Personalized irrigation protocols based on microbiome sequencing of infected root canals

Abstract

Root canal infections are complex microbial ecosystems characterized by diverse bacterial communities organized within biofilms, making complete disinfection a major challenge in endodontic therapy. Conventional irrigation protocols typically apply standardized approaches without considering individual variations in microbial composition, potentially contributing to persistent infections and treatment failures. Personalized irrigation protocols based on microbiome sequencing represent an emerging precision dentistry strategy that enables identification of patient-specific microbial profiles and optimization of antimicrobial interventions. Next-generation sequencing technologies provide detailed information regarding bacterial diversity, abundance, ecological interactions, and resistance-associated patterns within infected root canals. This information can guide the selection of irrigants, activation techniques, treatment duration, and disinfection intensity according to the specific microbial characteristics of each case. Integration of microbiome analysis with advanced irrigation technologies, artificial intelligence, and digital diagnostics may enhance microbial elimination while preserving periapical tissue health. Although clinical implementation remains limited due to cost, accessibility, and workflow challenges, microbiome-guided irrigation has significant potential to improve predictability, reduce persistent infections, and advance individualized endodontic care. Future developments in rapid chairside microbial analysis may facilitate real-time personalized treatment planning and establish a new paradigm in precision-based root canal therapy.