Teledentistry in pre-pandemic and post-pandemic dental care: adoption, clinical evidence and unresolved limits

Teledentistry expanded abruptly when the COVID-19 pandemic suspended face-to-face dental care, but the durability of that expansion and the evidence supporting routine use remain uncertain. This narrative review synthesized the adoption, the clinical evidence and the unresolved limits of teledentistry after the pandemic through four contrasts: the pre-pandemic, pandemic and post-pandemic periods; remote versus in-person examination; synchronous versus asynchronous modalities; and high-income versus low- and middle-income settings. PubMed, OpenAlex and Crossref were searched for literature published between 2015 and 2023, and the material was organized into five thematic axes under the SANRA framework. Interest in teledentistry increased about fivefold during the pandemic and publication volume surged after 2020, yet reported practice remained below stated awareness and post-pandemic persistence depended on policy and reimbursement. For screening and triage, remote assessment approached in-person performance, with sensitivity of 80-88% and specificity of 73-95% in the most comprehensive synthesis and high accuracy for oral lesion detection, but it was less reliable for lesion staging and for conditions requiring palpation or radiographs. Asynchronous capture dominated screening while synchronous video supported real-time decisions, and remote orthodontic monitoring improved plaque control in prospective studies. Adoption lagged in low- and middle-income settings, constrained by infrastructure, cost and connectivity, and regulation, privacy and equity remain unresolved. Teledentistry persisted beyond the acute pandemic as a triage and monitoring tool, complementary to rather than a substitute for in-person examination.