Publications by authors named "Masoud Parirokh"

74 Publications

Evaluating the Effect of Oblique Ridge Conservation on Stress Distribution in an Endodontically Treated Maxillary First Molar: A Finite Element Study.

J Endod 2021 Mar 23;47(3):500-508. Epub 2020 Dec 23.

Operative Department, Shahed Dental School, Shahed University, Tehran, Iran. Electronic address:

Introduction: Although the maxillary first molar (MFM) has been frequently subjected to stress analysis in endodontic investigations, the available data about the effect of its oblique ridge are quite sparse. The aim of this study includes evaluating the effect of the residual oblique ridge on the stress distribution after preparing conservative access cavities.

Methods: Based on the cone-beam computed tomographic data, the model of an intact MFM and 5 cavity designs were prepared for endodontic treatment, which were consequently filled with gutta-percha and dental resin composite (6 total models). All models were subjected to 4 types of occlusal loading; finite element analysis via ABAQUS CAE software (Dassault Systemes, Vélizy-Villacoublay, France) was accomplished, whereas other software programs such as (Mimics Research Materialise, Leuven, Belgium) and 3-Matic Research (Materialise) were also incorporated in different stages for detecting stress distribution.

Results: The stress distribution on the MFM is not only dependent on the remaining width of the oblique ridge but also on the type of loading. The most stress on the cervical region was concentrated on the palatal root in some type of loading, whereas the least stress on the occlusal surface was recorded when the whole oblique ridge was replaced by the composite resin.

Conclusions: When the occlusal contacts are occurring only on the palatal cusp, the stress distribution on the oblique ridge is noticeably affected by the cavity design.
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http://dx.doi.org/10.1016/j.joen.2020.12.010DOI Listing
March 2021

The Knowledge and Attitude of Diabetic Patients Regarding Oral and Dental Disorders in Kerman Diabetes Clinics.

J Dent (Shiraz) 2020 Sep;21(3):195-201

Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Statement Of The Problem: Diabetes mellitus is one of the most common endocrine disorders. This disease has devastating effects on many organs and tissues of the body including oral and dental tissues.

Purpose: The aim of this study was to evaluate the knowledge and attitude of diabetic patients about dental and oral diseases.

Materials And Method: In this cross-sectional study, 433 diabetic patients who referred to Kerman Diabetes Clinics were included. Data were collected using a questionnaire consisted of three parts of demographic characteristics, knowledge of oral and systemic complications of diabetes mellitus, and patients' attitude regarding their oral health. Data were analyzed using SPSS version 21 and employing t-test and multiple linear regression analysis. Statistically significant values were considered at ≤ 0.05.

Results: The mean scores for the knowledge of systemic and oral complications were 0.80±0.21 and 0.39±0.23, respectively. The mean total knowledge of diabetic patients was 0.53±0.18, and the mean score for the patients' attitude was 0.63±0.11. It was revealed that people with a family history of diabetes did not have significantly greater overall knowledge (= 0.082). Also, people with longer disease duration (= 0.004) and female patients (= 0.05) had significantly a better knowledge and attitude in terms of oral health.

Conclusion: The knowledge and attitude of patients regarding their oral and dental health and diseases were at moderate level, which should be promoted by constant planning and education according to the current needs of society.
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http://dx.doi.org/10.30476/DENTJODS.2020.77878.0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519939PMC
September 2020

Histological Evaluation of Human Pulp Response to Direct Pulp Capping with MTA, CEM Cement, and Biodentine.

J Dent (Shiraz) 2020 Sep;21(3):177-183

Dept. of Operative Dentistry, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran.

Statement Of The Problem: Direct pulp capping (DPC) is an established method in which the exposed pulp is coated with a suitable material to prevent further damage and to help its repair and healing. Different proposed materials may have different impact on pulp response during this treatment.

Purpose: The purpose of this study was to compare the response of human dental pulp after DPC with calcium-enriched mixture (CEM), mineral trioxide aggregate (MTA) cement, and Biodentine.

Materials And Method: In this clinical trial study, class V cavities were prepared on the buccal surfaces of 30 human premolar teeth, until the pulps were mechanically exposed. Then, teeth were randomly pulp capped with MTA, CEM cement and Biodentine, followed by resin modified glass ionomer filling. The fourth group was the control group (n= 10), in which the teeth were extracted without any prior intervention. Six weeks after the intervention, the teeth were extracted and prepared for histological evaluation in terms of the type and degree of pulp inflammation, dentin bridge formation and the presence of necrosis. Data were analyzed using Kruskal-Wallis and Mann Whitney U tests.

Results: In all groups, necrosis was not observed and inflammation was chronic. The Biodentine group exhibited significantly more pulpal inflammation compared with the other groups (= 0.001). There were no significant differences among CEM cement, MTA and Biodentine in terms of the dentine bridge formation. The thickness of the dentin bridge formed in the Biodentine group was significantly higher than MTA and control group (= 0.035 and = 0.011, respectively).

Conclusion: Although the dentin bridge formation and the thickness of dentin bridge formed in the Biodentine group were higher than the other groups, pulp showed greater inflammation compared to CEM cement and MTA. The results of this study suggested that MTA and CEM cement performed better when employed as the direct pulp capping material.
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http://dx.doi.org/10.30476/DENTJODS.2019.81796.0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519940PMC
September 2020

Comparison of Pulp Sensibility Tests Responses in Type 2 Diabetes Patients and Healthy Individuals.

J Endod 2020 Mar 17;46(3):364-369. Epub 2020 Jan 17.

School of Dentistry, University of Western Australia, Perth, Australia.

Introduction: Diabetes is a common disease that may have some influence on sensory nerves. The aim of this study was to evaluate dental pulp responses to 2 pulp sensibility tests (ie, cold and electric) in patients with type 2 diabetes compared with healthy individuals.

Methods: Three hundred twenty-two premolar teeth in 51 patients who had type 2 diabetes and 347 premolar teeth in 53 individuals with no medical conditions were investigated. The patients with type 2 diabetes were unified and had fasting plasma glucose <300, hemoglobin A1C <10, less than a 10-year history of diabetes mellitus, and no history of hypertension. Electric and cold pulp sensibility tests were performed for all teeth. The cold test results were recorded by the Heft-Parker visual analog scale, and the electric pulp test results were recorded based on the pulp tester's grade that evoked a response.

Results: There was no statistically significant difference between upper and lower premolar teeth in healthy individuals compared with the patients with diabetes in response to the cold and electric pulp tests (P > .05). In the patients with diabetes, the response of their upper premolars to the cold test was significantly reduced in diabetic patients >45 years of age (β = -1.15, P = .013). However, there was no significant correlation between the cold test and age in the lower premolars of both diabetic and nondiabetic participants (P > .05). There was also no significant correlation between the need for a higher number of the electric pulp test current to evoke a response in maxillary and mandibular premolars of the patients with diabetes and nondiabetic participants with age (P > .05).

Conclusions: There was a significant correlation between the reduction of maxillary premolar teeth responses to the cold test in diabetes patients >45 years of age.
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http://dx.doi.org/10.1016/j.joen.2019.11.016DOI Listing
March 2020

Efficacy of Pre-Medication with Ibuprofen on Post-Operative Pain after Pulpotomy in Primary Molars.

Iran Endod J 2018 ;13(2):216-220

Department of Pediatric Dentistry, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Pain management following dental procedures, particularly pulpotomies and extraction, is of great importance in pediatric dentistry. The aim of this study was to investigate the efficacy of pre-treatment with ibuprofen on post-operative pain following pulpotomy of primary molars.

Methods And Materials: In a split mouth double-blinded randomized clinical trial, 49 children aging between 6-10 years old were given either ibuprofen or a placebo 45 min prior to the treatment. After pulpotomy and placement of a stainless steel crown (SSC), the pain level was evaluated using the Wong-Baker face visual analogue scale for up to 7 days post-treatment. McNemar and Wilcoxon tests were used for data analysis.

Results: Forty-five patients were eligible to participate in this study. Pre-medication with ibuprofen significantly reduced pain during the first 24 h post-treatment (=0.032). However, there was no significant difference in the pain levels between placebo and ibuprofen groups at 48 and 72 h post-treatment (=0.154 and =0.197, respectively). The number of times patients needed analgesics in ibuprofen group was significantly lower compared to that in the placebo group (=0.008).

Conclusion: Pre-medication with ibuprofen resulted in less pain following pulpotomy and SSC placement in primary teeth.
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http://dx.doi.org/10.22037/iej.v13i2.16624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911297PMC
January 2018

Comparison of Postoperative Pain Following One-Visit and Two-Visit Vital Pulpectomy in Primary Teeth: A Single-Blind Randomized Clinical Trial.

Iran Endod J 2018 ;13(1):13-19

Dental Research Center, Department of Pediatric Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran.

Introduction: The aim of this study was to compare post-operative pain following one-visit pulpectomy and placing stainless steel crown (SSC), with two-visit treatment (performing pulpectomy at the first visit followed by placing SSC at the next visit one week later) in vital pulp of primary molars with carious involvement.

Methods And Materials: In this randomized clinical trial, 100 children aged 6-12 years with a carious primary molar tooth in need of pulpectomy were randomly divided into two groups of 50 each. In one-visit group, pulpectomy and placement of SSC were carried out at the same appointment. In two-visit group, pulpectomy of root canals was carried out at the first visit and placement of SSC was performed at the second visit one week after the first appointment. Post-operative pain was recorded using visual analogue scale (VAS) during one week after each treatment visit.

Results: No significant difference was found in the mean age and gender distribution between the two groups (˃0.05 for both comparisons). Findings revealed that in the two-visit (pulpectomy) group during first three days and 4-7 days after the first treatment appointment, pain felt by the children was significantly lower than that felt by the one-visit group at the same time period (˂0.0001 for both comparisons). Moreover, children in two-visit (pulpectomy) group consumed significantly lower amount of analgesics than those in the one-visit group (<0.0001).

Conclusion: No significant difference was found between pain felt by children during the first three days following one-visit pulpectomy and placement of SSC at the same appointment. Therefore, one-visit treatment of vital primary tooth is recommended.
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http://dx.doi.org/10.22037/iej.v13i1.18205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800435PMC
January 2018

Successful Ultra-Conservative Management of a Mandibular Premolar with Dens Invaginatus.

Iran Endod J 2017 ;12(3):390-395

Endodontic Department, Dental School, Kerman University of Medical Sciences, Kerman, Iran.

Dens invaginatus is one of the most common anomalies of tooth structure. It is caused by the invagination of the crown surface during odontogenesis that enters the pulp chamber of the affected tooth. Depending on the complexity of invagination, the tooth might present with pulp necrosis, open apex and a complicated root canal system. This case report presents an Oehlers' type 2 dens-invaginatus in a mandibular premolar with chronic apical abscess. In most cases, dens invaginatus is removed during treatment. However, in this case report, based on cone-beam computed tomography (CBCT) evaluation, non-surgical treatment and maintenance of the invaginated segment was chosen in order to prevent compromising the tooth structure and its susceptibility to future root fracture. This is a new treatment approach and has not been performed in previous reports. Calcium-enriched mixture (CEM) cement was used as an apical plug followed by gutta-percha in warm vertical compaction for root canal obturation. The case was followed up for 36 months after treatment. This report highlights the importance of selecting the appropriate treatment approach based on CBCT evaluation.
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http://dx.doi.org/10.22037/iej.v12i3.16559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527221PMC
January 2017

Treatment of a Maxillary Second Molar with One Buccal and Two Palatal Roots Confirmed with Cone-Beam Computed Tomography.

Iran Endod J 2017 ;12(3):371-375

Endodontic Department, Dental School, Kerman University of Medical Sciences, Kerman, Iran.

Root canal configuration is an important subject in endodontic practice and dentists should be familiar with all possible types of root canal configuration. A forty-three year old male was referred for root canal treatment of his maxillary left second molar tooth with symptomatic irreversible pulpitis. Pre-operative radiographs showed a three rooted molar. However, after access cavity preparation two palatal and one buccal orifices were detected. The patient was informed of the unusual root canal anatomy and cone-beam computed tomography (CBCT) was ordered for precise evaluation of the anatomy. CBCT image confirmed the presence of one buccal and two palatal root canals; an exceptionally rare condition.
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http://dx.doi.org/10.22037/iej.v12i3.16331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527217PMC
January 2017

Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review.

Iran Endod J 2017 ;12(2):123-130

Dental School, University of Western Australia, Perth, Australia.

Introduction: Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment.

Methods And Materials: Scopus, MEDLINE and CENTRAL databases were searched up to 30 January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers.

Results: Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis.

Conclusion: Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed
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http://dx.doi.org/10.22037/iej.2017.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421265PMC
January 2017

The most painful site of maxillary anterior infiltrations.

Dent Res J (Isfahan) 2016 Nov-Dec;13(6):539-543

Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran.

Background: The purpose of this study was to determine the most painful site of infiltration injection in the anterior part of maxilla.

Materials And Methods: This single-blinded clinical trial was conducted on thirty healthy volunteers. The participants received three maxillary infiltrations injected at the region of central and lateral incisors as well as canines at three separated appointments with a 2-week interval. The outcome variable was pain that measured immediately after needle insertion (time = 0) and during injection of anesthetic solution in 5, 30, and 55 s by a visual analog scale. Data were analyzed by SPSS software version 16 using Friedman test.

Results: There was no statistically significant difference in terms of needle insertion pain and during injection (time = 0, 5, 30, and 55 s) ( = 0.319, = 0.849, = 0.627, and = 0.939, respectively) in the three injection sites.

Conclusion: The pain intensity of infiltration was not associated with injection sites in the anterior maxilla.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256019PMC
http://dx.doi.org/10.4103/1735-3327.197030DOI Listing
February 2017

Postoperative Pain following Pulpotomy of Primary Molars with Two Biomaterials: A Randomized Split Mouth Clinical Trial.

Iran Endod J 2017 ;12(1):10-14

Department of Pediatric Dentistry, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: The aim of this randomized clinical trial split-mouth study was to compare the postoperative pain following use of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement as pulpotomy agents in carious primary molars.

Methods And Materials: Forty-seven children aged between 6-10 years old were enrolled in this study. Each child had two cariously involved primary molar in need of pulpotomy. After caries removal and preparing access cavity in one of the carious teeth, either MTA or CEM cement was randomly used as the pulpotomy agent, while the other cariously involved primary molar tooth was capped with the other material in a separate visit. After covering the radicular pulp with one of the capping materials the teeth were permanently restored with stainless steel crown (SSC). Postoperative pain was recorded by using Wong-Baker faces pain rating scale (Wong-Baker FPRS) up to seven days following the treatment. Data was analyzed using the Wilcoxon, McNemar, and chi square tests.

Results: Forty-five patients fulfilled the treatment procedure and returned the Wong-Baker FPRS forms. Overall 65.6% of the patients reported pain irrespective of the pulpotomy agents used. There was no significant difference in postoperative pain between the teeth that received either MTA or CEM cement as pulpotomy agents in the first, second and the third day (=0.805, =0.942, =0.705, respectively) following the procedure. The trend of the pain scores showed decreasing manner during the study period for the teeth in either groups of MTA or CEM cement. There was no significant difference between the two groups in the number of analgesics used following the treatment (>0.05).

Conclusion: The findings of the present study showed that a majority of the children felt pain following pulpotomy and SSC placement; however, there was no significant difference in pain reported when either MTA or CEM cement was used as pulpotomy agents.
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http://dx.doi.org/10.22037/iej.2017.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282371PMC
January 2017

The Effect of Mineral Trioxide Aggregate Mixed with Chlorhexidine as Direct Pulp Capping Agent in Dogs Teeth: A Histologic Study.

Iran Endod J 2016 ;11(4):320-324

Endodontic Department, Shahid Beheshti Dental School, Tehran, Iran.

Introduction: The aim of the present investigation was to compare the efficacy of mineral trioxide aggregate (MTA) and 0.2% chlorhexidine (CHX) mixture to pure MTA, as a pulp capping material.

Methods And Materials: The pulp of 24 lateral incisors and canines from four dogs were exposed and capped either with MTA or MTA+0.2% CHX. After 2 months the animals were sacrificed and the teeth were prepared for histological evaluation in terms of calcified bridge formation, the degree of inflammation and presence of necrosis. The Fisher's exact test was used for data analysis.

Results: The results showed that formation of complete calcified bridge in MTA specimens was significantly more than MTA+CHX (<0.05). No significant difference was found in the degree of inflammation and necrosis between MTA and MTA+CHX groups (>0.05).

Conclusion: Mixing MTA with CHX as pulp capping agent had a significant negative impact on formation of calcified bridge on directly capped dog's teeth.
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http://dx.doi.org/10.22037/iej.2016.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069910PMC
January 2016

The Effect of Maxillary First Molar Root Length on the Success Rate of Buccal Infiltration Anesthesia.

J Endod 2016 Oct 10;42(10):1462-6. Epub 2016 Aug 10.

School of Dentistry, University of Western Australia, Perth, Australia.

Introduction: Several variables may influence anesthesia success in maxillary molars. This investigation was conducted to evaluate the effect of root length on the success rate of infiltration injections of 2% lidocaine with 1:80,000 epinephrine.

Methods: One hundred maxillary first molars with irreversible pulpitis were treated. After the administration of a buccal infiltration injection of 2% lidocaine with 1:80,000 epinephrine, the patients' pain during dentin cutting, pulp exposure, and root canal instrumentation were evaluated using the Heft-Parker visual analog scale. No or mild pain was considered as success. Data were analyzed by the point-biserial correlation test and receiver operating characteristic curve analysis.

Results: Overall, 61% of the teeth had successful anesthesia after the administration of a single buccal infiltration injection of anesthetic solution. The point-biserial correlation test showed that the teeth that had palatal and distobuccal roots with longer root lengths showed significantly higher anesthesia failure (P < .05). However, receiver operating characteristic curve analysis did not show a clinically useful cutoff point of root length corresponding with anesthesia failure.

Conclusions: Maxillary first molars having irreversible pulpitis with longer roots may have more anesthesia failures after a single buccal infiltration injection with 2% lidocaine and 1:80000 epinephrine.
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http://dx.doi.org/10.1016/j.joen.2016.07.005DOI Listing
October 2016

Conservative Management of Unset Mineral Trioxide Aggregate Root-End Filling: A Case Report.

Iran Endod J 2016 1;11(3):241-5. Epub 2016 May 1.

Private Practice, Kerman, Iran.

This case report presents conservative management of unset mineral trioxide aggregate (MTA) after being placed as a root-end filling material following periapical surgery. Periapical surgery was indicated for a maxillary lateral incisor of a 15-year-old male due to persistent exudate and a large periapical lesion. During surgery Angelus MTA was placed as root-end filling. The next session it was noticed that MTA had failed to completely set. In an orthograde approach, calcium-enriched mixture (CEM) cement was used to obturate the root canal space. The patient was followed up for 27 months and did not exhibit any clinical signs and symptoms. Radiographic images showed complete healing of the lesion.
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http://dx.doi.org/10.7508/iej.2016.03.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947853PMC
July 2016

Indexing of Iranian Publications in Well-known Endodontic Textbooks: A Scientometric Analysis.

Iran Endod J 2016 1;11(3):157-63. Epub 2016 May 1.

Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Quoting an article in well-known textbooks is held as a credit for that paper. The numbers of Iranian publications mentioned in endodontic textbooks have increased during recent years. The aim of this investigation was to evaluate the number of Iranian articles quoted in eminent endodontic textbooks.

Methods And Materials: Three known textbooks (Ingle's Endodontics, Seltzer and Bender's Dental Pulp and Cohen's Pathways of the Pulp) were chosen and all the editions of the textbooks since 2000 were investigated for quoted Iranian publications. Only Iranian authors with affiliations from a domestic university were chosen. All references at the end of each chapter were read by hand searching, and results were noted. The trend and percentage of Iranian publications in different editions of the textbooks were also calculated. The number of citations of these publications in Google Scholar and Scopus databases were also obtained.

Results: The number of Iranian publications in all well-known textbooks have notably increased since 2000. The number and percentage of Iranian publications in the latest edition of Cohen's Pathways of the Pulp was higher compared to other textbooks as well as the previous edition of the same text.

Conclusion: Number and percentage of Iranian publications in the field of endodontics in all three textbooks have remarkably increased since 2000.
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http://dx.doi.org/10.7508/iej.2016.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947836PMC
July 2016

How Can Hypnodontics Manage Severe Gag Reflex for Root Canal Therapy? A Case Report.

Iran Endod J 2016 20;11(2):146-9. Epub 2016 Mar 20.

Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA.

In endodontics, severe involuntary gagging can have a severe impact on treatment procedure. There are many ways to ease the gag reflex, one of which is hypnosis. A 34-year-old male was referred for root canal treatment of a molar tooth. He had not received any dental treatments for the past nine years due to fear of severe gag reflex. Three hypnotic sessions based upon eye fixation, progressive muscle relaxation and guided imagery techniques were spent for psychosomatic management. The gag reflex was controlled and reduced to a normal level, and the required dental treatments including root canal therapy and restoration were performed successfully. This report shows that hypnosis can control gag reflex for dental treatments.
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http://dx.doi.org/10.7508/iej.2016.02.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841353PMC
May 2016

Efficacy of Articaine and Lidocaine for Buccal Infiltration of First Maxillary Molars with Symptomatic Irreversible Pulpitis: A Randomized Double-blinded Clinical Trial.

Iran Endod J 2016 20;11(2):79-84. Epub 2016 Mar 20.

Endodontic Department, Dental School, Shahid Saddoghi University of Medical Sciences, Yazd, Iran.

Introduction: The aim of the present study was to compare the efficacy of 2% lidocaine to 4% articaine in buccal infiltration of maxillary first molars with irreversible pulpitis. Moreover, the effect of root length on success of anesthesia irrespective of the type of anesthetic agent was assessed.

Methods And Materials: Fifty patients suffering from painful maxillary first molars with irreversible pulpitis received an infiltration injection of either 4% articaine with 1:100000 epinephrine or 2% lidocaine with 1:80000 epinephrine. Each patient recorded their pain score in response to a cold test on a Heft-Parker visual analogue scale (VAS) before commencing the treatment, 5 min following injection, during access preparation, after pulp exposure and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed using the multivariate logistic regression analysis, chi-square and t tests.

Results: Finally, 47 out of 50 patients were eligible to be included in this study. The anesthetic success rates in the lidocaine and articaine groups were 56.52% and 66.67%, respectively and the difference was not significant (P=0.474). Irrespective of the anesthetic agent, the length of the palatal root (Odds Ratio=0.24, P=0.007) had an adverse effect on anesthetic success. There was an association between longer palatal root length and anesthetic failure.

Conclusion: No significant difference was found between 2% lidocaine and 4% articaine in terms of anesthetic success in maxillary first molars with irreversible pulpitis. The length of the palatal root had a significant negative influence on anesthetic success.
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http://dx.doi.org/10.7508/iej.2016.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841339PMC
May 2016

Buffered Lidocaine With Sodium Bicarbonate did not Increase Inferior Alveolar Nerve Block Success Rate in Patients Having Symptomatic Irreversible Pulpitis.

Authors:
Masoud Parirokh

J Evid Based Dent Pract 2016 Mar 28;16(1):59-61. Epub 2016 Jan 28.

Article Title And Bibliographic Information: Effect of buffered 4% lidocaine on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind study. Schellenberg J, Drum M, Reader A, Nusstein J, Fowler S, Beck M. J Endod 2015;41(6):791-6.

Source Of Funding: The study was supported by Meyers/Reader Graduate Endodontic Support Fund

Type Of Study/design: Double blinded randomized controlled trial.
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http://dx.doi.org/10.1016/j.jebdp.2016.01.003DOI Listing
March 2016

Choice of Treatment Plan Based on Root Canal Therapy versus Extraction and Implant Placement: A Mini Review.

Iran Endod J 2015 1;10(3):152-5. Epub 2015 Jul 1.

Dental Research Center, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.

Case selection and treatment plan are important aspects of endodontic treatment. Dentists should organize the treatment plan based on their knowledge, abilities, skills and more importantly the patients' preference and dentition. Indubitably, the treatment plan for each patient is exclusive and "tailor-made" and cannot be used for all patients. Dentists' selfestimation of their abilities opens up treatment options; however, in difficult or complicated cases it is advisable to refer to a specialist. Currently, one of the most challenging aspects in dentistry is the choice between extraction and placement of implant (EPI) instead of a complicated root canal treatment (RCT). Overemphasis on one treatment plan while neglecting other options, not only mislead the dentist but also impose unnecessary charges to the patients. This mini-review compares RCT to EPI from various aspects to help practitioners in routine decision making.
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http://dx.doi.org/10.7508/iej.2015.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509120PMC
July 2015

A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis.

J Endod 2015 Sep 3;41(9):1408-11. Epub 2015 Jul 3.

School of Dentistry, University of Western Australia, Perth, Australia.

Introduction: Achieving anesthesia in mandibular molar teeth with irreversible pulpitis is very difficult. The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible pulpitis.

Methods: In a randomized, double-blind clinical trial, 82 first mandibular molar teeth with symptomatic irreversible pulpitis randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale. No or mild pain was considered as successful anesthesia. Data were analyzed by t and chi-square tests.

Results: Eighty patients were eligible to participate in this study, which showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) of IANBs compared with 1.8 mL of the same anesthetic solution (27.5%) although neither group had 100% successful anesthesia (P < .001).

Conclusions: Increasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis, but it did not result in 100% anesthetic success.
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http://dx.doi.org/10.1016/j.joen.2015.05.015DOI Listing
September 2015

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain.

Restor Dent Endod 2015 May 16;40(2):155-60. Epub 2015 Mar 16.

Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran.

Objectives: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis.

Materials And Methods: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests.

Results: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure.

Conclusions: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.
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http://dx.doi.org/10.5395/rde.2015.40.2.155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432259PMC
May 2015

Cytotoxicity of two resin-based sealers and a fluoride varnish on human gingival fibroblasts.

Iran Endod J 2015 18;10(2):89-92. Epub 2015 Mar 18.

Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;

Introduction: Assessment of cellular cytotoxicity is a regular method for evaluating the biocompatibility of novel materials. In a recent study, 5% fluoride varnish (Duraflur) has shown reasonable sealing ability and coverage of root canal walls when used as a sealer. The aim of the present study was to compare the cytotoxicity of Duraflur varnish with two popular commonly used root canal sealers (AH-Plus and AH-26) on human gingival fibroblasts (HGF).

Methods And Materials: The HGFs were incubated with different concentrations (1/2, 1/4, and 1/8) of AH-plus, AH-26, and Duraflur varnish for 24 h. The percentage of cell viability was assessed with methyl-thiazol-tetrazolium (MTT) assay. The data was analyzed using the one-way ANOVA followed by Student-Newman-Keuls test. The level of significance was set at 0.001.

Results: MTT assay showed that higher concentrations of the tested materials resulted in lower viability of HGFs. AH-Plus showed significantly greater cell viability compared to AH-26 at all dilutions (P<0.001); however, no significant difference was found between Duraflur and AH-Plus in terms of cell viability at 1/8 dilution (P>0.001). Duraflur showed significantly higher cell viability compared to AH-26 except at 1/2 dilution (P<0.001).

Conclusion: Although Duraflur varnish had better biocompatibility compared to AH-26, it should still be evaluated with further biocompatibility tests such as intraosseous and subcutaneous implantation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372780PMC
April 2015

Fluoride varnish as root canal sealer: a scanning electron microscopy and bacterial penetration study.

Iran Endod J 2015 24;10(1):64-8. Epub 2014 Dec 24.

Department of Endodontic, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.

Introduction: This study was carried out to evaluate the bacterial leakage of root canal fillings when cavity varnish containing 5% fluoride (Duraflur) was used as root canal sealer.

Methods And Materials: Root canals of 88 straight single-rooted teeth were prepared. Eighty teeth were randomly divided into 3 experimental groups (n=20) and two positive and negative control groups of ten each. The roots in group I and II were obturated with gutta-percha and AH-26 sealer using lateral condensation technique. The root canal walls in group II were coated with a layer of varnish before obturation. In group III the canals were obturated with gutta-percha and fluoride varnish as the sealer. Enterococcus faecalis (E. faecalis) was used to determine the bacterial leakage during 90 days. The Kaplan Meier survival analysis was used for assessing the leakage and log rank test was used for pairwise comparison. The rest of eight single rooted teeth were selected for scanning electron microscopy (SEM) evaluation with 5000× magnification.

Results: Leakage occurred between 20 to 89 days. Group III showed significantly less bacterial penetration than groups I and II (P=0.001 and P=0.011, respectively). However, there was no significant difference between group I and II (P>0.05). SEM evaluation showed that the varnish had covered all dentinal tubules.

Conclusion: The present study showed promising results for the use of fluoride varnish as root canal sealer but further in vitro and in vivo studies are needed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293584PMC
January 2015

Co-existence of two dens invaginations with one dens evagination in a maxillary lateral incisor: a case report.

J Dent (Tehran) 2014 Jul 31;11(4):485-9. Epub 2014 Jul 31.

Assistant Professor, Department of Endodontics, School of Dentistry, Shahed University.

A case with two simultaneous dens invaginations (DIs) and one dens evagination (DE) in a permanent maxillary lateral incisor is reported for the first time in a 21-year-old girl. DE known as talon cusp of the anterior teeth is a rare entity and its co-existence with DI has been reported scarcely in the literature. Simultaneous occurrence of two DIs with one DE has not been reported elsewhere. Undoubtedly, familiarity with the internal anatomy of such a rare condition can help prevent pulpal disease while performing restorative procedures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283752PMC
July 2014

Presence of two distal and one mesial root canals in mandibular second molars: report of four cases.

Iran Endod J 2014 5;9(3):229-32. Epub 2014 Jul 5.

Department of Endodontic, Dental School, Kerman University of Medical Sciences, Kerman, Iran.

Most mandibular second molars have one and two canals in distal and mesial roots, respectively. This report represents four cases of mandibular second molars with a single mesial and two distal root canals with two different canal configurations. After access cavity preparation, two teeth had one distal and two mesial orifices, whereas in the two other teeth one mesial and two distal orifices were found. In the teeth with two mesial canal orifices, the distal root canal and one of root canals with a mesial orifice joined together in the apical part of the root, whereas in the two other teeth with one mesial and two distal canal orifices, three separate canals each with a different apical foramen were detected. Dental practitioners should be aware that despite higher prevalence of one distal and two mesial root canals, the mandibular second molars may also have one mesial and two distal root canals.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099958PMC
July 2014

Comparison between prescription of regular or on-demand ibuprofen on postoperative pain after single-visit root canal treatment of teeth with irreversible pulpitis.

J Endod 2014 Feb 27;40(2):151-4. Epub 2013 Oct 27.

Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Pain management is very important in endodontic practice. The aim of this study was to compare the effect on pain relief of on-demand versus regular prescription of ibuprofen after single-visit root canal treatment in teeth with irreversible pulpitis.

Methods: Sixty mandibular and maxillary molar teeth with irreversible pulpitis without spontaneous pain had single-visit root canal treatment. After this treatment, patients were randomly allocated to 2 groups of 30 patients each. Patients in group 1 received a single dose of 400 mg ibuprofen and a rescue bag of the same medication to use if they felt pain and needed further medication. Patients in group 2 received the same medication as group 1 patients after treatment, and they were also provided with a prescription to use 400 mg ibuprofen every 6 hours for at least 24 hours. The patients were asked to rate their pain on a visual analog scale for up to 48 hours after treatment. The data were analyzed with Mann-Whiney, chi-square, Fisher exact, and McNemar tests.

Results: Two patients were excluded because they did not return their pain record forms. Data analysis of the remaining 58 patients showed no significant difference in pain felt by the patients in groups 1 and 2 at either 24 or 48 hours after treatment (P = .849 and P = .732, respectively). Patients in group 2 used significantly more medication compared with patients in group 1 (P = .04).

Conclusions: In patients who had irreversible pulpitis with no moderate to severe spontaneous pain, prescribing ibuprofen on a regular basis after root canal treatment had no significant effect on pain relief compared with an on-demand regimen up to 48 hours after treatment.
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http://dx.doi.org/10.1016/j.joen.2013.09.024DOI Listing
February 2014

Various strategies for pain-free root canal treatment.

Iran Endod J 2014 24;9(1):1-14. Epub 2013 Dec 24.

School of Dentistry, University of Western Australia, Perth, Australia.

Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases.

Materials And Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion.

Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region.

Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881296PMC
June 2014

Florid cemento-osseous dysplasia mimicking apical periodontitis: A case report.

Aust Endod J 2013 Dec 22;39(3):176-9. Epub 2011 Aug 22.

Private Practice, Tehran, Iran Endodontic Department, Shahed Dental School, Tehran, Iran Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran School of Dentistry, University of Western Australia, Perth, Western Australia, Australia.

Cemento-osseous dysplasia may present as a focal, periapical or florid lesion in the mandible or maxilla. The lesion may sometimes appear similar to peri-radicular lesions on a periapical radiograph. This report presents a case with irreversible pulpitis and root resorption as well as a mixed radiolucent/radiopaque lesion around a mandibular molar tooth root. Root canal treatment was performed and because of the radiographic signs of root resorption and the patient's fear of having a malignant disease, periapical surgery was also performed. The histopathology report confirmed the presence of florid cement-osseous dysplasia which was mimicking apical periodontitis. Follow-up radiography 12 months after the surgery illustrated complete healing of the radiolucent area.
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http://dx.doi.org/10.1111/j.1747-4477.2011.00325.xDOI Listing
December 2013

Prevalence of toothache and associated factors: a population-based study in southeast iran.

Iran Endod J 2013 1;8(3):123-8. Epub 2013 Aug 1.

Oral and Dental Diseases Research center, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: This study was carried out to estimate toothache prevalence among adult residents in Kerman.

Materials And Methods: This cross-sectional, population-based study was conducted among individuals aged over 18 years (n=1800). The relevant data on the prevalence of toothache and associated factors were collected by interviewing the individuals in their homes and filling out a questionnaire designed by the examiners. Prevalence of toothache and associated factors that patients recalled previous to their interview were analyzed by chi-square test and multivariate logistic regression analysis.

Results: Nine hundred ninety-one individuals (55.1%) reported toothache during the 6 months before the interview. The participants who flossed daily, had regular dental visits, and had higher education showed a significantly lower prevalence of toothache (P<0.05), whereas regular tooth brushing and economic level of residency had no significant effect on the prevalence of toothache. Individuals between the ages of 26 and 45 [odds ratio (OR)=2.0], with a family size of more than 4 (OR=1.5), not using dental floss (OR=1.5), or having a mental or psychological illness (OR=1.5) were more likely to have a history of toothache.

Conclusion: High prevalence of toothache (more than half) among residents of Kerman shows a serious and major public health problem. Toothache prevalence in middle aged adults, lower education, bigger family size, lower dental hygiene habit and/or those having mental or psychological illness were more common in the city of Kerman.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734515PMC
August 2013

The frequency of medically compromised patients in endodontic offices in iran.

Iran Endod J 2013 1;8(2):48-51. Epub 2013 May 1.

Oral and Dental Diseases Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: As the result of epidemiological transition and aging of Iranian population, the frequencies of systemic diseases among patients in of need endodontic treatment has increased, especially within developed cities. However, there have been no concise reports of systemic diseases in Iranian patients. Based on this need, the present investigation was conducted to assess the frequency of systemic disease among patients referred to endodontic private practice in three main cities in Iran.

Materials And Methods: In a retrospective study, the frequency of systematic diseases were abstracted from the health records of patients who were referred to three private practices limited to endodontics in Kerman, Mashhad, and Tehran between 1994 to 2011.

Results: Overall, 15,413 records of patients were assessed. The patterns of systematic diseases among endodontic patients in these three cities were different. The overall frequency of systemic disease in Kerman was significantly higher than two other cities (Kerman: 55.03%, Mashhad: 24.32%, Tehran: 22.16%; P<0.001). The most commonly occurring diseases were cardiac disease, hypertension, allergy and neurological disorders.

Conclusion: Since the number of endodontic patients with systematic diseases is considerably significant and varied, special training and educations for treatment of medically compromised patient should be considered at both post- and undergraduate training.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662035PMC
May 2013
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