Self-Perceived Confidence and Clinical Preparedness in Restorative Dentistry Among Undergraduate Dental Students

Abstract

Background

Key goals of undergraduate dental education include developing clinical confidence and preparing students for practice. This is particularly important in restorative dentistry when students transition from preclinical simulation to real clinical procedures. Assessing students’ perceptions of their own confidence offers important information about the efficacy of competency-based courses and clinical training.

Methods

A cross-sectional study was conducted among undergraduate dental students. A standardized, self-administered questionnaire was used to measure students’ confidence. It assessed confidence in basic restorative skills, cavity preparation, and performing restorations on different tooth types. It also evaluated confidence in managing various restorative indications. A five-point Likert scale was used to gauge confidence. Descriptive statistics were computed, and Mann-Whitney U, Kruskal-Wallis, and chi-square tests were used to compare academic levels and gender, with significance set at p < 0.05.

Results

Students reported high confidence in basic restorative procedures, particularly Class I cavity preparation (mean score >4.4/5). Female students showed greater confidence in controlling tooth coloration (p = 0.048), while no significant gender differences were observed in most procedures (p > 0.05). Confidence was generally higher for anterior than posterior restorations. Sixth-year students demonstrated the highest confidence in radiograph taking (p = 0.043) and local anaesthetic administration (p = 0.017), reflecting increased confidence with academic progression. Confidence in restoring different teeth improved significantly between the fourth and sixth years (p < 0.001). Significant improvements were also observed in complex (p = 0.006) and indirect restorations (p = 0.014). Most students (88.9%) reported that completing more restorative cases increased their confidence.

Conclusions

Self-perceived confidence in restorative dentistry increased with advancing academic level and clinical exposure. Lower confidence in posterior and complex restorations indicates the need for additional clinical experience. Enhanced simulation training and structured feedback may help ensure graduates develop competence, confidence, and readiness for independent practice.

Keywords

dental education restorative dentistry clinical confidence undergraduate dental students clinical preparedness

Introduction

The goal of dental education is to gradually develop students’ theoretical knowledge, preclinical skills, and clinical competence, enabling them to practice safely and independently after graduation. Students who get preclinical laboratory training gain the psychomotor and cognitive skills necessary to carry out clinical operations confidently and effectively. It takes suitable evaluation techniques, well-structured education, and alignment with predetermined learning objectives to achieve these competencies.^1,2

International dental education models emphasize clinical proficiency, scientific knowledge, communication skills, and the ability to diagnose, plan, and manage both basic and complex cases, though competency frameworks vary slightly between institutions.³ In conservative dentistry, performing both invasive and minimally invasive procedures demand accuracy, sound judgment, and familiarity with modern materials and technology. Continuous exposure to current scientific knowledge and evidence-based practices is therefore essential. Research indicates that high-quality instruction and experience enhance students’ self-perceived confidence, although many report feeling less confident when performing complex restorative procedures.^4-8

It is acknowledged that the shift from preclinical to clinical practice is a particularly difficult phase.⁹ Under supervision, students must control patient expectations, complete irreversible operations on schedule, and achieve competency requirements. Students’ psychological health, self-perceptions, and professional confidence can be greatly impacted by these pressures, performance anxiety, fear of making mistakes, and strict assessment procedures.^10-14 It has been demonstrated that offering excellent supervision and helpful criticism may lower stress and increase competence.^15,16

Research from across the world shows that, although it varies depending on procedural complexity, students’ confidence often rises with academic advancement. While simple operations and routine repairs tend to increase confidence, more complicated jobs including molar endodontics, indirect restorations, and full-mouth rehabilitation are linked to decreased confidence levels.^16,17 Additionally, confidence varies by year, gender, and clinical specialty; patterns seen in Saudi and Middle Eastern institutions are essentially consistent with worldwide trends.^18-21 Additionally, the use of competency-based evaluation methods has occasionally been associated with a decline in confidence, underscoring the significance of creating assessment frameworks that support skill development.²¹

Student confidence in dental clinical training is influenced by a number of factors, such as the amount of clinical experience, the curriculum’s structure, the quality of supervision, patient-related difficulties, and the intrinsic complexity of the dental treatment.^12-24 Strengthening curriculum, improving training methods, and increasing student readiness for practice all depend on an understanding of how students view their learning environment and how these views impact their clinical confidence.

Undergraduate dental education in Saudi Arabia consists of a six-year Bachelor of Dental Surgery (BDS) program, which involves clinical patient care and preclinical laboratory simulation, is followed by a required one-year internship. The fourth and sixth years mark the shift to clinical training, during which students hone their critical thinking, diagnostic, and patient management skills. While fifth-year students handle more cases, including multi-visit restorations, fourth-year students start treating patients by executing basic restorations under strict supervision. By the sixth year, students are responsible for increasingly intricate restorative treatments and thorough treatment planning. Graduates continue their clinical practice during the internship year, treating a large number of patients with less supervision in order to get ready for autonomous practice.

With the increasing focus on competency-based dental education in Saudi Arabia and the Middle East, it is important to study students’ views of their training environment. Research is also needed on their self-reported confidence in performing different restorative treatments. To better assist student growth, evidence-based improvements to instructional strategies, simulation training, and supervision procedures will be made possible by identifying areas of strength and weakness.

The purpose of this study is to assess how undergraduate dental students at the University of Ha’il view their clinical training environment and how confident they feel about carrying out restorative surgical treatments. It also looks for procedural and demographic characteristics linked to confidence and offers suggestions to improve clinical readiness and maximize the competency-based program.

Method

Study Design and Setting

This cross-sectional descriptive study was carried out at the College of Dentistry, University of Hail, situated in Hail City, Kingdom of Saudi Arabia. The purpose of the study was to evaluate and compare dental students’ opinions and levels of self-confidence in connection to how well they performed different restorative dental procedures and the fundamental clinical skills needed in restorative dentistry. Evaluating how undergraduate dental education affects students’ confidence in carrying out restorative treatments, handling clinical situations, and cultivating professional attitudes toward restorative practice was the main goal.

The Scientific Research and Ethics Committee of the College of Dentistry, University of Hail, thoroughly reviewed and approved the research protocol (Approval Number: H-2025-833). This approval attested to the study’s complete adherence to all national and institutional ethical guidelines governing research involving human subjects. The study also adhered to the Declaration of Helsinki’s ethical guidelines, which place a strong emphasis on respect for people, the freedom to make educated decisions, and the preservation of confidentiality and privacy.

All eligible students were personally contacted before to data collection and given a thorough explanation of the goals, processes, and purpose of the study. They were told that the study’s objective was to measure students’ opinions and self-assurance regarding restorative dentistry without having any impact on their academic achievement or clinical evaluation. Before giving their consent, participants had the chance to ask questions to make sure they understood everything.

Each student who agreed to participate signed a written informed consent form, confirming voluntary participation. They were made fully aware that they might reject or leave the research at any moment without giving a reason, and that participation was not required. All information gathered was guaranteed to be handled with the utmost confidentially, maintained safely, and examined anonymously for the sole purpose of study. Additionally, participants were told that their answers would not be available to their teachers and would not affect their future coursework, grades, or assessments. Additionally, they were told that their academic status and grades would not be impacted if they chose not to participate.

Study Population

The study population comprised undergraduate dental students at the University of Ha’il enrolled in the fourth, fifth, and sixth years of clinical training. These students had completed the foundational preclinical courses in restorative dentistry and were actively engaged in clinical patient care, providing them with sufficient exposure to restorative procedures. A total of 117 students participated in the study. Data were collected during the final weeks of the academic year in June 2024. Eligible participants included students who were present during the data collection period, agreed to participate voluntarily, and provided written informed consent. Only fully completed questionnaires were included in the final analysis to ensure data accuracy and reliability. Students were excluded if they were in preclinical years (first to third years), not yet involved in clinical restorative practice, absent during the data collection period, or declined to participate. In addition, incomplete or partially completed questionnaires were excluded from the study.

Data Collection Instrument

A standardized, self-administered questionnaire created specifically for this study was used to collect data (Supplemental material 1). The study team developed the questionnaire after thoroughly reviewing previous literature on dental students’ perceptions and self-confidence in restorative dentistry. Faculty members with expertise in restorative and operative dentistry reviewed the instrument to ensure content validity. After reviewing previous studies,^25,26 the questionnaire was further evaluated by dental faculty members (HAA, AAM, AFA) with more than 20 years of experience in dental sciences to ensure conceptual equivalence, content accuracy, and cultural appropriateness. A pilot study involving 20 participants was conducted to assess clarity, consistency, and comprehensibility of the items. Internal consistency reliability was assessed using Cronbach’s alpha, which demonstrated acceptable reliability of the instrument (α = 0.89). Based on feedback from the pilot testing and reliability analysis, minor linguistic and structural modifications were made before final data collection. Expert review confirmed the content validity and alignment with the study objectives. The final version of the questionnaire was administered to all eligible participants during clinical sessions under supervision and completed anonymously.

Questionnaire Structure

The questionnaire consisted of five main sections. This covered demographic information, self-confidence in performing restorative procedures, confidence in managing various restorative indications, confidence in treating different tooth types, and general opinions about restorative dentistry as a field.

Demographic and background data, such as age, gender, and current academic level (fourth, fifth, or sixth year), were gathered in the first part. The students’ confidence in carrying out a variety of restorative clinical procedures, including obtaining a history, diagnosing and arranging a course of treatment, taking radiographs, administering local anesthetic, and placing rubber dams, was evaluated in the second portion. Additionally, it assessed confidence in cavity preparation for various carious lesion categories, such as Class I, II, III, IV, V, and VI preparations. The participants’ self-confidence in carrying out restoration operations on various tooth kinds was the subject of the third segment. This involved evaluating self-assurance in the management of premolars, molars, and maxillary and mandibular front teeth.

The degree of confidence in handling various restorative indications, including as direct, indirect, and complicated restorations, as well as tooth hypersensitivity, reversible pulpitis, faulty restorations, and tooth discolouration or pigmentation, was assessed in the fourth part. The fifth and last section examined the students’ opinions on the suitability of the restorative clinical standards established by the Restorative Dentistry Unit, their opinions on whether handling more restorative cases boosts confidence, and their plans for future clinical practice, particularly whether they intend to handle all restorative procedures themselves or refer complicated cases to specialists. Additionally, this portion examined the students’ enthusiasm in pursuing a career in operational or restorative dentistry as well as how challenging they thought restorative practice would be.

Scoring System

A five-point Likert scale was used to assess each question in the confidence sections (Parts II, III, and IV). A score of one showed very little confidence, a score of two suggested little confidence, a score of three indicated a neutral answer, a score of four indicated confidence, and a score of five indicated extremely high confidence. Therefore, a higher score indicated a better level of felt confidence in one’s ability to manage a clinical condition or carry out the relevant surgery. Depending on the kind of question, responses to perception and opinion questions in the last portion were recorded as “Yes” or “No,” or as categorical alternatives like “Easy,” “Average,” “Difficult,” or “Very Difficult.”

For the opinion-based questions in Part V, responses were recorded as Yes/No or categorical choices (Easy, Average, Difficult, Very Difficult), depending on the question type.

Data Analysis

After collection, the completed questionnaires were reviewed for completeness, coded, and entered into the Statistical Package for the Social Sciences (SPSS) software, version 21.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistical analyses were performed to summarize participants’ demographic characteristics and overall responses. Mean, standard deviations, and frequency distributions were computed for each confidence-related item.

Inferential statistical tests were used to look for any differences between groupings. Male and female students’ confidence levels were compared using the Mann-Whitney U test, while students at different academic levels were compared using the Kruskal-Wallis test. The chi-squared test was used to examine relationships between categorical variables, such as opinions of restorative training and plans for future employment. Statistical significance was defined as a p-value of less than 0.05.

Results

Demographic Characteristics

A total of 117 undergraduate dental students engaged in this study. 53.0% were male (n = 62) and 47.0% were female (n = 55). The participants consisted of three years in academic grade, 23.1% 4th, 41.0% 5th and 35.9% 6th. The distributions of those tables are shown in Table 7.

Gender-Based Confidence in Fundamental Restorative Skills

In general, male and female students reported similar levels of confidence in all essential restorative exercises with no significant sex differences. For both groups, high confidence was reported in history taking, diagnosis and treatment planning, radiograph taking, local anesthesia administration, and cavity preparation with general scores reported regarding both the performance (Table 1). The best confidence scores were on Class I cavity preparation in both sexes, with mean scores of more than 4.4 for this area. Confidence was moderately high for more multifaceted procedures, such as Class II-V cavities, but slightly lower for Class VI cavity preparation (mean: males 3.84, females 4.13). These results indicate that students’ ability to perform core restorative skills was not influenced by gender.

Table 1.

Average Self-Confidence Scorings of Dental Student for the Restorative Treatment Based on Gender

Procedure	Gender	Mean	Std. deviation	Minimum	Maximum	P- value
What is your confidence level in history taking?	Male	4.21	.85	2.00	5.00	.341
What is your confidence level in history taking?	Female	4.31	.96	1.00	5.00	.341
What is your confidence level in diagnosis and treatment planning?	Male	3.74	.90	2.00	5.00	.105
	Female	3.96	.96	1.00	5.00	.105
What is your confidence level in radiograph taking?	Male	4.08	.87	2.00	5.00	,366
What is your confidence level in radiograph taking?	Female	4.16	1.05	1.00	5.00	,366
What is your confidence level in injecting local anesthesia?	Male	3.95	.89	2.00	5.00	.841
	Female	3.96	.99	1.00	5.00	.841
What is your confidence level in cavity preparation in general?	Male	4.18	95	1.00	5.00	.490
	Female	4.31	.86	1.00	5.00	.490
What is your confidence level in placing rubber dam?	Male	4.16	.98	2.00	5.00	.630
What is your confidence level in placing rubber dam?	Female	4.20	1.08	1.00	5.00	.630
What is your confidence level in Class I cavity perpetration?	Male	4.52	.90	1.00	5.00	.893
	Female	4.49	.96	1.00	5.00	.893
What is your confidence level in Class Il cavity perpetration?	Male	3.89	1.01	2.00	5.00	.599
	Female	3.95	1.11	1.00	5.00	.599
What is your confidence level in Class III cavity perpetration?	Male	4.11	.89	2.00	5.00	.218
	Female	4.27	.95	1.00	5.00	.218
What is your confidence level in Class IV cavity perpetration?	Male	4.03	.94	2.00	5.00	.080
	Female	4.29	.98	1.00	5.00	.080
What is your confidence level in Class V cavity perpetration?	Male	4.16	.96	2.00	5.00	.399
	Female	4.25	1.06	1.00	5.00	.399
What is your confidence level in Class VI cavity perpetration?	Male	3.84	1.32	1.00	5.00	.298
	Female	4.12	1.09	1.00	5.00	.298

Confidence in Restorative Treatment Across Tooth Types by Gender

Gender-based comparisons also revealed no statistically significant difference in confidence on tooth types. As reflected in Table 2, restoring anterior teeth reported greater confidence at both arches of male and female students than molars. Students who were male tended to report higher than average level of confidence with maxillary and mandibular anterior teeth and more than intermediate level of confidence with mandibular molars. Although there were differences, the trend was relatively similar between male and female as none of the discrepancies got statistically significant.

Table 2.

Average Self-Confidence Scoring of Dental Students for the Restorative Treatment of Different Types of Teeth, Based on Gender

Procedure	Gender	Mean	Std. deviation	Minimum	Maximum	P- value
What is your confidence level in performing restorative treatment in maxillary anterior teeth?	Male	3.53	1.45	1.00	5.00	.250
	Female	3.33	1.16	1.00	5.00	.250
What is your confidence level in performing restorative treatment in maxillary premolars?	Male	3.27	1.32	1.00	5.00	.928
	Female	3.27	1.16	1.00	5.00	.928
What is your confidence level in performing restorative treatment in maxillary molars?	Male	2.94	1.46	1.00	5.00	.962
	Female	2.91	1.13	1.00	5.00	.962
What is your confidence level in performing restorative treatment in mandibular anterior teeth?	Male	3.61	1.41	1.00	5.00	.073
	Female	3.27	1.18	1.00	5.00	.073
What is your confidence level in performing restorative treatment in mandibular premolars?	Male	3.39	1.38	1.00	5.00	.893
	Female	3.40	1.16	1.00	5.00	.893
What is your confidence level in performing restorative treatment in mandibular molars?	Male	2.77	1.45	1.00	5.00	.105
	Female	3.11	1.12	1.00	5.00	.105

Confidence in Managing Restorative Indications by Gender

As shown in Table 3, the student populations male and female have high confidence in performing direct restorations and moderate confidence in performing indirect and complex restorations (procedures involving multiple surfaces, or advanced clinical skills), as neither group was significantly different. Similarly, confidence in management of hypersensitivity, reversible pulpitis, and defective restorations was the same. The only statistically significant difference was in tooth pigmentation management as female students revealed greater confidence than males (p = 0.048). In addition to this single item, it did not seem that gender had any significant effect on confidence with respect to the management of restorative indications of intervention.

Table 3.

Average Self-Confidence Scorings of Dental Student for the Restorative Treatment Based on Gender

Procedure	Gender	Mean	Std. deviation	Minimum	Maximum	P- value
What is your confidence level in Direct restoration?	Male	4.26	.90	1.00	5.00	.379
What is your confidence level in Direct restoration?	Female	4.29	1.12	1.00	5.00	.379
What is your confidence level in Indirect restoration?	Male	3.48	.97	2.00	5.00	.718
What is your confidence level in Indirect restoration?	Female	3.55	1.15	1.00	5.00	.718
What is your confidence level in Complex restoration?	Male	3.27	1.16	1.00	5.00	.346
What is your confidence level in Complex restoration?	Female	3.47	1.07	1.00	5.00	.346
What is your confidence level in management tooth hypersensitivity?	Male	3.24	1.21	1.00	5.00	1.000
	Female	3.25	1.08	1.00	5.00	1.000
What is your confidence level in management of reversible pulpitis?	Male	3.45	1.33	1.00	5.00	.588
	Female	3.58	1.23	1.00	5.00	.588
What is your confidence level in repair of defective direct dental restorations?	Male	3.73	1.16	1.00	5.00	.787
	Female	3.80	1.11	1.00	5.00	.787
What is your confidence level in replacement of defective direct dental restorations?	Male	3.77	1.137	1.00	5.00	.873
	Female	3.80	1.13	1.00	5.00	.873
What is your confidence level in management of tooth pigmentation?	Male	3.03	1.24	1.00	5.00	.048
	Female	3.47	1.23	1.00	5.00	.048

Confidence in Basic Procedures by Academic Level

Notable differences in confidence emerged between students at varying academic levels of confidence were noted. Across core procedures, a distinct pattern of increasing confidence increases from the 4th to 6th year was reflected in Table 4. Seemingly statistically significant differences in radiograph taking (p = 0.043), local anesthesia administration (p = 0.017), and cavity preparation for Class VI were found in the 6th-year students and were the highest scores among 6th-year students. Confidence in class II cavity preparation did not rise to statistical significance, but improvement in confidence was statistically significant across academic levels. These responses suggest that high clinical exposure and experience are positively related to students’ perceived competence.

Table 4.

Average Self-Confidence Scorings of Dental Student for the Restorative Treatment Based on Study Level

Procedure	Study level	Mean	Std. deviation	Minimum	Maximum	P- value
What is your confidence level in history taking?	4th level	4.26	.86	3.00	5.00	.548
	5th level	4.19	,89	1.00	5.00
	6th level	4.33	.95	1.00	5.00
What is your confidence level in diagnosis and treatment planning?	4th level	3.67	.92	2.00	5.00	.234
	5th level	3.79	.92	1.00	5.00
	6th level	4.02	.95	1.00	5.00
What is your confidence level in radiograph taking?	4th level	4.00	.92	2.00	5.00	.043
	5th level	3.96	.97	2.00	5.00
	6th level	4.38	.94	1.00	5.00
What is your confidence level in injecting local anesthesia?	4th level	3.67.	.83	2.00	5.00	.017
	5th level	3.88	.94	2.00	5.00
	6th level	4.24	.96	1.00	5.00
What is your confidence level in cavity preparation in general?	4th level	4.11	.89	2.00	5.00	.444
	5th level	4.23	.90	1.00	5.00
	6th level	4.33	.93	1.00	4.00
What is your confidence level in placing rubber dam?	4th level	4.41	.84	2.00	5.00	.319
	5th level	4.04	1.03	2.00	5.00
	6th level	4.19	1.11	1.00	5.00
What is your confidence level in Class I cavity perpetration?	4th level	4.63	.74	2.00	5.00	.788
	5th level	4.46	1.03	1.00	5.00
	6th level	4.48	.92	1.00	5.00
What is your confidence level in Class Il cavity perpetration??	4th level	3.78	1.05	2.00	5.00	.091
	5th level	3.77	1.04	1.00	5.00
	6th level	4.17	1.06	1.00	5.00
What is your confidence level in Class III cavity perpetration?	4th level	4.04	.85	2.00	5.00	.339
	5th level	4.19	.91	2.00	5.00
	6th level	4.29	.97	1.00	5.00
What is your confidence level in Class IV cavity perpetration?	4th level	4.19	.88	2.00	5.00	1.000
	5th level	4.16	.99	2.00	5.00
	6th level	4.14	1.00	1.00	5.00
What is your confidence level in Class V cavity perpetration?	4th level	4.26	.86	2.00	5.00	.905
	5th level	4.15	1.07	1.00	5.00
	6th level	4.24	1.03	1.00	5.00
What is your confidence level in Class VI cavity perpetration?	4th level	4.22	.97	2.00	5.00	.013
	5th level	3.56	1.38	1.00	5.00
	6th level	4.29	1.043	1.00	5.00

Confidence in Restorations Across Tooth Types by Academic Level

Academic grade significantly (and significantly) affects the learners’ confidence to perform restorative work in all tooth types. Table 5 and Figure 1 demonstrates that confidence grew incrementally between the 4th, 5th, and 6th years, per maxillary and mandibular anterior teeth, premolars, and molars (p < 0.001, all comparisons). The greatest increases occurred between the 4th and 6th years, especially for molar restorations. The evidence demonstrates the transfer of experience and clinical judgement with students in the course of training.

Table 5.

Average Self-Confidence Scoring of Dental Students for the Restorative Treatment of Different Types of Teeth, Based on Study Level

Procedure	Study level	Mean	Std. deviation	Minimum	Maximum	P- value
What is your confidence level in performing restorative treatment in maxillary anterior teeth?	4^th level	2.23	1.19	1.00	5.00	<.001
	5^th level	3.42	1.03	1.00	5.00	<.001
	6^th level	4.21	1.12	1.00	5.00	<.001
What is your confidence level in performing restorative treatment in maxillary premolars?	4^th level	2.00	.96	1.00	4.00	<.001
	5^th level	3.21	.92	1.00	5.00	<.001
	6^th level	4.17	.96	1.00	5.00	<.001
What is your confidence level in performing restorative treatment in maxillary molars?	4^th level	1.74	.90	1.00	4.00	<.001
	5^th level	2.81	1.12	1.00	5.00	<.001
	6^th level	3.81	1.06	1.00	5.00	<.001
What is your confidence level in performing restorative treatment in mandibular anterior teeth?	4^th level	2.07	1.14	1.00	4.00	<.001
	5^th level	3.67	.88	2.00	5.00	<.001
	6^th level	4.10	1.19	1.00	5.00	<.001
What is your confidence level in performing restorative treatment in mandibular premolars?	4^th level	2.11	1.12	1.00	4.00	<.001
	5^th level	3.44	.92	2.00	5.00	<.001
	6^th level	4.17	1.080	1.00	5.00	<.001
What is your confidence level in performing restorative treatment in mandibular molars?	4^th level	2.00	1.11	1.00	4.00	<.001
	5^th level	2.63	.94	1.00	5.00	<.001
	6^th level	3.88	1.21	1.00	5.00	<.001

Figure 1.

Progression of dental students’ self-confidence in restorative treatment across study levels by tooth type

Confidence in Managing Restorative Indications by Academic Level

Differences between student academies were similarly apparent in students’ confidence regarding a range of restorative indications. Indirect restorations yielded significant improvements (p = 0.014), complex restorations (p = 0.006) and the management of hypersensitivity, reversible pulpitis and defective restorations (p < 0.05) (see Table 6 for all) were as follows. Sixth-year students were the most confident in these areas, a further result of the effects of clinical exposure and practice. These findings underscore advancement in competency for more complex and advanced restoration treatment in students.

Table 6.

Average Self-Confidence Scorings of Dental Student for the Restorative Treatment Based on Study Level

Procedure	Study level	Mean	Std. Deviation	Minimum	Maximum	P- value
What is your confidence level in Direct restoration?	4th level	4.44	.85	2.00	5.00	.106
	5th level	4.08	1.03	1.00	5.00
	6th level	4.38	1.06	1.00	5.00
What is your confidence level in Indirect restoration?	4th level	3.33	1.04	2.00	5.00	.014
	5th level	3.31	.93	2.00	5.00
	6th level	3.86	1.14	1.00	5.00
What is your confidence level in Complex restoration?	4th level	3.11	1.09	1.00	5.00	.006
	5th level	3.13	1.06	1.00	5.00
	6th level	3.81	1.09	1.00	5.00
What is your confidence level in management tooth hypersensitivity?	4th level	.311	1.15	1.00	5.00	.021
	5th level	3.00	1.07	1.00	5.00
	6th level	3.62	1.15	1.00	5.00
What is your confidence level in management of reversible pulpitis??	4th level	2.81	1.42	1.00	5.00	<.001
	5th level	3.33	1.04	1.00	5.00
	6th level	4.17	1.15	1.00	5.00
What is your confidence level in repair of defective direct dental restorations?	4th level	3.48	1.42	1.00	5.00	.029
	5th level	3.63	.89	2.00	5.00
	6th level	4.10	1.12	1.00	5.00
What is your confidence level in replacement of defective direct dental restorations?	4th level	3.70	1.29	1.00	5.00	.030
	5th level	3.56	.97	1.00	5.00
	6th level	4.10	1.14	1.00	5.00
What is your confidence level in management of tooth pigmentation?	4th level	3.00	1.47	1.00	5.00	.027
	5th level	3.02	1.06	1.00	5.00
	6th level	3.64	1.23	1.00	5.00

Students’ Perceptions of Restorative Dentistry

Table 7 summarizes students’ general perceptions. Most agreed (88.9%) that more restorative cases build confidence, 69.2% believed the restorative expectations laid out by the unit were sufficient. In addition, 89.7% stated that they would want to practice all restorative procedures independently in their future practice. The perceived difficulty of restorative dentistry was an average for 63.2% of subjects, easy for 23.1%, difficult for 12.0%. These comments suggest generally favorable perceptions for restorative training which acknowledge both the problem and the skill-fault.

Table 7.

Demographic Characteristics and Perceptions of Undergraduate Dental Students Toward Restorative Dentistry

Question		Frequency	Percentage
Gender	Male	62	53.0%
Gender	Female	55	47.0%
Study level	4^th level	27	23.1%
	5^th level	48	41.0%
	6^th level	42	35.9%
In future, will you choose to refer the cases for a specialist whenever you feel necessary?	Yes	104	88.9%
	No	13	11.1%
Would you choose Operative dentistry as a line of specialty in the future?	Yes	70	59.8
	No	47	40.2
Do you think that restorative dentistry practice is?	Easy	27	23.1%
	Average	74	63.2%
	Difficult	14	12.0%
	Very difficult	2	1.7%
Do you think the restorative requirements determined by the restorative Unit are enough?	Yes	81	69.2%
	No	36	30.8%
Do you think that your confidence level in restorative will increase when perform more restorative cases?	Yes	104	88.9%
	No	13	11.1%
In future, do you wish to perform all restorative procedures in all cases by yourself?	Yes	105	89.7%
	No	12	10.3%

Association Between Perceptions and Gender

Gender-related variation in perception did not yield any significant associations for most items analyzed. Male and female responses indicated that not only did they perceive Restorative Requirements as satisfactory, but that doing more cases improved their confidence, and their intent to do restorative procedures independently (Table 8). Only in perceptions of difficulty was a significant difference reported: female students were more likely to rate restorative dentistry as easy, and males as difficult (p = 0.012). Though different, across gender,

Table 8.

Average Self-Confidence of Dental Students’s Opinion About Endodontic Requirements Determined by the Restorative Unit and Their Restorative Practice in General, Based on Their Gender

Question		Male	Female	P value
Do you think the restorative requirements determined by the restorative Unit are enough?	Yes	43	38	.975
	Yes	36.8%	32.5%
	No	19	17
	No	16.2%	14.5%
Do you think that your confidence level in restorative will increase when perform more restorative cases?	Yes	56	48	.602
	Yes	47.9%	41.0%
	No	6	7
	No	5.1%	6.0%
In future, do you wish to perform all restorative procedures in all cases by yourself?	Yes	55	50	.697
	Yes	47.0%	42.7%
	No	7	5
	No	6.0%	4.3%
In future, will you choose to refer the cases for a specialist whenever you feel necessary?	Yes	57	47	.268
	Yes	48.7%	40.2%
	No	5	8
	No	4.3%	6.8%
Would you choose Operative dentistry as a line of specialty in the future?	Yes	34	36	.244
	Yes	29.1%	30.8%
	No	28	19
	No	23.9%	16.2%
Do you think that restorative dentistry practice is	Easy	9	18	.012
	Easy	7.7%	15.4%
	Average	41	33
	Average	35.0%	28.2%
	Difficult	11	3
	Difficult	9.4%	2.6%
	Very difficult	1	1
	Very difficult	0.9%	0.9%

Association Between Perceptions and Academic Level

Some attitude items were significantly related to academic degree. As seen in Table 9, students in the 6th year were more likely to refer complex cases to specialists (p < 0.001) and 5th year students were more likely to pursue operative dentistry as a specialty (p < 0.001). The general acceptance that confidence grows with an increase in the number of restorative cases differed significantly by level (p = 0.014) and the 5th year had the highest agreement. Views concerning difficulty in procedure did not vary markedly across grades. These findings demonstrate the progress of student clinical insight and career interest in their progression through training.

Table 9.

Average Self-Confidence of Dental Students’ Opinion About Restorative Requirements Determined by the Restorative Unit and Their Restorative Practice in General, Based on Their Academic Level

Question		4th	5th	6th	P value
Do you think the restorative requirements determined by the restorative Unit are enough?	Yes	19	32	30	.878
	Yes	16.2%	27.4%	25.6%
	No	8	16	12
	No	6.8%	13.7%	10.3%
Do you think that your confidence level in restorative will increase when perform more restorative cases?	Yes	26	45	33	.014
	Yes	22.2%	38.5%	28.2%
	No	1	3	9
	No	0.9%	2.6%	7.7%
In future, do you wish to perform all restorative procedures in all cases by yourself?	Yes	26	44	35	.074
	Yes	22.2%	37.6%	29.9%
	No	1	4	7
	No	0.9%	3.4%	6.0%
In future, will you choose to refer the cases for a specialist whenever you feel necessary?	Yes	27	46	31	<.001
	Yes	23.1%	39.3%	26.5%
	No	0	2	11
	No	0.0%	1.7%	9.4%
Would you choose Operative dentistry as a line of specialty in the future?	Yes	22	32	16	<.001
	Yes	18.8%	27.4%	13.7%
	No	5	16	26
	No	4.3%	13.7%	22.2%
Do you think that restorative dentistry practice is	Easy	3	13	11	.269
	Easy	2.6%	11.1%	9.4%
	Average	19	28	27
	Average	16.2%	23.9%	23.1
	Difficult	5	7	2
	Difficult	4.3%	6.0%	1.7%
	Very difficult	0	0	2
	Very difficult	0.0%	0.0%	1.7%

Discussion

The present study investigated undergraduate dental students’ self-perceived confidence and competence in conducting restorative dentistry procedures at the University of Ha’il. The results show that confidence levels in essential clinical abilities are typically favorable, with observable gains across academic years. These findings are consistent with worldwide dental education trends, which show that confidence usually increases with cumulative clinical experience and skill repetition.^4,5,16,23,27 Nevertheless, variabilities were identified between procedure kinds, tooth categories, and academic levels, underlining the intricate connection between curriculum structure, learning environment, supervision quality, and student psychological aspects.

The majority of restorative activities show no statistically significant gender-related differences, indicating that male and female students acquire skills equally. This is in line with other research conducted both domestically in Saudi Arabia and abroad, which also demonstrated no significant gender differences in operational dentistry confidence.^10,18,22 Female students showed significantly higher confidence in managing tooth pigmentation. This finding aligns with other Middle Eastern studies, where females sometimes outperform males in esthetic tasks and procedures requiring fine motor skills.^19,21,28 Possible causes may include increased esthetic awareness, more attention to detail, or differing learning motives, as stated in earlier dental education work.^27,29

Students displayed increased confidence in restoring anterior teeth compared to posterior teeth, particularly molars—a tendency commonly observed in the literature.^16,20,23,27 Anterior teeth are often more accessible, need less complicated equipment, and are commonly treated sooner in the curriculum, which may explain increased student comfort levels. Conversely, molar restorations require knowledge of complicated anatomy, deeper cavity preparations, and more technique-sensitive procedures, features that typically result in reduced self-efficacy among dental students internationally.^1,9,16,19 According to studies from Malaysia, the UK, and Jordan, molar endodontics and posterior restorations are among the operations that students do with the least confidence.^6,17,20,27

Students reported the highest confidence in performing direct restorations, while confidence was lower for indirect and more complex restorations. This pattern—where confidence decreases as the complexity of the procedure increases—has been consistently reported in previous studies.^{5,7,11,16,21,23} Direct restorations are performed more often in student clinics, giving repeated experience that enhances procedural memory and decision-making. Conversely, research from Saudi Arabia, Ireland, and Turkey have shown that limited exposure to indirect restorations during training frequently results in decreased confidence and more anxiety.^10,11,21,24 Confidence gaps may be shaped by procedure-specific characteristics rather than general psychological or educational inequalities, as evidenced by the considerable gender difference seen specifically in pigmentation management. This is consistent with competency-based education models, which show that task difficulty and practice frequency have a greater impact on students’ confidence than demographic characteristics.^3,18,23

The most remarkable outcome of the study was the constant and significant rise in confidence from the 4th to 6th academic year across practically all rehabilitative categories. In terms of radiograph taking, local anesthetic, Class VI cavity preparation, and advanced restorative indications, sixth-year students expressed the most confidence. This pattern of growth is consistent with research from other nations that indicates greater autonomy, case diversity, and clinical experience are important factors in the development of competence.^6,12,16,23 Furthermore, research consistently reveal a substantial link between clinical exposure volume and self-perceived competence.^22,23,27 As students’ advance, they improve manual skills, gain experience addressing patient variability, and learn to handle complications—factors that appear to support the increased confidence demonstrated by final-year students in this research.

Students generally expressed positive attitudes toward restorative dentistry, with most indicating that completing a higher number of cases enhances their confidence. This perception aligns with experiential learning theories and is supported by empirical research showing that repeated practice increases self-efficacy and reduces stress during clinical procedures.^13,14,28 Additionally, recent evidence suggests that the number of procedures completed can serve as a useful, though not sole, indicator of final-year student competency in operative dentistry, providing a more nuanced understanding of clinical preparedness.²⁷ Interestingly, although a large number of students reported interest in autonomously undertaking restorative operations in future practice, sixth-year students were more disposed to send challenging cases to experts. This finding resembles comparable outcomes reported in research from Saudi Arabia and the UK, where older students gain more accurate self-assessment abilities and realize the limitations of general practice training.^5,6,12,21,30 This trend indicates growing clinical judgment and better knowledge of the complexities of modern restorative care.

The finding that 69% of students believed the restorative requirements were satisfactory implies widespread satisfaction with the program, albeit opportunity exists for improvement. Previous research suggest that requirement-based systems can contribute to stress, hurried procedures, and diminished confidence in complicated jobs.^21,28,30 On the other hand, competency-based systems may greatly increase confidence through focused skill development and structured feedback when they are implemented correctly.^3,15,20 However, because of strict evaluation standards and inconsistent teacher expectations, inadequate use of competence frameworks has been associated with lower confidence.^12,21 There are no discernible gender variations in perception, which is consistent with research showing that faculty support and instructional quality have a considerably greater impact on confidence than demographic variables.^15,16,28

These results highlight how crucial it is to match clinical instruction to students’ developmental stages and procedural complexity. It is clear from integrating data from international research that developing competence and confidence requires frequent exposure, supported professional interactions, and structured feedback.^6,12,16,23 Early and gradual engagement with difficult and posterior restorations, reinforced by simulation-based training and reflection activities, should be given top priority in curriculum design. By connecting observed confidence patterns to previous research, it is possible to identify areas where instructional tactics might be improved to minimize anxiety and skill gaps. In order to guarantee that graduates are capable, self-assured, and ready for autonomous restorative practice, these observations can guide changes to the course design, case distribution, and evaluation procedures.

This study has several limitations. Its cross-sectional design prevents the assessment of changes in students’ confidence over time, and the single-institution sample may limit the generalizability of the findings. Additionally, reliance on self-reported measures introduces potential response bias, and the absence of objective clinical performance assessments limits the evaluation of actual competence. Variations in supervisor input and case difficulty were not fully controlled, which may have influenced student perceptions. To validate and expand upon these findings, multi-institutional, longitudinal studies incorporating both subjective and objective measures are recommended. Additionally, multiple statistical comparisons were conducted without adjustment, which may increase the risk of Type I error. Future studies could apply corrections, such as the Bonferroni method, to minimize this risk. Future studies might look at how students’ abilities, self-assurance, and decision-making could be enhanced by employing virtual reality in restorative dental teaching. Virtual reality provides safe, immersive practice and might enhance conventional clinical training. A relevant topic for research is contrasting VR-based techniques with traditional methods.^31-33

Conclusions

Undergraduate dental students at the University of Ha’il often display great confidence in core restorative abilities, with confidence improving gradually across academic levels. The need for more clinical exposure, focused modeling, and structured feedback is highlighted by lower confidence in posterior and difficult restorations. The majority of students acknowledged that completing more restorative situations advances confidence, and older students’ tendency to refer complicated cases indicates that their clinical judgment has matured. These findings underline the necessity of curriculum improvements that give different clinical experiences and assist the development of competent, confident, and practice-ready dental graduates.

Supplemental Material

Supplemental Material -Self-Perceived Confidence and Clinical Preparedness in Restorative Dentistry Among Undergraduate Dental Students

Supplemental Material for Self-Perceived Confidence and Clinical Preparedness in Restorative Dentistry Among Undergraduate Dental Students by Hazza A. Alhobeira, Ahmed A. Madfa, Teflah S. Alhudayris, Noor M. Alharthi, Abdullah F. Alshammar in Journal of Medical Education and Curricular Development

Footnotes

ORCID iD

Ahmed A. Madfa

Ethical Considerations

The Medial Ethical Committee of College of Dentistry, University of Ha’il, Saudi Arabia, approved the protocol of this study. All methods were performed in accordance with the declaration of Helsinki.

Authors’ Contributions

HAA, AFA, and AAM contributed to the concept of the research, study design, data collection, supervision, statistical analysis, writing the original draft, and reading and editing the final paper. TSA, and NMA contributed to data collection, and writing the original draft. Every author evaluated and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.*

Supplemental Material

Supplemental material for this article is available online.

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