Evolution of liquid biopsy in endodontics

Liquid biopsy, an innovative and minimally invasive diagnostic technique that evaluates circulating biomarkers in body fluids, has dramatically reshaped the fields of oncology, prognosis, and personalized medicine. This emerging concept is now garnering growing interest in dentistry – particularly in endodontics – where traditional diagnostic methods often suffer from subjectivity and limited accuracy. One of the major clinical dilemmas remains the precise differentiation between reversible and irreversible pulpitis, a distinction crucial for treatment planning. Misjudgement can result in overtreatment through unnecessary root canal therapy or undertreatment leading to persistent pain and infection. Recent studies indicate that readily accessible biological fluids, such as dentinal fluid (DF), pulpal blood, and gingival crevicular fluid, contain quantifiable molecular biomarkers that mirror the inflammatory and degenerative condition of the dental pulp. This comprehensive narrative review consolidates current research on the utilization of liquid biopsy in endodontics. It provides a detailed discussion on the identification and validation of potential biomarkers, reviews advancing techniques for sample collection and molecular analysis, and highlights the diagnostic and clinical significance alongside existing research gaps and future prospects. Collectively, the evidence underscores that molecular diagnostics may pave the way toward a new paradigm of objective, accurate, and personalized endodontic care.