Clinical Applications and Evidence Maturity of Guided Endodontics: A Scoping Review

Background/Objectives: Guided endodontics transfers a virtually planned drilling path into the tooth through printed templates, dynamic navigation and, more recently, robotic and augmented reality systems. This scoping review mapped the reported indications and appraised how mature the evidence is for each one. Methods: The review followed PRISMA-ScR. PubMed/MEDLINE was searched from January 2016 to September 2026, with supplementary hand-searching undertaken, and all records were screened in duplicate. Risk of bias was assessed with RoB 2, ROBINS-I, the JBI checklist for case series and criteria adapted from QUIN and PRILE 2021. Results: From 341 records and eight studies identified by other means, 234 studies were included across eight indications: six randomised trials, three non-randomised comparative studies, 24 case series, 93 case reports, 11 cadaveric and 97 laboratory studies, so that 108 of the 234 were laboratory or cadaveric and only nine were controlled clinical studies. Controlled clinical evidence exists only for access to obliterated anterior and single-rooted canals and for endodontic microsurgery. In the laboratory, static guides deviated by 1.1 to 2.8 degrees against 9.5 to 21.2 degrees for freehand access; in a randomised trial, static guidance lowered technical failure from 19 to 1.7 per cent. Guided retrieval of separated instruments performed worse than freehand. None of the six trials was at low risk of bias, and none reported how its randomisation sequence was generated. Conclusions: Guided endodontics is accurate and conserves tooth structure in laboratory and early clinical work, but the strength of evidence differs sharply between indications. Access to calcified single-rooted canals and guided microsurgery are supported by small trials, none at low risk of bias; the remaining indications rest on laboratory data or case reports, and instrument retrieval is not supported.