New Clinical Advancements in Endodontics

Dear Colleagues,

The current landscape of clinical endodontics is undergoing a profound reconfiguration, driven by a transition from empirical "clean and shape" protocols toward a therapeutic strategy rooted in biological evidence and digital precision. This evolution represents more than a mere optimization of the armamentarium; it is a fundamental paradigm shift where long-term success is dictated by the synergy between biomechanical tooth preservation and high-resolution microbiological control.

At the core of contemporary technological progress is the integration of navigational systems and three-dimensional imaging into the daily clinical workflow. Guided endodontics—utilizing 3D-printed static guides or real-time dynamic navigation—has transformed the management of calcified canals and complex dental anomalies from high-risk iatrogenic procedures into predictable, minimally invasive interventions. This sub-millimetric precision enables the implementation of "minimally invasive endodontics" concepts, where the conservation of pericervical dentin becomes a priority for maintaining the structural integrity of the tooth under masticatory loads, thereby challenging traditional Black’s cavity access designs.

Simultaneously, the revolution in bioinductive materials has redefined therapeutic goals in managing pulpal pathology. The widespread introduction of calcium silicate-based sealers and latest-generation bioceramics has facilitated a decisive move toward vital pulp therapy and regenerative endodontics. The ability of these materials to induce a favorable biological response and promote hard tissue formation through the controlled release of calcium ions provides superior solutions for managing open apices or iatrogenic perforations, overcoming the physico-chemical limitations of traditional hydrophobic materials.

A major challenge remains the complexity of the root canal system, where bacterial biofilms persist in areas inaccessible to mechanical instrumentation. In this context, innovations in fluid dynamics and laser energy represent the vanguard of endodontic disinfection. Sonic and ultrasonic activation technologies, and particularly laser-activated irrigation protocols based on induced cavitation phenomena (such as PIPS or SWEEPS), optimize the penetration of irrigants into dentinal tubules and isthmuses. This ensures a reduction in bacterial load to levels incompatible with the survival of persistent microorganisms like Enterococcus faecalis.

Finally, the integration of artificial intelligence (AI) and deep learning algorithms into CBCT volume interpretation promises a standardization of diagnosis and treatment planning. The capacity to detect incipient periapical lesions or vertical root fractures with an accuracy exceeding the human eye will allow for earlier intervention and more rigorous monitoring of periapical healing. Consequently, modern endodontics is positioned at the intersection of precision engineering and regenerative biology, transforming the preservation of natural dentition into an increasingly predictable and sustainable clinical objective.

Prof. Dr. Mihaela Jana Ţuculinǎ
Prof. Dr. Paula Perlea
Guest Editors

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• bioceramic materials
• minimally invasive endodontics
• regenerative endodontics
• laser-activated irrigation
• CBCT