Microbiome dynamics in endodontic pathology: A narrative review

Objectives: To synthesize current evidence on microbial diversity, biofilm behavior, and host–microbe interactions in primary, secondary, and persistent endodontic infections. Methods: A narrative review of published literature was conducted focusing on microbiome composition, biofilm formation, and host immune interactions in endodontic pathology. Emphasis was placed on studies utilizing next-generation sequencing and molecular diagnostic approaches. Results: Endodontic infections demonstrated polymicrobial ecosystems comprising bacterial, fungal, and viral species. Advanced sequencing technologies revealed complex microbial networks and strain-level diversity not detected by conventional culture methods. These findings highlighted microbial interactions that influence disease progression and treatment resistance. Conclusions: Understanding microbiome dynamics is essential for developing targeted antimicrobial strategies and personalized endodontic therapies. Integration of molecular diagnostics may improve clinical outcomes and long-term treatment success.