Review Article

Introduction: Highly cited published articles play a critical role in shaping clinical practice, research directions, and advancements in a specific field of science. The current comprehensive scoping review aimed to provide an overview of highly cited articles published in the “Iranian Endodontic Journal” (IEJ), based on the IEJ’s H-index (=29); highlighting their key findings and prominent implications in the field of endodontics. Materials and Methods: A systematic search was conducted in Scopus database to identify the top 29 highly cited published articles. The articles were selected based on their citation count (h-index); reflecting their impact and influence within the scientific community. Data extraction was performed to gather relevant information; including authors, titles, publication years, and the main topic(s) of each article. Results: The selected highly cited published articles covered a broad range of endodontic topics; demonstrating the diversity and depth of research in the field. Key findings include significant contributions in vital pulp therapy, antimicrobial agents, root canal disinfection, regenerative techniques, cone-beam computed tomography applications, and intracanal medicaments. The distribution of research areas reflects the importance of evidence-based practice in clinical decision-making and patient care. Conclusions: These highly cited published articles have shown to have substantial impact on the field of endodontics. They have influenced clinical practice, guided research directions, and have improved patient care. The summary of key findings from each topic and the number of articles related to each area can provide readers with valuable insights into the distribution of research areas, and the significance of contributions made by the aforementioned highly cited published articles.

Association between Apical Periodontitis and Chronic Diseases: An Umbrella Review

Gabriella Serrão , Karem Paula Pinto , Cláudio Malizia Alves Ferreira , Luciana Moura Sassone, Tatiana Kelly da Silva Fidalgo , Emmanuel João Nogueira Leal Silva

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 134-144

Introduction: To assess the methodological quality of systematic reviews (SRs) that evaluated the association between apical periodontitis (AP) and chronic diseases. Materials and Methods: A systematic search was performed in the databases PubMed, Virtual Health Library, Scopus, Cochrane Library, Embase, Web of Science and Open Grey. SRs that evaluated the association between any chronic disease and AP, and that had performed a valid risk of bias assessment were included. The AMSTAR-2 tool was used for quality assessment and each included systematic review received a final categorization as having “high”, “moderate”, “low”, or “critically low” quality. Results: Nine studies that met the eligibility criteria were included. The diseases investigated were cardiovascular diseases, diabetes mellitus, HIV, osteoporosis, chronic liver disease, blood disorders and autoimmune diseases. The systematic reviews included in this umbrella review showed a ‘low’ to ‘high’ quality of evidence. Conclusion: There are substantial heterogeneity and several methodological concerns in the included studies. It was observed a positive association between diabetes mellitus and apical periodontitis with limited evidence, no association between HIV and apical periodontitis and a positive association between apical periodontitis and cardiovascular disease, blood disorders, chronic liver disease, osteoporosis and autoimmune diseases with moderate evidence.

Clinical Trial

Postoperative Endodontic Pain after Treatment Using XP-endo Finisher: A Randomized Clinical Trial

Leonardo Alexandre Fernandes, Cristiane Flaviana de Sousa Santos, Vania Portela Ditzel Westphalen, Ulisses Xavier da Silva Neto, Everdan Carneiro

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 145-151

Introduction: This randomized clinical trial aimed to determine whether the XP-endo finisher combined with or without foraminal enlargement has any significant effect on the incidence and intensity of postoperative pain in necrotic pulps. Materials and Methods: Clinical pain levels were measured after 6, 12, 24, 48, and 72 hours and at 7 postoperative days. All treatments were performed by an endodontist in a single visit. One hundred and twenty patients were included. All patients had a single tooth treated. The patients were divided into four groups: No FE (None Foraminal Enlargement) (n=30), FE (Foraminal Enlargement) (n=30), No FE+XPF (None Foraminal Enlargement+XP-endo Finisher) (n=30) and XPF+FE (XP-endo Finisher and Foraminal Enlargement) (n=30). The canals were irrigated with sodium hypochlorite, shaped using WaveOne Gold Medium file, and then filled by using a matching single cone and AH-Plus sealer. The cavity was filled using glass ionomer cement. Pain intensity was assessed using the visual analog scale. The data were analyzed with the ANOVA and Games-Howell test. The significance level was 5%. Results: The XPF+FE group experienced a higher level of pain, being classified on the visual analog scale as moderate for 48 postoperative hours and mild for 7 postoperative days (P<0.05). In the other groups, the pain was mild, only with different time intervals (P>0.05). Conclusions: Foraminal enlargement associated with XP-endo Finisher may cause moderate postoperative pain.

Original Article

Effects of White Chicken Eggshell Powder on Compressive Strength, Water Solubility, and Setting Time of Calcium-Enriched Mixture

Mahdi Sedigh-Shams, Seyed Mohammad Reza Nabavizadeh, Elham Jafari

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 152-158

Introduction: The present study aimed to evaluate the effects of adding chicken eggshell powder (CESP) to calcium-enriched mixture (CEM) cement on its compressive strength (CS), solubility, and setting time. Materials and Methods: In this study, CESP was added at weight percentages of 3% and 5% to the powder component of the CEM cement. To measure the CS, a total of 36 samples (height, 6 mm; diameter, 4 mm) were tested in a universal testing machine. The setting time was assessed for 18 disk-shaped samples (diameter, 10 mm; height, 1 mm). Additionally, solubility test was performed on 18 samples (diameter, 8 mm; height, 1 mm) after 24 hours, 72 hours, seven days, and 14 days under dehydration conditions by calculating the weight changes; the results were then subjected to a normality test. Next, for the comparison of different test groups, parametric ANOVA test and post-hoc Tukey’s multiple comparison test were performed at a significance level of 0.05. Results: The addition of 5% CESP to the CEM cement significantly reduced its setting time and water solubility (P=0.02 and P=0.01, respectively). Moreover, it significantly increased the CS over a 21-day period (P<0.001). Additionally, the addition of 3% CESP also resulted in a significant increase in CS (P<0.001). While 3% CESP reduced setting time and water solubility, the difference was not statistically significant. Conclusion: The findings suggest that the addition of 5% CESP to CEM cement has the potential to improve its sealing ability, durability, and ability to withstand chewing forces in endodontic treatments. These results highlight the relevance of CESP as an additive for cement modifications and indicate its potential clinical implications.

Effect of Silver Nanoparticles of Herbal Origin on the Compressive and Push-out Bond Strengths of Mineral Trioxide Aggregate

Mohammad Samiei, Khosro Adibkia, Negin Ghasemi, Ayda Tupal , Seraj Mohaghegh

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 159-164

Introduction: The purpose of this in vitro study was to investigate the effect of incorporating silver nanoparticles (AgNPs) of herbal origin into mineral trioxide aggregate (MTA) on the push-out bond strength (PBS) and compressive strength (CS) in simulated furcal area perforations. Materials and Methods: In this in vitro study, simulated furcal area perforations (1.3 mm in diameter and 2 mm in depth) were created in 40 extracted human lower molar teeth, which were divided into two groups (n=20): MTA alone and MTA combined with AgNPs (2% wt). Using a universal testing machine, PBS was evaluated by performing push-out tests, while CS was assessed using cylindrical specimens. The normal distribution of data was checked using the Kolmogorov-Smirnov test, and statistical analysis was performed using two-way ANOVA. Results: The CS results showed no significant difference between the MTA group at 4 and 21 days (P=0.297), but a significant difference was observed in the nanosilver/MTA group (P=0.013). However, there was no significant difference in the push-out bond strength among the study groups (P>0.05). Conclusion: The incorporation of herbal origin silver nanoparticles did not significantly affect the PBS or CS of MTA.

Case Report

Minimally invasive vital pulp therapy (VPT) techniques have become increasingly popular for treating mature permanent teeth with irreversible pulpitis. However, in cases where less invasive VPT approaches, such as miniature pulpotomy, fail to provide symptom relief and desired outcomes, alternative treatment strategies need to be explored. This case report presents the successful application of tampon pulpotomy, a modified full pulpotomy technique, in a vital molar tooth with irreversible pulpitis, after a previous miniature pulpotomy failure. The tampon pulpotomy procedure involved the placement of an endodontic biomaterial (i.e. calcium-enriched mixture cement) over the pulpal wound to stop bleeding and create a favorable environment for pulpal healing/regeneration. The patient was followed up for a period of 10 years, during which the tooth remained asymptomatic, functional, and exhibited normal periodontal ligament. This case report highlights the potential effectiveness of tampon/full pulpotomy as a retreatment option in cases where more conservative VPT techniques have shown limited success, offering a conservative approach to preserve tooth structure and pulpal vitality.

Endodontic and Surgical Management of an Invasive Cervical Resorption in a Maxillary Central Incisor: A Case Report

Marina da Cunha Isaltino, Camila da Silva Souza, Natália Gomes de Oliveira, Paulo Maurício Reis de Melo Júnior, Christianne Tavares Velozo Telles, Diana Santana de Albuquerque

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 168-173

The current study aims to report a case of invasive cervical resorption in a maxillary left central incisor with a history of dental trauma. After thorough clinical and tomographic evaluations, cervical cavitation, an irregularity in the gingival contour and crown discoloration were observed. Furthermore, presence of an extensive and well-defined area of invasive cervical resorption with pulp communication was discovered. The suggested diagnosis was asymptomatic irreversible pulpitis. The resorption area was treated with the complete removal of granulation tissue, sealed with light-curing glass ionomer cement. Then, the chemo-mechanical preparation and obturation of the root canal were performed. After two years of clinical follow-up and cone-beam computed tomography examination, there were no clinical signs and symptoms, the filling of the resorption area remained intact, and no hypodense image in the cervical region of tooth #21 could be detected. The management reported in this case presented a possible viable treatment for invasive cervical resorption, provided that correct diagnosis is made.

Endodontic Management of a Maxillary Central Incisor with two Roots: A Case Report and Literature Review

Sajedeh Namaei Ghasemi, Maryam Forghani, Sahar Karimpour

Iranian Endodontic Journal, Vol. 18 No. 3 (2023), 27 June 2023, Page 174-180

Maxillary incisors are typically straightforward cases for root canal therapy. While it is commonly assumed that maxillary central incisors have a single root canal, they may occasionally exhibit variations in their root canal system anatomy. In this report, we present a case of a maxillary central incisor with multiple