Objective: Accurate knowledge of apical morphology is crucial for determining the correct working length and achieving an optimal seal, both of which are vital for long-term endodontic success. This review summarizes and evaluates the current literature on the physiological foramen, focusing on its diameter and the distance between the anatomical apex and the physiological foramen. Materials and Methods: A systematic literature search was conducted using the databases PubMed (via Medline), Embase, LILACS, and Scopus. Studies addressing the anatomy of the physiological foramen were selected based on predefined inclusion criteria. A total of 743 records were identified. After removing 103 duplicates, the titles and abstract of 640 records were screened, with 625 being excluded as irrelevant. Fifteen full texts were assessed and six excluded for not meeting inclusion criteria. Five additional articles were found through manual search. In total, 14 studies were included in the review. The risk of bias was assessed using the AQUA tool. Results: Considerable variation in the diameter of the physiological foramen was observed across the included studies, ranging from 0.15 mm to 0.43 mm depending on tooth type and location. Additionally, the distance between the anatomical apex and the physiological foramen varied from 0.1 mm to 1.2 mm. Conclusions: The results demonstrate considerable heterogeneity in the dimensions and position of the physiological foramen, with oval shapes occurring more frequently than round or irregular ones. Standardized definitions and consistent terminology are essential to improve comparability across studies and to enhance the clinical applicability of research findings. Recognizing these anatomical variations optimizes endodontic treatment outcomes and minimizes procedural errors.

The meta-analysis systematically summarized evidence on how socioeconomic status (SES), access to dental care, and oral health programs (OHP) affect caries prevalence and severity among children and adults in Europe. Four electronic databases (PubMed, Scopus, Cochrane Library and Embase) were systematically screened from 1947-2026, supplemented by cross-referencing and manual searches, without language restrictions. Study selection, data extraction and quality assessment were done in duplicate. Methodological quality was assessed using the NHLBI Study Quality Assessment Tools according to study design. Certainty of evidence was graded using GRADE Profiler 3.6. Mean differences (MD) were calculated for changes in DMFT, and odds ratios (OR) for the presence of dental caries in individuals using fixed-or random-effects models. Electronic searching identified 1800 articles; 23 studies were included in the review (>169,000 participants) and 14 in the meta-analyses (>88,000). Nine studies evaluated the effectiveness of OHP stratified by SES, and ten examined OHP in low-SES populations. Among low-SES individuals, participation in OHP was associated with a significantly lower increase in DMFT (MD[95% CI]=-0.63[-0.94;-0.31];very low certainty) and significantly lower odds of having dental caries (OR[95% CI]=0.61[0.52;0.73];very low) compared with non-participation. Among program participants, individuals with low SES showed a significantly greater increase in DMFT than those with high SES (MD[95% CI]=0.79[0.30;1.21];very low) and had significantly higher odds of having dental caries (OR[95% CI]= 2.88[1.97;4.22];very low). Participation in OHP may be associated with reducing dental caries in European populations, but benefits are unequally distributed and increase with higher SES. However, this conclusion is based on a limited number of well-conducted trials.