<h4>Introduction and aims</h4>Root canal therapy is a crucial aspect of endodontic treatment aimed at preserving natural dentition. Over the years, advancements in three-dimensional (3D) technology have revolutionized diagnosis and treatment planning. Different 3D technologies are used in dental care, such as cone-beam computed tomography (CBCT), which ensures 3D slice visualization, root canal microanatomy, and dynamic navigation throughout the pulp cavity. By exploring the latest technological progress in this field, we seek to understand how these innovations are enhancing precision, efficiency, and patient outcomes, shedding light on the benefits and potential impact of 3D imaging in improving root canal procedures.<h4>Methods</h4>Literature was searched from different databases, including PubMed, ScienceDirect, The Cochrane Library, Scopus, and Google Scholar. Inclusion criteria involved studies on 3D technology in root canal therapy with comparison groups, including RCTs and non-RCTs. Excluded studies lacked 3D imaging advancements, a control group, or were review articles or case studies. Quality assessment utilized QUIN for in vitro studies and ROBINS-I for non-RCTs to evaluate the studies' validity.<h4>Results</h4>According to the PRISMA guidelines, among 5015 initial articles, 16 were included. CBCT was the most used 3D imaging technique for root imaging followed by micro-computed tomography (MCT) and limited CBCT (LCBCT) imaging methods. 2D radiographs and 2D histological methods and clearing techniques were the most common comparative modalities. Overall, 3D imaging streamlined dental treatment as clinicians could visualize much clearer and higher-quality images. Different resolutions and voxel sizes were applied to improve imaging quality.<h4>Conclusion</h4>Three-dimensional imaging, especially CBCT, improves root canal treatments by providing superior image quality. CBCT outperforms other techniques like MCT and LCBCT, enhancing clarity. Varying resolu Over the years, advancements in three-dimensional (3D) technology have revolutionized diagnosis and treatment planning. Different 3D technologies are used in dental care, such as cone-beam computed tomography (CBCT), which ensures 3D slice visualization, root canal microanatomy, and dynamic navigation throughout the pulp cavity. By exploring the latest technological progress in this field, we seek to understand how these innovations are enhancing precision, efficiency, and patient outcomes, shedding light on the benefits and potential impact of 3D imaging in improving root canal procedures. 29 Overall, the application of 3D imaging techniques in root canal treatments has significantly improved the understanding of root canal morphology, aiding in diagnosis, treatment planning, and procedural precision. In this study, we aim to investigate the ongoing improvements in 3D imaging in root canal procedures. Examining the recent technological development of 3D imaging in root canal procedures will help us understand the increased level of precision and efficiency and improve patient outcomes with these innovations. This exploration will help us understand the potential of 3D imaging to enhance the root canal procedure. 33 , 37 , 38 , 40 , 41 , 46 , 48 3D imaging techniques, including CBCT and MCT, were accurate, except for a few studies that reported that other techniques, such as PSP 33 and the combination of 2D and 3D techniques, 46 were also accurate. A single study reported that LCBCT was not as accurate as PSP and film radiographs, 42 as shown in Table 2 . Table 2 Impact of 3D imaging on root canal treatment parameters. 52 , 52 This preference for CBCT can be attributed to several factors. CBCT can be used at low and high resolutions, which provides detailed insight into the complex root canal anatomy, such as root fusion, multiple roots, and accessory canals, which can be missed or misdiagnosed by conventional radiographs, 53 resulting in better, enhanced, and accurate diagnosis and treatment planning. Moreover, its fast-scanning time makes it a practical choice in most clinical settings. 56 However, identification of minor anatomical changes might be difficult with CBCT. 57 Therefore, for a more detailed study of structures and quantification of dental parameters, including trabecular thickness, bone volume, and connectivity density, MCT can play a better role. 58 Moreover, the present study identified different advancements, such as changes in resolution (low or high) and voxel sizes with different and faster scanning times. All these advancements positively impacted accuracy and precision, which ultimately enhanced the diagnosis and treatment planning for root canal therapy. 60 Another study used high resolution to visualize complete root fractures and observed higher diagnostic accuracy, particularly in the no-filling group. 61 Furthermore, developments in software algorithms have enabled automated analysis of root canal morphology, aiding in the precise identification of anatomical variations and complexities. In a case study of a patient who presented with unsuccessful root canal treatment, CBCT imaging was performed, and the images were imported into a novel segmentation software, which allowed for successful and quick management of the tooth with ledges. However, this level of accuracy cannot be achieved using traditional radiography. The synthesis of evidence presented in this review underscores the transformative potential of 3D imaging technology in optimizing root canal therapy protocols and underscores the need for continued research and clinical validation to maximize its clinical utility while ensuring patient safety and affordability Moreover, this study provides evidence of how different image resolutions influence the precision and accuracy of clinical diagnosis and treatment planning for endodontically treated teeth.

This review synthesizes current laboratory and clinical evidence on nickel-titanium (NiTi) endodontic instruments and translates it into guidance for clinical practice, addressing inconsistencies in the translation of research findings and a lack of standardization. Evidence on the evolution, metallurgy, heat treatments (e.g., M-Wire, Gold, and Blue), geometric design, mechanical properties, and clinical performance of contemporary NiTi systems were synthesized, with emphasis on shaping outcomes, including canal transportation, volumetric changes, unprepared canal walls, and remaining dentin thickness. Modern NiTi instruments, particularly those with advanced heat treatments, provide superior flexibility and cyclic fatigue resistance compared with conventional alloys, enabling safer and more predictable canal preparation. Continuous rotary systems often achieve better canal centering and less transportation than reciprocating systems; however, both leave a substantial portion of canal walls untouched, highlighting the essential role of chemical debridement. Long-term clinical success depends primarily on biological factors and careful technique rather than on the specific instrument system. Therefore, NiTi instruments represent the standard of care, offering anatomically respectful canal shaping. Clinicians should integrate knowledge of alloy properties, design features, and failure mechanisms with conservative, load-managing techniques to maximize safety and efficiency.

Root canal filling is a critical determinant of endodontic treatment success, yet limited evidence exists regarding the superiority of specific techniques or materials over others. This systematic review and meta-analysis compared the clinical and radiographic outcomes of different root canal obturation techniques and materials in primary treatments and retreatments. We systematically searched PubMed, Cochrane Library, and ScienceDirect up to the last week of November 2025 following PRISMA guidelines. Studies were included if they reported primary or retreatment outcomes with at least 6 months of follow-up, < 25% loss to follow-up, and explicit documentation of obturation techniques and clinical/radiographic success. Risk of bias was assessed with ROBINS-I (cohort studies) and RoB 2.0 (randomized studies), and the overall evidence certainty was rated using GRADE. Success rates were compared across techniques using mixed-effects meta-regression, estimating differences in outcomes (beta coefficients) with 95% confidence intervals and accounting for between-study heterogeneity. Eighty-four studies (11,965 samples) met all inclusion criteria. In primary treatments, overall success rates were 87.1% at 6 months and 87.2% at 12 months, without significant differences among techniques. At 24 months, success increased to 92.0%; cold lateral condensation (CLC) (difference: 5.0%, p = 0.021) and carrier-based (CB) techniques (difference: 7.5%, p = 0.011) showed higher success than single-cone (SC). Beyond 3 years, success decreased to 84.9%, with no statistically significant differences among warm vertical compaction (WVC), warm lateral compaction (WLC), CLC, SC, and CB techniques. In retreatments, success rates were 92.9% at 6 months, 77.0% at 12 months, and 83.5% at 24 months. At 12 months, SC showed a marginally higher success than CLC (p = 0.045), while at 24 months, CB significantly outperformed WVC (p = 0.004). Beyond 3 years, success decreased to 73.7%, with no significant differences between CLC and CB techniques. Overall, primary treatments presented higher success than retreatments. At 24 months, CLC and CB techniques showed modest advantages, which were not maintained at longer follow-ups. Success appears multifactorial, with operator expertise and case selection having greater impact than obturation technique. The overall certainty of evidence remained low to very low, particularly for long-term outcomes. Bioceramic sealers used with SC techniques have not demonstrated clear clinical benefits or improved retreatment outcomes. High heterogeneity and risk of bias suggest a need for well-powered, multicenter, long-term randomized trials with standardized outcome reporting to establish clinical standards (PROSPERO registration: CRD42024524608).

Postoperative pain affects 25-40% of Randomized Controlled Trial (RCT) patients, impairing oral health-related quality of life (OHRQoL). This double-blind RCT randomized 80 single-visit RCT patients to low-level laser therapy (LLLT) (808 nm periapical laser) or placebo postoperatively. LLLT reduced 24-hour Visual Analog Scale (VAS) pain scores (2.1±1.2 vs 4.8±1.5; p<0.001) across all timepoints. Oral Health Impact Profile-14 (OHIP-14) scores improved significantly (15.3±3.1 vs 22.7±4.5; p<0.001) with 58% less analgesic use. Immediate LLLT advances RCT recovery as safe adjunct for pain control and enhanced OHRQoL.