Effectiveness of Conservative Endodontic Procedures Compared With Conventional Approaches: A Systematic Review

Abstract

Background: Conservative endodontics emphasizes preservation of healthy dentine, maintenance of pulp vitality where feasible, and biologically appropriate treatment of immature teeth. The relevant approaches include minimally invasive access cavity designs, vital pulp therapy, regenerative endodontic procedures, and selected modifications of conventional root canaltreatment.
Objective: To summarize evidence comparing these conservative approaches with conventional procedures, focusing on treatment success, pulp and periapical healing, postoperative pain, dentine preservation, root development, complications, and tooth survival.
 Methods: The supplied PRISMA 2020 flow diagram reports records identified from PubMed, Embase, the Cochrane Library, and Web of Science, with additional records from reference lists and grey literature. After duplicate removal and screening, 30 records were included in the evidence map across four domains: access cavity design, vital pulp therapy, regenerative endodontics versus apexification, and single- versus multiple-visit root canal treatment. Search dates, complete strategies, and study-level verification should be confirmed against the original search records before submission.

Results: The supplied flow diagram reports 1,304 records identified, 202 duplicates removed, 1,102 records screened, 908 records excluded, 194 full-text reports assessed, 164 full-text reports excluded, and 30 studies included. Conservative procedures may provide important benefits in appropriately selected cases, but their evidence and objectives differ by clinical domain. Minimally invasive access designs may preserve dentine, although long-term clinical superiority is not established. Vital pulp therapy may maintain pulp vitality in selected mature teeth when diagnosis, asepsis, haemostasis, biomaterial choice, and coronal sealing are adequate. Regenerative endodontic procedures may permit continued root development in selected immature permanent teeth. A Cochrane review of 47 studies and 5,693 analyzed teeth found no clear difference in radiographic failure between single- and multiple-visit treatment (RR 0.93; 95% CI 0.81–1.07), while pain during the first week was more frequent after single-visit treatment (RR 1.55; 95% CI 1.14–2.09).
 Conclusion: Conservative endodontics is an individualized treatment philosophy rather than a universally superior alternative to conventional care. The PRISMA counts in this manuscript must be retained only if they can be reconciled with the original screening log and full-text decisions. Treatment selection should reflect diagnosis, tooth maturity, anatomy, infection status, restorability, and patient preferences. This article is a structured narrative synthesis and should not be interpreted as a newly conducted systematic review.