{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:47:24Z","timestamp":1787971644949,"version":"build-2784847793"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T00:00:00Z","timestamp":1716249600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T00:00:00Z","timestamp":1716249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Research Institute for Dental Sciences","award":["43004649"],"award-info":[{"award-number":["43004649"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Despite advancements in vital pulp therapy (VPT), a subset of cases fails to achieve desired outcomes. This study based on a previous large-scale cohort study involving 1257 VPT-treated teeth, aiming to describe the demographic data and clinical characteristics of all failed cases and their management protocols. Clinical records\/images of 105 failed cases treated by a single endodontist (2011\u20132022) were examined, including 10 extracted teeth. Asymptomatic cases with PDL widening received no intervention, while others underwent management protocols, including (selective)\u00a0RCT and (tampon)\u00a0re-VPT. These retreatments were assessed for success (defined as radiographic evidence of healing) and survival (characterized by the retention\/function of the treated tooth) using Kaplan\u2013Meier analysis. While 51.4% of all initial failures were diagnosed due to symptoms, 48.6% were symptom-free. Notably, failed cases with symptomatic irreversible pulpitis, and apical periodontitis\/widened PDL before initial treatment significantly outnumbered asymptomatic cases and normal PDL, respectively (P\u2009=\u20090.001). Moreover, most of the initial failures were observed in teeth with composite resin rather than amalgam restorations (P\u2009=\u20090.002). The success and survival rates for the management protocols were 91.78% and 95.79%, respectively, over an average follow-up period of 36.94 (\u00b1\u200923.30) months. RCT and re-VPT procedures provide successful outcomes for managing unsuccessful VPTs.<\/jats:p>","DOI":"10.1038\/s41598-024-62565-3","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T15:02:29Z","timestamp":1716303749000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Managing failed vital pulp therapies in mature permanent teeth in a retrospective cohort study, with success and survival rates of managing protocols"],"prefix":"10.1038","volume":"14","author":[{"given":"Saeed","family":"Asgary","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla","family":"Roghanizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Jafar","family":"Eghbal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Akbarzadeh Baghban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,21]]},"reference":[{"key":"62565_CR1","first-page":"663","volume":"40","author":"AM Kielbassa","year":"2009","unstructured":"Kielbassa, A. M., Muller, J. & Gernhardt, C. R. Closing the gap between oral hygiene and minimally invasive dentistry: A review on the resin infiltration technique of incipient (proximal) enamel lesions. Quintessence Int. 40, 663\u2013681 (2009).","journal-title":"Quintessence Int."},{"key":"62565_CR2","doi-asserted-by":"publisher","first-page":"20280","DOI":"10.1038\/s41598-022-24815-0","volume":"12","author":"M Zhang","year":"2022","unstructured":"Zhang, M. et al. Factors affecting the outcome of full pulpotomy in permanent posterior teeth diagnosed with reversible or irreversible pulpitis. Sci. Rep. 12, 20280. https:\/\/doi.org\/10.1038\/s41598-022-24815-0 (2022).","journal-title":"Sci. Rep."},{"key":"62565_CR3","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1016\/j.joen.2021.07.015","volume":"47","author":"CS Hirschberg","year":"2021","unstructured":"Hirschberg, C. S. et al. AAE position statement on vital pulp therapy. J. Endod. 47, 1340\u20131344. https:\/\/doi.org\/10.1016\/j.joen.2021.07.015 (2021).","journal-title":"J. Endod."},{"key":"62565_CR4","first-page":"23","volume":"9","author":"S Yazdani","year":"2014","unstructured":"Yazdani, S. et al. Health technology assessment of CEM pulpotomy in permanent molars with irreversible pulpitis. Iran. Endod. J. 9, 23\u201329 (2014).","journal-title":"Iran. Endod. J."},{"key":"62565_CR5","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.joen.2017.12.010","volume":"44","author":"S Asgary","year":"2018","unstructured":"Asgary, S., Hassanizadeh, R., Torabzadeh, H. & Eghbal, M. J. Treatment outcomes of 4 vital pulp therapies in mature molars. J. Endod. 44, 529\u2013535. https:\/\/doi.org\/10.1016\/j.joen.2017.12.010 (2018).","journal-title":"J. Endod."},{"key":"62565_CR6","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1111\/iej.13449","volume":"54","author":"S Cushley","year":"2021","unstructured":"Cushley, S. et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: A systematic review and meta-analysis. Int. Endod. J. 54, 556\u2013571. https:\/\/doi.org\/10.1111\/iej.13449 (2021).","journal-title":"Int. Endod. J."},{"key":"62565_CR7","first-page":"295","volume":"9","author":"S Asgary","year":"2014","unstructured":"Asgary, S., Fazlyab, M., Sabbagh, S. & Eghbal, M. J. Outcomes of different vital pulp therapy techniques on symptomatic permanent teeth: A case series. Iran. Endod. J. 9, 295\u2013300 (2014).","journal-title":"Iran. Endod. J."},{"key":"62565_CR8","doi-asserted-by":"publisher","first-page":"103158","DOI":"10.1016\/j.jdent.2019.06.005","volume":"88","author":"S Cushley","year":"2019","unstructured":"Cushley, S. et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. J. Dent. 88, 103158. https:\/\/doi.org\/10.1016\/j.jdent.2019.06.005 (2019).","journal-title":"J. Dent."},{"key":"62565_CR9","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1016\/j.joen.2021.08.008","volume":"47","author":"M Sabeti","year":"2021","unstructured":"Sabeti, M., Huang, Y., Chung, Y. J. & Azarpazhooh, A. Prognosis of vital pulp therapy on permanent dentition: A systematic review and meta-analysis of randomized controlled trials. J. Endod. 47, 1683\u20131695. https:\/\/doi.org\/10.1016\/j.joen.2021.08.008 (2021).","journal-title":"J. Endod."},{"key":"62565_CR10","doi-asserted-by":"publisher","first-page":"19664","DOI":"10.1038\/s41598-022-20918-w","volume":"12","author":"A Ather","year":"2022","unstructured":"Ather, A., Patel, B., Gelfond, J. A. L. & Ruparel, N. B. Outcome of pulpotomy in permanent teeth with irreversible pulpitis: A systematic review and meta-analysis. Sci. Rep. 12, 19664. https:\/\/doi.org\/10.1038\/s41598-022-20918-w (2022).","journal-title":"Sci. Rep."},{"key":"62565_CR11","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1016\/j.joen.2023.04.001","volume":"49","author":"NA Taha","year":"2023","unstructured":"Taha, N. A., Abuzaid, A. M. & Khader, Y. S. A randomized controlled clinical trial of pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: Outcome, quality of life, and patients\u2019 satisfaction. J. Endod. 49, 624-631.e622. https:\/\/doi.org\/10.1016\/j.joen.2023.04.001 (2023).","journal-title":"J. Endod."},{"key":"62565_CR12","doi-asserted-by":"publisher","first-page":"3287","DOI":"10.1007\/s00784-021-04310-y","volume":"26","author":"S Asgary","year":"2022","unstructured":"Asgary, S. et al. Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: A randomized controlled trial. Clin. Oral Investig. 26, 3287\u20133297. https:\/\/doi.org\/10.1007\/s00784-021-04310-y (2022).","journal-title":"Clin. Oral Investig."},{"key":"62565_CR13","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1016\/j.joen.2018.08.004","volume":"44","author":"L Awawdeh","year":"2018","unstructured":"Awawdeh, L., Al-Qudah, A., Hamouri, H. & Chakra, R. J. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: A prospective randomized clinical trial. J. Endod. 44, 1603\u20131609. https:\/\/doi.org\/10.1016\/j.joen.2018.08.004 (2018).","journal-title":"J. Endod."},{"key":"62565_CR14","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.39374","volume":"15","author":"S Drouri","year":"2023","unstructured":"Drouri, S., El Merini, H., Sy, A. & Jabri, M. Evaluation of direct and indirect pulp capping with Biodentine in vital permanent teeth with deep caries lesions. Cureus 15, e39374. https:\/\/doi.org\/10.7759\/cureus.39374 (2023).","journal-title":"Cureus"},{"key":"62565_CR15","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1038\/sj.bdj.2014.200","volume":"216","author":"JF Siqueira Jr","year":"2014","unstructured":"Siqueira, J. F. Jr., R\u00f4\u00e7as, I. N., Ricucci, D. & H\u00fclsmann, M. Causes and management of post-treatment apical periodontitis. Br. Dent. J. 216, 305\u2013312. https:\/\/doi.org\/10.1038\/sj.bdj.2014.200 (2014).","journal-title":"Br. Dent. J."},{"key":"62565_CR16","doi-asserted-by":"publisher","first-page":"6619731","DOI":"10.1155\/2021\/6619731","volume":"2021","author":"S Asgary","year":"2021","unstructured":"Asgary, S. & Roghanizadeh, L. Grafting with bone substitute materials in therapy-resistant periapical actinomycosis. Case Rep. Dent. 2021, 6619731. https:\/\/doi.org\/10.1155\/2021\/6619731 (2021).","journal-title":"Case Rep. Dent."},{"key":"62565_CR17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176724","volume":"12","author":"AM Kielbassa","year":"2017","unstructured":"Kielbassa, A. M., Frank, W. & Madaus, T. Radiologic assessment of quality of root canal fillings and periapical status in an Austrian subpopulation\u2014An observational study. PLoS One 12, e0176724. https:\/\/doi.org\/10.1371\/journal.pone.0176724 (2017).","journal-title":"PLoS One"},{"key":"62565_CR18","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-52654-8","author":"S Asgary","year":"2024","unstructured":"Asgary, S. et al. Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years. Sci. Rep. https:\/\/doi.org\/10.1038\/s41598-024-52654-8 (2024).","journal-title":"Sci. Rep."},{"key":"62565_CR19","doi-asserted-by":"publisher","first-page":"274","DOI":"10.22037\/iej.v18i4.43232","volume":"18","author":"A Ardavan","year":"2023","unstructured":"Ardavan, A., Roghanizadeh, L. & Asgary, S. Tampon vital pulp therapy in the management of excessive haemorrhage in inflamed pulps: A hypothesis. Iran. Endod. J. 18, 274\u2013276. https:\/\/doi.org\/10.22037\/iej.v18i4.43232 (2023).","journal-title":"Iran. Endod. J."},{"key":"62565_CR20","doi-asserted-by":"publisher","first-page":"165","DOI":"10.22037\/iej.v18i3.42508","volume":"18","author":"S Asgary","year":"2023","unstructured":"Asgary, S. & Roghanizadeh, L. Tampon pulpotomy: Long-term successful results of a molar with irreversible pulpitis and previous vital pulp therapy failure. Iran. Endod. J. 18, 165\u2013167. https:\/\/doi.org\/10.22037\/iej.v18i3.42508 (2023).","journal-title":"Iran. Endod. J."},{"key":"62565_CR21","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.pdj.2023.05.003","volume":"33","author":"A Boontankun","year":"2023","unstructured":"Boontankun, A., Manmontri, C., Chaipattanawan, N. & Chompu-inwai, P. Pulp canal calcification in young permanent teeth that have undergone vital pulp therapy: A review. Pediatr. Dent. J. 33, 199\u2013210 (2023).","journal-title":"Pediatr. Dent. J."},{"issue":"Suppl 1","key":"62565_CR22","doi-asserted-by":"publisher","first-page":"S110","DOI":"10.1111\/adj.12997","volume":"68","author":"B Kahler","year":"2023","unstructured":"Kahler, B., Taha, N. A., Lu, J. & Saoud, T. M. Vital pulp therapy for permanent teeth with diagnosis of irreversible pulpitis: Biological basis and outcome. Aust. Dent. J. 68(Suppl 1), S110-s122. https:\/\/doi.org\/10.1111\/adj.12997 (2023).","journal-title":"Aust. Dent. J."},{"key":"62565_CR23","doi-asserted-by":"publisher","first-page":"8788358","DOI":"10.1155\/2022\/8788358","volume":"2022","author":"W Shang","year":"2022","unstructured":"Shang, W. et al. The understanding of vital pulp therapy in permanent teeth: A new perspective. Biomed. Res. Int. 2022, 8788358. https:\/\/doi.org\/10.1155\/2022\/8788358 (2022).","journal-title":"Biomed. Res. Int."},{"key":"62565_CR24","doi-asserted-by":"publisher","DOI":"10.3390\/ma12132102","author":"XV Tran","year":"2019","unstructured":"Tran, X. V. et al. Reparative mineralized tissue characterization after direct pulp capping with calcium-silicate-based cements. Materials (Basel) https:\/\/doi.org\/10.3390\/ma12132102 (2019).","journal-title":"Materials (Basel)"},{"key":"62565_CR25","doi-asserted-by":"publisher","first-page":"3233","DOI":"10.1007\/s00784-023-04938-y","volume":"27","author":"I L\u00f3pez-Valverde","year":"2023","unstructured":"L\u00f3pez-Valverde, I., Vignoletti, F., Vignoletti, G., Martin, C. & Sanz, M. Long-term tooth survival and success following primary root canal treatment: A 5- to 37-year retrospective observation. Clin. Oral Investig. 27, 3233\u20133244. https:\/\/doi.org\/10.1007\/s00784-023-04938-y (2023).","journal-title":"Clin. Oral Investig."},{"key":"62565_CR26","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1590\/1678-7757-2016-0464","volume":"25","author":"R Holland","year":"2017","unstructured":"Holland, R. et al. Factors affecting the periapical healing process of endodontically treated teeth. J. Appl. Oral Sci. 25, 465\u2013476. https:\/\/doi.org\/10.1590\/1678-7757-2016-0464 (2017).","journal-title":"J. Appl. Oral Sci."},{"key":"62565_CR27","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1111\/iej.13724","volume":"55","author":"IV Do Nascimento","year":"2022","unstructured":"Do Nascimento, I. V. et al. Chronic systemic corticosteroid therapy influences the development of pulp necrosis and experimental apical periodontitis, exacerbating the inflammatory process and bone resorption in rats. Int. Endod. J. 55, 646\u2013659. https:\/\/doi.org\/10.1111\/iej.13724 (2022).","journal-title":"Int. Endod. J."},{"key":"62565_CR28","first-page":"165","volume":"18","author":"MS Hosseini","year":"2016","unstructured":"Hosseini, M. S. et al. Prevalence and incidence of thyroid dysfunction in individuals aged over 55 years, Tehran thyroid study. Iran. J. Endocrinol. Metab. 18, 165\u2013172 (2016).","journal-title":"Iran. J. Endocrinol. Metab."},{"key":"62565_CR29","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s40618-017-0753-4","volume":"41","author":"GR Williams","year":"2018","unstructured":"Williams, G. R. & Bassett, J. H. D. Thyroid diseases and bone health. J. Endocrinol. Investig. 41, 99\u2013109. https:\/\/doi.org\/10.1007\/s40618-017-0753-4 (2018).","journal-title":"J. Endocrinol. Investig."},{"key":"62565_CR30","doi-asserted-by":"publisher","first-page":"83","DOI":"10.4103\/2279-042x.141099","volume":"3","author":"M Karimifar","year":"2014","unstructured":"Karimifar, M. et al. Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism. J. Res. Pharm. Pract. 3, 83\u201387. https:\/\/doi.org\/10.4103\/2279-042x.141099 (2014).","journal-title":"J. Res. Pharm. Pract."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62565-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62565-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62565-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T15:07:00Z","timestamp":1716304020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62565-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,21]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["62565"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-62565-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,21]]},"assertion":[{"value":"24 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest regarding the publication of this paper. Prof. Saeed Asgary is the inventor of CEM cement (Endodontic Filling Material; USA, 7,942,961, 2011 May 17).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"11621"}}