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Tooth preservation through nonsurgical root canal treatment is therefore a risk reduction strategy. However, evidence relevant to endodontic decision\u2010making remains dispersed among clinical series, laboratory research, pulp testing studies and oncology dental guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To synthesise contemporary evidence relevant to endodontic management before, during and after head and neck radiotherapy, and to present a clinically applicable, dose\u2010informed framework for diagnosis, treatment planning, technical modification and follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative review with integrative synthesis was undertaken using evidence from clinical outcome studies, dosimetric and planning studies, pulp sensibility and vascular assessment studies, laboratory investigations of irradiated dental tissues and materials and guideline\u2010based oncology dental literature. Evidence was organised by radiotherapy phase as before treatment, during treatment, early after radiotherapy and late after radiotherapy, and interpreted using three tooth\u2010level dose tiers: below 30 Gray, 30\u201360 Gray and at least 60 Gray.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Radiotherapy depresses neural sensibility responses, yielding false\u2010negative cold and electric pulp testing results that do not reliably indicate pulp necrosis. Vascular\u2010oriented assessments suggest that pulpal blood flow may be partly preserved or recover later in some teeth. Hyposalivation and radiation\u2010related caries accelerate structural breakdown and often trigger pulpal disease through restorative destabilisation. Laboratory evidence indicates dose\u2010dependent alterations in dentine structure and mechanics that may complicate adhesion, fracture resistance and retreatment. Direct clinical outcome data remain limited, yet available series in irradiated patients report symptom control and tooth retention after primary root canal treatment, with no osteoradionecrosis events attributed to nonsurgical endodontics. Technical priorities include conservative working length control, minimisation of apical extrusion of debris, irrigants, intracanal medicaments, filling materials and rapid establishment of a durable coronal seal. Evidence gaps include prospective dose\u2010annotated cohorts, retreatment\u2010specific data and outcome reporting in proton\u2010based radiotherapy populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Endodontic care before, during and after radiotherapy should be dose\u2010informed, phase\u2010matched and centred on tooth preservation in high\u2010dose regions, with cautious interpretation of sensibility testing and explicit linkage of prognosis to restorability and coronal integrity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70193","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T09:16:03Z","timestamp":1780650963000},"page":"2046-2070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Endodontic Management Before, During and After Head and Neck Radiotherapy: Biological, Diagnostic and Clinical Considerations in Head and Neck Cancer Patients"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9367-9082","authenticated-orcid":false,"given":"Jing\u2010zhi","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Stomatology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"},{"name":"School of Stomatology Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin","family":"Tay","sequence":"additional","affiliation":[{"name":"The Graduate School Augusta University  Augusta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_17_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2019.1643037"},{"key":"e_1_2_17_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13678"},{"key":"e_1_2_17_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/sej.sej_136_20"},{"key":"e_1_2_17_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u20100707.92616"},{"key":"e_1_2_17_6_1","unstructured":"American Dental Association.2022.\u201cCancer Therapies and Dental Considerations.\u201dhttps:\/\/www.ada.org\/resources\/ada\u2010library\/oral\u2010health\u2010topics\/cancer\u2010therapies\u2010and\u2010dental\u2010considerations."},{"key":"e_1_2_17_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/1678\u20107757\u20102022\u20100329"},{"key":"e_1_2_17_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.70096"},{"key":"e_1_2_17_9_1","volume-title":"StatPearls [Internet]","author":"Arya L.","year":"2023"},{"key":"e_1_2_17_10_1","doi-asserted-by":"publisher","DOI":"10.1922\/EJPRD_2297Aydin05"},{"key":"e_1_2_17_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066\u2010021\u201001896\u2010w"},{"key":"e_1_2_17_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12032\u2010025\u201002998\u20106"},{"key":"e_1_2_17_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748241255845"},{"key":"e_1_2_17_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2017.09.011"},{"key":"e_1_2_17_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.11.021"},{"key":"e_1_2_17_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/23800844221086563"},{"key":"e_1_2_17_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cden.2007.10.003"},{"key":"e_1_2_17_18_1","doi-asserted-by":"publisher","DOI":"10.1102\/1470\u20107330.2004.0054"},{"key":"e_1_2_17_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109847"},{"key":"e_1_2_17_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2025.101352"},{"key":"e_1_2_17_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2019.12.005"},{"key":"e_1_2_17_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41368\u2010024\u201000320\u20100"},{"key":"e_1_2_17_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ors.12939"},{"key":"e_1_2_17_24_1","doi-asserted-by":"publisher","DOI":"10.33448\/rsd\u2010v10i7.16127"},{"key":"e_1_2_17_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010025\u201010192\u20107"},{"key":"e_1_2_17_26_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975\u20105950.154812"},{"key":"e_1_2_17_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dental.2022.04.014"},{"key":"e_1_2_17_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33100"},{"key":"e_1_2_17_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2025.07.009"},{"key":"e_1_2_17_30_1","unstructured":"Faculty of Dental Surgery Royal College of Surgeons of England.2025.\u201cThe Oral & Dental Management of Patients Before During and After Cancer Therapy. 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