BACKGROUND:Major advances in pulp biology, biomaterials, and tissue engineering have fuelled the development of regenerative strategies aimed at preserving or restoring pulp vitality. Despite this progress, the clinical translation of these discoveries remains limited or absent. AIMS:Although there is a global agenda to reduce and replace animal use in medical research, we believe that a critical missing link in the translational pipeline of regenerative endodontics innovations is the lack of rigorously validated, clinically relevant preclinical models to use in advancing promising in vitro findings through regulatory processes to human application. METHODS:While novel alternative methodologies (NAMs), including microfluidics, organoids, and organ-on-chip systems, offer human-relevant in vitro models and are rapidly transforming early-stage screening and mechanistic studies, they are currently insufficient to replicate the complex systemic elements provided by animal models, which are essential for demonstrating in vivo efficacy of regenerative therapies. Regulatory approval of devices, drugs, and biologics continues to require robust preclinical evidence generated in whole-organism systems, particularly when complex interactions involving immunity, vascularisation, innervation, and aging are central to therapeutic success. RESULTS:In this perspective article, we discuss key scientific, methodological, and logistical considerations for the systematic development and validation of orthotopic animal models in regenerative endodontics research. We place particular emphasis on vital pulp treatment as a biologically and clinically relevant framework for studying pulp repair and in demonstrating the efficacy of novel therapies. We highlight the challenges that have hindered consensus in model selection and standardisation, and emphasise the need for coordinated transdisciplinary efforts to overcome these barriers. CONCLUSION:We argue that prioritising standardised orthotopic vital pulp treatment models, in combination with evolving NAMs, represents a critical step to bridge the gap between mechanistic discoveries and clinical translation in regenerative endodontics.

OBJECTIVE: The objective of this study was to develop an evidence-based S3-level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth. METHODS: An evidence-based medical guideline based on systematically searched and appraised evidence as well as a structured consensus (S3-level) was jointly developed by the European Federation of Conservative Dentistry (EFCD), the European Society of Endodontology (ESE), the Organization for Caries Research (ORCA), and the German Society of Conservative Dentistry (DGZ), following the methodological framework of the Association of Scientific Medical Societies in Germany (AWMF) and the GRADE approach. Four working groups formulated key clinical questions regarding: (1) caries removal strategies, (2) cavity liners, (3) management of exposed pulps, and (4) materials for direct pulp capping and pulpotomy. Systematic reviews were conducted for each question, and evidence was synthesized and graded for quality. A structured consensus process was used to formulate recommendations. In order to encourage its wide dissemination, this article is freely accessible on Clinical Oral Investigations, International Endodontic Journal, and Caries Research journals' websites. RESULTS: Evidence supports selective (SE) or stepwise caries removal (SW) over non-selective removal (NSE) to reduce the risk of pulp exposure in deep caries. Routine use of cavity liners after caries removal showed no consistent clinical benefit and is not routinely recommended. For vital pulp therapy following pulp exposure, both direct pulp capping and pulpotomy are effective options in teeth without irreversible pulpitis, while pulpotomy is an acceptable alternative to pulpectomy in cases with signs of irreversible pulpitis. Hydraulic calcium silicate cements demonstrated superior clinical outcomes compared to calcium hydroxide and should be preferred for pulp capping and pulpotomy. The certainty of evidence ranged from very low to moderate across questions and outcomes. CONCLUSION: For deep caries, maintaining pulp vitality by using less invasive management strategies is supported by current evidence. Implementation of this guideline requires clinician training, patient-centred decision-making, and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long-term outcomes.

AIM:This systematic review aimed to synthesise evidence on the microbiome of deep or extremely deep caries associated with a range of different pulp conditions, by analysing studies using next-generation sequencing (NGS) approaches. METHODOLOGY:The review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and protocol was registered prospectively at the Open Science Framework (https://osf.io/vnwjh/). A literature search was carried out in the following databases: MEDLINE via PubMed, Scopus, Cochrane Database for Systematic Reviews (CDSR), Web of Science, the clinicaltrials.gov, and the Open Science Framework, in English language without time restriction. The last search was performed on May 1st 2025. An additional online search of the four major journals in the field of endodontics (International Endodontic Journal, Journal of Endodontics, Australian Endodontic Journal and the European Endodontic Journal) was also carried out independently starting from January 1st, 2010 to May 1st 2025. Only original research articles that used an NGS approach and investigated the microbiome of deep or extremely deep caries associated with different pulp diagnoses, assessed preoperatively, were included. The Johanna Brigg's Institute (JBI's) Critical Appraisal Instrument for Studies Reporting Prevalence Data was used to assess the risk of bias of included studies. RESULTS:Among 1914 articles initially identified, four were considered eligible for inclusion and further assessed for certain parameters. The overall risk of bias of the three and one included studies was characterised as 'unclear' and 'high'. Firmicutes were the most prevalent phylum in all cases. In cases of irreversible pulpitis, Firmicutes prevalence increased compared with cases of normal pulp and reversible pulpitis, while the prevalence of Actinobacteria, Proteobacteria and Bacteroidetes decreased. Lactobacillus was the most abundant genus in all cases, with its abundance in cases of symptomatic irreversible pulpitis increasing substantially. CONCLUSIONS:The NGS studies evaluated in this review create a preliminary, but comprehensive map of the microbiome of deep caries associated with a range of pulpal diagnoses. Α shift in microbiome as the asymptomatic cases become progressively symptomatic seems to occur, which may be relevant to management of deep caries in terms of complete or selective caries removal.

AIM:To produce a glossary of controversial terminology relating to a variety of anatomical features of root canals. MATERIALS AND METHODS:A multi-stage consensus process was designed and applied to generate definitions for controversial terms describing root and canal anatomy. The overall direction of the project was provided by an Executive Group, whereas a separate Task & Finish Group was convened to compile a preliminary list of controversial terms together with proposed definitions. This draft was then circulated to an international panel of 32 experts, who took part in an anonymous, web-based Delphi exercise to give independent feedback. Findings from this Delphi round were subsequently examined and debated during a virtual meeting. RESULTS:Following the Delphi exercise, 14 of the 15 proposed terms achieved the pre-specified consensus threshold, with more than 70% of respondents rating them above 7. Consensus was not initially reached for the remaining term ('furcation accessory canal'); its definition was subsequently amended and put through a further Delphi round, after which agreement was achieved. A follow-up virtual meeting involving 19 experts reviewed the Delphi outcomes and proposed further refinements. In response, the Executive Group and Task & Finish Group prepared the final version of the glossary. CONCLUSION:Through a rigorous, structured process of international expert consensus, a glossary addressing controversial terminology in root and canal anatomy has been established. This resource offers a dependable basis for consistent, standardised terminology going forward, with relevance across clinical practice, teaching and research.

BACKGROUND:Obtaining an accurate preoperative diagnosis ascertaining the level of pulpal inflammation is fundamental to selecting subsequent endodontic care. Conventional diagnostic methods, including thermal and electric pulp testing, percussion and radiographic assessment, rely largely on subjective patient responses and indirect indicators of pulpal health, resulting only in limited discrimination between pulp necrosis and vitality. These limitations often hinder reliable differentiation between levels of pulpitis such as reversible and irreversible pulpitis, which may result in either under-treatment or over-treatment. Advances in the understanding of pulpal pathophysiology and the success of vital pulp treatment techniques have highlighted the need for objective, accurate, biologically relevant, molecular-based point-of-care diagnostic approaches. OBJECTIVES:This narrative review aimed to synthesise current evidence on the biological basis of pulpal inflammation, critically evaluate the limitations of conventional diagnostic methods, while exploring the potential role of molecular biomarkers and preoperatively/intraoperatively sourced biological fluids in the objective assessment of pulpitis. METHODS:A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus and Web of Science databases. Relevant peer-reviewed original research articles, narrative and systematic reviews and experimental and clinical studies related to pulpitis, caries-induced pulpal inflammation, diagnostic methods, biomarkers and biological fluids were included. The selected literature was qualitatively synthesised to identify prevailing themes. RESULTS:The findings indicate that pulpitis is characterised by complex immune and vascular responses that are inadequately captured by traditional diagnostic tests. Biomarkers associated with inflammatory activity, tissue breakdown and immune regulation potentially offer objective measures of disease presence, severity and progression. Among preoperative biological fluids, gingival crevicular fluid (GCF) demonstrates superior site-specificity and biological relevance compared with saliva and systemic blood, despite limitations related to sample volume and standardisation. In addition, intraoperative biological sources such as dentinal fluid and pulpal blood provide direct, site-specific information reflective of the pulpal microenvironment, with potential to enhance diagnostic accuracy during clinical treatments. CONCLUSION:GCF-based molecular diagnostics are biologically plausible tools to assist preoperative diagnosis having shown encouraging preliminary findings for objective pulpal assessment. However, their clinical utility requires validation through prospective biomarker-outcome studies, standardised diagnostic thresholds and strong analytical validation before considering routine endodontic application.

BACKGROUND:Extended reality (XR) technologies, encompassing augmented reality (AR), virtual reality (VR), and mixed reality (MR), are increasingly used in endodontic education and practice. A gap exists regarding understanding of XR's applications and limitations among endodontic educators and practitioners. OBJECTIVES:This narrative review aims to (A) explain the technical foundations of AR, VR, and MR systems; (B) review current applications of XR in endodontic education and clinical practice; (C) examine limitations and barriers to adoption; and (D) outline future directions. METHOD:An overview of the technical foundations of XR was provided. A comprehensive electronic search was conducted across PubMed, Scopus, and Web of Science databases to identify papers on applications of XR in endodontics. After screening, 33 articles met the inclusion criteria and were subjected to full-text review. The main features of the studies were extracted, and a narrative summary was prepared. RESULTS:The review shows that XR technologies have been applied in endodontic education for training in visualisation of root canal anatomy, access cavity preparation, and microsurgical procedures, with most studies demonstrating improved comprehension and procedural accuracy. Haptic feedback systems and head-mounted displays enable realistic training that surpasses traditional methods of education. However, most applications remain educational, with few clinical studies involving real patients. Challenges include hardware costs, technical setup complexity, data security concerns and lack of standardisation. CONCLUSIONS:When thoughtfully implemented, XR has the potential to improve endodontic education, support clinical workflow and enhance the overall practice of endodontics. Coordinated efforts among clinicians, educators, engineers and regulators are needed to validate these technologies, develop practical implementation standards and integrate XR into routine endodontic education and care.

Vital pulp treatment (VPT) encompasses a range of biologically based procedures that aim to preserve the dental pulp, minimise intervention and improve long-term tooth survival. However, a lack of reliable, accurate diagnostic tests to assess the inflammatory status of the dental pulp coupled with use of outdated diagnostic nomenclature that does not support pulp preservation strategies, are two major limitations in effective implementation of VPT in clinical practice. This narrative review aims to discuss the limitations of the current diagnostic methods and the classification of pulp disease, while exploring emerging research on solutions designed to overcome these limitations. Contemporary evidence supports adoption of a pulp disease classification that best describes the disease as continuum, rather than dichotomous approach of reversible/irreversible pulpitis. The recent advances in understanding the pathophysiology of pulpitis at molecular level could be exploited for development of novel biomarker-based diagnostic chairside tests. Moving forward, a refinement of the nomenclatures describing pulpitis, together with integration of objective diagnostic technologies are crucial for improving the diagnostic accuracy and enabling more successful application of pulp preservation therapies and predictable treatment outcomes for patients.

OBJECTIVES:To develop a Core Outcome Set suitable for adults and children for use in studies of Dental Behaviour Support (DBS) techniques, including non-pharmacological DBS, sedation and General Anaesthesia research. METHODS:Two systematic reviews generated a preliminary list of candidate outcomes that were shared with Key Stakeholders (KSG) and Public Patient Involvement (PPI) groups, who shortlisted outcomes for further exploration. Patients, carers, clinicians, and researchers were invited to participate in a Delphi panel. A modified e-Delphi was used to generate prioritisation and consensus across outcomes. A subsequent series of consensus meetings with panellists, patient groups and professional stakeholder groups determined the final outcomes within the COS. RESULTS:Twenty-three candidate outcomes were rated by 88 panellists in Round 1. The attrition rate between Rounds 1 and 3 was 21.6%. Thirty-four to 32 panellists attended the consensus meetings. The BeSiDe core outcome set for Dental Behaviour Support consisted of nine outcomes: acceptability, adverse effect, anxiety, behavioural response, cost, pain, therapeutic alliance, time and treatment completion. An additional subset of three core outcomes for use in pharmacological DBS studies was agreed upon: recovery, sedation effect and physiological monitoring. Each outcome was presented with a plain-language label and description to support consistent interpretation across stakeholders. CONCLUSIONS:A core outcome set to be used across all DBS studies was produced covering both adults and children, with supplementary additional outcomes available to use in studies exploring only pharmacological DBS approaches. The list is for use in research, though there is obvious transferability to clinical practice. TRIAL REGISTRATION:COMET Initiative database (Study ID: 2101), registered September 2022.

PURPOSE/OBJECTIVES:Dental education is undergoing a digital transformation, yet the adoption of immersive technologies such as haptic virtual reality (HVR) remains limited. This study aimed to map global adoption trends, barriers, and opportunities for equitable integration of HVR in dental curricula. METHODS:A 73-item global survey (July-August 2025) was distributed to dental educators across 57 countries via professional networks and social media. The mixed-methods instrument, validated by experts, assessed simulation methods, usage, barriers, and perceptions. Descriptive and exploratory inferential statistics (e.g., one-way ANOVA, Kruskal-Wallis, and chi-square tests) were used to analyze quantitative data, while thematic analysis was used to analyze qualitative responses. Ethical approval was granted by a university ethics review board (No. 13/2023). RESULTS:Responses from 130 educators (115 institutions, 57 countries) showed traditional methods (phantom heads, n = 118; benchtop exercises, n = 84) dominating (∼80% clinical training time), while HVR (n = 42, primarily in undergraduate programs) and mixed reality (n = 14, primarily in undergraduate programs) were less prevalent, especially in postgraduate programs (10% HVR use). Barriers in implementing HVR simulators were mainly external, with a lack of resources (66.3%) and resistance from staff and students (21.3%), while personal barriers such as technological limits (9.0%), lack of training (2.2%), and lack of evidence (1.1%) were less common (total n = 89). Countries with higher socioeconomic status were found to use HVR more in undergraduate education than the less well-off countries (p = 0.002). CONCLUSION(S):Immersive technologies remain underutilized in dental education, particularly at the postgraduate level, creating potential gaps in clinical preparedness. Strategic integration, collaboration, and sustainability-focused adoption may enhance equity and clinical readiness, informing accreditation and policy reforms.

INTRODUCTION:To develop new regenerative endodontic procedures we require an understanding of the basic biology of the dentin-pulp complex and its behavior in health, disease and healing. Clinicians and scientific research partnerships are essential for this field to advance. Translational-targeted tissue regenerative approaches can then be identified, developed in tandem with the development of novel next-generation diagnostics. Combined, these advancements will improve clinical outcomes. METHODS:This narrative review aims to summarize developments over recent decades in the field of dentin-pulp complex biology focusing on our understanding of the intersection between inflammation and regeneration. RESULTS:Our knowledge of inflammation and regeneration in the pulp has rapidly expanded. As carious disease progresses the microflora changes, pulpal cells detect this infection and mount a defensive immune response. The cytokines released orchestrate immune cell infiltration and activation, with cells such as neutrophils utilizing their antimicrobial armamentarium, including the release of neutrophil extracellular traps. This response although defensive, can be double-edged, leading to detrimental effects on the host tissue. Damaged tissue signals, combined with bacterial components, then activate molecular pathways, such as the inflammasome, which further exacerbate immune activity. In individuals with systemic diseases, such as type 2 diabetes, the chronic inflammation can accelerate tissue aging and potentially increase pulpal mineralization events. Epigenetic and immunotherapeutic compounds have been shown to modulate inflammation and enable innate regenerative responses. The use of high-quality preclinical laboratory-based in vitro, ex vivo, and animal models is however essential to underpin the next stages of evidence-based clinical translation. Enhanced knowledge of the molecular response during pulpitis has the potential to facilitate accurate objective diagnosis and guide the most appropriate treatments. CONCLUSION:Sustained collaboration between scientist and clinicians with a translational-focus will continue to increase our understanding of the association between inflammation and regeneration within the dentin-pulp complex. Further research in this area will lead to clinical benefit in the form of new point-of-care diagnostics and therapeutics.

INTRODUCTION AND AIMS:Endodontic postgraduate programmes should offer students a wide range of experiences and training in all facets of the specialisation. This study aimed to assess the current postgraduate education practices in endodontics across dental schools worldwide. METHODS:The current survey consisted of an online questionnaire that had been validated and piloted. It comprised 68 questions in three sections: general information about the programme, preclinical education, and clinical education. The survey included faculty members who teach postgraduate endodontics from one dental school in each participating country. The data was presented using simple descriptive statistics. RESULTS:In total, 33 faculty members, with a response rate of 85%, from different countries completed the survey. The majority of dental schools that participated in the survey offer a 3-year postgraduate programme. The postgraduate students develop abilities in various instrumentation techniques, irrigation devices, sealers/cements, root canal filling techniques, surgery, and microscope use. Most of the schools conduct a final-year exit examination. CONCLUSIONS:Postgraduate education differs globally in its preclinical and clinical training. The survey offers initial insights into postgraduate endodontic education and can help establish mutual educational standards and key focus areas. CLINICAL RELEVANCE:The curricula for preclinical and clinical education in postgraduate endodontics programmes vary globally.

To explore gender distribution within the field of Endodontology in Europe and to evaluate the representation of women in executive and academic roles within scientific societies as well as national and international conferences. After ethical approval, an online questionnaire was developed and shared with the European Society of Endodontology and the 36 national Endodontic societies officially affiliated. The survey inquired about gender composition amongst members, executive committee roles, participation in major congresses and representation in leadership and authorship positions within scientific journals affiliated with these societies over the last 5 years. Information was also retrieved from publicly available websites. Genders of the first, last and corresponding authors from scientific journals were identified. The relative ratio of women amongst society members, executive committee roles, participation in major congresses and representation in leadership and authorship positions within scientific journals was calculated. The ratio of women in leadership positions was statistically compared with the mean relative ratio of women amongst society members using a one-sample t-test. The current proportion of women in individual roles was compared with the general proportion of women members using the Binomial test. Women account for 44% of members in endodontic societies. No significant discrepancy was observed in the overall representation of women as members in executive or editorial committees or in authorship positions within scientific journals in relation to the mean relative ratio of female society members but are significantly underrepresented in key positions such as society presidents, treasurers and scientific event organizers ( p  < .05). Additionally, women were significantly underrepresented at scientific events, both as lecturers and workshop leaders, at major congresses of national/international societies ( p  < .05). Few initiatives have been implemented to address these inequities; only three societies reported programmes aimed at promoting women in leadership or scientific roles. Within the limitations of this study, women appear to be fairly represented as members of executive and editorial committees in national endodontic societies and the ESE, as well as in authorship positions within scientific journals, but underrepresentation of women in positions of power and scientific forums persists. Some countries have begun implementing strategic measures to promote gender equity.

The pulp responds to disease and trauma through inflammation which modulates the tooth's ability to instigate healing mechanisms. In vitro human dental pulp cell (HDPC) culture models are widely used to study the tooth's response to pro-inflammatory stimuli. The purpose of this review is to generate a structured appraisal of in vitro research methodologies to study HDPC cultures in a state of inflammation. In this narrative review the Scopus, PubMed and Google Scholar databases were searched to identify studies reporting the use of HDPC cultures in vitro in inflammation-associated research until December 2024. The dataset initially identified 642 publications, which were manually screened to identify 246 relevant studies for inclusion and methodologically mined for information on: (i) study purpose, (ii) source and characterisation of cells, (iii) pro-inflammatory stimuli used and (iv) assays and markers used to characterise the inflammatory response. The collected data underpinned this review. Most published studies aimed to characterise HDPC responses to a range of pro-inflammatory stimulants which included bacterial components (lipopolysaccharides [LPS] and lipoteichoic acids [LTA]), cytokines and biomaterials. These stimulations were studied: to characterise their effect in the development of new scaffolds and dental (bio)materials and to mimic the in vivo environment. Various tooth sources were used to establish HDPC cultures, and predominantly, cells were isolated using the pulp tissue explant technique. The most frequently used stimulant and concentrations were LPS at 1 and 10 μg/mL. The time for cell stimulation prior to inflammatory response assay varied from 15 min to 10 days. Inflammatory assessments were performed using quantitative polymerase chain reaction (qPCR), Western Blotting, enzyme-linked immunosorbent assay (ELISA) and high-throughput assays targeting archetypical cytokines and dentinogenic and mineralisation-associated molecules. This review highlights the broad range of experimental conditions used to study HDPC inflammatory responses in vitro and combines these data to identify a framework for a consensus and a more uniform experimental approach. Standardisation of in vitro experimental conditions to evaluate the pulps response to inflammatory stimuli would enhance research rigour and improve clinical translation to ultimately inform patient treatment and outcomes.