Prevention and Management of Tooth Discolouration of Endodontic Origin (DEO): A State-of-the-Art Review

Tooth discolouration of endodontic origin (DEO) refers to an undesirable change in tooth colour arising from the pulp space as a result of reactive physiological processes, pathological processes or endodontic procedures and materials. As DEO frequently affects teeth in the aesthetic zone, it may substantially impair self-esteem and oral health-related quality of life, making its prevention and minimally invasive management clinically important.

This state-of-the-art review summarizes current knowledge on the aetiology, diagnosis, prevention and management of DEO. Emphasis is placed on the colour stability of contemporary endodontic materials, preventive clinical protocols, case selection, bleaching techniques, regulatory aspects of bleaching agents, safety considerations and possible complications. Restorative treatment options are also discussed for situations in which bleaching is ineffective, contraindicated or insufficient to achieve an acceptable aesthetic outcome.

Given the broad scope of the review and the anticipated heterogeneity of the available evidence, a narrative review study type was adopted. A targeted literature search was conducted in PubMed from database inception to April 2026 using relevant keywords related to the DEO topic. The search was supplemented by screening the reference lists of identified articles and key reviews.

Prevention should focus on preserving pulp vitality whenever possible, selecting materials with a low discolouration potential, performing meticulous endodontic procedures and providing a durable coronal seal. When treatment is required, bleaching should be considered the first-line option whenever clinically appropriate. Restorative intervention should be reserved for cases in which bleaching is contraindicated, unsuccessful or insufficient to achieve an acceptable aesthetic outcome. Selection and use of bleaching agents must comply with applicable local regulatory requirements.

By integrating current evidence, clinical experience and regulatory considerations, this review provides a contemporary basis for clinical decision-making and supports the forthcoming position statement of the European Society of Endodontology on prevention and management of DEO.