Abstract: Modern endodontics in India is experiencing a significant transformation with the integration of advanced technologies, minimally invasive techniques, and evidence-based clinical practices. This narrative review explores key innovations such as rotary and reciprocating systems, dental operating microscopes, cone-beam computed tomography (CBCT), regenerative endodontics, and bio-ceramic sealers. Despite these advancements, stark disparities persist between urban and rural regions due to financial constraints, limited training opportunities, and infrastructural deficiencies. The review further discusses systemic challenges, including patient misconceptions and gaps in continuing education. It also outlines promising future directions, including AI-assisted diagnostics, minimally invasive approaches, and tele-dentistry. The review underscores the need for strategic policy reforms, equitable resource allocation, and nationwide training initiatives to bridge the accessibility gap and elevate the standard of endodontic care across India.