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The American Association of Endodontists has published two new member-exclusive analyses from Fluent Research: the Q1 2026 Endodontic Market Landscape Report and the Q1 2026 Endodontic Market Landscape Report: Miscellaneous CDT Codes Analysis.

Together, the reports provide a comprehensive view of how commercially insured patients are accessing endodontic care and how practice patterns continue to evolve.

Because the analyses are based on insurance claims, they reflect utilization within the commercially insured population and may not capture procedures performed outside the insured environment. Several notable trends emerged.

Endodontic Treatment Volume Continues to Shift

A notable finding from the Endodontic Market Landscape report is a decline in endodontic treatment volume within the commercially insured population analyzed by Fluent.

According to the report, treatment volume declined 2.3% in 2024 and an additional 5.7% in 2025. While those numbers may appear concerning at first glance, researchers cautioned against interpreting them as a direct measure of all endodontic care occurring nationwide.

Insurance claims reflect not only treatment decisions but also changes in insurance enrollment, and benefit design. The findings suggest several possible factors that may have contributed to the trend.

One factor is a reduction in the number of patients covered by commercial dental insurance. Fluent’s projections, based on the National Association of Dental Plans (NADP) total insured population, indicate that the commercially insured market was smaller than in previous years, with the total insured population declining approximately 2–3% from 2023 to 2024. At the same time, many Medicare Advantage plans have modified dental benefits, shifting from more comprehensive coverage toward preventive and diagnostic-focused models.

Endodontists Increased Their Share of Procedures

Although overall treatment volume declined, endodontists continued to perform a larger share of endodontic procedures.

The percentage of treatments performed by endodontists increased from 43% in 2023 to 45% in 2025. During the same period, the percentage performed by general practitioners declined from 46% to 45%, while the percentage performed by other specialties declined from 11% to 10%.

Treatment volume among endodontists also proved more resilient than among other provider groups. Endodontist-performed procedures declined 0.7% in 2024 and 2.0% in 2025, compared with declines of 2.5% and 7.0%, respectively, for general practitioners. This suggests that even as overall demand softens, more complex cases continue to be referred to specialists.

Demographic Shifts Are Reshaping Endodontic Care

One of the clearest findings in the report is a shift in the demographic profile of endodontic patients.

Within the claims data analyzed, adults age 65 and older were the only age group to show growth in treatment volume during 2024. Although utilization moderated somewhat in 2025, older adults continue to represent a growing share of endodontic care. At the same time, younger age groups, including patients ages 0 to 19, experienced declining utilization.

Researchers attribute these changes to several long-term trends. Americans are retaining their natural teeth longer and entering retirement with more heavily restored dentitions, increasing the need for tooth-preserving treatment later in life. Expanded dental coverage through Medicare Advantage may also be contributing to greater utilization among older adults.

Researchers also noted that advances in preventive and minimally invasive dentistry could influence future treatment patterns. New therapies designed to arrest or reverse early carious lesions before they progress may reduce the need for endodontic treatment among younger patients. Although it is too early to understand the full impact of these innovations, they are expected to play an increasing role in how dental disease is managed.

Taken together, these findings suggest that future demand for endodontic care will be influenced by both an aging population and continued advances in prevention and early intervention.

Shifts in Endodontic Procedure Mix

The analysis identified shifts within procedure categories. Pulp capping increased its share of treatment volume from 11% in 2023 to 12% in 2025. Procedures classified as “other,” driven in part by intraorifice barriers, increased from 4% to 5%. Pulpotomy and endodontic therapy each experienced modest declines in overall share during the study period, reflecting broader changes in how disease is managed and treated earlier in its progression.

State-Level Trends Varied, but All Major Markets Declined in 2025

The eight states with the highest treatment volume, California, Florida, Illinois, New York, Pennsylvania, Texas, Virginia, and Washington, all experienced declines in 2025.

Declines ranged from 4.2% in Florida to 15.2% in New York. While state-level performance varied during 2024, every major market analyzed experienced lower treatment volume in 2025. Regional economic conditions, differences in insurance coverage, and local provider dynamics likely contributed to the variation in decline across states.

Diagnostic and Imaging Services Continued to Expand

The Miscellaneous CDT Codes Analysis identified continued growth across diagnostic and imaging-related procedures.

Combined treatment volume for the miscellaneous CDT codes analyzed increased 6.8% in 2024 and 5.0% in 2025.

Radiographic imaging codes D0220 and D0230 accounted for the largest share of utilization, representing more than 200 million projected procedures in 2025.

Among lower-volume codes, D0364 (CBCT with interpretation and report) demonstrated the strongest growth, increasing 13.4% in 2024 and 11.0% in 2025. The analysis also found continued growth in consultation services, pulp vitality testing, and post-removal procedures.

Imaging Utilization Continued to Increase

Imaging-related services represented the fastest-growing category among the miscellaneous CDT codes analyzed.

Growth occurred across all provider types and age groups. General practitioners performed the majority of imaging and diagnostic procedures, although utilization also increased among endodontists and other specialists. The report projects continued growth in imaging utilization through 2026, driven by advances in technology, increased accessibility, and the growing role of imaging in diagnosis and treatment planning.

Large Group Practices Continued to Expand

Practice size remained an important differentiator.

Practices with 50 or more locations increased treatment volume by 12.2% in 2024 and 8.1% in 2025 within the miscellaneous CDT code analysis. By comparison, solo practices grew 5.5% in 2024 and 6.1% in 2025.

Within the core endodontic treatment analysis, large group practices experienced smaller declines than solo practices and continued to gain market share.

Key Takeaways

The Fluent reports identified several important trends within the commercially insured marketplace:

  • Endodontists continue to perform an increasing share of endodontic procedures.
  • Adults age 65 and older represent a growing segment of the patient population.
  • Diagnostic imaging, including CBCT, continues to expand.
  • Large group practices continue to gain market share relative to smaller practice models.

While claims-based analyses do not capture every procedure performed nationwide, they provide valuable insight into utilization patterns and evolving market dynamics affecting endodontic care. As patient demographics, technology, and practice models continue to evolve, these findings provide an important benchmark for understanding the forces shaping the future of endodontic care.

The American Association of Endodontists proudly announces the district director candidates for terms beginning in 2027. Terms are three years in length, unless noted otherwise. Members will approve the nominees at the General Assembly in San Antonio, Texas.

The AAE Board of Directors is responsible for the AAE’s policy, strategic, and governance matters. The board includes two representatives from each of the seven districts. Each year, the AAE district caucus nominating committees elect nominees to fill upcoming vacancies on the board. In addition to the directors, the board is comprised of six officers, the executive director, the Journal of Endodontics editor, and the Foundation for Endodontics president.

The following is the slate of nominees that will be voted on at the 2027 General Assembly:

District I

Nominee: Maobin Yang, D.D.S., M.D.S., Ph.D., Philadelphia, PA

Nominating Committee Chair: Garry L. Myers, D.D.S., Midlothian, VA

District III

Nominee: Theodore D. Ravenel, D.M.D., Augusta, GA

Nominating Committee Chair: Luis Camillo Yepes, D.D.S., M.S., Charleston, SC

District IV

Nominee: Kari Brodsky, D.D.S., M.S., M.B.A., West Bloomfield, MI

Nominating Committee Chair: Michael J. Mintz, D.D.S., Dyer, IN

District V

Nominee: Fabricio Teixeira, D.D.S., M.S., Ph.D., Dallas, TX

Nominating Committee Chair: Erin Loggins, D.D.S,, Houston, TX

District VII

Nominee: Shane White, M.S., M.A., Ph.D., Los Angeles, CA

Nominating Committee Chair: Kevin Keating, D.D.S., M.S., Elkgrove, CA

Additional nominations for district director positions may be made in writing to the District Caucus Nominating Committee chairs. Such additional nominations must be made with the approval of the nominee and accompanied by a petition that includes the printed names and signatures of 25 voting members of that district. To be eligible, the nominations must be received by the District Caucus Nominating Committee chair no later than October 15, 2026.

The AAE thanks the following directors who are completing their terms on the Board of Directors in April 2027: Drs. Fiza Singh, District I; Brian Bergeron, District III; Alfred Wiemann, District IV; David W. Clanton, Sr, District V; and Nadia Chugal, District VII.

For more information on this process, please contact Katherine Rouse, assistant director, executive operations, at 800-872-3636 (North America) or 312-872-0472 (International), or email krouse@aae.org.

The Worth Saving Campaign is a year-round endeavor for the AAE, but the traditional start to this public awareness effort has always been Save Your Tooth Month each May. This year was no exception, and thanks to the hard work of our staff, particularly our Marketing and Communications department, our year started off with a great deal of fanfare. On the evening of May 12, the Prudential Center in Chicago was the backdrop for a spectacular lighting display, promoting the start of Save Your Tooth Month. Earlier that day, the entire staff of the AAE gathered in our office to assemble 2,000 dental care kits that were distributed to Chicago school children through our partnership with the Chicago Mobile Dental Care Foundation.

The message about the importance of saving your natural teeth takes many forms through our campaign. Due to the advocacy efforts of several dedicated members, 12 Governors issued proclamations declaring May to be Save Your Tooth Month in their respective states.  I’m proud to say that Minnesota was among the 12. In addition to our kickoff events, an extensive media pitch resulted in over 20 radio and television interviews that were aimed at educating and encouraging the public to seek treatment options that will help them preserve their natural teeth and educating about the advantages of doing so. The month’s media events included two in-studio on-the-air interviews in Chicago and Minneapolis, pushing me way out of my comfort zone. The content of these interviews included information on symptoms of endodontic disease, seeking emergency care, post-trauma treatment, and how an endodontist is the best person to treat these conditions. Emphasis was also given to making sure that patients inquire about treatment options that would help maintain their natural teeth and not just accept a referral for extraction. The journalists involved were genuinely interested in our message.

Our digital footprint is ever expanding as well with webpages and social media devoted to patient/consumer education, addressing and dispelling misinformation, and providing patient resources. The AAE has also engaged in influencer partnerships to help spread our message about the benefits of preserving natural teeth.  A link to the recently released study from King’s College in London regarding the systemic health benefits of endodontic treatment garnered more than 144 million media impressions, introducing the public to science-based evidence that root canal treatment can have a positive effect on one’s whole-body health status.

In addition to the public education resources, there are multiple items available for members to assist you in promoting Save Your Tooth all year long. These include the Whole-Body Benefits webpage, Referral patterns webpage, our new Trauma Guidelines, as well as the Save Your Tooth Month toolkit. Consider sharing these at your local dental society meetings if the opportunity presents itself.

So why are we trying so hard to get our message in front of the public versus the general dental community? Well, those of you old enough to remember our initial public awareness campaign that was directed toward general dentists, you might remember the financial assessment that we all paid to finance that initiative, and you also might remember that it fell completely flat. After the fact, it became apparent that our efforts were misdirected, and we needed to take our message directly to our potential patients, specifically the lay public.

One might think this would seem self-serving since we definitely depend on referrals from our general dentist colleagues, but it was clear that not all general dentists would share the option of seeing an endodontist. Taking our message directly to the patient public has increased the general awareness of endodontists and endodontic treatment, evidenced by our increasing market share of endodontic procedures performed on an annual basis. We are still the only specialty to enjoy this surge in public awareness and demand for specialty care. So I would like to offer thanks on your behalf to Kim, Elisabeth and Rae in our Marketing and Communications department for getting our message out there. So let’s all do our part to propagate that message that teeth are Worth Saving, and that endodontists are just the people to take care of that task.

By Dr. Andrew Chong

Endodontic training prepares us to make difficult decisions, manage risk, and perform at a high level under pressure. It also prepares us to generate income. What it usually does not provide is a clear framework for managing that income once we earn it.

That gap is understandable. Dental school and residency are focused on clinical development, not personal finance, investing, tax strategy, or long-term wealth building. As a result, many clinicians leave training with significant earning potential, but without a clear framework for managing money. They may save aggressively, pay down debt, buy investments recommended by someone else, or simply hope that income alone will solve the problem.

Income helps, but income by itself is not a financial plan.

The first step is not choosing a stock, buying real estate, or deciding whether to hire a financial advisor. The first step is understanding where you stand. Every endodontist should have a personal balance sheet. At its simplest, that means knowing your assets, your liabilities, your income, and your expenses. Net worth is assets minus liabilities. Cash flow is income minus expenses. This sounds basic, but it is often the step that creates the most clarity.

Once you understand where you are, the next step is determining where you want to go. Generic rules of thumb can be helpful, but they should not replace actual planning. Saving 20% of income, buying a house, maximizing retirement accounts, or paying down loans may all be reasonable decisions, but whether they are optimal depends on the individual.

A new graduate with student loans, a practice owner with variable income, a mid-career endodontist with young children, and a late-career clinician approaching retirement may all require different strategies.

The better approach is to think long term and work backward. What do you want your life to look like in 10, 20, or 30 years? Do you want to own a practice? Retire early? Work fewer days? Build generational wealth? Pay for private school or college? Maintain flexibility for family? Once the larger goal is clear, the financial decisions become easier to organize.

Before aggressively investing, there also needs to be a defensive layer. An emergency fund, appropriate insurance, disability coverage, and a system for managing cash flow are not exciting, but they are foundational.

In endodontics, a beautiful obturation does not matter if the diagnosis is wrong or isolation is poor. Personal finance is similar. Investment returns matter, but they matter much less if the foundation is weak.

From there, the focus can shift to investing. A useful starting point is recognizing that there is no universally “best” investment. Stocks, bonds, real estate, mutual funds, ETFs, private investments, and cash all serve different purposes. The better question is not, “What is the best investment?” The better question is, “What tool best fits my goal, time horizon, risk tolerance, liquidity needs, and level of interest?”

Real estate is a good example. It can be an excellent investment vehicle. It offers potential appreciation, cash flow, leverage, tax advantages, and some diversification away from the stock market. However, real estate is often marketed as more passive than it really is. Properties require capital, time, management, maintenance, tenant screening, repairs, financing, and tolerance for unexpected expenses. A rental property may look profitable on paper, but one major repair or vacancy can erase months of cash flow. Real estate can
build wealth, but it is not effortless wealth.

Stocks represent a different type of opportunity. Buying a stock means buying ownership in a business. If that business grows in value and the market eventually recognizes that value, the investor can benefit. Stocks are liquid, accessible, scalable, and can be highly efficient from a time-input-to-dollar-output perspective.

However, that accessibility is also a risk.

Because opening a brokerage account and buying a stock is easy, many people mistake ease of access for ease of success.

Successful investing is not gambling, guessing, or copying a ticker from social media. It requires patience, discipline, objectivity, and the ability to separate price from value. At its core, investing is about estimating what an asset is worth and trying to buy it for less than that value. That sounds simple, but it is difficult in practice because markets are emotional, noisy, and often uncomfortable. Good investments rarely feel obvious in the moment.

For many clinicians, ETFs may be the most practical starting point. An exchange-traded fund allows an investor to buy a diversified basket of assets, often at low cost, with more flexibility than a traditional mutual fund. A broad-market ETF can provide exposure to hundreds of companies in a single purchase. For someone who does not want to analyze individual businesses, this can be an effective, low-maintenance way to participate in
long-term market growth.

Mutual funds can also serve a role, especially for investors who prefer professional management or are investing through certain retirement plans. However, fees, lack of control, tax efficiency, and investment style should be understood before assuming that a mutual fund is the right choice. The same principle applies across all investment products: understand what you own, why you own it, what it costs, and what role it plays in the
broader plan.

One of the biggest challenges for high-income professionals is not knowledge alone. It is behavior.

Endodontists are used to being analytical and detail-oriented, but investing often tests a different skillset. Markets decline. Headlines become alarming. Other people appear to be getting rich faster. Clients, colleagues, and friends may talk about real estate deals, speculative stocks, crypto, private investments, or the next major opportunity. The temptation is to constantly react.

But wealth is usually built through consistency, not constant movement.

In clinical practice, we know that discipline matters. We do not change an irrigation protocol because of one difficult case. We do not abandon working length control because a case becomes frustrating. We rely on principles, systems, and judgment. Investing should be approached the same way. A good financial plan should be durable enough to survive volatility, life changes, market cycles, and emotional decision-making.

The goal is not to become a professional investor unless that is something you truly want to pursue. The goal is to become informed enough to make better decisions, ask better questions, avoid obvious mistakes, and align your money with the life you are trying to build.

For endodontists, the opportunity is significant. We have strong earning potential, specialized clinical skills, and the ability to generate meaningful cash flow over a career. But income must be converted into assets, and assets must be managed with intention.

Financial success does not require perfection. It requires clarity, discipline, and a system.

Know where you stand. Define where you want to go. Protect the foundation. Understand the tools available. Invest with patience and purpose.

That framework may not be flashy, but it works.

Andrew Chong, D.D.S., is an Endodontist with AC Professional Endodontics, LLC, in Honolulu, Hawaii. 

Disclaimer

The views and opinions expressed by authors are solely those of the authors and do not necessarily reflect the official policy or position of the American Association of Endodontists (AAE). Publication of these views does not imply endorsement by the AAE.

By Priscilla L. Carpenter, D.D.S., M.S.

A New View
There’s something special about July in endodontics.

Across the country, clinics are buzzing with excitement as a new class of residents settles in, returning residents take on new responsibilities, and graduating residents begin the next phase of their careers. It’s a month filled with fresh starts, new perspectives, and endless possibilities.

For our incoming first-year residents, welcome! In the coming weeks, you’ll spend countless hours behind the microscope. At first, it may feel unfamiliar, finding your orientation, adjusting your ergonomics, learning to work in a magnified world. But before long, what once seemed overwhelming will become second nature. In many ways, residency itself follows that same path. There will be moments that challenge you, frustrate you, and stretch you beyond what you thought you were capable of. Lean into those moments. Every difficult case, every question you ask, and every lesson you learn is shaping you into the endodontist you set out to become.

To our second-year residents, congratulations on reaching this milestone. Think back to where you were just one year ago. The things that once required your full concentration now come with greater confidence. As you continue to grow clinically, you’ll also become an important resource for your newest co-residents. Never underestimate the impact of a kind word, a helpful tip, or simply reminding someone that they’re not alone in the learning process.

To our residents entering the final year of their two or three-year programs, this is your opportunity to refine your craft and prepare for what’s next. Take advantage of every remaining opportunity to learn from your faculty, challenge yourself with complex cases, and enjoy the unique camaraderie that residency offers.

And to our newest endodontists, congratulations!!! Completing residency is an incredible accomplishment, but graduation isn’t the finish line; it’s the starting point of a lifelong career. As you begin your first months in practice, remember that no one expects you to know everything. Continue asking questions, seek out mentors, stay connected with your classmates, and embrace every opportunity to learn. The transition from resident to practitioner comes with new challenges, but it’s also one of the most rewarding seasons of your career. Trust the training that brought you here, and don’t lose the curiosity that made you successful in residency.

One of my favorite things about our specialty is that we never stop learning. Even after residency, every case teaches us something new. The curiosity, humility, and commitment to excellence you develop now will serve you throughout your career.

As this new academic year begins, I also want to encourage you to join us for APICES 2026 on August 14-15 in St. Louis. APICES is one of the few opportunities each year where residents from across the country come together to learn, collaborate, and build friendships that often last well beyond residency. Whether you’re attending for the first time or returning for another year, I hope you’ll take full advantage of the experience.  The conversations between lectures, the people you meet, and the shared experiences with your fellow residents are just as valuable as the educational program itself.

To our newest residents, welcome to the family. To our returning residents, welcome back.

Wherever you are in your journey, take a moment to appreciate how far you’ve come, embrace the challenges ahead, and remember to enjoy the process.

Here’s to another incredible year of learning, growth, and advancing our specialty. I can’t wait to see many of you in St. Louis.

As Chair of the Resident and New Practitioner Committee, I want The Paper Point, and our committee, to be a resource for you. If there are topics you’d like to see covered in future editions, ideas for educational or networking opportunities, or ways you think the RNPC can better serve residents and new practitioners, I’d love to hear from you. Please don’t hesitate to reach out at PCarpenter.DDS@gmail.com. Your feedback, ideas, and involvement help shape the future of our committee and strengthen our endodontic community.

All the best,
Priscilla L. Carpenter, D.D.S., M.S.
Resident and New Practitioner Committee Chair

If you’re managing student loan debt—or preparing to refinance—recent changes to federal student loan rules could have a significant impact on your repayment strategy. New federal borrowing limits and repayment options are now in effect, making it more important than ever for borrowers to understand how these changes may affect their financial future.

To help borrowers navigate these updates, AAE Advantage Partner SoFi has published a comprehensive guide explaining what’s changed, who is affected and what steps borrowers should consider. The article covers topics such as new borrowing limits for graduate and professional students, changes to federal repayment plans and practical considerations for borrowers evaluating their options.

AAE members are encouraged to read SoFi’s full article, “Student Loans: What to Do as the New Rules Go Live,” for a detailed overview of the changes and guidance on next steps.

As an AAE Advantage Partner, SoFi also offers exclusive student loan refinancing benefits for eligible AAE members. To learn more about available refinancing options and member benefits, visit SoFi.com/AAE.

The 2026 ADEA Annual Session & Exhibition was held March 21–24, 2026, in Montréal, Québec, Canada.

During the Section on Endodontics meeting, attendees discussed several key issues affecting endodontic education, including faculty recruitment and retention, the ongoing shortage of endodontic educators, increased collaboration among programs, and opportunities to strengthen engagement within the academic community. Dr. Steven Katz delivered the AAE Presidential Update, highlighting the association’s strategic initiatives, public awareness efforts, clinical guideline development, research collaborations, and the importance of continued faculty engagement and mentorship. Representing the AAE as its delegate to the ADEA Council of Advanced Education Programs (COAEP), Dr. Ted Ravenel participated in these discussions and helped ensure the specialty remained connected to broader conversations shaping advanced dental education and residency training. Overall, the meeting reinforced many of the priorities currently facing the AAE and provided valuable insight into emerging trends, challenges, and opportunities within endodontic education.

“So what’s in it for me?” All too often, this is the response one receives when asking someone to join their respective professional association. It is human nature to seek value in our expenditures, but when it comes to membership, one must look not only at the tangible benefits, but also at those less visible attributes to fully understand the value of becoming a member. I learned early on from my dad, who is a general dentist, that members of a profession are responsible for its health and well-being, so if we do not care for it, there are others who will step in and take over in an attempt to control our specialty and regulate our activities. The relative autonomy that we enjoy as a specialty, in addition to our favorable image and respect of the public are due in no small part to some intangible benefits of AAE membership – Advocacy and Marketing/Public Relations.

Association membership amplifies our voices in legislative and regulatory arenas, thus allowing us to protect our ability to practice at the high standards that we have set for ourselves. Likewise, our collective message resonates with greater force in the court of public opinion, educating patients about the value of specialty endodontic care and our unique position as the specialists in saving natural teeth. Long-standing members of an association often cite Advocacy as one of the most important benefits of membership, and I would have to agree.

Of course, not all of the benefits of AAE membership exist in the “intangible cloud”. Many are clearly evident, and some we each make use of on a frequent if not daily basis. A subscription to the Journal of Endodontics is included in your membership, and as one of the premier endodontic journals in the world, it serves as a vital source of information regarding advances and research activities in our specialty. Our AAE Annual Meeting is widely recognized as the top Endodontic conference in the world and serves as a vital source of continuing education presentations. The same can be said for our Fall meeting, Insight Track which is devoted to a specific topic of interest to our specialty and presents top speakers to educate our attendees. Most of these presentations are archived on our remote learning platform, Endo on Demand, so if one is unable to attend, the opportunity for learning still exists. Each of these continuing education resources are available to AAE members at substantial discounts relative to the cost for non-members.

Our meetings also serve another important function in that they provide a venue for camaraderie – a place to catch up with old friends and an opportunity to make new connections. Speaking of connections, another benefit that can be used on a daily basis is the AAE Connection, our online interactive platform. Here, you can engage in discussion forums on various topics with other members to learn more about what others are doing in their practices, or even seek some advice on planning your retirement. The list of topics is only limited by one’s imagination, and of course our Code of Conduct. As an additional incentive, AAE Advantage offers discounted products and services such as insurance plans or financial services to our members through our trusted partners program.

I could continue to list the incentives and benefits of AAE membership, but by now I am sure you get the idea. I also realize that if you are reading this, I am likely preaching to the choir, but this provides a good opportunity to remind everyone of just what your AAE membership can do for you, and what it does for our specialty. So be sure to renew your membership promptly to avoid any lapses, and if you know another endodontist who is not yet a member, encourage them to join so they can take advantage of all of the opportunities and be a part of our collective voice. So now, if you are asked: “What’s in it for me?”, you will know exactly what to tell them. Always remember that we are stronger together.

By Omid Dianat, DDS, MS

Artificial intelligence (AI) has integrated into human life faster than almost any prior technology. ChatGPT reached 100 million users in two months, a pace that took the telephone 75 years. The FDA has now cleared more than 1,300 AI-enabled medical devices, and healthcare AI investment is projected to grow from $37 billion to over $600 billion this decade. Endodontics, with its heavy reliance on structured imaging data, sits at the epicenter of this transformation.

Seeing What We Could Not See Before

The most mature endodontic AI application is segmentation: teaching a network to outline anatomical structures on CBCT, voxel by voxel. U-Net architectures trained with micro-CT-derived ground truth can now delineate the tooth, pulp cavity, pulp chamber, and root canals with Dice similarity coefficients up to 96 percent (1). In maxillary premolars, automated pulp cavity segmentation has reached DSC values of 88 to 93 percent while running 75 times faster than manual methods (2).

Root canal morphology, one of the most persistent clinical challenges, is another area where AI is making progress. Deep learning classifiers can now identify C-shaped canals in mandibular second molars with an AUC as high as 0.99 on periapical radiographs (3), a performance that has been externally validated across four datasets from multiple institutions (4). Separately, on panoramic radiographs, ensemble CNN models can predict root number in maxillary premolars with an AUC of 0.94, matching an experienced endodontist (5).

Sharpening Conventional CBCT: The Move Toward Virtual Micro-CT

While CBCT provides essential 3D information, its spatial resolution is often limited by radiation dose and detector constraints. Deep learning “super-resolution” is beginning to close that gap. Recent micro-CT-guided neural networks have demonstrated the ability to enhance standard CBCT slices to reveal accessory canals and isthmuses that are invisible at conventional resolutions (6, 7). This technology suggests a future where we can extract near-micro-CT detail from a standard patient scan.

Diagnostic Performance and Clinical Reality

Periapical lesion detection on 2D radiographs is where most researchers have focused. AI models have reached a plateau of high performance, with pooled sensitivity values between 0.92 and 0.94 (8). In practical terms, current AI models can reliably identify periapical radiolucencies on conventional radiographs, though performance varies with image type and ground truth definitions.

A recent randomized controlled trial put this to a real-world test. Thirty dentists evaluated 50 panoramic radiographs in a crossover design, with and without AI assistance. Overall diagnostic accuracy improved from 91.6% to 93.3% (p < 0.001). Junior clinicians gained the most from this, and AI shifted treatment decisions toward more conservative approaches (9).

Meanwhile, independent evaluation of commercial CBCT platforms reveals a critical nuance: while high sensitivity (93.9%) makes AI an excellent tool for ruling out disease (fewer missed lesions), moderate specificity (65.2%) and performance drops in root-filled teeth introduce the risk of false positives (10). These findings tell us an important point: Current AI tools tend to be stronger at identifying disease on CBCT than at ruling out false positives, and performance varies substantially across clinical contexts. The reason might be simple: AI platforms give back what they have been fed, so if we haven’t trained one AI system to identify internal root resorption, it simply will not!

The Path Forward

Newer training paradigms are expanding what is possible with limited data. Self-supervised learning methods, which learn visual representations from unlabeled images before fine-tuning on a small, labeled set, have achieved 84% accuracy for external cervical resorption detection on periapical radiographs (11). This matters because labeled endodontic datasets are expensive and scarce. Self-supervised methods that reduce our dependence on them will accelerate our progress in the field.

Limitations and Conclusion

The evidence so far is encouraging but incomplete. Most published studies rely on small, single-center datasets, and annotation quality varies widely. AI in endodontic imaging needs more multi-center data collection, more open-source models, and a shift from simply training models toward studies that measure endodontic outcomes using different AI tools.

In conclusion, AI will not replace endodontists; it is a pattern recognition instrument that, when properly validated, can make us faster, more consistent, and more confident. The technology is no longer a prospective matter; it is a fast-paced reality. The question for our specialty is not whether to engage with it, but how to do so responsibly.

References

  1. Lin X, Fu Y, Ren G, et al. Micro-computed tomography-guided artificial intelligence for pulp cavity and tooth segmentation on cone-beam computed tomography. J Endod. 2021;47(12):1933-1941.
  2. Santos-Junior AO, Fontenele RC, Sampaio Neves F, et al. A unique AI-based tool for automated segmentation of pulp cavity structures in maxillary premolars on CBCT. Sci Rep. 2025;15:5509.
  3. Yang S, Lee H, Jang B, et al. Development and validation of a visually explainable deep learning model for classification of C-shaped canals of the mandibular second molars. J Endod. 2022;48(7):914-921.
  4. Yang S, Kim KD, Kise Y, et al. External validation of the effect of combined use of object detection for C-shaped canal classification: a multicenter study. J Endod. 2024;50(5):627-636.
  5. Azgari E, Azgari C, Sazak Ovecoglu H. Deep learning-based detection of root numbers in maxillary premolars. Int Endod J. 2026. doi:10.1111/iej.70091.
  6. Nazari A, Najafi SMY, Abbasi R, et al. Deep learning for dentomaxillofacial CBCT image quality enhancement: a pilot study. Imaging Sci Dent. 2025;55(3):271-279.
  7. Chen P, Shen B, Yang Y, et al. Deep learning super-resolution for dental CBCT using micro-CT reference and edge loss function. J Dent. 2026;164:106209.
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Dear Colleagues,
The Honors and Awards Committee is seeking nominations for AAE awards to be presented at AAE28 in Toronto. As you think back on your career, is there a mentor who played an important role in your success, a researcher whose work shaped the field, an educator who inspired countless students, or an endodontist who has made exceptional contributions to the specialty, the dentistry profession and their community? Consider nominating them for an AAE award!

Nominating candidates who have influenced your practice, your science or your life is a wonderful way to show your appreciation for their contributions.

Please visit aae.org/awards to review the award categories; the list of past award winners; and take a moment to familiarize yourself with the revised award criteria and the updated steps to submit a nomination to the AAE.

All nominations will remain confidential and must be received before September 11, 2026. Nominations remain active for two years. Nominations received last year will remain active for consideration during this cycle and new nominations received will remain active for one additional cycle. Please note that candidates not selected previously may be re-nominated.

Many thanks for your thoughtful consideration. Please nominate here.

Warm regards,

Cindy R. Rauschenberger, DDS, MS
Honors and Awards Committee Chair