Journal of endodontics最新文献

{"title":"Refining Pulpal Diagnostics for Predictable Vital Pulp Treatment.","authors":"Ikhlas El Karim, Henry F Duncan, Imad About, Orla M Dunne, Fionnuala T Lundy","doi":"10.1016/j.joen.2026.08.022","DOIUrl":"10.1016/j.joen.2026.08.022","url":null,"abstract":"<p><strong>Introduction: </strong>Vital pulp treatment (VPT) comprises a range of biologically based procedures aimed at preserving pulp vitality, reducing the need for invasive interventions, and improving long-term tooth survival. Despite growing evidence supporting these approaches, their implementation in clinical practice remains limited by the lack of reliable methods for accurately assessing the inflammatory status of the dental pulp and by the continued use of diagnostic terminology that does not adequately support pulp-preserving treatment strategies.</p><p><strong>Methods: </strong>This narrative review examines the limitations of current pulp diagnostic methods and traditional classifications of pulp disease. It also explores emerging research and innovative approaches aimed at improving diagnostic accuracy and facilitating more effective application of VPT.</p><p><strong>Results: </strong>Contemporary evidence suggests that pulp disease is more appropriately viewed as a continuum rather than through the traditional dichotomous classification of reversible and irreversible pulpitis. Advances in the understanding of pulpitis pathophysiology at the molecular level have identified potential biomarkers that may enable the development of objective chairside diagnostic tests. These emerging technologies offer the potential to provide more precise assessment of pulpal inflammation and improve treatment decision-making.</p><p><strong>Conclusions: </strong>Refinement of the terminology used to describe pulp disease, together with the integration of objective, biomarker-based diagnostic technologies, is essential for improving diagnostic accuracy. Such advances are expected to support wider adoption of VPT, enhance the predictability of clinical outcomes, and promote successful long-term preservation of natural teeth.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiographic Outcomes of Bone Lid Technique in Endodontic Microsurgery: A Retrospective Study.","authors":"Yani Chen, Zhikang Wang, Jian Yuan, Ziqiao Jiang, Wenjin Cai, Ying Wang","doi":"10.1016/j.joen.2026.08.030","DOIUrl":"10.1016/j.joen.2026.08.030","url":null,"abstract":"<p><strong>Introduction: </strong>To compare the clinical and radiographic outcomes of the bone lid (BL) technique and conventional osteotomy (CO) in endodontic microsurgery (EMS) for teeth with an intact labial or buccal cortical plate (≥1 mm).</p><p><strong>Methods: </strong>This retrospective study included 64 teeth from 64 patients who underwent EMS between January 2021 and July 2025. Cases were assigned to the BL group or CO group according to the surgical approach. Cone-beam computed tomography data were evaluated at baseline and at 3, 6, and 12‑24 months after surgery. The primary outcome was comprehensive success, defined as both clinical and radiographic success at 6 and 12‑24 months. Secondary outcomes included clinical success, radiographic success, lesion volume reduction, grayscale value changes, buccal cortical plate thickness, and alveolar arch contour. Regression models were used to identify outcome-associated factors.</p><p><strong>Results: </strong>The BL group achieved greater lesion volume reduction and better preservation of buccal cortical plate thickness at both intervals (P < .05). Alveolar arch collapse was less frequent in the BL group at 6 months (6.3% vs 73.1%, P < .05) and 12‑24 months (0.0% vs 26.3%, P < .05). Clinical success (asymptomatic healing) was comparable between groups at all timepoints (eg, T3: 100.0% in BL vs 77.3% in CO, P > .05). However, the BL group showed significantly higher radiographic complete healing rates at T2 (80.0% vs 30.3%, P < .05) and T3 (100.0% vs 59.1%, P < .05) and higher comprehensive success at T2 (90.0% vs 54.5%, P < .05) and T3 (100.0% vs 68.2%, P < .05).</p><p><strong>Conclusions: </strong>For teeth with a preoperative buccal cortical plate ≥1 mm, the BL technique provided more favorable radiographic healing and better preserved alveolar arch contour than CO.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability, Efficacy, and Immunomodulatory Impact of Nanoemulsion-encapsulated Lipoxin A4 in the Context of Pulpal Inflammation.","authors":"Léna Guyon, Solène Tessier, Mikaël Croyal, Mathilde Gourdel, Hélène Terrisse, Joelle Veziers, Hélène Gautier, Pierre Weiss, Alexis Gaudin","doi":"10.1016/j.joen.2026.08.015","DOIUrl":"10.1016/j.joen.2026.08.015","url":null,"abstract":"<p><strong>Introduction: </strong>Lipoxin A4 (LXA4) is a specialized proresolving mediator with the potential to modulate dental pulp inflammation. However, its therapeutic use is limited by instability and rapid degradation. This study aimed to develop and evaluate LXA4-loaded nanoemulsions (NELX) as a delivery system to promote inflammation resolution both in vitro and in vivo.</p><p><strong>Methods: </strong>NELX were formulated with LXA4 and characterized by dynamic light scattering, tunable resistive pulse sensing, scanning transmission electron microscopy, and liquid chromatography-tandem mass spectrometry. Encapsulation efficiency, stability, and drug payload were determined. In vitro, THP-1-derived macrophages (M0, M1, and M2) were exposed to NELX, and metabolic activity, cytokine expression, and secretion were assessed. In vivo efficacy was investigated in a murine air pouch model and a rat molar pulpitis model. Histologic and immunohistochemical analyses (hematoxylin and eosin, cluster of differentiation [CD] CD68, and CD163) were performed.</p><p><strong>Results: </strong>NELX achieved complete encapsulation (100%) of 20 μM LXA4 by day 3 and remained stable for 45 days at 4°C. In vitro, NELX preserved metabolic activity and promoted macrophage polarization toward an anti-inflammatory M2 phenotype, with increased interleukin (IL) 10 and IL-1 receptor antagonist expression and IL-1 receptor antagonist secretion. In vivo, NELX reduced IL-6 levels in the air pouch model and suppressed IL-6 and IL-1β secretion in the pulpitis model, with effects comparable to Ledermix Paste. Histology confirmed reduced inflammatory infiltration and enhanced recruitment of CD163+ macrophages.</p><p><strong>Conclusions: </strong>NELX provide a stable and effective delivery system for LXA4, promoting resolution of dental pulp inflammation through targeted immunomodulation. This strategy holds promise for novel biologically based anti-inflammatory therapies in endodontics.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Micro-computed Tomographic Evaluation of the Location and Prevalence of Accessory Canals in Maxillary Central and Lateral Incisors.","authors":"Thomas L Kwun, Kuan Wei Tung, Bruno Cavalcanti, Young Bin Bok, Jae Min Shin, Neville J McDonald","doi":"10.1016/j.joen.2026.08.031","DOIUrl":"10.1016/j.joen.2026.08.031","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the location (distance from the apex) and prevalence of accessory canals and apical delta in maxillary central and lateral incisors.</p><p><strong>Methods: </strong>A total of 465 maxillary incisors were collected (central incisor n = 230, lateral incisor n = 235). Following the exclusion of inadequate teeth according to exclusion criteria, maxillary central incisors (n = 192) and lateral incisors (n = 174) were scanned using a Scanco μCT 100 Cabinet micro-computed tomography scanner (Wangen-Brüttisellen, Switzerland). DragonFly Software (Montreal, Canada) was used to reconstruct and measure a 3-dimensional image. The measurements were made by 2 observers. All accessory canals (ACs) and apical deltas were identified, and the distance was measured from the root apex for all identified accessory canals. The sample size was calculated using G∗Power, and data were statistically analyzed with estimates of the quantiles and bootstrap confidence intervals through SPSS (SPSS 31.0. Armonk, NY) and R software (R 4.4.0 Vienna, Austria). P-values ≤.05 were considered statistically significant.</p><p><strong>Results: </strong>The prevalence of accessory canals in maxillary central and lateral incisors was 49% and 37.4%, respectively. In maxillary central incisors, 80% of ACs were located within 5.57 mm of the root apex, whereas in maxillary lateral incisors, 80% were found within 4.27 mm. The prevalence of apical delta was 2.6% in maxillary central incisors and 2.9% in maxillary lateral incisors. In both tooth types, 80% of apical deltas were confined to within 2.0 mm of the root apex.</p><p><strong>Conclusion: </strong>ACs are not rare anatomical structures in maxillary central and lateral incisors. Within the limitations of this study, maxillary central and lateral incisors had 80% of ACs within 5.57 and 4.27mm of the root apex. Both groups had 80% of the apical delta within 2.0 mm from the root apex. Clinicians should be aware of these anatomical findings when treating maxillary incisors, particularly during endodontic microsurgery.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the Pulp Biology and Regeneration Group Symposium 2025: Trends and Innovations in Pulp Preservation and Regeneration.","authors":"","doi":"10.1016/j.joen.2026.08.014","DOIUrl":"10.1016/j.joen.2026.08.014","url":null,"abstract":"","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suzetrigine (Journavx) for Acute Dental Pain: First Clinical Case Series of a Selective Naᵥ1.8 Inhibitor in Endodontics.","authors":"Zakery James, Marwan Moqbel Al-Barrak, Gautam Shirodkar, Nikita B Ruparel","doi":"10.1016/j.joen.2026.08.013","DOIUrl":"10.1016/j.joen.2026.08.013","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency dental pain remains a significant clinical challenge, with many patients experiencing moderate-to-severe pain that is inadequately controlled by non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. This is compounded by high rates of anesthetic failure in dental practices for cases with symptomatic irreversible pulpitis. Inflammation-driven upregulation of Naᵥ1.8 sodium channels contributes to persistent nociceptive signaling and local anesthetic failure. Suzetrigine (Journavx), a first-in-class selective Naᵥ1.8 inhibitor approved for acute moderate to severe pain, offers a mechanism-based approach by targeting the peripheral sodium channel driving inflammatory dental pain.</p><p><strong>Methods: </strong>This case series describes four patients treated at endodontic specialty practices who received suzetrigine for distinct acute pain scenarios: (1) augmentation of local anesthesia in a patient with symptomatic irreversible pulpitis and prior anesthetic failure, (2) management of preoperative emergency dental pain in a patient with symptomatic irreversible pulpitis refractory to conventional analgesics, (3) control of post-treatment inflammatory flare-up pain inadequately managed by NSAIDs and corticosteroids, and (4) management of post-surgical pain in a medically complex patient with Ehlers-Danlos syndrome for whom NSAIDs and corticosteroids were contraindicated. Suzetrigine was prescribed as a 100 mg oral loading dose, followed by 50 mg every 12 hours as needed.</p><p><strong>Results: </strong>Across all four cases, suzetrigine provided clinically meaningful reductions in pain intensity. In case 1, a single preoperative loading dose facilitated profound pulpal anesthesia and successful completion of nonsurgical root canal treatment on 2 teeth that had previously been refractory to multi-agent local anesthetic protocols. In case 2, suzetrigine consistently reduced pain from 6-8/10 to ≤2/10, effectively bridging the patient to definitive treatment over 6 days without opioid use. In case 3, suzetrigine in combination with ibuprofen and acetaminophen achieved complete symptom resolution of flare-up pain that had been inadequately controlled by high-dose ibuprofen, a corticosteroid dose pack, and antibiotics. In case 4, a single loading dose provided significant pain relief in a patient with contraindications to NSAIDs and corticosteroids. No adverse effects attributable to suzetrigine were reported in any case.</p><p><strong>Conclusions: </strong>This case series provides the first clinical evidence for the use of suzetrigine in the management of acute dental pain thereby highlighting the role of Naᵥ1.8 in both preoperative and postoperative dental pain. Further investigation through randomized controlled trials to establish optimal dosing, combination strategies, and efficacy relative to conventional analgesic regimens is warranted.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Hypoxic Pathways for Dental Pulp Regeneration.","authors":"Shengyan Yang, Waruna Lakmal Dissanayaka","doi":"10.1016/j.joen.2026.08.029","DOIUrl":"10.1016/j.joen.2026.08.029","url":null,"abstract":"<p><strong>Introduction: </strong>Introduction: Hypoxia is a critical feature of the dental pulp microenvironment and profoundly influences stem cell behavior and tissue regeneration. Hypoxia-inducible factor 1-alpha (HIF-1α), the master transcription factor governing cellular adaptation to hypoxic stress, plays a pivotal role in coordinating biological processes essential for pulp regeneration. However, the therapeutic potential of targeting HIF-1α signaling in endodontics has not been extensively reviewed.</p><p><strong>Methods: </strong>A narrative review was conducted using the PubMed and Scopus databases up to August 2025, with search terms related to hypoxia, HIF-1α, dental pulp cells, and pulp regeneration. Laboratory studies investigating hypoxic conditions, HIF-1α manipulation, and their effects on dental pulp cell proliferation, differentiation, and paracrine functions were included in the review.</p><p><strong>Results: </strong>Hypoxia and HIF-1α activation have been reported to influence the proliferation, odontogenic differentiation, and stemness of dental pulp stem cells, although findings regarding differentiation remain inconsistent across studies. HIF-1α-related signaling appears to modulate the stem cell secretome, including cytokine and extracellular vesicle composition, which may contribute to angiogenesis, neurogenesis, and immunomodulation. Various strategies to target the HIF-1α pathway have been explored for pulp regeneration, including hypoxia preconditioning, hypoxia-mimetic agents, and genetic approaches, with promising but preliminary results.</p><p><strong>Conclusions: </strong>HIF-1α is a central regulator of pulp regeneration. Strategies targeting HIF-1α signaling offer promising translational opportunities for regenerative endodontic therapies, though optimal protocols, specificity, and long-term safety require further investigation.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top 100 Most Cited Articles on Stem Cell-based Regenerative Endodontics: A Bibliometric Analysis of Scientific Evolution and Translational Gaps.","authors":"Gustavo Adrián Morales Valladares, Claudia Brizuela, Dayana Arleth Betancourt Cisneros, Erika Elizabeth Espinosa Torres, Martha Elena Gallegos Intriago, Karla Galud Palomeque Viteri, Cinthia Julissa Zambrano Viteri, Esteban Astudillo-Ortiz","doi":"10.1016/j.joen.2026.08.011","DOIUrl":"10.1016/j.joen.2026.08.011","url":null,"abstract":"<p><strong>Introduction: </strong>Stem cell-based regenerative endodontics has evolved into a biologically driven strategy for pulp-dentin complex regeneration. Despite substantial research output, the extent to which high-impact evidence has been translated into clinical practice remains poorly defined. Accordingly, this study aimed to systematically analyze the 100 most cited articles in this field to delineate research trends, characterize the knowledge structure, and identify key barriers to clinical translation.</p><p><strong>Methods: </strong>A systematic search was conducted in the Web of Science Core Collection (WoS-CC) on July 11, 2026. Articles were ranked by citation count to identify the 100 most cited publications on stem cell-based regenerative endodontics. Data on publication and citation characteristics were extracted, including total citations, year of publication, authorship, institutional affiliations, and keywords. Descriptive statistics and Spearman's rank correlation were applied to assess consistency in citation counts.</p><p><strong>Results: </strong>A total of 1,433 records were identified in the WoS-CC. After removing 62 records before screening (60 ineligible document types and 2 non-English records), 1,371 articles were screened. Following title/abstract screening, 317 full-text articles were assessed for eligibility, and the top 100 most cited publications were included in the bibliometric analysis. These articles accumulated 11,823 citations in the WoS-CC, 13,862 in Scopus, and 21,179 in Google Scholar. Scientific output increased markedly after 2008, whereas peak citation impact was observed between 2007 and 2012. The United States, China, and Japan were the leading contributors. Dental pulp stem cells were the most extensively studied cell population. Reviews constituted the largest study category (42%), followed by animal studies (38%), in vitro investigations (14%), and clinical studies (6%), highlighting the limited availability of high-level clinical evidence.</p><p><strong>Conclusions: </strong>The most influential literature in stem cell-based regenerative endodontics remains largely confined to preclinical research, underscoring a persistent translational gap between experimental advances and clinical implementation. These findings highlight the need for rigorously designed clinical studies to enable the effective integration of these therapies into routine endodontic practice.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulp and Periapical Biology: The Foundations of Personalized Endodontics.","authors":"Ove A Peters","doi":"10.1016/j.joen.2026.08.027","DOIUrl":"10.1016/j.joen.2026.08.027","url":null,"abstract":"<p><strong>Introduction: </strong>This article seeks to provide a perspective for future developments of endodontic care delivery, based on disease burden und contemporary clinical frameworks. Indeed, endodontic care has traditionally focused on the management of local disease conditions and long-term function. Here the concept of P4 Medicine (predictive, preventive, personalized, and participatory) may offer a strategic opportunity to reframe endodontics as driven by the notion of risk and its management. Based on data available for caries, the occurrence of untreated pulpal disease is likely substantial, leading to about 50% prevalence of apical periodontitis (AP). Future integration of P4 principles requires linking insights from pulp biology, including inflammation and regenerative responses, with risk assessment tools and minimally invasive interventions.</p><p><strong>Conclusions: </strong>This paper proposes a precision care framework for the endodontic patient, rooted in biology. For example, emerging models challenge conventional diagnostic terms, such as \"irreversible pulpitis,\" as not meaningful and promote vital pulp therapy where feasible. The notion of prevention is extended to endodontics, since established intracanal microbiota is unlikely to be eradicated. Person-specific interplay between microbial burden and immune competence leads to AP. In some cases, untreated AP, specifically when associated with molars, may lead to serious, even life-threatening conditions. Moreover, emerging evidence suggests that even subclinical AP may have systemic health consequences such as an elevated risk of cardiovascular diseases. Collectively, a biologically grounded, predictive, and preventive model of care may elevate the standard of endodontic treatment while addressing current gaps in access, education, and outcomes.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Journey of Endodontic Biomaterials: Navigating Scientific, Clinical, Patient, and Regulatory Demands.","authors":"Matthias Widbiller, Kerstin M Galler, Gottfried Schmalz","doi":"10.1016/j.joen.2026.08.026","DOIUrl":"10.1016/j.joen.2026.08.026","url":null,"abstract":"<p><strong>Introduction: </strong>The development of endodontic biomaterials requires balancing scientific performance, clinical practicality, patient expectations, and regulatory requirements. This review synthesizes these perspectives to map current strengths, limitations, and translational pathways for materials used in vital pulp therapy, root repair, and root canal filling, as well as regenerative endodontics.</p><p><strong>Methods: </strong>Narrative literature synthesis integrating recent primary studies, systematic reviews, regulatory standards and normative documents, alongside clinical and market observations, to derive a holistic framework for endodontic biomaterials.</p><p><strong>Results: </strong>Scientific priorities favor biocompatibility and bioactivity and regenerative potential, whereas clinicians prioritize ease of handling, predictable performance, and cost-effectiveness. Patients primarily value symptom relief, function, and aesthetics. Regulatory frameworks impose safety and quality requirements through biological validation and mechanical testing. Developments over the past decades demonstrate that hydraulic calcium silicate cements have achieved successful clinical translation by reconciling, in particular, biocompatibility with clinical performance. Biomaterials used in regenerative endodontic procedures likewise show promising clinical outcomes; however, histological evidence frequently indicates reparative tissue formation rather than true pulp-dentin complex regeneration. Emerging directions in both fields, including premixed and fast-setting formulations, smart materials or drug-device combinations, and customized scaffolds for endodontic tissue engineering, hold considerable promise but require clinically relevant testing and demonstration of superiority over current state-of-the-art applications.</p><p><strong>Conclusions: </strong>Future innovation in endodontic biomaterials will depend on integrating scientific rigor, clinical feasibility, patient demand, and regulatory strategy from early development to ensure safe, adoptable, and clinically meaningful advances in care.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}