{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:44:07Z","timestamp":1792176247330,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005089","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["7242140"],"award-info":[{"award-number":["7242140"]}],"id":[{"id":"10.13039\/501100005089","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This case report presents the 24\u2010month outcomes of regenerative endodontic procedures (REPs) combined with apical microsurgery in a mature permanent tooth with a blunderbuss open apex and chronic apical periodontitis. A multimodal assessment protocol integrating laser Doppler flowmetry (LDF), magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) volumetric analysis was employed to comprehensively evaluate the therapeutic efficacy of this combined approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>A 25\u2010year\u2010old female patient presented with a mandibular right canine diagnosed with pulp necrosis, a blunderbuss open apex and a large periapical radiolucency. Despite multiple sessions of chemomechanical disinfection, persistent sanguopurulent intracanal exudate was observed, indicating an extraradicular infection. Apical microsurgery was therefore performed to eradicate the extraradicular biofilm, after which autologous CGF was compacted into both the pulp space and the apical surgical site, followed by coronal sealing with iRoot BP Plus. This combined approach aimed to promote tissue regeneration within the canal and concurrently facilitate periapical bone healing. Over a 24\u2010month follow\u2010up period, complete periapical osseous healing was confirmed at 12\u2009months. At 18 and 24\u2009months, LDF demonstrated that blood perfusion in the treated tooth was comparable to that of the contralateral healthy tooth, and MRI revealed continuous homogeneous pulp\u2010like signal within the intraradicular tissue. The tooth also regained positive responses to cold and electric pulp testing from 6\u2009months postoperatively, indicating recovery of sensory nerve fibre function rather than definitive pulp vitality. Concurrent CBCT volumetric analysis documented a progressive reduction in pulp space volume of 9.88% over 24\u2009months, suggesting hard tissue deposition; however, the histological nature of this tissue remains undetermined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70234","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:41:22Z","timestamp":1786513282000},"page":"2472-2482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regenerative Endodontic Procedures With Apical Microsurgery for a Mature Permanent Tooth With a Blunderbuss Open Apex and Chronic Apical Periodontitis: A 24\u2010Month Case Report"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9501-9614","authenticated-orcid":false,"given":"Zhen","family":"Liu","sequence":"first","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoling","family":"Zhou","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianqian","family":"Wan","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengxiong","family":"Cai","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxia","family":"Qiu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9472-280X","authenticated-orcid":false,"given":"Xiaoru","family":"Zhu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Chang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxi","family":"He","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral &amp; Maxillofacial Reconstruction and Regeneration, School of Stomatology The Fourth Military Medical University  Xi'an Shaanxi China"},{"name":"Department of Stomatology, Air Force Medical Center The Fourth Military Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13681"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2018.01.021"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2021.03.015"},{"key":"e_1_2_11_5_1","first-page":"55","article-title":"Dental Pulp Neurophysiology: Part 1. Clinical and Diagnostic Implications","volume":"75","author":"Ashraf A.\u2010E.","year":"2009","journal-title":"Journal of the Canadian Dental Association"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-025-06826-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.29742"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41415-022-3988-1"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-7325.1997.tb02470.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells14030201"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-024-04095-y"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.12868"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13287-019-1247-4"},{"key":"e_1_2_11_14_1","first-page":"559","article-title":"A Survey of Cusp Fractures in a Population of General Dental Practices","volume":"15","author":"Fennis W. M. M.","year":"2002","journal-title":"International Journal of Prosthodontics"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41368-024-00334-8"},{"key":"e_1_2_11_16_1","first-page":"4","article-title":"Regenerative Endodontics by Cell Homing: A Review of Recent Clinical Trials","volume":"49","author":"Hongji Y.","year":"2022","journal-title":"Journal of Endodontics"},{"issue":"3","key":"e_1_2_11_17_1","article-title":"Evaluation of Blood Clot, Platelet\u2010Rich Plasma, and Platelet\u2010Rich Fibrin\u2010Mediated Regenerative Endodontic Procedures in Teeth With Periapical Pathology: A CBCT Study","volume":"48","author":"Jha P.","year":"2023","journal-title":"Restorative Dentistry & Endodontics"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-06137-9"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.12954"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/aej.70015"},{"key":"e_1_2_11_21_1","first-page":"317","article-title":"3\u2010Dimensional Analysis of Regenerative Endodontic Treatment Outcome","volume":"41","author":"Mostafa E. E.","year":"2014","journal-title":"Journal of Endodontics"},{"issue":"1","key":"e_1_2_11_22_1","first-page":"32","article-title":"Two\u2010Dimensional Radiographs and Cone\u2010Beam Computed Tomography Assessment of Concentrated Growth Factor and Platelet\u2010Rich Fibrin Scaffolds in Regenerative Endodontic Treatment of Immature Incisors With Periapical Radiolucency: A Randomized Clinical Trial","volume":"50","author":"Moussa S. M.","year":"2024","journal-title":"Journal of Endodontics"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.70911"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13300"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/edt.12424"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2018.06.015"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2017.07.002"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/rb\/rbaf058"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2017.12.005"},{"key":"e_1_2_11_30_1","first-page":"412","article-title":"Extraradicular Infection and Apical Mineralized Biofilm: A Systematic Review of Published Case Reports","volume":"51","author":"Sousa B. C.","year":"2025","journal-title":"Journal of Endodontics"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.reth.2023.08.006"}],"container-title":["International Endodontic Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iej.70234","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iej.70234","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iej.70234","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:46:53Z","timestamp":1792172813000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iej.70234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/iej.70234"],"URL":"https:\/\/doi.org\/10.1111\/iej.70234","archive":["Portico"],"relation":{},"ISSN":["0143-2885","1365-2591"],"issn-type":[{"value":"0143-2885","type":"print"},{"value":"1365-2591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"assertion":[{"value":"2026-02-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}