Endodontic treatment in the conditions of type I dentinal dysplasia: features and applicability of practical approaches

Background. Endodontic therapy within dentinal dysplasia conditions represents an overly complex clinical domain that integrates both diagnostic challenges and technical limitations. Understanding these challenges is essential for optimizing treatment strategies, preventing iatrogenic complications, and improving long-term outcomes in affected patients. Objective. To assess and systematize practical diagnostic, technical and treatment considerations that potentially may optimize endodontic procedures provided within the conditions of dentinal dysplasia, and stratify evidence-based impact of such considerations taking into account their origin within the pool of available literature data. Materials and Methods. Comprehensive literature review was based upon broad search strategy, which was adopted to maximize sensitivity and inclusiveness. The primary database used for the search was PubMed with the use of Medical Subject Headings (MeSH), while to enhance coverage and minimize the risk of missing pertinent articles not yet indexed or published in lower-impact outlets, supplementary searches were also performed via the Google Scholar platform. Results. Following the exclusion of non-relevant records, duplicates, and articles that, upon content analysis, were determined to be unrelated to the defined research aim, final study cohort was refined to 10 publications, all of which consisted exclusively of case reports. Analysis of available evidence demonstrated substantial heterogeneity in the reported outcomes of endodontic treatment among patients affected by dentinal dysplasia. Overall, the evidence demonstrates temporal transition from consistently poor outcomes with conventional methods, through a period dominated by extractions and restorative strategies, to the emergence of guided endodontics as the potential reliably successful modality for the management of dentinal dysplasia. Nevertheless, the majority of published cases reported high rates of treatment failure. Conclusion. Provided analysis revealed that endodontic treatment of teeth with signs of dentinal dysplasia represents significant clinical challenges related with difficulties to identify root canal orifices, obtain apical patency, retain anatomically-driven trajectory of instrumentation and prevent complications linked with unreasonable loss of dentine structure, perforations, ledges and instruments fracture. Conventional instrumentation approaches, which previously have been applied for the teeth with obliterations and curvatures, while also for management of ledges, may serve as first line treatment options, considering their conservative nature. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.