Narrative Review of Endodontic Biomaterials.

Advancements in biomaterials have transformed the field of endodontics, shifting treatment approaches from mechanical interventions to biologically driven regenerative therapies. This narrative review explores the evolving landscape of endodontic biomaterials, emphasizing their roles in disinfection, obturation, root repair, surgical procedures, and regenerative endodontics. Key materials such as mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM) cement demonstrate superior sealing, biocompatibility, and osteogenic potential compared to traditional materials. The integration of nanotechnology, bioactive components, and smart drug delivery systems has further enhanced antimicrobial properties and tissue interaction. Clinical applications, including regenerative procedures using platelet-rich fibrin and case-based biomaterial usage, are discussed to illustrate their relevance and effectiveness in real-world practice. Despite significant progress, challenges such as regulatory hurdles, economic limitations, and translational gaps persist. Emerging trends such as 3D printing, personalized medicine, and multifunctional scaffolds offer promising directions for future endodontic care. Continued interdisciplinary collaboration is essential to overcome current barriers and facilitate widespread adoption of next-generation biomaterials. Unlike prior reviews that categorize endodontic biomaterials descriptively by material class or technological advancement, this review introduces an indication-based comparative framework aligning biomaterial properties with specific clinical decision points and corresponding levels of evidence. By integrating biological mechanisms, translational considerations, and clinical application within a structured decision-oriented model, the manuscript offers analytical synthesis rather than a purely descriptive overview.