Endodontics

Endodontics centres on the diagnosis, treatment and prevention of diseases affecting the dental pulp and periapical tissues. Root canal therapy aims to eliminate microbial biofilms from the complex root canal system, shape and disinfect canals using mechanical instrumentation and chemical irrigants, and seal the space with gutta-percha and sealers to prevent reinfection. Accurate determination of working length and canal anatomy underpins successful debridement and obturation and relies on both two-dimensional radiographs and three-dimensional cone-beam computed tomography (CBCT), now enhanced by artificial intelligence. Advances in irrigation protocols, including sonic or ultrasonic activation and standardised intracanal medicaments, have improved biofilm disruption and tissue dissolution. The rise of bioceramic-based cements offers bioactivity and predictable calcium ion release to stimulate hard-tissue formation and maintain pulp vitality in vital pulp therapy. Emerging regenerative strategies exploit dental pulp stem cells and scaffolds to rebuild the dentine–pulp complex, while digital guided endodontics affords template-based precision for access cavity preparation and microsurgical procedures. Post-operative pain management has been refined through adjunctive techniques such as cryotherapy and photobiomodulation, and predictive models using machine learning. Collectively, these innovations enhance treatment predictability, patient comfort and long-term outcomes in diverse clinical scenarios worldwide.

Research from Nature Portfolio

Comparative imaging studies have demonstrated that CBCT markedly outperforms digital intraoral radiography in detecting simulated apical lesions, with especially high accuracy for early-stage defects in cancellous bone. These findings support the routine use of CBCT in complex diagnostic scenarios. High-resolution CBCT scans processed through dedicated three-dimensional planning software have achieved working length measurements within half a millimetre of actual canal lengths, offering a non-invasive adjunct to electronic apex locators, although operator validation remains imperative. Innovative clinical trials of intraoral cryotherapy in patients with symptomatic apical periodontitis have revealed significant reductions in postoperative pain and inflammatory mediators such as substance P, indicating that controlled cold irrigation protocols can moderate neurogenic inflammation and improve comfort without compromising treatment efficacy.

Research from all publishers

An expert consensus on irrigation and intracanal medication has standardised protocols for overcoming vapour-lock in the apical third, optimising irrigant selection, and guiding interappointment dressings to reduce residual infection and improve clinical predictability. Preclinical and clinical evaluations of ferumoxytol nanozymes have shown dual antimicrobial and regenerative action in chronic apical periodontitis: catalytic activation of hydrogen peroxide eradicates mature biofilms with efficacy similar to sodium hypochlorite yet without cytotoxicity, while stimulating apical papilla stem cells via WNT and Notch pathways to enhance osteogenic repair. A comprehensive review of nanomaterials in endodontics highlights the versatile applications of nanoparticles in sealers, root-repair agents and drug-delivery systems, offering antimicrobial coatings, controlled release of anti-inflammatory or regenerative agents and improved adaptation to canal irregularities.

Endodontics publication trend

The graph below shows the total number of articles in endodontics across all publications each year (not limited to Nature Index journals).

Technical terms

Cone-Beam Computed Tomography (CBCT): A three-dimensional X-ray modality providing high-resolution images of dental anatomy and periapical tissues with lower radiation than conventional CT.

Electronic Apex Locator (EAL): A device measuring electrical impedance or frequency ratios to determine file tip position relative to the apical constriction.

Biofilm: A structured community of microorganisms embedded in an extracellular matrix that adheres to canal walls and resists antimicrobials.

Bioceramics: Calcium silicate-based hydraulic cements that set by hydration, release calcium ions and promote hard-tissue formation.

Nanozyme: A nanomaterial with enzyme-like catalytic properties capable of generating reactive species to target biofilms.

Apical Periodontitis: Inflammatory destruction of periapical tissues secondary to microbial invasion of the pulp and root canal system.

Radiomics: Quantitative extraction of image features from medical scans to characterise tissue properties and support diagnostic models.

References

1. Detectability of simulated apical lesions on mandibular premolars and molars between radiographic intraoral and cone-beam computed tomography images: an ex vivo study. Scientific Reports (2022).
2. Endodontic length measurements using cone beam computed tomography with dedicated or conventional software at different voxel sizes. Scientific Reports (2021).
3. The influence of intraoral cryotherapy on postoperative pain and substance P in symptomatic apical periodontitis: randomized clinical study. Scientific Reports (2024).
4. Expert consensus on irrigation and intracanal medication in root canal therapy. International Journal of Oral Science (2024).
5. Ferumoxytol nanozymes effectively target chronic biofilm infections in apical periodontitis. Journal of Clinical Investigation (2024).
6. Application of Nanomaterials in Endodontics. BME Frontiers (2024).
7. Expert consensus on digital guided therapy for endodontic diseases. International Journal of Oral Science (2023).