Digital twin technologies in endodontics: Current evidence, challenges, and future perspectives

To provide a narrative review of digital twin technology in endodontics, focusing on current applications, key challenges, and future perspectives. A targeted search of PubMed, Scopus, and Web of Science (2020–2025) was conducted using the keywords (“digital twin” OR “digital-twin”) AND (endodontics OR “root canal” OR dentistry). Given the emerging nature of the field, a selective, interpretative narrative synthesis was undertaken rather than an exhaustive systematic review. Digital twin applications in endodontics include infrared thermography models for nickel–titanium (NiTi) instrument monitoring, cone-beam computed tomography (CBCT)-driven anatomical replicas for diagnostic planning, and simulation-based platforms for education and guided procedures. These studies demonstrate feasibility for enhancing diagnostic accuracy, procedural safety, and clinical training. However, evidence is limited by small sample sizes, absence of multicenter trials, lack of standardised protocols, and no cost-effectiveness analyses. Lessons from other fields such as oncology, cardiology, orthodontics, and implantology suggest opportunities for integrating multimodal data and personalised treatment planning into endodontics. Digital twin technology represents an emerging innovation in endodontics with demonstrated applications in diagnosis, education, and guided procedures. Nevertheless, current research remains preliminary. Large-scale clinical studies, economic evaluations, and standardised workflows are required before routine adoption can be justified. Ethical considerations regarding data privacy, interoperability, and accountability must also be addressed to ensure responsible integration.