مقالات رزومه دکتر سعید عسگری

Apical periodontitis (AP) is a common inflammatory condition predominantly caused by the response of the immune system to microbial invasion within the root canal system. Contrary to conventional perception, AP may occur in vital teeth with inflamed pulp; adding complexity to diagnosis and treatment. AP, due to its frequent lack of symptoms and reliance on radiographic evaluation for detection, often presents diagnostic challenges. In addition, AP pathogenesis involves complex interactions between microbialvirulence and host immune response at the cellular and molecular levels. Comprehensive diagnostic procedures, including patient history, clinical examination, and radiographic evaluation, are essential for early detection and necessary intervention, with the recognition of clinical signs and symptoms underscoring the importance of regular dental evaluations. The current review primarily discusses the radiographic and clinical features of AP in vital and non-vital teeth; introducing a new taxonomic classification to improve diagnostic precision and treatment outcomes. Moreover, it proposes different treatment categories/options for the management of AP, based on pulp status as well as clinical and radiographic findings; emphasizing vital pulp therapy and root canal treatment for vital and non-vital teeth with AP, respectively. Furthermore, the global and regional epidemiology of AP is presented, along with its association with systemic health conditions; e.g., cardiovascular diseases, diabetes mellitus, and adverse pregnancy outcomes. Moreover, future research directions are advocated to improve the efficacy and predictability of diagnosis and treatments; paving the path for clinicians in early detection, accurate diagnosis, and effective management of AP to enhance oral health outcomes

Artificial intelligence (AI) is transforming the diagnostic methods and treatment approachesinthe constantly evolving field of endodontics. The currentreview discusses the recent advancements in AI; with a specific focus on convolutional and artificial neural networks. Apparently, AI models have proved to be highly beneficial in the analy sis of root canal anatomy,detecting periapical lesions in early stages as well as providing accurate working-length determination. Moreover, they seem to be effective in predicting the treatment success next toidentifying various conditions e.g., dental caries, pulpal inflammation, vertical root fractures, and expression of second opinions for non-surgical root canal treatments. Furthermore, AI has demonstrated an exceptional ability to recognize landmarks and lesions in cone-beam computed tomography scans with consistently high precision rates. While AI has significantly promoted the accuracy and efficiency of endodontic procedures, it is of high importance to continue validating the reliability and practicality of AI for possible widespread integration into daily clinical practice. Additionally, ethical considerations related to patient privacy, data security, and potential bias should be carefully examined to ensure the ethical and responsible implementation of AI in endodontics.

The current case report aims to document a rare presentation of a distant odontogenic lesion of a 35-year -old male patient with mild clinical discomfort in the mandibular right first molar; exploring the diagnostic and therapeutic intricacies of an uncommon distant endodontic pathosisultimately resolved through meticulous nonsurgical retreatment. Desp ite a normal oral examination, diagnostic radiography revealed a suboptimal root canal treatment and apical lesions surrounding mesial- and distal-root apices; including a distinct radiolucency beneath the apex of the second mandibular molar discovered through panoramic radiography, and confirmed via cone-beam computed tomography. In addition, the computed tomography disclosed a previously unreported and unusually large endodontic lesion that extended toward the mandibular canal; highlighting a necessity for the continued exploration of a unique endodontic presentation. A nonsurgical endodontic retreatment led to a remarkable reduction in the radiolucent lesions within one year; emphasizing the significance of comprehensive diagnostic approaches and individualized treatments

Invasive cervical root resorption (ICRR) is a dental pathology, marked by unexpected destruction originating in the cervical region of the tooth. This comprehensive literature review provides a holistic view into the pathogenesis, clinical manifestation, and precise management of ICRR, aiming to guide endodontists and enhance patient care and treatment outcomes. The review delves into the potential etiology of ICRR, covering contributing factors such as trauma, orthodontic treatment, and other pertinent conditions. It outlines the clinical and radiographic indicators, underscoring the crucial role of early detection and precise diagnosis in effectively managing and halting ICRR progression. The exploration of treatment approaches is thorough, ranging from non-surgical methods like vital pulp therapy or root canal treatment to surgical interventions. This review accentuates the essential role of interdisciplinary collaboration among diverse dental specialties in enhancing ICRR management. It highlights the importance of a consolidated strategy in enhancing treatment outcomes and preserving tooth structure and function. Moreover, it investigates prevention methods, risk evaluation, and identifies prospective research pathways to address the existing knowledge gaps.

Invasive cervical root resorption (ICRR) is a rare and clinically complex condition marked by the progressive loss of dental hard tissues below the junctional epithelium. This case report outlines the management of a 32-year -old female patient presenting with ICRR class 3 affecting a maxillary incisor. Despite the absence of symptoms, the expansivenature of the defect warranted conservative surgical intervention. The procedure involved the surgical removal of inflamed tissues, followed by an ultraconservative modified pulpotomy utilizing calcium-enriched mixture (CEM) cement through a surgical window. The selected intervention is substantiated by its potential benefits, such as minimal removal of tooth structure and the inherent biocompatibility and sealing capabilities of CEM cement. A one-year follow-up revealed arrested resorption, re-establishment of periodontal attachment, and successful esthetic restoration, affirming the efficacy of vital pulp therapy in surgically addressing advanced ICRR. Accurate diagnosis, strategic treatment planning, and a patient-centered approach proved critical in achieving favorable outcomes.

Over recent decades, the definition of irreversible pulpitis (IP), as an irrevocable condition of a compromised dental pulp tissue, has forced clinicians towards invasive root canal treatments. However, the current best evidence challenges the alignment between clinical symptoms and the perceived irreversibility of a negotiated dental pulp tissue. In the above-mentionedcontext, vital pulp therapy (VPT) has emerged as a revolutionary and transformative approach; introducing minimally invasive techniques to sustain pulp vitality in cases of IP. The present paper aimed to rigorously examine the corresponding published systematic reviews to explore the diverse spectrum of VPT modalities and their outcomes in managing IP cases. Besides, the current review seems to have assertedthe need to discard the conventional terminology of irreversible pulpitis, based on the effectiveness of VPTs in the achievement of pulp tissue healing within cases clinically diagnosed as IP.

This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021.

Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the “citation per year” of each top 101 articles was calculated. Spearman’s rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators.

The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r = 0.828, P˂0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals’ bibliometric indicators.

Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. “European Journal of Dentistry” from Turkey, “Saudi Dental Journal” from Saudi Arabia, and “Iranian Endodontic Journal” and “Journal of Lasers in Medical Sciences” both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals.

A 30-year-old male patient with the chief complaint of pink spot discoloration of the tooth crown in his upper left central incisor was referred for endodontic and esthetic management. After thorough clinical and radiographic examinations, the final diagnosis was class IV invasive cervical resorption (ICR) which was conservatively treated with an orthograde approach; i.e. vital pulp therapy with calcium-enriched mixture cement (VPT/CEM). The use of VPT/CEM was successful to restore esthetics and stop the ICR; confirmed clinically, radiographically, and tomographically at one-year recall. The above-mentioned minimally invasive approach reported in the current case study may be considered a practical treatment modality for ICR, specifically in anterior teeth. 

 To investigate the effects of the COVID-19 pandemic on the patients’ attendance/distribution patterns within different departments and the perception of the dental team providing dental services during the COVID-19 outbreak in a private dental clinic. Moreover, the impact of SARS-CoV-2 on dental professionals next to the role of personal protective equipment in the prevention of infection in the corresponding teams was simultaneously investigated.

A clinic located in the northern part of Tehran was selected. Forty-four dentists with 48 staff members were involved in treatment teams. Preventive strategies, i.e., personnel/operator/patient management comprising full Personal Protective Equipment (PPE), high–volume evacuation suctions, primary screening questions, pulse oximetry, the patient’s body temperature measurement as well as administrative controls, e.g. disinfection of surfaces and using stairs instead of lifts, were implemented to manage the prevalence of disease and analyze the impact of COVID-19 on the distribution/attendance patterns of patients. 

 During 6 months, a 26% reduction in the number of patients was observed after the pandemic; however, men’s and women’s distributions were not affected. The department of orthodontics reported a 6% increase in new cases whereas the department of pediatric dentistry revealed the least changes in the number of patients. In the departments of operative dentistry, prosthodontics, oral/maxillofacial surgery, and periodontics, the number of patients was reduced by 10-30%. In addition, three dentists and four staff members were affected by COVID-19 during the mentioned period.

 It seems that the potential for COVID-19 transmission in dental clinics is relatively low.

The current case study evaluated the effect of vital pulp therapy on a human dental pulp after a long-term period using micro-computed tomography (MCT) for the first time. In the presented report, the successful outcomes of full pulpotomy using calcium-enriched mixture (CEM) cement on an irreversible pulpitis case were documented clinically/radiographically over 5 years. Due to an unrestorable crown fracture at the 5-year recall, the tooth was extracted and evaluated by MCT; the images showed that CEM pulpotomy allowed the dental pulp to create complete dentinal bridges without pulp canal obliteration (PCO). These MCT results showed that CEM pulpotomy, as a bio-regenerative treatment, caused no negative consequence of PCO or calcific metamorphosis on dental pulp over the long term.

In late December 2019, a new type of coronavirus, called novel coronavirus disease 2019 (COVID-19), caused a major outbreak of severe pneumonia in Wuhan (Huanan seafood market) and then, across China. As of 31 March 2020, COVID-19 has spread in 200 countries, including Iran, and imposed serious health-related threats to the public worldwide. Fever, dry (non-productive) cough, myalgia, and pneumonia seem to be the symptoms of COVID-19 disease. To date, and despite various studies and investigations, except for chloroquine and hydroxychloroquine, which have recently been temporarily approved by FDA, no other vaccines and/or antiviral agents have been clinically endorsed for the treatment of COVID-19 disease. Nevertheless, prevention of the disease and control of the infection is deemed a top priority for the general public. Owing to the characteristics of different dental treatments and settings, the risk of virus transmission can be considered high between patients and dental practitioners. Therefore, the need for strict and tough effective infection control protocols in dental practice is of great importance, namely for the dental centers in the potentially affected areas with COVID-19. This study, based on relevant evidence, aimed to review the basic knowledge of COVID-19 and address the recommended protocols of infection control for the dental practitioners and treatments in hypothetically stricken areas.

In late December 2019, a new type of coronavirus, called novel coronavirus disease 2019 (COVID-19), caused a major outbreak of severe pneumonia in Wuhan (Huanan seafood market) and then, across China. As of 31 March 2020, COVID-19 has spread in 200 countries, including Iran, and imposed serious health-related threats to the public worldwide. Fever, dry (non-productive) cough, myalgia, and pneumonia seem to be the symptoms of COVID-19 disease. To date, and despite various studies and investigations, except for chloroquine and hydroxychloroquine, which have recently been temporarily approved by FDA, no other vaccines and/or antiviral agents have been clinically endorsed for the treatment of COVID-19 disease. Nevertheless, prevention of the disease and control of the infection is deemed a top priority for the general public. Owing to the characteristics of different dental treatments and settings, the risk of virus transmission can be considered high between patients and dental practitioners. Therefore, the need for strict and tough effective infection control protocols in dental practice is of great importance, namely for the dental centers in the potentially affected areas with COVID-19. This study, based on relevant evidence, aimed to review the basic knowledge of COVID-19 and address the recommended protocols of infection control for the dental practitioners and treatments in hypothetically stricken areas.

The main cause of endodontic failure is residual bacteria in the root canal system. Enterococcus faecalis (E. faecalis) is the predominant species isolated from infected root canals. This study aims to compare the antibacterial activity of calcium-enriched mixture (CEM) cement and Biodentine as root canal filling materials on E. faecalis. Methods and Materials: Seventy extracted human single-rooted teeth were prepared and infected with E. faecalis for 24 h. Specimens were randomly divided into control or experimental groups; the later were filled with either CEM cement or Biodentine. Dentinal samples were collected after 7 and 30 days and transferred to test tubes. After incubation, the number of colony forming units (CFUs) were counted and analyzed using the Kruskal-Wallis test, followed by the Mann Whitney U test. The level of significance was set at 0.05. The reduction in mean CFU level of E. faecalis was significantly more in the presence of CEM cement at both time intervals (P<0.001). Compared to the positive control, Biodentine significantly reduced the mean CFU level only after 30 days (P<0.01). Although both biomaterials exerted antibacterial activity against E. faecalis, the CEM cement had more antibacterial activity than Biodentine.

In endodontics, metal artifacts are the major weak points of employing cone-beam computed tomography (CBCT) in teeth with metallic posts and restorations. The aim of this article is to introduce a novel technique for preparation of beneficial CBCT images of anterior teeth with metal posts and/or crowns. In this novel technique, the patient who was instructed to take CBCT images for reason of implant surgery, was asked to puff out his cheeks/lips during the rotation of x-ray tube. By comparing the image taken with this technique to normal image it was obvious that after applying the cheek puffing technique, the metal artifacts around restored anterior teeth significantly reduced. Then it seems that this novel technique removes the metal artifacts from the crowned teeth to distances far from the tooth structure and enables more accurate diagnosis.

The antimicrobial substantivity of Mixture of Doxycycline, Citric acid, and Tween 80 (MTAD), Tetraclean, Tetraclean NA, Q-Mix, 2% Chlorhexidine (CHX) and Octenisept was assessed in human root dentine blocks infected with Enterococcus (E.) faecalis. Methods and Materials: A total of 170 dentine tubes were prepared from human maxillary incisors. After crown and apical third removal, cementum was abraded. The remaining center-holed pieces were cut into 4-mm blocks, infected with E. faecalis in Brain Heart Infusion (BHI) broth for 28 days, then randomly divided into 6 experimental groups (n=25) and 2 controls (n=10). At 0, 7, 14, 21 and 28 days, dentine chips were removed from the canals, with sequential round burs with increasing diameters, and collected into freshly prepared BHI broth. After culturing, growing colonies were counted as colony forming units (CFU). Conventional non-parametric tests (Kruskal-Wallis and Mann-Whitney tests) were used to assess intra-group (at different time frames) and inter-group (at each experimental time) differences (P=0.05). Tetraclean yielded the lowest CFU counts (P<0.001) at each observation time. Tetraclean NA and Q-Mix showed better (P<0.001) substantivity than 2% CHX and MTAD (except for Q-Mix versus MTAD at 14 days, P=0.21). In this in vitro study, Tetraclean NA and Q-Mix displayed the best antimicrobial substantivity against E. faecalis after Tetraclean in infected human root dentine. Considering the findings of our study and potential drawbacks of antibiotic-based irrigants, free-antibiotic irrigants may represent viable alternative for final rinse in root canal treatment.

Direct pulp capping (DPC) is a conservative vital pulp therapy, which has some limitations in primary dentition. The aim of this study was to evaluate pulpal response of primary teeth after DPC with two biocompatible materials naming calcium-enriched mixture (CEM) and bioactive glass (BAG). Methods and Materials: This study was designed as a randomized clinical trial. After obtaining informed consent, 20 sound primary canines scheduled for orthodontic extraction, were selected. Following mechanical pulp exposure, the exposed site was capped with either CEM cement or BAG and then restored with amalgam. Teeth were extracted after two months and examined histopathologically. Parameters of hard tissue bridge (HTB) formation, its type and pulpal inflammation scores, were compared between the two groups. Data were analysed using the Fisher’s exact test. All CEM specimens showed inflammation scores of 0 (less than 10%). In the BAG group, inflammation scores of 0, 1 and 2 were observed in 7, 2 and 1 specimens, respectively. Fisher’s exact test showed no significant differences (P>0.05). All CEM specimens (100%) formed HTB, which was irregular in all cases. In 7 of 10 teeth in BAG, HTB formed and was irregular. Fisher’s exact test revealed no significant differences between the two groups in this regard (P<0.001). Both CEM and BAG are suitable DPC agents in terms of HTB formation and pulp inflammation scores.

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.

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 t-test and ANOVA.
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 (P In this in vitro 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.

As the dental pulp could not be directly inspected before endodontic treatment, indirect evaluation of the pulp status via 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 adjacent tooth maxillary first 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.

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.

Annually ~2 million permanent teeth are lost in public dental clinics in Iran. Many of these losses are caused by difficulties in provision of timely root canal treatment (RCT) or their low quality. The present guideline aimed to find and recommend the best treatment options for management of vital permanent teeth with carious exposure.

The guideline domain was examined and treatment options were determined as scenarios comprised of indications and possible interventions. Two main indications including carious pulp exposure with or without irreversible pulpitis in open-apex and in closed-apex permanent teeth were included. Nine treatment options were found for each indication based on the available literature. Exhaustive search was performed to find the current evidence and the retrieved studies were critically reviewed. Treatment options and their supporting evidence were extracted. Search for the side effects and benefits of each treatment option was also performed. The expenses regarding each treatment were then determined and treatment options with Level of Evidence (LOE) I and II evidence were presented to an expert panel for each indication. Each clinical scenario was examined and rated by each member considering six aspects: effectiveness of the intervention, costs, side effects, side benefits, applicability of the scenario and generalizability of the treatment. The best scenarios were chosen based on the expert panel ratings and the recommendations were extracted.

Based on the present guideline, full pulpotomy with calcium enriched mixture (CEM) cement is recommended in vital permanent teeth with open- or closed-apex, with or without irreversible pulpitis, following carious pulp exposure (Grade A recommendation).

Adherence to the present guideline may help preserve pulp vitality and decrease the risk of loss of vital permanent teeth with carious pulp exposure.

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.
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 (P>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 (P>0.05).
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.

The aim of the present in vitro study was to evaluate the genotoxicity of mineral trioxide aggregate (MTA) after adding different concentrations of disodium hydrogen phosphate and silver nanoparticles using the Ames test.
Methods and Materials: TA100 strain of Salmonella typhimurium was used to evaluate mutagenicity of experimental materials with and without S9 mix fraction. The materials tested in this study consisted of MTA, MTA/disodium hydrogen phosphate and MTA/silver nanoparticles at 0.1, 0.01, 0.001 and 0.0001 concentrations. Negative and positive control groups consisted of 1% dimethyl sulfoxide and sodium azide with 2-aminoanthracene, respectively. The number of colonies per plate was determined. If the ratio of the number of histidine-revertant colonies to spontaneous revertants of the negative control colonies was ≥2, the material was regarded a mutagenic agent.
In all the concentrations of the three tested materials, the Ames test failed to detect mutations.
Under the limitations of the present study, MTA/disodium hydrogen phosphate and MTA/silver nanoparticles were biocompatible in relation to mutagenicity.

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 Actinomyces 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 a traumatically 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.

This case report presents the successful surgical treatment of a symptomatic open apex upper central incisor with a failed overfilled mineral trioxide aggregate (MTA) apical plug. Unintentional overextension of the MTA had occurred two years before the initial visit. An apical lesion adjacent to the excess MTA was radiographically detectable. Endodontic surgery was performed using calcium-enriched mixture (CEM) cement as a root-end filling material. Curettage of the apical lesion showed a mass of unset MTA particles; histopathological examination revealed fragments of MTA and granulation tissues. Up to 18-month follow-up, the tooth was clinically asymptomatic and fully functional. Periapical radiograph and CBCT images showed a normal periodontal ligament around the root. In conclusion, favorable outcomes in this case study suggested that root-end filling with CEM cement might be an appropriate approach; in addition, however many factors probably related to the initial failure of the case, the extrusion of MTA into the periapical area should be avoided.