCT justification.