Table 4.

Examples of multiple-choice questions, which were part of the endodontic assessment and important findings indicating if the question is valuable (appropriate, understandable, and friendly).

Question 1	‘Basic’	You have just completed the root canal treatment (cleaning and shaping using hand files) of two teeth in the Lab: a maxillary central incisor and a maxillary first premolar. Then, you took notes to be able to obturate the root canals in the next session: Tooth 11 —Working Length (WL): 22 mm, Initial Apical File (IAF): # 30, Master Apical File (MAF): # 50, Last file used in the Step-Back procedure: #80 Tooth: 24 (2 canals)—Buccal Canal WL: 19 mm, IAF: # 15, MAF: # 30, Last file used in the step-back procedure: # 55. Palatal Canal WL: 18 mm, IAF: # 20, MAF: # 35, Last file used in the step-back procedure: #60. Following your notes, answer: What are the handle colors for the files #30, #15, #55, #20, #35, #80, #60 respectively? (a) Green, blue, red, green, red, black, and blue (b) Blue, white, red, purple, pink, gray, and green (c) Green, white, red, yellow, green, purple, and red □ (d) Blue, white, red, yellow, green, black, and blue	These questions had 100% of correct answers and 100% of confidence (‘Situation 1’). A simple recall and understanding of ideas. They were valuable questions, and very basic.
Question 7	‘Basic’	The apical stop should be developed slightly short of the apical foramen; approximately 1.0 mm has been suggested. This leaves a tiny remaining portion of the canal not properly cleaned of bacteria and/ or debris. This section of the canal should finally be cleaned, not shaped, using fine instruments, no. #10 or no. #15, to the radiographic apex (or slightly beyond it). This procedure is know as: (a) working length (b) apical patency□ (c) crown-down phase (d) step-back phase
Question 16	‘Moderate’	Put the sentences in order according to the protocol of instrumentation for ProTaper Gold that is attached to the Lab wall: 1. Use F1, F2, and F3 to enlarge the apical third (F2 or F3 will be your Master Apical File (MAF), depending on the canal anatomy and depending on the Initial Apical File (IAF) 2. Create radicular access (coronal pre flaring) with SX (golden/short file) until it gets resistance 3. Determine the Working Length: taking an X-Ray with the largest hand file (this file should be a #15, #20, or #25) 4. Use shaping files S1 and S2: S1 with brushing strokes, until it gets resistance. S1 is not required to reach the working length. S2 with brushing strokes, up to the working length. 5. Pre-determine the tooth length: measuring from the reference point (incisal or occlusal edge) to the radiographic apex 6. Use the patency file (#10 or #15) 1 mm less than your pre-determined X-ray measurement 7. Irrigate (before/during/after) and use the patency file to maintain the glide path and to check the foramen patency (approximately 1.5 mm beyond working length) (a) 5, 2, 6, 3, 4, 1, 7 □ (b) 1, 2, 3, 4, 5, 6, 7 (c) 2, 1, 3, 4, 6, 5, 7 (d) 5, 2, 6, 3, 1, 4, 7	This question also had 100% of correct answers; however it had only 89.66% of confidence (‘Situation 1’). Here, a complex sequence/alternatives that requires connection between theory and clinic procedures proved to be valuable, even if with some uncertainty by the students.
Question 9	‘Moderate’	Mark the correct alternative regarding rotary Nickel-Titanium (Ni-Ti) instruments: (a) clinical usage leads to great macroscopic changes in the alloy (b) have low flexibility (c) are able to accommodate great stress without increasing the strain, which means that in severe curved canals the strain against the canal wall is low □ (d) to prevent “cyclic fatigue” (fracture by stress) you should not force the instrument in apical direction and to prevent “taper lock” (torsional fracture) you should keep the instrument moving (in-and-out).	Question 9 had the highest level of incorrect answers (31%,) and it also had the highest percentage of misconceptions (17%). A connection between and theory clinical expertise was necessary (cognitive connection that sometimes is not possible at the preclinical stage of the dental program). Even so, we classified this question as “valuable”. Question 18 also had misconceptions—it required the indication of the wrong alternative. Redesigning and improvement of negative questions for future assessments would be interesting.
Question 18	‘Moderate’	Choose the alternative that does not refer to the sodium hypochlorite (NaOCL)(bleach), irrigant of choice in endodontics. (a) it presents toxicity. If it is inadvertently extruded through the tooth apex, or fell in the patient’s skin severe accidents may occur (b) it has the ability to dissolve vital and necrotic tissue, by breaking down proteins into amino acids (c) it has antimicrobial action, because of its high pH (d) it reduces the microhardness of dentin, which helps to negotiate and to maintain patency in narrow, tortuous, and calcified canals. However it might cause dentin erosion □
Question 20	‘Moderate’	Underextending the access cavity preparation may lead to: (a) a missed canal (b) fracture of endodontic instruments (c) discoloration of the crown (d) all of the above □	Question with a high percentage of incorrect answers (24.14%) and, also, uncertainty. However, the positive point was that questions like this, requiring a mental picture of a clinical scenario, induced less number of misconceptions (P = 0.007).
Question 5	‘Basic’	Look at the palatal view of the maxillary lateral below and mark the design that represents an ideal traditional outline form for the endo access: □	Two similar questions with different results. Question 5 had less incorrect answers and less uncertainty. Questions using images and questions that required a mental picture of a clinical scenario—had less number of misconceptions (P = 0.007). Those are ‘valuable questions’.
Question 14	‘Basic’	Which of the following is the ideal endo-access (tooth face and outline) for mandibular incisors? (a) buccal and oval (b) lingual and oval (c) lingual and triangular □ (d) buccal and triangular

Correct answer is checked by □.