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Abstract

Endodontic pathology encompasses a range of diseases affecting the dental pulp and periapical tissues, stemming primarily from microbial infection, trauma, and chemical or mechanical irritants. This pathology typically originates when the protective enamel and dentin are breached, allowing microbial invasion that ultimately infects the pulp tissue. Once infected, the pulp undergoes inflammation—known as pulpitis—which, if untreated, can progress to irreversible pulpitis and pulpal necrosis. Endodontic infections often extend beyond the pulp, causing apical periodontitis, periapical abscesses, or cystic lesions, impacting both local oral health and systemic health. The inflammatory response within endodontic pathology is multifactorial, involving complex interactions among microbial agents, host immune responses, and environmental factors. The microbial composition of endodontic infections predominantly includes anaerobic bacteria, though recent studies have also identified fungal and viral contributions to endodontic infections. The microbial biofilms formed within root canals protect these pathogens from host immune defenses and complicate treatment, leading to chronic inflammation and potential bone resorption in periapical tissues. In advanced cases, untreated endodontic lesions may spread, resulting in systemic complications such as cellulitis, sinusitis, or even life-threatening infections. Diagnostic advances, including cone-beam computed tomography (CBCT) and molecular microbial analyses have enabled a more comprehensive understanding of endodontic infections, providing clinicians with precise diagnostic capabilities and insights into the microbiome of infected root canals. Treatment strategies focus on eradicating infection and inflammation while preserving tooth structure. Root canal therapy (RCT) remains the gold standard for managing endodontic infections, involving biomechanical cleaning, shaping, and debridement of the root canal system followed by obturation to prevent re-infection. In cases of treatment failure or persistent infection, surgical endodontics, including apicoectomy, may be required to address periapical pathology directly. Emerging research on regenerative endodontics and bioactive materials offers promising alternatives to traditional RCT, aiming to restore pulpal vitality and support periapical healing. Bioactive materials, such as mineral trioxide aggregate (MTA) and bioceramics, have shown improved outcomes in sealing the root canal, while regenerative techniques are investigating stem cell applications to promote pulpal tissue regeneration. The long-term prognosis of endodontic pathology depends on timely diagnosis, effective debridement, and careful obturation of the root canal. While RCT remains successful in over 90% of cases, recurrent infections underscore the importance of aseptic techniques, ongoing advances in endodontic materials, and patient adherence to follow-up care. As knowledge of microbial dynamics, host-pathogen interactions, and tissue healing continues to expand, endodontic therapy is evolving to embrace less invasive, biologically driven approaches that aim to retain natural dentition and promote tissue regeneration for enhanced patient outcomes.