High resolution images and 3D models of the root canal anatomy enhance reflective reasoning in dental students. A qualitative and quantitative assessment

Abstract

To evaluate the educational value of high‐resolution micro‐CT images and 3D models of maxillary premolars in enhancing dental students' understanding of root canal complexity and reflective reasoning. Eighteen extracted adult maxillary premolars were scanned using a micro‐CT system (SkyScan 1273, Bruker, Belgium) to create high‐resolution images and 3D models compiled into a digital atlas. A mixed‐methods design was implemented. In the quantitative phase, 94 dental students reviewed the materials and completed a seven‐item questionnaire on a 10‐point Likert scale assessing perceived usefulness, motivation, and learning contribution. In the qualitative phase, 15 students participated in focus groups guided by the See/Think/Wonder routine. They analyzed periapical radiographs followed by the micro‐CT images and 3D models and produced hand‐drawn representations of premolars before and after the intervention. Quantitative data were analyzed using descriptive statistics and nonparametric paired tests, while qualitative data were coded and examined with Atlas.ti. Students reported high agreement across items (median scores 9–10), indicating that the digital materials better illustrate root channels, were intuitive, helped them understand better, should complement their studies, motivated them to learn, and contributed to their learning and treatments. Post‐intervention drawings demonstrated significantly greater anatomical detail, including accessory canals and apical deltas. Qualitative findings revealed more complex, clinically oriented reasoning, though some students expressed uncertainty or anxiety upon recognizing anatomical variability. High‐resolution micro‐CT images and 3D models enhance comprehension of root canal complexity and foster reflective reasoning, although increased awareness of anatomical variability may generate anxiety in some learners.

INTRODUCTION

Premolars exhibit considerable anatomical variability, ¹ which may compromise both diagnosis and treatment if not properly identified. ² , ³ Consequently, a comprehensive knowledge of tooth anatomy has always been fundamental to dental education ⁴ and indispensable for the effective management of diseases affecting the root canal system. ⁵

In dental education, conventional methods such as textbook‐based lectures or radiographic images provide useful approximations of tooth anatomy; however, they often fail to fully convey the internal structural complexity. ⁶ , ⁷ Previous studies have stated that traditional approaches to teaching tooth morphology should be complemented by innovative pedagogical strategies that better represent anatomical structures, sustain students' attention, and address diverse learning styles. ⁸

Innovative pedagogical strategies have sought to overcome the limitations of traditional teaching methods. In this regard, 3D models of the external tooth anatomy generated using intraoral scanners have been developed, enhancing student engagement, the assessment of general dental morphology, and knowledge retention in dental anatomy. ⁶ Likewise, the use of Cone Beam Computed Tomography (CBCT) technology, which enables visualization of the internal anatomy of anatomical structures in e‐learning environments, has been shown to be more effective than physical models for improving spatial understanding of dental anatomy, particularly in remote learning contexts. ⁷

In this context, micro‐computed tomography (micro‐CT), with its higher resolution capacity compared to CBCT, enables the acquisition of three‐dimensional images that accurately represent the intricate anatomy of the root canal system. Although these images have been increasingly introduced into dental education, most existing studies have focused on their application to treatment planning or outcome evaluation. ⁹ , ¹⁰ Considerably less attention has been given to their potential as pedagogical tools for fostering students' understanding of internal tooth complexity and for enhancing their reasoning processes. Addressing this gap and following methodological analogies in medical education, where interactive 3D micro‐CT models have been used for complex internal structures such as the paranasal sinuses, ¹¹ the present study explores how exposure to high‐resolution micro‐CT images and 3D models of maxillary premolars influences dental students' awareness of anatomical variability and their reflective reasoning processes.

Reflective thinking refers to an active process in which learners examine their observations and assumptions to make sense of complex situations. ¹² In endodontic education, this involves interpreting intricate root canal anatomy, questioning initial representations derived from simplified models or radiographs, and integrating high‐resolution visual information to enhance reflective reasoning under conditions of anatomical variability and diagnostic uncertainty. One method to assess reflective thinking elicited by an educational tool is the See–Think–Wonder routine (Project Zero, Harvard University). This thinking routine allows students to construct scenarios through observation, the formulation of questions and meaningful reflections based on images or objects that are carefully examined. ¹³ This approach encourages learners to engage deeply with visual material by sequentially asking: What do you see? What do you think about that? What does it make you wonder? It fosters careful observation before inference, supporting a reflective and metacognitive approach to understanding complex phenomena. ¹⁴

The objective of this study was to evaluate the impact of high‐resolution micro‐CT images and three‐dimensional models of maxillary premolars on dental students' reflective thinking, their awareness of root canal anatomical complexity, and their perceptions of the usefulness of these resources in endodontic education.

MATERIALS AND METHODS

This study was conducted in the Dental University Clinic of Universidad de La Frontera (Chile) and had the approval of the local ethics committee. In this university, the undergraduate dental program extends over a 6‐year period and undergraduate students begin treating patients in the third year (preclinical year), while endodontic treatments are performed in the 4th year. Prior to engaging in the interviews, all participants were informed of the nature of the study, allowed to ask questions, and give informed consent.

High resolution images and 3D models of the internal anatomy of premolars

Eighteen maxillary first and second premolars were scanned using a Micro‐CT (SkyScan 1273, Bruker, Kontich, Belgium) set at 100 kV, 150 mA, 360° rotation around the vertical axis with a rotation step of 0.5°, frame average of 2, and spatial resolution of 23.3 μm, using a 1.0‐mm‐thick aluminum filter. Teeth were extracted for reasons not related to this study. High‐resolution images of all dental structures (enamel, dentin, and canal space) (Figure 1A), including the apical delta (Figure 1B), as well as three‐dimensional models of the root canals were generated using CTan software (Bruker) and compiled into an atlas. The atlas, including high‐resolution images and the 3D model provided to the students, can be accessed on the Zenodo platform at the following link: https://zenodo.org/records/15396214.

FIGURE 1.

Representative high resolution images provided to the students. (A) Reconstruction of a maxillary premolar depicting the dental structures, including the root canal system. (B) High resolution images of apical delta of 10 maxillary premolars.

Outcomes assessment

Three outcomes were assessed: the perception of the educational material's usefulness, the impact on students' thinking routines (reflective reasoning), and their awareness of the complexity of internal dental anatomy. The outcomes were evaluated using both quantitative and qualitative approaches.

Quantitative assessment

To evaluate students' perceptions of the usefulness of the high‐resolution images and 3D models of dental pulp anatomy, the entire cohort of fourth‐year dental students was exposed to the material (n = 105). The resources were first presented orally during lectures in each course and later made available on the course's virtual platform for unrestricted access.

Four weeks later, a seven‐item questionnaire using a 10‐point Likert scale was administered (Figure 2), with an additional No Response (NR) option. All questions were designed to assess students' perceptions of intuitiveness, motivational value, and the pedagogical contribution of the digital resources to learning root canal anatomy.

FIGURE 2.

Responses of 94 students about the perception of the usefulness of the high resolution images and 3D models of maxillary premolars.

The seven‐item Likert scale questionnaire was adapted from selected items of the instrument developed by Chevalier et al., ¹⁵ which assessed dental students' perceptions of the usefulness of a preclinical 3D‐printed laboratory simulation for the management of deep caries and exposed pulp. For the purposes of the present study, relevant items were selected, translated, and thematically adapted to the educational context of high‐resolution micro‐CT images and 3D models of internal root canal anatomy. Content validity was evaluated through expert review by a focus group consisting of two endodontists and one general dentist, and the adapted questionnaire was pilot‐tested with a group of undergraduate dental students to ensure clarity, relevance, and appropriateness of the items.

Descriptive statistics and bar charts were used to summarize and visualize the distribution of responses for each item. Data analysis was performed using R software (version 4.4.2).

Qualitative assessment (thinking routine)

To further explore students' perceptions and cognitive shifts, three focus groups were conducted, each including five randomly selected fourth‐year dental students (n = 15) from the subsequent academic year, none of whom had prior exposure to the educational materials used in the quantitative phase. This design allowed for an unbiased exploration of students' baseline understanding of internal tooth anatomy. Sessions were held in a university classroom, moderated by two facilitators who were not part of the teaching staff (one academic trained in qualitative research methods and one dental researcher), and were audio recorded. Students were also asked to produce hand‐drawn representations of a maxillary premolar to further explore their anatomical understanding.

At the beginning of each session, the moderators explained to the students that the responses would be anonymous and that there were no incorrect answers, and they were encouraged to share their views in a neutral, nonjudgmental environment. Discussions were guided using the See/Think/Wonder thinking routine (“What do you see?,” “What do you think about that?,” “What does it make you wonder?”), developed by Project Zero at the Harvard Graduate School of Education.

Each group was first shown five periapical radiographs of maxillary premolars and invited to engage in the See/Think/Wonder routine and produce hand‐drawn representations of a maxillary premolar. Subsequently, high‐resolution micro‐CT images and 3D models of the premolars and root canal systems were presented, after which students again responded to the thinking routine and completed the drawing task. All data were recorded and collected.

Qualitative data were analyzed using a thematic analysis approach in ATLAS.ti, structured around the See/Think/Wonder prompts as a priori analytic domains, with codes developed inductively within each domain to capture participants' observations, interpretations, and questions (Table S1). Analytic rigor was supported through peer debriefing with the lead author to refine code definitions and reach consensus on interpretive decisions. Sample adequacy and data saturation were assessed by tracking the emergence of new codes across focus groups within each domain; by the third group, no new substantive codes were identified, with subsequent data contributing only minor elaborations.

Quantitative assessment (drawings)

As noted above, participants were asked to draw on paper a maxillary premolar with its internal anatomy before and after exposure to the high‐resolution images and 3D models. Each student's drawing was coded for the presence or absence (0/1) of five internal anatomical features: more than one main root, accessory canals, apical delta, isthmus, and pulp horns (Table 1). Coding was performed independently for pre‐ and post‐intervention drawings.

TABLE 1.

Categorization of the internal anatomy features depicted in premolar drawings before and after viewing the high resolution images and 3D models.

Student	Before viewing the 3D models and micro‐CT images					After viewing the 3D models and micro‐CT images
	More than one main canal per root	One or more accessory canals	Apical delta	Isthmus	Pulp horns	More than one main canal per root	One or more accessor y canals	Apical delta	Isthmus	Pulp horns
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Note: Red: the drawing did not include the mentioned feature. Green: the drawing did include the feature. McNemar's Chi‐squared test showed statistically differences before and after viewing the 3D models in the categories Presence of accessory canals in the drawings, presence of apical delta and the overall aggregate of all categorical data.

To assess overall changes in drawing complexity, a per‐participant count of depicted features (ranging from 0 to 5) was computed for the pre‐ and post‐intervention drawings. Differences in these paired counts were analyzed using the Wilcoxon signed‐rank test, a nonparametric alternative appropriate for paired ordinal or non‐normally distributed data.

To examine changes in specific anatomical features, the proportion of students depicting each individual feature before and after the intervention was analyzed using McNemar's chi‐squared test with continuity correction, appropriate for paired binary data. When no variability was present at baseline (i.e., when a feature was not depicted by any student before the intervention), no inferential test was performed and results were reported descriptively.

All analyses were performed in RStudio (R version 4.4.2), with a significance level of α = 0.05.

RESULTS

A total of 94 students completed the questionnaire (89.5% response rate) and 15 participated in the qualitative phase (100% response rate).

Perception on the usefulness of the high resolution images and 3D models of the dental pulp anatomy

Overall, the quantitative results indicate high levels of agreement across most items, with median responses of 9 or 10 (Figure 2). Interquartile ranges were low across all items (IQR = 1–3), indicating limited dispersion and relatively consistent responses among students (Figure 2). In particular, participants rated the high‐resolution images and 3D models as user‐friendly and intuitive, as adding value to root canal treatment, as illustrating the root canal system more effectively than traditional learning methods, as complementing textbook readings on canal anatomy, and as supporting a deeper understanding of the root canal system compared to traditional methods (Figure 2).

By contrast, the items (the high‐resolution images and 3D models) motivated me to learn about the root canal system and contributed to successful learning showed slightly lower central tendency (median = 9 rather than 10), and in the case of the motivation item, greater dispersion (IQR = 3) (Figure 2). Nevertheless, responses to both items remained largely positive (approximately 80% and 88% ≥ 7, respectively) (Figure 2).

Reflective reasoning

The students' responses to the thinking routine became notably more complex after observing the high‐resolution images and 3D models. During the interviews, the students gave more detailed descriptions of the internal anatomy of premolars and elaborated clinically relevant questions after observing the high‐resolution images and 3D models.

When reviewing periapical radiographs of maxillary premolars (before examining the atlas), limited visualization of or variations in the internal anatomy were reported by the students. While students recognized features such as mesio‐distal curvatures or dilacerations, they expressed uncertainty in identifying accessory canals, canal bifurcations, or apical deltas. In all such cases, they reported needing complementary imaging or diagnostic tools, such as angled radiographs, apex locators, or even CBCT. They were also able to recognize the limitations of periapical radiographs in detecting key anatomical structures, which led to a sense of uncertainty:

You don't see the internal anatomy clearly on a periapical radiograph. At most, you can make out the canals separately.

There might be canal curvatures (on the palatal‐buccal aspect), but on a periapical we'd only see one straight canal. So we miss a lot with periapicals.

You'd need a shifted radiograph to better visualize more than one canal.

This image (radiograph) alone wouldn't be very helpful, ideally, we'd order a CBCT.

I feel it's like working blind. It doesn't offer much unless supplemented with other tools. Just knowing average lengths isn't enough.

After reviewing periapical radiographs, students were shown high resolution images and 3D models of maxillary premolars. While analyzing them, students identified various internal anatomical features of maxillary premolars that are not easily visible in the radiographs. They highlighted complex structures such as apical deltas, accessory canals, and variability in the direction and location of canal exits. Moreover, students concluded that more variation of the internal anatomy could be observed with high resolution images, unlike the more uniform appearance of the radiographs.

An apical delta can be observed.

There are accessory canals that have their own apical constrictions.

You can see the different canal exits; it's noticeable that one accessory canal is toward the interproximal area.

If I had to describe the internal anatomy of this tooth in one word, it would be complicated.

Moreover, the use of high resolution images helped students to think of clinically relevant questions and acknowledge the importance of root canal treatment steps, such as chemo‐mechanical instrumentation and the role of irrigants:

These images show the importance of using irrigation, to reach inaccessible canal structures.

The canals in the premolar appear intertwined. Performing proper chemo‐mechanical instrumentation would be challenging.

I think it's important to recognize when there might be a second canal or an extra root. This tooth, for example, has a pronounced mesial curvature, which influences the type of instrument we should use in endodontics.

It makes me wonder: what is my actual working length?

How effective will the disinfection of the accessory canal be by the end of the treatment?

This tooth has two lateral canals. How many apical constrictions might it have?

As expected, after visualizing the internal anatomy, students became more cautious in considering their clinical approach to root canal treatment. Interestingly, rather than providing reassurance, the improved visualization also led to increased uncertainty among some students.

I believe these kinds of images really help us realize just how the internal anatomy can be, and how limited periapical radiographs are.

I think this kind of anatomical variation is more common than we usually assume. But we have to visualize it in three dimensions. If we only think in 2D, we simply don't see it.

Now that I know how different each tooth can be, it makes me feel uncertain, even a bit anxious, about what the internal anatomy is really like.

That's actually dangerous. You might assume one case is easy, but you end up with a very difficult case, simply because the canals were different from what you expected.

The problem is that in the clinic we'd say, ‘Oh, this case isn't complicated.’ Because based on the radiograph, we'd think everything is fine. But now, knowing it (the root canal system) can take different features, I wouldn't be so sure. It's hard to trust.

Awareness of the complexity of the internal anatomy

A summary of the internal anatomical features of premolars illustrated in the students' drawings before and after the intervention is presented in Table 1, while Figure 3 shows representative student drawings before and after exposure to the high‐resolution images and 3D models.

FIGURE 3.

Representative student drawings before (A, C) and after (B, D) exposure to high‐resolution images and 3D models. Following the exposure, most students depicted a more complex root canal anatomy, including apical deltas (green arrow), accessory canals (red arrows), and pulp horns (blue arrow).

At the overall level, students depicted significantly more complex root canal systems after viewing the high‐resolution images and 3D models (Table 1, Figure 3). The per‐participant count of depicted features increased significantly from pre‐ to post‐intervention (median pre = 1, median post = 3; Wilcoxon signed‐rank test, V = 101, p = 0.002), indicating a global increase in anatomical awareness.

At the level of specific anatomical features, the proportion of students depicting accessory canals increased significantly after the intervention (from 7% to 60%; McNemar p = 0.013) (Table 1). No student depicted an apical delta before the intervention, whereas 47% did afterward (Table 1); due to the absence of baseline variability, no inferential test was applicable and this result is reported descriptively. The representation of pulp horns increased from 53% to 87%, showing a nonsignificant trend (p = 0.074) (Table 1). No statistically significant changes were observed for the depiction of more than one root or isthmi.

Interestingly, 11 out of 15 students illustrated noticeably larger root canal systems after the exposure (Figure 3B,D).

DISCUSSION

The objective of this study was to evaluate the impact of high‐resolution images and 3D models of maxillary premolars on students' awareness of root canal anatomical complexity, their reflective reasoning, and their perception of the resources' usefulness in endodontic education. A total of 94 undergraduate students participated in the quantitative phase, and 15 participated in the qualitative phase of the study, and results show that, in general, the perception of the usefulness of the material was positive. The material allowed a significantly greater awareness of the complexity of the root canal anatomy, and some students reported feelings of uncertainty/anxiety when envisioning themselves performing endodontic procedures. The material also induced the students to formulate clinically relevant questions and comments.

Premolars exhibit considerable variability in their root morphology and canal system configuration. Micro–computed tomography studies have identified 12 different root canal configurations in premolars, ¹⁶ with multiple combinations of main canals and apical foramina, as well as a frequent presence of accessory canals and ramifications in the apical third. Depending on the population studied, the reported prevalence of accessory canals ranges from 36% to 73%, ¹⁶ , ¹⁷ , ¹⁸ accessory foramina in approximately 65% of cases, ¹⁶ and apical deltas in up to 14% of teeth. ¹⁸ The remarkable anatomical variability underscores the need for an awareness of the anatomical complexity of these teeth for the anticipation of possible variations, since the frequency of endodontic technical errors increases as the root canal configurations become more complex. ¹⁹

While prior studies have shown the educational value of digital and 3D resources in dental anatomy, our intervention differs from the cited literature in both anatomical focus and pedagogical purpose. Scanners of the external anatomy; ⁶ and CBCT‐based e‐learning approaches ⁷ primarily address general tooth morphology; however, their spatial resolution limits detailed visualization of complex internal features such as accessory canals and apical deltas. In contrast, our study employs high‐resolution micro‐CT, a nonclinical modality that provides visualization of internal root canal anatomy and exposes students to the extent of anatomical variability. This positions the micro‐CT atlas as a complementary educational resource rather than a replacement for existing tools.

Moreover, while previous 3D learning tools emphasize spatial understanding and performance outcomes, our intervention explicitly targets reflective thinking by integrating micro‐CT images within a structured See/Think/Wonder routine and combining image analysis with hand‐drawn representations. Finally, although interactive micro‐CT–derived 3D models have been used in medical anatomy education as methodological analogues, ¹¹ our study differs from previous work in that it evaluates their educational impact specifically in the context of internal root canal morphology, with a focus on students' reflective thinking and engagement with anatomical complexity. Rather than emphasizing the technological novelty of the models themselves, our approach examines how high‐resolution visualization of canal system variability influences students' reasoning processes and learning experiences, which have been less explored in prior digital anatomy studies.

A previous study concluded that incorporating 3D anatomy teaching allows students to visualize and spatially understand the relationships among anatomical components, fostering deeper anatomical awareness. ⁷ In the present study, before viewing the high‐resolution images and 3D models, only one out of fifteen students drew a premolar including accessory canals; one depicted an isthmus; and none illustrated an apical delta (Table 1). After exposure to the visual materials, a significantly higher number of students incorporated accessory canals and apical deltas in their drawings, reflecting an improved awareness of the anatomical complexity of premolar root canal systems. Additionally, following the exposure, most students illustrated noticeably larger root canals, a finding that may result from the enhanced attention to the root canal system elicited during the study, given that attention has been shown to modify perceived object size. ²⁰

A positive outcome observed in this study was the enhancement of students' reflective reasoning after interacting with high‐resolution images and 3D models. Participants were able to articulate clinically relevant reflections, such as the importance of irrigation to reach inaccessible canal structures, the selection of files according to canal curvature, and the determination of working length. Previous studies using virtual patient educational tools have also reported improved reflective reasoning and diagnostic ability, ²¹ and similar results have been observed with virtual reality interventions. ²² However, no studies were found that specifically assessed reflective reasoning using high‐resolution images or 3D models. The present study therefore demonstrates that such accessible resources can also foster reflective reasoning, offering a practical alternative to more complex technological approaches.

Although overall improvement in students' understanding and visualization of root canal anatomy was observed, learning gains were not uniform across the cohort. Qualitative data from thinking‐routine interviews were collected anonymously, preventing the linkage of individual perceptions, such as uncertainty or anxiety, to specific learning gains. Interestingly, anxiety‐related themes emerged, suggesting that engagement with anatomical complexity can elicit affective responses influencing learning. Lazarus et al. ²³ highlight that anatomy learning inherently involves uncertainty, and that pedagogical strategies can foster learners' tolerance to it, potentially shaping both cognitive and emotional responses. These findings underscore the need for future studies to integrate individual quantitative and qualitative data, enabling a deeper understanding of how emotional factors and uncertainty tolerance interact with learning outcomes when using advanced anatomical models.

As noted above, an unexpected qualitative finding was that some students expressed feelings of uncertainty or apprehension after engaging with the high‐resolution images and 3D models, particularly when reflecting on future endodontic practice. These responses should be interpreted as hypotheses emerging from qualitative data, rather than as evidence of increased anxiety, since the latter was not measured in this study. From a conceptual standpoint, students' accounts may be viewed through constructs such as knowledge anxiety and information anxiety, which have been described as emotional discomfort arising when individuals are confronted with complex or demanding knowledge domains ²⁴ , ²⁵ or with a perceived gap between what is understood and what one feels should be understood. ²⁶ In this context, increased awareness of root canal variability may temporarily challenge prior assumptions derived from simplified representations.

In this study, to address potential anxiety generated during the activity, once data collection was completed, students were explicitly reminded that although root canal anatomy is complex and variable, established clinical steps and protocols exist to manage this complexity effectively in practice. In particular, emphasis was placed on the role of adequate access preparation, systematic canal exploration, and the use of chemical disinfection strategies such as irrigation, which allow clinicians to manage anatomical variability even when all structures cannot be directly visualized.

This study was conducted with fourth‐year undergraduate dental students who had initiated clinical patient care in their third year and were, at the time of participation, engaged in comprehensive adult and pediatric care for approximately 20 h per week. Evidence from dental and medical education suggests that the sequencing and integration of clinical exposure within the curriculum can influence how students cognitively interpret and respond to instructional materials, particularly when new learning resources introduce clinical complexity that contrasts with previously simplified models. ²⁷ , ²⁸ Consequently, the curricular timing and clinical demands of this cohort likely influenced students' responses to the high‐resolution micro‐CT images and should be considered when interpreting the findings and extrapolating them to programs with different curricular structures.

Over the past two decades, anatomy educators have increasingly adopted cutting‐edge technologies to create more engaging, interactive, and meaningful learning experiences for students. Among these innovations, 3D visualization has generated substantial optimism as an alternative or complementary resource in medical education. However, despite this enthusiasm, it remains essential to understand how learners interact with such technologies in order to identify their potential limitations. ²⁹ These resources are reported to improve comprehension and positively influence both what and how students learn, ²⁹ which is concordant with our results. However, when students are inexperienced with 3D computer technology, the use of the model is detrimental to learning for students. ¹¹ Therefore, the design and implementation of such models need to be considered. ¹¹ In the present study, the overall perception of the resources was highly positive, which we attribute both to the improved visualization of the root canal system and to the user‐friendly and intuitive nature of the resources, namely, the direct access to high‐resolution images and the use of QR codes linking to interactive 3D models, which was appreciated by the majority of the students.

This study presents certain limitations that should be acknowledged. The assessment was conducted shortly after the educational intervention, preventing evaluation of long‐term knowledge retention or transfer to clinical performance. Additionally, the sample was restricted to undergraduate students from a single dental school, which may limit the generalizability of the findings to other educational contexts or institutions with different curricula.

CONCLUSION

The findings of this study suggest that high‐resolution micro‐CT images and 3D models of dental internal anatomy are valuable educational tools that enhance students' awareness of anatomical complexity and stimulate more reflective reasoning. The use of these digital resources not only improved the accuracy and detail of students' anatomical representations but also encouraged critical questioning about endodontic procedures and clinical decision‐making. Interestingly, for some students, the increased awareness of anatomical variability also elicited feelings of anxiety and apprehension about performing root canal treatments. This highlights the need to develop educational strategies that help students manage these emotional responses to complex clinical situations.

AUTHOR CONTRIBUTIONS

Natalia Soto‐Faúndez: Conceptualization; investigation; visualization; methodology; formal analysis; writing – review and editing; supervision; data curation. Ana Bucchi: Conceptualization; investigation; writing – original draft; funding acquisition; formal analysis; data curation; resources; software. Cristina Bucchi: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; validation; visualization; writing – review and editing; formal analysis; resources; project administration.

FUNDING INFORMATION

This study was funded by the National Agency for Research and Development (ANID, Chile), FONDEQUIP EQM220061 project and SIA 85240252, and the Teaching Development and Innovation Project DID24‐0006, Undergraduate Vice‐Rectory.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS APPROVAL STATEMENT

This study was approved by the ethical committee of Universidad de La Frontera, Temuco, Chile.

PERMISSION TO REPRODUCE MATERIAL FROM OTHER SOURCES

Not applicable.

Supporting information

Supplementary Table 1: Main qualitative codes identified using Atlas.ti within the See/Think/Wonder thinking routine during the review of 2D periapical images (C1) and highresolution images and 3D models (C2), including code categorization and representative participant quotations.

Biographies

Ana Bucchi is physical anthropologist, PhD, and is currently a faculty member at Universidad de La Frontera, Chile, where she teaches interdisciplinary integration courses using problem‐based learning methodologies within the dental curriculum. She is a recognized expert in micro‐computed tomography (Micro‐CT) and image analysis. Her research interests focus on the application of emerging technologies in both education and professional practice.

Natalia Soto‐Faúndez is a dentist holding a master's degree and serves as a full‐time faculty member at Universidad de La Frontera, Chile. She is involved in preclinical teaching within the dental curriculum. Her research interests lie in higher education pedagogy and qualitative research methodologies applied to health sciences education.

Cristina Bucchi is a dentist holding a doctoral degree and is currently a faculty member at Universidad de La Frontera, Chile, where she teaches interdisciplinary integration courses using problem‐based learning and contributes to the postgraduate program in endodontics. Her primary research interests are centered on endodontics, with a focus on pulp biology and regenerative approaches.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are openly available in Zenodo at https://zenodo.org/records/15396214.