Journal of endodontics最新文献

{"title":"A Novel Robot-Assisted Access in Endodontic Microsurgery Combined with Sinus Floor Elevation for Maxillary First Molar","authors":"Weiwei Qiao PhD ,&nbsp;Li Qin DDS ,&nbsp;Chen Chen DDS ,&nbsp;Yeyu Lin MDS ,&nbsp;Xining Zhang MDS ,&nbsp;Yi Zhou PhD ,&nbsp;Liuyan Meng PhD","doi":"10.1016/j.joen.2025.11.022","DOIUrl":"10.1016/j.joen.2025.11.022","url":null,"abstract":"<div><div>Endodontic microsurgery (EMS) is an important treatment option for endodontic disease when the nonsurgical endodontic treatment fails. However, EMS for maxillary molars often presents a clinical challenge due to the root apex close to the maxillary sinus floor, which may increase the risk of sinus membrane perforation. Furthermore, the depth between the apex of the palatal root and the buccal cortical plate significantly impacts EMS precision for restricting visualization and instrument access. This case report is the first to use an autonomous robotic system for minimally invasive EMS on a maxillary first molar, combined with precise lateral wall sinus fenestration. A 55-year-old male patient presented with symptomatic apical periodontitis associated with previously treated left maxillary first molar. Cone-beam computed tomography revealed low-density areas surrounding the mesiobuccal and palatal (P) roots, and maxillary sinus floor descended between the palatal and buccal roots. Integrating cone-beam computed tomography and intraoral scan data, the autonomous robotic system performed guided sinus fenestration localization, autonomous osteotomy, and a 15-mm root-end resection from buccal to palatal root, with real-time monitoring of depth, angulation, and force. The clinician employed endoscopic assistance to verify the integrity of the sinus membrane and ensure the removal of debris from the surgical site. Root-end preparation and filling were carried out under a microscope. Follow-ups at 1 week, 1 month, 3 months, and 6 months indicated an absence of clinical symptoms. This approach offers a precise and minimally invasive treatment option for molars with a descended maxillary sinus floor located between the buccal and palatal root.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 464-471"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guided Auto-Transplantation of a Supernumerary Tooth Into a Surgically Created Socket Using Osseodensification and a Palatal Connective Tissue Graft: A Case Report","authors":"Javier Domínguez Bernal DDS ,&nbsp;Nandini Suresh BDS, MDS, FDS RCS(Eng) ,&nbsp;Venkateshbabu Nagendrababu BDS, MDS, FDS RCPS (Glasg), PhD ,&nbsp;Naresh Yedthare Shetty BDS, MDS ,&nbsp;Gabriel Darío Godínez Aréchiga DDS ,&nbsp;Paul M.H. Dummer BDS, MScD, PhD, DDSc ,&nbsp;Francesc Abella Sans DDS, PhD","doi":"10.1016/j.joen.2025.12.001","DOIUrl":"10.1016/j.joen.2025.12.001","url":null,"abstract":"<div><div>This case report describes the replacement of a missing maxillary right central incisor (tooth number 8) with a supernumerary tooth using cone beam computed tomography based digital planning, a three-dimensional printed donor replica tooth, osseodensification, and connective tissue grafting. A 36-year-old male presented with general periodontitis and a healed socket in the number 8 region 3 months postavulsion. Based on cone beam computed tomography scans, auto-transplantation of a single-rooted mandibular supernumerary tooth into a surgically created socket in the number 8 region was planned. Root canal treatment was performed on the donor tooth prior to its extraction. Digital planning was performed, and a three-dimensional replica of the donor tooth was designed and printed. The surgically created socket was prepared with an osseodensification technique. Extraction of the donor tooth was performed atraumatically, and soft tissue grafting and splint stabilization was performed after its placement in the socket. A definitive crown was placed at 12 months. At 30 months the transplanted tooth was functional and asymptomatic, with no clinical or radiographic signs of apical pathosis.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 472-478"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into the March 2026 Issue of the JOE","authors":"Anita Aminoshariae DDS, MS,&nbsp;Amir Azarpazhooh DDS, MSc, PhD, FRCD(C),&nbsp;Gerald N. Glickman DDS, MS, MBA, JD,&nbsp;Jianing He DMD, PhD,&nbsp;Sahng G. Kim DDS, MS,&nbsp;Anil Kishen BDS, MDS, PhD,&nbsp;Ariadne M. Letra DDS, MS, PhD,&nbsp;Linda Levin DDS, PhD,&nbsp;Ronald Ordinola-Zapata,&nbsp;Frank C. Setzer DMD, PhD, MS,&nbsp;Franklin R. Tay BDSc(Hons), PhD,&nbsp;Kenneth M. Hargreaves DDS, PhD","doi":"10.1016/j.joen.2026.02.007","DOIUrl":"10.1016/j.joen.2026.02.007","url":null,"abstract":"","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 331-333"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating Adhesion Molecules in Stem Cell – Immune Cell Interactions Using Organoids","authors":"Lauren Rotondi DDS,&nbsp;Fang-Chi Li DDS, MSc, PhD,&nbsp;Marco Magalhaes DDS, MSc, PhD,&nbsp;Anil Kishen BDS, MDS, PhD","doi":"10.1016/j.joen.2025.11.007","DOIUrl":"10.1016/j.joen.2025.11.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Immune cell-mesenchymal stem cell interactions modulate repair and regeneration, with cell-to-cell interactions being a necessary component facilitating this crosstalk. This study used a collagen-based organoid model to examine direct cell-to-cell interactions between stem cells from apical papilla (SCAP) and macrophages (MQ). The aim was to better understand how adhesion molecules contribute to apical periodontitis dynamics in the immature permanent tooth.</div></div><div><h3>Methods</h3><div>Two-dimensional SCAP-MQ co-cultures were compared to three-dimensional (3D) SCAP-MQ self-assembled tissue constructs under 3 conditions: non-stimulated, lipopolysaccharide (LPS), and interleukin (IL)-4 for up to 7 days. Expression of 5 candidate adhesion molecules (CD200, CD200 R, intercellular adhesion molecule (ICAM)-1, N-cadherin, and lymphocyte function-associated antigen (LFA)-1) were assessed by quantitative real time polymerase chain reaction and confocal microscopy.</div></div><div><h3>Results</h3><div>LPS decreases CD200 and CD200 R immunofluorescence in an organoid model (<em>P</em> &lt; .05). <em>N-CADHERIN</em> gene expression increased on day 5 in the 3D model in response to LPS (<em>P</em> &lt; .05). LFA-1 showed a trend toward increased immunofluorescence in the juxtacrine zone of the organoid model under LPS stimulation, though this difference was not significant. <em>ICAM-1</em> gene expression in the 2D model increased in response to LPS (<em>P</em> &lt; .05) but no change was observed with IL-4.</div></div><div><h3>Conclusion</h3><div>Extracellular collagen and inflammatory conditions modulate adhesion molecule expression in SCAP-MQ co-cultures. LPS promoted N-cadherin, ICAM-1, and LFA-1 expression, while IL-4 increased CD200, CD200 R, and ICAM-1. These findings highlight the molecular mechanisms underlying SCAP-MQ interactions and validate the use of 3D models to potentially inform future therapeutic strategies for enhancing pulpal regeneration.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 414-420.e4"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Organic Debris Removal by 2 Irrigant Activation Systems using a Novel Chairside Quantitative Assay.","authors":"Sean Kennelly, Derek Lin, Hacer Aksel, Mohini Ratakonda, Jorge Vera","doi":"10.1016/j.joen.2026.02.015","DOIUrl":"10.1016/j.joen.2026.02.015","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate a novel quantitative adenosine triphosphate assay, to evaluate organic debris/bacterial reduction after irrigation activation with passive ultrasonic irrigation and the XP-endo Finisher (XPF), and to compare its efficacy with traditional colony-forming unit (CFU) detection in vitro.</p><p><strong>Methods: </strong>The root canals of 40 extracted single-canal teeth were shaped to a 30.04 using NiTi files. Following inoculation of the root canals with Enterococcus faecalis for 3 weeks, the teeth were randomly allocated into 2 experimental groups (n = 20): (1) activation of 5.25% NaOCl using passive ultrasonic irrigation, or (2) activation using the XPF. The quantitative adenosine triphosphate assay (Endocator) was used before and after the irrigant activation protocols to determine the amount of bacteria/organic debris present. Data were analyzed using the Student t test and the Mann-Whitney U test (P = .05).</p><p><strong>Results: </strong>The Endocator raw score exhibited a strong correlation with the number of bacteria present, as determined by CFU counts (R² = 0.99). In contrast, Endoscore values showed a high correlation with the logarithmically transformed CFU counts (R² = 0.95). The amount of intracanal organic debris/bacteria remaining after the passive ultrasonic irrigation and XPF protocols was approximately 1.7% and 1.2%, respectively. No statistically significant differences were observed between the groups regarding the amount of residual bacteria remaining in the canals after the irrigation protocols (P > .05).</p><p><strong>Conclusion: </strong>Both irrigation activation systems were similarly effective in removing organic debris/bacteria from the root canal system following final irrigation. None of the tooth samples was completely free of bacterial or organic debris residues after treatment with either of the tested systems.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taxonomy and Virulence Factors in the Root Canal Microbiome: Metagenomic Insights by Lesion Size and Clinical Factors in Primary Endodontic Infections.","authors":"Blake C Clarke, Ronald Ordinola-Zapata, W Craig Noblett, Michael Gould, Christopher Staley","doi":"10.1016/j.joen.2026.02.016","DOIUrl":"10.1016/j.joen.2026.02.016","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the taxonomic and functional profiles of the root canal microbiome in teeth with large versus small periapical lesions, examining the influence of clinical variables on microbial composition and functional pathways.</p><p><strong>Methods: </strong>Samples from 25 teeth with large (>8 mm) and 20 with small periapical lesions (<2 mm) were analyzed. Quantitative polymerase chain reaction, 16S next-generation and whole genome sequencing were used to assess microbial load, diversity, and composition. Functional predictions were performed using the Kyoto Encyclopedia of Genes and Genomes and MetaCyc databases. Alpha diversity was calculated using Shannon and Chao1 indices. Beta diversity was assessed using ANOSIM and PERMANOVA. Significant variables were explored using MaAsLin3. Kruskal-Wallis tests were used for univariate comparisons.</p><p><strong>Results: </strong>Teeth with large lesions exhibited significantly higher bacterial load (P = .011), but comparable alpha diversity and number of species per group in 16S and whole genome analysis (P > .05). Lesion size showed significance by ANOSIM (P = .04) but not in PERMANOVA (P = .36). Age was significant in both beta diversity tests, but the effect size only explained 3.6% of the variance. All clinical variables were not significant in 16S analysis for beta diversity. MetaCyc pathway analysis identified percussion sensitivity as the most influential clinical variable in both tests (ANOSIM R = 0.182, P = .012; PERMANOVA R² = 0.063, P = .046). MaAsLin3 modeling revealed enrichment of enzymatic pathways involved in methionine and cysteine-related metabolism.</p><p><strong>Conclusions: </strong>Large periapical lesions contain significantly higher bacterial load, but similar diversity compared to small lesions. Functional predictions suggest bacterial metabolic activity may contribute to mechanical allodynia in endodontic infections.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regenerative Endodontic Procedures: Mapping and Critical Appraisal of Clinical Trial Evidence.","authors":"Felipe Oliveira Nunes, Eduardo Borges Sollim, Carolynne Ferreira Dos Santos, Maria Karolina Martins Ferreira, João Daniel Mendonça Moura, Juliana Melo Brandão, Manoel Damião Sousa-Neto, Paulo Jorge Palma, Rafael Rodrigues Lima","doi":"10.1016/j.joen.2026.02.017","DOIUrl":"10.1016/j.joen.2026.02.017","url":null,"abstract":"<p><strong>Introduction: </strong>Regenerative endodontic procedures (REPs) are biologically based approaches aimed at restoring the vitality of immature teeth with pulp necrosis. Over the past decades, these procedures have gained increasing attention. This study mapped and critically appraised the clinical trial evidence on REPs, providing an overview of research trends and methodological characteristics.</p><p><strong>Methodology: </strong>A comprehensive bibliometric analysis was conducted following Bibliometric Reviews of the Biomedical Literature guidelines using the Web of Science Core Collection database. Randomized and nonrandomized clinical trials available in the database up to 2025 were included, covering the full period of indexed clinical evidence on REPs. Quantitative variables (citations, countries, journals, and keywords) and qualitative aspects (techniques, materials, irrigants, intracanal medications, and barriers) were analyzed.</p><p><strong>Results: </strong>Among the 6,287 retrieved records, 58 clinical studies met the inclusion criteria. The most productive authors were De-Jesus-Soares A, Gomes BPFA, Kang J, Nazzal H, and Elheeny AAH. The most cited author was Xuan K, with 346 citations. Asia was the most productive continent, and the Journal of Endodontics published the highest number of studies. The most frequent keywords were regenerative endodontics, revascularization, and immature teeth. Blood clot induction was the predominant regenerative technique, while sodium hypochlorite, triple antibiotic paste, and mineral trioxide aggregate were the most commonly used irrigant, intracanal medication, and barrier material, respectively.</p><p><strong>Conclusions: </strong>Clinical evidence on REPs suggests a consolidation of biologically based strategies, particularly blood clot induction with mineral trioxide aggregate barriers. However, methodological heterogeneity limits the strength and comparability of findings, highlighting the need for standardized protocols and long-term randomized studies.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Chatbots Taking American Board of Endodontics Simulated Oral Board Examination.","authors":"Poorya Jalali, Feng-Ming Wang, Seyed AmirHossein Ourang, Samira Zahedrozegar, Hossein Mohammad-Rahimi, Ali Nosrat","doi":"10.1016/j.joen.2026.02.014","DOIUrl":"10.1016/j.joen.2026.02.014","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to assess the overall performance of artificial intelligence (AI) chatbots in taking the American Board of Endodontics simulated Oral Board Examination.</p><p><strong>Methods: </strong>Three oral board cases were constructed by 2 academic board-certified endodontists. Each case included a comprehensive patient profile consisting of medical history, dental history, and results of clinical testing, followed by 20 consecutive open-ended oral board-style questions. Two publicly accessible AI chatbots were selected to take the exam: GPT-4o and Gemini-2.5 Pro. Responses were scored based on a comprehensive rubric on a 4-point ordinal scale (0-3) by the same 2 examiners independently: response validity, citation validity, and overall performance score. A Cumulative Link Mixed Model (proportional odds) was used with fixed effects for chatbot and case, and random intercepts for reviewer and question to analyze and compare the performance of models, that is, inter- and intra-chatbot comparisons.</p><p><strong>Results: </strong>Gemini-2.5 Pro and GPT-4o achieved high mean overall performance scores of 2.83 (±0.42) and 2.73 (±0.51), respectively. Cumulative Link Mixed Model showed no significant difference between the 2 chatbots in probability of receiving an excellent score (ie, 3) in response validity (odds ratio = 2.44, 95% confidence interval [0.98-6.06], P = .054) or in overall performance (odds ratio = 2.04, 95% confidence interval 0.97-4.30, P = .061). There was a positive correlation between response validity and citation validity for GPT-4o (ρ = 0.21, P = .019).</p><p><strong>Conclusions: </strong>Both chatbots scored considerably high in the simulated American Board of Endodontics Oral Board Examination. Results of this study support the concept of using AI chatbots as aid in endodontic education.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Postoperative Instructions After Nonsurgical Root Canal Treatment: Readability, Usability, and Transparency.","authors":"Tara Boroumand, Mohammad A Sabeti","doi":"10.1016/j.joen.2026.02.013","DOIUrl":"10.1016/j.joen.2026.02.013","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative recovery after root canal treatment (RCT) relies on patients' ability to interpret instructions. However, the readability, usability, and transparency of online postoperative instructions for nonsurgical RCT are unclear. This study evaluated their readability, understandability, actionability, and transparency using a standardized Google search.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of online postoperative instructions for nonsurgical RCT from the first 100 Google search results. Readability was assessed using four grade-level formulas and summarized as an Average Grade Level (AGL). Understandability and actionability were evaluated using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), and transparency was assessed against Journal of the American Medical Association benchmarks. Outcomes were compared with recommended thresholds and between practice types.</p><p><strong>Results: </strong>Sixty-three webpages met inclusion criteria. Mean AGL was 11.49; no webpage met the recommended sixth-grade reading level. Endodontic practice webpages were less readable than general practice webpages (AGL 11.82 vs 11.16; P = .022). Mean PEMAT-P understandability and actionability were 74.34% and 60.16%; 47/63 webpages (75%) met the understandability benchmark, but 7 (11%) met the actionability benchmark. Readability was not correlated with PEMAT-P scores. Journal of the American Medical Association transparency scores were low; most webpages met only one criterion, and none met all four.</p><p><strong>Conclusions: </strong>Online postoperative instructions for nonsurgical RCT require reading levels above recommended targets, offer limited actionable information, and lack transparency. Endodontic practice webpages are less readable than general practice webpages, yet they do not provide better understandability, actionability, or transparency. These findings highlight the need for guideline-based, low-literacy, actionable postoperative instructions.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Survival and Outcomes of Direct Pulp Capping with Bioceramic iRoot BP Plus in Symptomatic Irreversible Pulpitis.","authors":"Huixiang Lv, Yanfeng Li, Haining Cui","doi":"10.1016/j.joen.2026.02.009","DOIUrl":"10.1016/j.joen.2026.02.009","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term efficacy and safety of the bioceramic material iRoot BP Plus compared with mineral trioxide aggregate (MTA) in direct pulp capping for symptomatic irreversible pulpitis (SIP).</p><p><strong>Methods: </strong>A single-center retrospective cohort study was conducted, including SIP patients who underwent direct pulp capping between January 2016 and December 2020, with a minimum follow-up of 36 months. Propensity score matching (PSM) with replacement was used to balance baseline characteristics, resulting in 92 teeth each in the iRoot BP Plus group and the MTA group The primary outcome was pulp survival, assessed by combined clinical and radiographic criteria. Statistical analyses for group comparisons incorporated weights from the PSM. Secondary outcomes included pain intensity changes, reparative dentin bridge formation, and complications. An exploratory multivariable Cox regression analysis with a reduced set of covariates was employed to identify prognostic factors, and sensitivity analyses were performed according to tooth position and preoperative pain level.</p><p><strong>Results: </strong>At 36 months post-treatment, the pulp survival rate was 88.0% (95% confidence interval [CI]: 79.6-93.4%) in the iRoot BP Plus group and 86.9% (95% CI: 78.3-92.6%) in the MTA group, with no statistically significant difference (P = .730). The absolute difference was 1.1% (95% CI: -8.4% to 10.7%). No significant differences were observed between groups in reparative dentin bridge formation (78.3% vs. 75.0%), vitality response, or complication rates. Exploratory multivariate analysis identified higher preoperative pain level (visual analog scale ≥7) as an independent risk factor for treatment failure (hazard ratio = 2.35, 95% CI: 1.22-4.52, P = .010), whereas the type of capping material did not influence outcomes (hazard ratio = 0.98, 95% CI: 0.46-2.11, P = .962). Subgroup analyses further confirmed comparable performance of both materials across different tooth positions and pain strata.</p><p><strong>Conclusion: </strong>iRoot BP Plus demonstrates comparable long-term efficacy to MTA in direct pulp capping for SIP, with favorable clinical applicability and safety. Preoperative pain intensity, rather than the choice of capping material, appears to be a critical determinant of prognosis.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}