{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:40:47Z","timestamp":1792806047181,"version":"4.5.0"},"reference-count":49,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.jp","jendodon.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endodontics"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.joen.2026.08.022","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:19:29Z","timestamp":1787926769000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining Pulpal Diagnostics for Predictable Vital Pulp Treatment"],"prefix":"10.1016","author":[{"given":"Ikhlas","family":"El karim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry F.","family":"Duncan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"About","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orla M.","family":"Dunne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fionnuala T.","family":"Lundy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.joen.2026.08.022_bib1","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/iej.13688","article-title":"Present status and future directions\u2014vital pulp treatment and pulp preservation strategies","volume":"55","author":"Duncan","year":"2022","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib2","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1177\/00220345211046874","article-title":"MMP-9 levels and NaOCl lavage in randomized trial on direct pulp capping","volume":"101","author":"Ballal","year":"2022","journal-title":"J Dent Res"},{"key":"10.1016\/j.joen.2026.08.022_bib3","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/iej.13974","article-title":"Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline","volume":"56","author":"Duncan","year":"2023","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib4","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/iej.13762","article-title":"Effectiveness of diagnosing pulpitis: a systematic review","volume":"56","author":"Donnermeyer","year":"2023","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1365-2591.1980.tb00834.x","article-title":"Clinical signs and symptoms in pulp disease","volume":"13","author":"Dummer","year":"1980","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib6","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/iej.13064","article-title":"Dissecting dentine\u2013pulp injury and wound healing responses: consequences for regenerative endodontics","volume":"52","author":"Duncan","year":"2019","journal-title":"Int Endod"},{"key":"10.1016\/j.joen.2026.08.022_bib7","doi-asserted-by":"crossref","DOI":"10.3389\/fdmed.2021.651219","article-title":"Deciphering reparative processes in the inflamed dental pulp","volume":"2","author":"El karim","year":"2021","journal-title":"Front Dent Med"},{"key":"10.1016\/j.joen.2026.08.022_bib8","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/j.1747-4477.2002.tb00386.x","article-title":"The mechanism of pulpal wound healing","volume":"28","author":"Tj\u00e4derhane","year":"2002","journal-title":"Aust Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib9","article-title":"3D-imaging of whole neuronal and vascular networks of the human dental pulp via clarity and light sheet microscopy","volume":"26","author":"Fran\u00e7a","year":"2019","journal-title":"Sci Rep"},{"key":"10.1016\/j.joen.2026.08.022_bib10","first-page":"507","article-title":"Role of intradental A- and C-type nerve fibers in dental pain mechanisms","volume":"88","author":"N\u00e4rhi","year":"1992","journal-title":"Proc Finn Dent Soc"},{"key":"10.1016\/j.joen.2026.08.022_bib11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1600-0722.1979.tb01937.x","article-title":"Electrical stimulation of teeth with a pulp tester in the cat","volume":"87","author":"N\u00e4rhi","year":"1979","journal-title":"Eur J Oral Sci"},{"key":"10.1016\/j.joen.2026.08.022_bib12","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1177\/002203458506400411","article-title":"The characteristics of intradental sensory units and their responses to stimulation","volume":"64","author":"N\u00e4rhi","year":"1985","journal-title":"J Dent Res"},{"key":"10.1016\/j.joen.2026.08.022_bib13","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and central sensitization in chronic and widespread pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"10.1016\/j.joen.2026.08.022_bib14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3727\/036012984816714785","article-title":"The function of intradental nerves in relation to the sensations induced by dental stimulation","volume":"9","author":"Narhi","year":"1984","journal-title":"Acupunct Electrother Res"},{"key":"10.1016\/j.joen.2026.08.022_bib15","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1111\/j.1365-2591.2008.01436.x","article-title":"Neuropeptide y Y1 receptor in human dental pulp cells of noncarious and carious teeth","volume":"41","author":"El Karim","year":"2008","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib16","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.archoralbio.2006.04.009","article-title":"Vasoactive intestinal polypeptide (VIP) and VPAC1 receptor in adult human dental pulp in relation to caries","volume":"51","author":"El Karim","year":"2006","journal-title":"Arch Oral Biol"},{"key":"10.1016\/j.joen.2026.08.022_bib17","doi-asserted-by":"crossref","DOI":"10.1096\/fj.202001667RR","article-title":"Endogenous Mas-related G-protein-coupled receptor X1 activates and sensitizes TRPA1 in a human model of peripheral nerves","volume":"35","author":"McMillan","year":"2021","journal-title":"FASEB J"},{"key":"10.1016\/j.joen.2026.08.022_bib18","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1016\/j.pain.2010.10.016","article-title":"Human odontoblasts express functional thermo-sensitive TRP channels: implications for dentin sensitivity","volume":"152","author":"El Karim","year":"2011","journal-title":"Pain"},{"key":"10.1016\/j.joen.2026.08.022_bib19","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1002\/cne.20794","article-title":"Distinct expression of TRPM8, TRPA1, and TRPV1 mRNAs in rat primary afferent neurons with A\u03b4\/C-fibers and colocalization with Trk receptors","volume":"493","author":"Kobayashi","year":"2005","journal-title":"J Comp Neurol"},{"key":"10.1016\/j.joen.2026.08.022_bib20","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1113\/jphysiol.1987.sp016733","article-title":"Cold stimulation of teeth: a comparison between the responses of cat intradental A delta and C fibers and human sensation","volume":"39","author":"Jyv\u00e4sj\u00e4rvi","year":"1987","journal-title":"J Physiol"},{"key":"10.1016\/j.joen.2026.08.022_bib21","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1111\/iej.13629","article-title":"A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis","volume":"54","author":"Careddu","year":"2021","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib22","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-62565-3","article-title":"Managing failed vital pulp therapies in mature permanent teeth in a retrospective cohort study, with success and survival rates of managing protocols","volume":"14","author":"Asgary","year":"2024","journal-title":"Sci Rep"},{"key":"10.1016\/j.joen.2026.08.022_bib23","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3389\/fphys.2020.00021","article-title":"Genetic and epigenetic characterization of pulpal and periapical inflammation","volume":"11","author":"Fouad","year":"2020","journal-title":"Front Physiol"},{"key":"10.1016\/j.joen.2026.08.022_bib24","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1111\/j.1365-2591.2012.02016.x","article-title":"Diagnosis of the condition of the dental pulp: a systematic review","volume":"45","author":"Mej\u00e0re","year":"2012","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib25","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/edt.12424","article-title":"The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: a systematic review","volume":"34","author":"Ghouth","year":"2018","journal-title":"Dent Traumatol"},{"key":"10.1016\/j.joen.2026.08.022_bib26","first-page":"1","article-title":"Pulp diagnosis: current guidelines, shortcomings, and future developments","volume":"69","author":"Maloney","year":"2023","journal-title":"J Ir Dent Assoc"},{"key":"10.1016\/j.joen.2026.08.022_bib27","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.3390\/app11062747","article-title":"Pulse oximetry as a diagnostic tool to determine pulp vitality: a systematic review","volume":"11","author":"Almudever-Garcia","year":"2021","journal-title":"Appl Sci"},{"key":"10.1016\/j.joen.2026.08.022_bib28","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s11282-017-0301-0","article-title":"Magnetic resonance imaging in endodontics: a literature review","volume":"34","author":"Ariji","year":"2018","journal-title":"Oral Radiol"},{"key":"10.1016\/j.joen.2026.08.022_bib29","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/iej.13080","article-title":"European Society of Endodontology position statement: management of deep caries and the exposed pulp","volume":"52","author":"Duncan","year":"2019","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib30","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/iej.13424","article-title":"A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response","volume":"54","author":"Demant","year":"2021","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib31","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.joen.2021.07.015","article-title":"AAE position statement on vital pulp therapy","volume":"47","year":"2021","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2026.08.022_bib32","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/iej.13866","article-title":"Factors that influence the outcome of pulpotomy in permanent teeth","volume":"56","author":"Duncan","year":"2023","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib33","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/iej.13647","article-title":"A critical analysis of research methods to study clinical molecular biomarkers in endodontic research","volume":"55","author":"Zehnder","year":"2022","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib34","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/iej.13950","article-title":"Molecular biomarkers for objective assessment of symptomatic pulpitis: a systematic review and meta-analysis","volume":"56","author":"Karrar","year":"2023","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib35","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1111\/iej.14078","article-title":"Discriminatory performance of the pulpal inflammatory biomarkers; Interleukin-8 and TNF-\u03b1 in patients with symptoms indicative of reversible and irreversible pulpitis: a diagnostic accuracy study","volume":"57","author":"Nawal","year":"2024","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/iej.70030","article-title":"The relationship between pulpal diagnostic conditions and potential inflammatory biomarkers","volume":"59","author":"Sabeti","year":"2026","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib37","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1111\/iej.13547","article-title":"Identification and validation of novel biomarkers and therapeutics for pulpitis using connectivity mapping","volume":"54","author":"Al-Natour","year":"2021","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib38","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1111\/iej.70017","article-title":"Proteomic profiling of dentinal fluid for the identification of biomarkers in pulpal inflammation: an exploratory study","volume":"58","author":"Brizuela","year":"2025","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib39","series-title":"FDA-NIH Biomarker Working Group. BEST (Biomarkers, Endpoints, and other Tools) Resource. [Internet]","year":"2016"},{"key":"10.1016\/j.joen.2026.08.022_bib40","doi-asserted-by":"crossref","DOI":"10.3389\/fdmed.2022.867414","article-title":"Molecular characterization of irreversible pulpitis: a protocol proposal and preliminary data","volume":"3","author":"Fouad","year":"2022","journal-title":"Front Dent Med"},{"key":"10.1016\/j.joen.2026.08.022_bib41","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/0030-4220(70)90416-0","article-title":"Diagnosis of diseases of the pulp","volume":"29","author":"Baume","year":"1970","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"10.1016\/j.joen.2026.08.022_bib42","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1111\/j.1834-7819.2007.tb00522.x","article-title":"A clinical classification of the status of the pulp and the root canal system","volume":"52","author":"Abbott","year":"2007","journal-title":"Aust Dent J"},{"key":"10.1016\/j.joen.2026.08.022_bib43","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/j.joen.2009.09.034","article-title":"Diagnostic terminology: report of an online survey","volume":"35","author":"Glickman","year":"2009","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2026.08.022_bib44","doi-asserted-by":"crossref","DOI":"10.1016\/j.jdent.2019.06.005","article-title":"Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review","volume":"88","author":"Cushley","year":"2019","journal-title":"J Dent"},{"key":"10.1016\/j.joen.2026.08.022_bib45","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1111\/iej.13844","article-title":"Effectiveness of pulpotomy compared with root canal treatment in managing non-traumatic pulpitis associated with spontaneous pain: a systematic review and meta-analysis","volume":"56","author":"Tomson","year":"2023","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib46","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/iej.12793","article-title":"Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs","volume":"50","author":"Wolters","year":"2017","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2026.08.022_bib47","first-page":"33","article-title":"Classification systems for low back pain: a review of the methodology for development and validation","volume":"12","author":"Ford","year":"2007","journal-title":"Physther Rev"},{"key":"10.1016\/j.joen.2026.08.022_bib48","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1001\/jamadermatol.2020.1698","article-title":"Creation and validation of classification criteria for discoid lupus erythematosus","volume":"156","author":"Elman","year":"2020","journal-title":"JAMA Derma"},{"key":"10.1016\/j.joen.2026.08.022_bib49","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/iej.14254","article-title":"Clinical validation of a proposed diagnostic classification for pulpitis","volume":"58","author":"Karrar","year":"2025","journal-title":"Int Endod J"}],"container-title":["Journal of Endodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099239926004541?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099239926004541?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:40:26Z","timestamp":1792802426000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0099239926004541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":49,"alternative-id":["S0099239926004541"],"URL":"https:\/\/doi.org\/10.1016\/j.joen.2026.08.022","relation":{},"ISSN":["0099-2399"],"issn-type":[{"value":"0099-2399","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Refining Pulpal Diagnostics for Predictable Vital Pulp Treatment","name":"articletitle","label":"Article Title"},{"value":"Journal of Endodontics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.joen.2026.08.022","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc. on behalf of American Association of Endodontists.","name":"copyright","label":"Copyright"}]}}