Endodontic Complexity: A Scoping Review of Case Difficulty Assessment Tools and Indices

Area of Science:

• Dental Science
• Endodontics
• Clinical Practice

Background:

• Accurate assessment of endodontic case difficulty is vital for clinical success, referrals, and patient safety, especially for general dental practitioners (GDPs).
• Endodontic treatment complexity varies significantly, necessitating reliable tools for evaluation.

Purpose of the Study:

• To identify and appraise existing tools and indices developed for assessing endodontic case difficulty.
• To provide an overview of the characteristics, components, scoring systems, and validation methods of these assessment tools.

Main Methods:

• A scoping review following PRISMA-ScR guidelines.
• Comprehensive search of seven databases for studies published between January 2000 and July 2025.
• Thematic synthesis of data from 15 included studies evaluating endodontic difficulty assessment tools.

Main Results:

• Fifteen studies evaluated various endodontic case difficulty assessment tools (e.g., AAECDA, ECAF, E-CAT, EndoApp, DETI).
• Tools primarily focused on non-surgical root canal treatment, with one addressing endodontic microsurgery.
• Significant variation exists in tool structure, scoring, validation rigor, and reliability (inter- and intra-rater agreement).

Conclusions:

• Endodontic difficulty assessment tools are diverse and evolving, supporting clinical decision-making and education.
• Refinement, psychometric validation, and global applicability are key to enhancing tool utility.
• These tools aid in standardizing endodontic case assessment across different settings.