The future of endodontic diagnosis: A narrative review focusing on biological markers

Innovative methods for pulpal diagnosis are becoming increasingly important in endodontics, as traditional diagnostic techniques often lack the precision and reliability needed for confident decision making. Molecular diagnostic approaches, like biomarker analysis and advanced sampling methods, represent a step forward in clinical practice. This narrative review aims to identify key biomarkers associated with pulpal inflammation, compare published cutoff points for these biomarkers, and briefly review molecular methods and sampling techniques.

This study is a narrative review of literature identified by a web-based search on PubMed. Original scientific articles, such as clinical studies, reviews, and case reports, were included.

Several biomarkers have been associated with pulp inflammation and have been reported as statistically significant, including interleukin 1, 6, and 8; tumor necrosis factor-α; vascular endothelial growth factor; fibrocyte growth factor acidic; and matrix metalloproteinases 8 and 9. Although some cutoff points for these biomarkers have been identified, further research is necessary to refine their clinical applicability. Various sample collection methods, such as gingival crevicular fluid, dentinal fluid, pulpal tissue, and pulpal blood, have been used. Among the analytical techniques, enzyme-linked immunosorbent assay and Luminex protein assays have proven to be the most accurate, sensitive, and specific for evaluating pulpal inflammation.