Precision Endodontics-Advancing Towards Omics-Guided Personalisation: A Narrative Review

To critically evaluate the emerging contribution of genomics, transcriptomics, proteomics, metabolomics and microbiomics to the development of precision endodontics, and to examine the opportunities and translational challenges associated with integrating omics technologies into clinical endodontic practice.

This narrative review synthesises recent literature across the biomedical and dental sciences, encompassing endodontic research and the principles of translational precision medicine and dentistry to assess the potential applications of omics technologies in endodontics, focusing on how these innovative approaches can inform clinical practice.

Emerging evidence suggests that omics technologies may enhance understanding of the biological mechanisms underlying pulpal and periapical diseases and support the identification of candidate biomarkers relevant to diagnosis, prognosis, treatment selection and outcome monitoring. Genomic and transcriptomic studies have identified molecular signatures associated with host susceptibility, inflammatory responses and tissue repair processes. Proteomic and metabolomic investigations have revealed biomarkers and metabolic pathways that may improve disease characterisation and provide insight into pulpal vitality and periapical healing. Microbiomic analyses have expanded understanding of the complex microbial ecology of endodontic infections and may contribute to the development of more targeted disinfection strategies. Furthermore, integrating multi-omics platforms and data with artificial intelligence (AI) could yield sophisticated predictive models to support personalised decision-making, thereby advancing individualised patient care. However, despite these advances, the current evidence remains largely exploratory. Many reported biomarkers and molecular signatures have not undergone robust validation, and significant challenges persist regarding standardisation, reproducibility, data integration, cost-effectiveness and clinical implementation.

The concept of precision endodontics represents a potential evolution from conventional 'one-size-fits-all' approaches to more tailored interventions guided by extensive omics data. The synergistic integration of omics and AI may provide a roadmap for developing the next generation of biologically individualised endodontic therapies. However, translating omics-driven approaches into clinically applicable diagnostic and therapeutic tools remains at an early stage. Future progress will depend on rigorous validation studies, interdisciplinary collaboration and the development of practical translational frameworks. While the combined application of omics technologies and AI has considerable potential, substantial evidence gaps must be addressed before precision endodontics can be routinely implemented in clinical practice.