Iranian Endodontic Journal

Abstract

Introduction: CRISPR-Cas9 gene-editing technology has revolutionized biomedical research, offering precise genomic manipulation. However, its translation into endodontics- specifically for biofilm disinfection and pulp-dentin regeneration- remains a subject of intense investigation and debate. Materials and Methods: A narrative review was conducted based on the electronic search of PubMed, Scopus, and Google Scholar from the year of (2000 to 2026) to identify studies investigating CRISPR-Cas9 applications in endodontic pathogens and dental pulp stem cells. Discussion: The review synthesizes current evidence on three frontiers: 1) Antimicrobial Precision, where CRISPR antimicrobials target resistance genes in Enterococcus faecalis biofilms; 2) Regenerative Endodontics, highlighting the engineering of stem cells to survive hypoxic, necrotic root canal environments; and 3) Host Modulation, utilizing gene editing to dampen periapical inflammation. Crucially, the review critically appraises the significant barriers to clinical adoption, including the lack of efficient intra-canal delivery systems, immunogenicity risks, and stringent regulatory hurdles for non-lethal dental conditions. Conclusion: While CRISPR-Cas9 holds transformative potential for personalized endodontics and tissue engineering, it remains a high-cost research tool at present. Clinical viability depends on the development of safe, non-viral delivery vectors and the establishment of regulatory pathways for localized dental gene therapies.