Abstract
Background: Endodontic treatment varies in complexity, and accurate assessment of case difficulty is essential for clinical success, guiding referrals, and enhancing patient safety, particularly amongst general dental practitioners (GDPs).
Objective: This scoping review aimed to identify and appraise the available tools and indices developed to assess endodontic case difficulty.
Methods: The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of seven databases (PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar) was conducted for studies published between January 2000 and July 2025. Articles were included if they described, developed, evaluated, or validated tools specifically assessing endodontic case difficulty or complexity. Data were extracted and synthesised thematically to summarise tool characteristics, components, scoring systems, and validation methods.
Results: Out of 1134 initial records, 15 studies met the inclusion criteria. These studies were published between 2001 and 2025 across multiple countries. They evaluated various endodontic case difficulty assessment tools, including the American Association of Endodontists Case Difficulty Assessment (AAECDA) form, Endodontic Case Assessment Form (ECAF), Endodontic Complexity Assessment Tool (E-CAT), EndoApp, and Dutch Endodontic Treatment Index (DETI). Most studies identified tools designed for non-surgical root canal treatment; however, one specifically considered endodontic microsurgery. The tools varied in structure, scoring logic, and validation rigour. While most tools shared common domains, such as patient, tooth, and treatment-related factors, reliability assessments showed considerable variation in inter- and intra-rater agreement.
Conclusion: Endodontic difficulty assessment tools are diverse and evolving, supporting clinical decision-making and educational development. Continually refining the tools, conducting psychometric validation, and ensuring global applicability will help to enhance their utility across various settings and user groups.