Publications by authors named "Saeed Asgary"

170 Publications

Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial.

Clin Oral Investig 2021 Dec 2. Epub 2021 Dec 2.

Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, 1983963113, Tehran, Iran.

Objective: The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.

Materials And Methods: A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis.

Results: At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).

Conclusion: In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.

Clinical Relevance: Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.
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http://dx.doi.org/10.1007/s00784-021-04310-yDOI Listing
December 2021

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope.

Int J Biomater 2021 15;2021:5584268. Epub 2021 Sep 15.

Iranian Centre for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran.

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.
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http://dx.doi.org/10.1155/2021/5584268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457968PMC
September 2021

Management of primary molars with irreversible pulpitis employing tampon pulpotomy: Report of three cases with 34-month mean follow-up.

Clin Case Rep 2021 Apr 4;9(4):2289-2294. Epub 2021 Mar 4.

Dental Materials Research Center Mashhad University of Medical Sciences Mashhad Iran.

This study suggests that tampon-based coronal pulpotomy using a calcium silicate-based biomaterial can be a reliable approach for the treatment of vital primary molars with irreversible pulpitis.
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http://dx.doi.org/10.1002/ccr3.4017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077301PMC
April 2021

Importance of 'Time' on 'Haemostasis' in Vital Pulp Therapy - Letter to the Editor.

Eur Endod J 2021 Mar;6(1):128-129

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

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http://dx.doi.org/10.14744/eej.2020.82574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056802PMC
March 2021

The Role of Vital Pulp Therapy in the Management of Periapical Lesions - Letter to the Editor.

Eur Endod J 2021 Mar;6(1):130-131

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

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http://dx.doi.org/10.14744/eej.2020.04706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056806PMC
March 2021

Grafting with Bone Substitute Materials in Therapy-Resistant Periapical Actinomycosis.

Case Rep Dent 2021 25;2021:6619731. Epub 2021 Feb 25.

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

Actinomycosis can be one of the causes of persistent periradicular lesions. This is the report of a patient who was first referred with complaint of pain in maxillary right incisors. A standard root canal therapy was carried out. Unluckily, the patient returned with recurrent symptoms; therefore, surgical endodontic retreatment was decided. While the large periradicular lesion was curetted, a whitish yellow granule-like material came out from the periapical area that was submitted for histopathological examination. The apices of both maxillary right incisors were resected. Root-end cavities were sealed with calcium-enriched mixture (CEM) cement. Finally, the remaining large defect was filled with natural bone substitutes. Since the histopathological diagnosis revealed actinomycotic infection, oral penicillin V was prescribed for four weeks. At two-year recall, the bone healing process was completed. Apical actinomycosis can cause therapy-resistant lesions. Root-end surgery employing CEM and bone substitutes might be an effective method to help bone healing in large periradicular lesions.
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http://dx.doi.org/10.1155/2021/6619731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932786PMC
February 2021

An Innovative Drug Delivery System Loaded with a Modified Combination of Triple Antibiotics for Use in Endodontic Applications.

Int J Dent 2020 25;2020:8859566. Epub 2020 Aug 25.

Department of Endodontics, Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran 198396-3113, Iran.

The objective of the current study was to introduce "Polylactic co-Glycolic Acid- (PLGA-) Coated Ceramic Microparticles" as an innovative drug delivery system, loaded with a new combination of triple antibiotics (penicillin G, metronidazole, and ciprofloxacin (PMC)) for use in endodontic treatments. Ceramic microparticles were made from -tricalcium phosphate and hydroxyapatite and examined by "Scanning Electronic Microscope (SEM)." Then, fixed amounts of the selected antibiotics were added to a prepared PLGA solution and stirred thoroughly. Next, the prepared ceramic microparticles were dispersed completely in the drugs solution. The deposited "PMC-loaded PLGA-coated ceramic microspheres (PPCMs)" were dried and incubated in phosphate buffer saline (PBS) for 21 days. The drug release from PPCMs was quantified by a UV spectrophotometer. The antimicrobial activity of PPCMs was investigated using the "Agar Plate Diffusion Test (ADT)," "Minimum Inhibitory Concentration (MIC)," and "Minimum Bactericidal Concentration (MBC)" against () and (). The cell viability test (MTT) was conducted for cytotoxicity against human gingival fibroblasts. SEM micrographs of PPCMs showed spherical-like ceramic microparticles with smooth surfaces. Crystal-like antibiotic particles (chunks) were also found on PPCMs. Initial burst of antibiotics (31 g/mL, 160 g/mL, and 18 g/mL for ciprofloxacin, metronidazole, and penicillin G, respectively, in the first 4 days) followed by gradual and sustained release was observed within a period of 21 days. PPCMs demonstrated pH close to normal physiological environment and antibacterial activity against and in the first 2 days. MTT showed cell viability of more than 70% for PPCMs after 24 h and 72 h of exposure. In conclusion, PPCMs demonstrated satisfactory release of antibiotics, antibacterial activity against the selected microorganisms, and biocompatibility. Thus, PPCMs may be used to deliver modified triple antibiotics to the root canal system for use in endodontic applications.
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http://dx.doi.org/10.1155/2020/8859566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469079PMC
August 2020

Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis.

J Oral Rehabil 2021 Mar 9;48(3):332-342. Epub 2020 Oct 9.

Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.

Objectives: The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp.

Materials And Methods: A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05).

Results: For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed.

Conclusion: The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.
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http://dx.doi.org/10.1111/joor.13057DOI Listing
March 2021

Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial.

Pain Res Manag 2020 30;2020:5853412. Epub 2020 Jun 30.

Endodontology Research Center, Endodontic Department, Dental School, Kerman University of Medical Sciences, Kerman 7618751689, Iran.

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA ( = 188), PCEM ( = 194), or RCT ( = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (=0.939), and the trend/changes in pain relief were parallel (=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes ( < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.
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http://dx.doi.org/10.1155/2020/5853412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345601PMC
November 2020

Cone-beam computed tomography analysis of lingual mandibular bone depression in the premolar region: A case report.

Clin Case Rep 2020 Mar 11;8(3):523-526. Epub 2020 Feb 11.

Dentofacial Deformity Research Center Research Institute of Dental Sciences Shahid Beheshti University of Medical Sciences Tehran Iran.

Asymptomatic lingual depression in the mandible should be evaluated with advanced radiographic modalities such as cone-beam computed tomography (CBCT) using the software features to achieve correct diagnosis and avoid unnecessary endodontic and/or surgical interventions.
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http://dx.doi.org/10.1002/ccr3.2713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069851PMC
March 2020

Management of Symptomatic Horizontal Mid-root Fractures after Unsuccessful Orthograde Endodontic Retreatments.

Cureus 2019 Aug 24;11(8):e5473. Epub 2019 Aug 24.

Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IRN.

This case report describes the management of symptomatic horizontal mid-root fractures in previously traumatized central incisors, which initially had been treated endodontically and retreated afterwards. A 26-year-old female, who had suffered a traumatic injury to the maxillary anterior teeth, was referred owing to the failure of the corresponding orthograde endodontic retreatment and consequent pain/discomfort. Periapical radiographs and cone beam computed tomography showed that both central incisors had horizontal root fractures in their middle third, root canal fillings in their coronal segments, a considerable dislocation of the apical fragments and large radiolucent lesions between their apical segments and coronal fragments. Based on the obtained radiographic and clinical findings, a surgical endodontic retreatment approach for the main segments without removing the apical fragments was applied employing calcium-enriched mixture (CEM) cement as the retrograde biomaterial. Thirty-month clinical and radiographic follow-ups demonstrated successful outcomes. This case report showed the healing potential of horizontal mid-root fractures after surgical endodontics using CEM cement without removing apical fragments.
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http://dx.doi.org/10.7759/cureus.5473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053693PMC
August 2019

Bioactivity of endodontic biomaterials on dental pulp stem cells through dentin.

Restor Dent Endod 2020 Feb 4;45(1):e3. Epub 2019 Nov 4.

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

Objectives: This study investigated the indirect effect of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA), as 2 calcium silicate-based hydraulic cements, on human dental pulp stem cells (hDPSCs) through different dentin thicknesses.

Materials And Methods: Two-chamber setups were designed to simulate indirect pulp capping (IPC). Human molars were sectioned to obtain 0.1-, 0.3-, and 0.5-mm-thick dentin discs, which were placed between the 2 chambers to simulate an IPC procedure. Then, MTA and CEM were applied on one side of the discs, while hDPSCs were cultured on the other side. After 2 weeks of incubation, the cells were removed, and cell proliferation, morphology, and attachment to the discs were evaluated under scanning electron microscopy (SEM). Energy-dispersive X-ray (EDXA) spectroscopy was performed for elemental analysis. Alkaline phosphatase (ALP) activity was assessed quantitatively. The data were analyzed using the Kruskal-Wallis and Mann-Whitney tests.

Results: SEM micrographs revealed elongated cells, collagen fibers, and calcified nucleations in all samples. EDXA verified that the calcified nucleations consisted of calcium phosphate. The largest calcifications were seen in the 0.1-mm-thick dentin subgroups. There was no significant difference in ALP activity across the CEM subgroups; however, ALP activity was significantly lower in the 0.1-mm-thick dentin subgroup than in the other MTA subgroups ( < 0.05).

Conclusions: The employed capping biomaterials exerted biological activity on hDPSCs, as shown by cell proliferation, morphology, and attachment and calcific precipitations, through 0.1- to 0.5-mm-thick layers of dentin. In IPC, the bioactivity of these endodontic biomaterials is probably beneficial.
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http://dx.doi.org/10.5395/rde.2020.45.e3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7030969PMC
February 2020

Does occlusal reduction reduce post-endodontic pain? A systematic review and meta-analysis.

J Oral Rehabil 2020 Apr 16;47(4):528-535. Epub 2020 Jan 16.

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

Objectives: Pain management during endodontic therapy is an important issue in clinical practice. The objective of this systematic review and meta-analysis was to evaluate the efficacy of occlusal reduction to control the post-operative endodontic pain in adults undergoing root canal therapy.

Materials And Methods: Electronic database and manual searches of English papers were conducted up to August 2019 to identify randomised placebo-controlled trials. The MeSH terms used were (endodontics OR root canal therapy) AND (postoperative pain) AND (occlusal reduction). The primary outcome measure was the post-operative pain intensity up to 72 hours. Pooled standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random-effects inverse variance method. The statistical heterogeneity was assessed using the Cochrane Q test. The significance level was set at P < .05.

Results: In total, six randomised controlled trials including 344 participants were included. Our meta-analyses showed that relief of occlusal surface did not significantly reduce the pain intensity scores at 12- (SMD = -0.46; 95% CI = -1.24, 0.30; P = .239), 24- (SMD = -0.17; 95% CI = -0.73, 0.38; P = .533) and 48- (SMD = -0.67; 95% CI = -1.38, 0.03; P = .063) when compared to placebo. However, at 72 hours, patients received intervention showed significant more pain reduction than placebo groups (SMD = -1.07; 95% CI = -1.81, -0.32; P = .005).

Conclusion: Based on this meta-analysis, the efficacy of occlusal reduction in post-endodontic pain control for up to 2 days is not supported. However, on day three, it had a positive influence on the control of post-endodontic pain.
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http://dx.doi.org/10.1111/joor.12929DOI Listing
April 2020

Surgical endodontics for management of progressive actinomycosis.

Gen Dent 2020 Jan-Feb;68(1):61-64

Actinomycosis is caused by gram-positive, branching, filamentous, anaerobic bacteria of the genus Actinomyces. This case report describes treatment of a 35-year-old woman who had a progressive apical lesion after nonsurgical endodontic retreatment of her maxillary left lateral incisor. The area had localized soft tissue swelling, and the tooth was sensitive to percussion. Radiographic evaluation showed a large apical lesion with a clear margin. After treatment options, including extraction, were discussed, the patient chose to preserve the tooth through endodontic surgery. Root-end resection, canal preparation, and filling with calcium-enriched mixture cement were performed. Histopathologic examination of surgical specimens revealed a radicular cyst associated with actinomycosis. At an 18-month follow-up, the patient was symptom free and bone healing was almost completed. Periradicular actinomycosis is one of the most common reasons for the failure of nonsurgical endodontic treatment and retreatment. If a tooth is nonresponsive to nonsurgical endodontic treatments, apical actinomycotic infection should be suspected and a surgical approach should be planned to obtain a successful outcome.
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January 2020

Vital Pulp Therapy as a Conservative Approach for Management of Invasive Cervical Root Resorption: A Case Series.

J Endod 2019 Sep 11;45(9):1161-1167. Epub 2019 Jul 11.

Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran; Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland, Baltimore, Baltimore, Maryland. Electronic address:

Introduction: Clear treatment guidelines with predictable outcomes for invasive cervical root resorption (ICRR) do not exist. Recent studies show that an internal approach for the excavation and repair of resorptive lacunae using bioactive materials might be preferred over external surgical approaches in cases with extensive ICRR. The procedure appears to interrupt and stop the resorptive process and preserves the periodontium. The aim of this case series was to report on the clinical and radiographic outcomes in cases with ICRR treated with vital pulp therapy techniques using calcium-enriched mixture cement.

Methods: Teeth with the diagnosis of ICRR and normal pulpal and periodontal status were included. After rubber dam isolation and the removal of existing restorations, the resorptive lacunae were accessed internally, and the contents were partially or fully removed. A vital pulp therapy technique was chosen based on the accessibility of the resorptive lacunae during excavation. Teeth were then restored and followed up.

Results: Six teeth with ICRR (Heithersay class 2, 3, or 4) were selected. One tooth was treated with pulp capping, 1 with partial pulpotomy, 2 with full pulpotomy, and 2 with partial pulpectomy. The average follow-up time was 19.6 months. After treatment, all teeth remained functional and asymptomatic with a normal periodontium. No progression of the resorption or development of new resorption was observed.

Conclusions: Internal excavation of the contents of resorptive lacunae in combination with vital pulp therapy with calcium-enriched mixture cement could be a reliable approach for the treatment of ICRR.
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http://dx.doi.org/10.1016/j.joen.2019.05.020DOI Listing
September 2019

Regenerative Endodontics: A Scientometric and Bibliometric Analysis.

J Endod 2019 Mar;45(3):272-280

Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran; Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland. Electronic address:

Introduction: Scientometric analyses outline the research output in a field and, therefore, help researchers and funding agencies to focus more on underinvestigated areas and make more efficient decisions related to public health. The aim of this study was METHODS: Electronic searches were done in MEDLINE and Scopus databases using specified search criteria. All articles related to the field of regenerative endodontics until December 2017 were included. The total number of publication/year and the yearly growth rate of publications were calculated. The following data were extracted and analyzed: authors, country of origin, journal, number of citations, study design, and level of evidence (LOE). The visualization maps for authorship/coauthorship, citations, and country of origin of articles were prepared and analyzed.

Results: A total of 694 articles were included. The average yearly growth for publications was 40.4% between 2007 and 2017. The highest number of articles were ex vivo/in vitro (n = 342, 49.27%). The distribution of articles based on LOE was as follows: LOE 1, 8.34%; LOE 2, 6.00%; LOE 3, 0.66%; LOE 4, 11.67%; and LOE 5, 73.33%. Collectively, 1820 authors contributed to the publications included in this study: 1001 authors within 40 collaborating clusters and 819 authors within 149 noncollaborating clusters. The United Sates was the lead country regarding the number of publications, citations, and international collaborations. The Journal of Endodontics published the highest number of articles.

Conclusions: The total number of publications in the field of regenerative endodontics shows exponential growth in the past decade. However, the proportion of articles with LOE 1 is low. The research groups around the globe are encouraged to focus their collaborative efforts on higher-quality and clinically oriented research.
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http://dx.doi.org/10.1016/j.joen.2018.11.010DOI Listing
March 2019

Intentional replantation of a molar with several endodontic complications.

J Stomatol Oral Maxillofac Surg 2019 Nov 7;120(5):489-492. Epub 2018 Dec 7.

Endodontist, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran. Electronic address:

When non-surgical and surgical endodontic retreatments are impractical, intentional replantation (IR) might be employed as an accepted endodontic treatment procedure. This report describes an IR and root amputation of a tooth with several endodontic complications. A 28-year-old woman was referred for management of tooth #37. The tooth had a history of root canal therapy by a general dentist. Clinically the tooth was sensitive to palpation/percussion. Radiographic evaluation showed concurrent root/furcal perforations associated with radiolucent lesions, an inadequate root canal treatment and massive gutta-percha overextensions via perforation sites. The tooth was atraumatically extracted. After mesial root amputation and root-end/furcal preparations, the cavities were filled with calcium-enriched mixture cement. The tooth was then quickly replanted. During one-year clinical follow-ups, the tooth was functional and free of signs/symptoms; radiographic evaluation revealed complete bone healing. This case highlights that IR in hopeless teeth with several endodontic complications might be a successful approach.
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http://dx.doi.org/10.1016/j.jormas.2018.11.019DOI Listing
November 2019

Triple antibiotic paste: momentous roles and applications in endodontics: a review.

Restor Dent Endod 2018 Aug 20;43(3):e28. Epub 2018 Jun 20.

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

This study investigated the latest findings and notions regarding 'triple antibiotic paste' (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.
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http://dx.doi.org/10.5395/rde.2018.43.e28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103545PMC
August 2018

Delayed miniature pulpotomy in a symptomatic mature molar.

Dent Res J (Isfahan) 2018 Jul-Aug;15(4):302-305

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

This case report describes miniature pulpotomy (MP) with calcium-enriched mixture (CEM) cement, 1 week after carious pulpal exposure of a symptomatic mature molar. A 24-year-old woman was referred with complaining of severe lingering pain on the second upper left molar; a dental history revealed that the tooth had been prepared 1 week ago, but on pulp exposure, her dentist just dressed the cavity. After anesthesia/isolation in the same session, the temporary restoration was removed, the previously pulpal exposure was observed, and MP was carried out. Hemorrhage was effectively controlled using 5.25% NaOCl, the clot free pulpal wound was completely covered employing CEM cement, and the cavity was permanently restored by resin composite. The patient's pain gradually relieved within 24 h. The tooth was functional and able to respond to vitality tests in regular clinical follow-ups. At 15-month follow-up, a dentinal bridge was observed under the capping biomaterial, radiographically; moreover, no calcification or apical pathosis was detected. MP with CEM cement might be a treatment option for the management of exposed dental pulp with a clinical diagnosis of irreversible pulpitis, although further trials with larger sample size and longer follow-ups are recommended.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073943PMC
August 2018

Partial Necrosis Consequence of the Infection Spreading from an Adjacent Apical Periodontitis: A Case Report.

Iran Endod J 2018 ;13(3):420-423

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

As the dental pulp could not be directly inspected before endodontic treatment, indirect evaluation of the pulp status (para)/clinical tests should be performed which need careful inspection. This report presents a root-treated right maxillary first molar with recurrent abscess formation and a radiolucent periradicular lesion surrounding the distobuccal root of the right maxillary second molar. The patient underwent surgical retreatment, employing CEM root-end filling, which resulted in no relief from sign/symptoms. In the cone-beam computed tomography (CBCT), the relationship of the lesion with the mesio-buccal root of the second maxillary molar was detected. Despite the latest tooth showed positive responses to pulp sensibility tests, endodontic therapy was planned for it. During treatment, it became clear that the mesiobuccal canal pulp was necrotic, although vital pulp tissues were present in two other root canals. Following treatment, full recovery from all discomforts was obtained and the lesion healed after 18 months. This case showed that a more complicated evaluation such as CBCT should be used for diagnosis of perpetuated lesions. Furthermore, it might be probable that root canals of vital teeth become necrotic due to involvement in the adjacent apical lesion, a phenomenon known as anachoresis.
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http://dx.doi.org/10.22037/iej.v13i3.22089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064033PMC
January 2018

Physical Properties, Cytocompatibility and Sealability of HealApex (a Novel Premixed Biosealer).

Iran Endod J 2018 ;13(3):299-304

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

Introduction: The objective of this study was to evaluate the physical properties, cytotoxicity and sealing ability of HealApex _a new premixed calcium-silicate-phosphate-based biosealer_ in comparison with AH-26.

Methods And Materials: Setting time, working time, film thickness, flow and radiopacity evaluation were performed according to ISO 6876 specification. L929 fibroblasts were incubated with the extracts of sealers and cytotoxicity was then evaluated using MTT assay. Thirty intact extracted human premolars were instrumented using step-back technique. The specimens were obturated with gutta-percha and experimental sealers employing lateral condensation technique. Sealing ability of sealers was investigated for up to one month using fluid filtration method. Data were statistically analyzed by -test and ANOVA.

Results: Physical properties of both sealers conformed to ISO specification. AH-26 exhibited significantly higher flow, higher radiopacity and lower film thickness; whereas HealApex showed lower setting time (<0.05). HealApex represented high cell viability (<0.05); however, AH-26 demonstrated significantly lower cell viability compared with the negative control group (<0.05). There was no significant difference in microleakage between the sealers after 1 and 7 days; however, after 30 days, HealApex displayed better sealing ability (<0.05).

Conclusions: In this study, HealApex revealed acceptable physical properties, biocompatibility and good sealing ability as an endodontic sealer. Obtained results showed the new sealer had acceptable physical properties and good biocompatibility. In short term, the sealing ability of HealApex was comparable with AH-26 whilst in long term, HealApex's sealing ability was better than the epoxy resin-based sealer.
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http://dx.doi.org/10.22037/iej.v13i3.20188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064026PMC
January 2018

Periodontal healing following non-surgical repair of an old perforation with pocket formation and oral communication.

Restor Dent Endod 2018 May 13;43(2):e17. Epub 2018 Apr 13.

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

Iatrogenic perforations negatively impact the outcome of endodontic treatments. Studies on prognostic factors showed that perforations in the coronal third of the root with periodontal pocket formation have an unfavorable prognosis. A 36-year-old female was referred for endodontic evaluation of tooth #13 with a history of an iatrogenic perforation, happened 3 years ago. There was a sinus tract associated with perforation, 10 mm probing on the mesial and mesio-palatal, bleeding on probing, radiolucent lesion adjacent to the perforation and complete resorption of the interdental bone between teeth #13 and #12. After the treatment options were discussed, she chose to save the tooth. The tooth was accessed under rubber dam isolation, the perforation site was cleaned and disinfected using 0.5% sodium hypochlorite and sealed with calcium-enriched mixture cement. Eighteen months after treatment the tooth was functional and asymptomatic. The probing depths were normal without bleeding on probing. Radiographically, the interdental crestal bone formed between teeth #13 and #12. Despite all negative prognostic factors in this case (, perforations in the coronal third, pocket formation, and radiolucent lesion), healing was unexpectedly achieved via non-surgical repair of the perforation. Further research on biological aspects of healing in the periodontium following iatrogenic perforations are recommended.
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http://dx.doi.org/10.5395/rde.2018.43.e17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952056PMC
May 2018

Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis.

J Endod 2018 Jul 30;44(7):1057-1065. Epub 2018 Apr 30.

Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran. Electronic address:

Introduction: The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of corticosteroids on postoperative endodontic pain and to determine/adjust between-trial heterogeneity using meta-regression analysis.

Methods: A systematic literature search was conducted to identify randomized clinical trials using corticosteroids to manage postoperative endodontic pain in adults. The outcome measure was pain intensity scores at 6, 12, and 24 hours postoperatively. Standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were estimated using the random effect inverse variance method. The level of significance was set at P < .05. Meta-regression analysis was also performed to examine the associations between effect sizes and study-level covariates.

Results: Eighteen randomized clinical trials, comprising 1088 patients, were included. Corticosteroids significantly reduced the incidence of postoperative pain in endodontic patients at 6 hours (SMD = -1.03; 95% CI, -1.55 to -0.51; P = .000), 12 hours (SMD = -1.089; 95% CI, -1.71 to -0.46; P = .001), and 24 hours (SMD = -0.957; 95% CI, -1.34 to -0.56; P = .000). Meta-regression analysis showed that the type and dose of drug, performing intention-to-treat analysis, and using rescue medication could significantly influence the effect size at different time points.

Conclusions: Corticosteroids had a postoperative pain-reducing effect in endodontic patients, and the choice of drug regimens could be an important predictor of pain reduction.
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http://dx.doi.org/10.1016/j.joen.2018.03.010DOI Listing
July 2018

Surgical Endodontics Regenerative Periodontal Surgery for Management of a Large Periradicular Lesion.

Iran Endod J 2018 ;13(2):271-276

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

Treatment success of periodontal-endodontic lesions is dependent on the elimination of both disease causative factors, whether they exist separately or concurrently. This report presents successful endodontic management of a misdiagnosed large periradicular pathology, which had not resolved after a previous periodontal regenerative surgery. A patient complaining of discomfort in the left maxillary region was referred. He had undergone regenerative surgery for treatment of a large periradicular defect; however, there was no further amelioration of the clinical signs/symptoms. Radiographically, a large periradicular lesion filled with bone substitute materials was detected around tooth #25. The endodontic treatment of the tooth was imperfect; therefore, surgical endodontic retreatment was planned. During root-end surgery, the biopsy containing bone substitute materials was obtained. Root-end filling/sealing using calcium-enriched mixture cement was completed. The histopathological examination showed granulation tissues enclosing exogenous materials. In two-year radiographic evaluation, resolving lesion and complete bone healing was observed. The first fundamental step in the management of periradicular lesions is correct diagnosis of the lesion origin and set-by step of the treatment plan according to the main causative factor. Regenerative periodonttal surgery, without considering the defective apical seal, will only cause a painful procedure for the patient without any positive benefit. Following appropriate apical seal, the endodontic lesion healing can be anticipated.
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http://dx.doi.org/10.22037/iej.v13i2.20648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911307PMC
January 2018

Rapid Bone Healing after Intentional Replantation of a Molar with Apical Actinomycosis.

Iran Endod J 2018 ;13(1):135-138

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

Actinomycosis is a rare lesion of the jaws and may present as periapical pathosis; therefore, it is essential to be correctly diagnosed and managed. This case presentation describes management of a tooth with a symptomatic apical periodontitis caused by species supplemented with medicine prescription. A woman was referred for endodontic management of tooth #19. The tooth had a history of previous nonsurgical endodontic retreatment. Clinically, the tooth was very sensitive to percussion. Radiographic evaluation showed a large periapical lesion. Intentional replantation (IR) was planned. The tooth was atraumatically extracted. Without any curettage, through the blood flow coming out of the socket, a small yellowish granule was detected and sent for examination. After root-end preparations, the cavities were filled with calcium-enriched mixture cement and the tooth was carefully replanted. Histopathological assessment proved actinomycosis sulfur granule. According to infectious disease specialist recommendation, low-dose and long-term penicillin V was prescribed. Interestingly, at 2-month follow-up, remarkable bone healing was observed. In the cases of apical actinomycosis, IR in combination with antibiotic therapy, even without the curettage of the lesion, may be successfully employed.
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http://dx.doi.org/10.22037/iej.v13i1.19369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800456PMC
January 2018

Effect of Different Additives on Genotoxicity of Mineral Trioxide Aggregate.

Iran Endod J 2018 ;13(1):37-41

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

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http://dx.doi.org/10.22037/iej.v13i1.16913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800439PMC
January 2018

Evaluation of Four Pulpotomy Techniques in Primary Molars: A Randomized Controlled Trial.

Iran Endod J 2018 ;13(1):7-12

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

Introduction: This trial was designed to evaluate the clinical and radiographic success rates of calcium-enriched mixture (CEM) cement with and without low level laser therapy (LLLT) and compare them to that of formocresol (FC) and ferric sulfate (FS) in primary molar pulpotomies.

Methods And Materials: This randomized clinical trial was conducted on a total of 160 teeth selected from 40 patients aged 3-9 years. Patients with at least four primary molars needing pulpotomy, were included in order to have each tooth assigned randomly in one of the four following groups; FC, FS, CEM, and LLLT/CEM. Six- and twelve-month follow-up periods were conducted in order to enable a clinical and radiographic evaluation of the treated teeth. Collected data were analyzed using Cochran Q Tests.

Results: The 12-month clinical success rate for each technique was: FC=100%, FS=95%, CEM=97.5% and LLLT/CEM=100% with no significant differences (>0.05). Furthermore, 12-month radiographic success rate for each technique was: FC=100%, FS=92.5%, CEM=95% and LLLT/CEM=100% with no significant differences (>0.05).

Conclusion: Favorable outcomes of four treatment techniques in pulpotomy of primary molar teeth were comparable. CEM with/without LLLT may be considered as a safe and successful pulpotomy treatment modality compared to current conventional methods.
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http://dx.doi.org/10.22037/iej.v13i1.18407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800434PMC
January 2018

Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars.

J Endod 2018 Apr 1;44(4):529-535. Epub 2018 Feb 1.

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

Introduction: Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis.

Methods: Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year.

Results: The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05).

Conclusions: In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.
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http://dx.doi.org/10.1016/j.joen.2017.12.010DOI Listing
April 2018

Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: A multi-center randomized controlled trial.

Am J Dent 2017 Jun;30(3):151-155

Proteomics Research Center, Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare success rates of full pulpotomy (FP) with two endodontic biomaterials on symptomatic vital teeth with closed apices in the presence of apical periodontitis.

Methods: In this multicenter controlled clinical trial, 412 volunteers met the inclusion criteria; they were all randomly allocated to either FP/ProRoot mineral trioxide aggregate (MTA) or FP/calcium enriched mixture (CEM) group. The subjects were followed up for 2 and 5 years to evaluate and compare the treatment outcomes. Data were analyzed using Chi square test and the multiple binary logistic regression model.

Results: Data for a total number of 344 and 304 subjects were available for 2- and 5-year follow-ups. In terms of clinical outcomes, 2- and 5-year success rates of both groups were ≥ 98%, without significant differences. In terms of radiographic outcomes, the 2-year result of FP/MTA was significantly superior to FP/CEM (P= 0.005); however, the 5-year success rates were similar (P= 0.413). Age and preoperative periapical status did not affect the treatment outcomes.

Clinical Significance: Both MTA and CEM biomaterials were found to be equally effective pulpotomy agents for mature permanent molars with irreversible pulpitis and associated apical periodontitis in different age groups. The performance of this novel minimally invasive biotechnology may support a paradigm shift towards more biologic/conservative treatments in dentistry worldwide.
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June 2017

Failure of Cone-Beam Computed Tomography in Detection of Fiber Post Perforation.

Iran Endod J 2017 ;12(3):396-400

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

Detection of iatrogenic root perforation during post-space preparation especially in labiolingual plane can be challenging due to the two-dimensional nature of conventional radiography; this can be even more challenging if the cemented post is radiolucent. Cone-beam computed tomography (CBCT) scans were shown to be a valuable diagnostic aid in diagnosis of such cases. However, in this case, the application of CBCT did not help in diagnosis of a labial fiber post perforation in a maxillary central incisor which was finally detected through exploratory surgery.
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http://dx.doi.org/10.22037/iej.v12i3.17690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527222PMC
January 2017
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