From Patent to Practice? A Retrospective Cohort Analysis of Translational Attrition in Endodontic Innovation

To characterize the translational pathway of endodontic technology from patent filing to clinical availability, with four objectives: (i) determine the grant rate and jurisdictional distribution; (ii) characterize temporal dynamics of the grant process; (iii) map distribution across technology categories; and (iv) evaluate maturity and regulatory status in a strategic subset.

A retrospective cohort of 201 patent families was identified from European Patent Office Espacenet (Cooperative Patent Classification class A61C5*), priority years 2012-2014. Variables included technology category, jurisdiction, granted status in the USA, Europe, and Japan, time until first grant, and patent status at 31 December 2025. A strategic subset (n = 20), defined as families with identifiable regulatory or commercial signals, was further analysed using a Technology Maturity Index (TMI, 1-5) and regulatory signals (Food and Drug Administration (FDA) clearance, Conformité Européenne (CE) marking, clinical evidence). Kaplan-Meier analysis modelled time to first grant, and translational attrition was mapped across the translation process.

Of 201 endodontic patent families, 112 (55.7%) were granted in at least one major market. Median time until the first patent was granted was 1652 days (Interquartile Range (IQR) 1290-2043). Instrumentation dominated (80.1%), and energy-based devices showed a numerically higher grant rate (66.7%), although this difference was not statistically significant. Twenty families (10.0%) carried identifiable regulatory or commercial signals; 16 (80.0%) reached near-commercial maturity (TMI ≥ 4) and 15 achieved TMI = 5, representing 7.5% of the original cohort.

Endodontic technology translation is prolonged and highly selective, showing progressive narrowing from filing to commercial realization, with only 7.5% (15/201) of the families reaching confirmed full market availability. These findings provide a descriptive framework for interpreting emerging technologies and highlight the need to consider both time and attrition when evaluating innovation in endodontics.