Smart Root Canal Therapy: Intelligence Refinement of Clinical Procedures

Root canal therapy (RCT) is the primary treatment modality for pulpal and periapical diseases. Although the fundamental objective of RCT has remained unchanged for over a century, its technical details have been continuously refined and transformed. Preoperative diagnostic approaches have evolved from two-dimensional imaging to three-dimensional volumetric reconstructions and, more recently, to artificial intelligence-assisted analytical frameworks. Treatment modalities have progressed from manual instrumentation to motor-driven systems and guided or robotic-assisted interventions. Disinfection strategies have also begun to shift from passive chemical irrigation towards actively guided nano-enabled systems. Moreover, obturation materials have advanced from inert substances to bioactive compounds and, prospectively, to adaptive trends. These transitions reflect not only technological progress but also the continuing efforts of endodontists to improve precision, safety, efficiency, and biological outcomes. However, the primary goal of RCT remains the effective elimination of infection and the prevention of reinfection. In this review, the term 'Smart RCT' is used as a conceptual framework that integrates digital intelligence, engineering-based operative assistance, and material-based biological functions. We systematically synthesise contemporary evidence on the development and application of smart technologies across the major stages of RCT. By critically evaluating both the potential and current limitations of these technologies, this review aims to provide an evidence-based perspective on the integration of intelligent advances into contemporary endodontic decision-making and clinical practice.