• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.243-250
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• 2012

Trigeminal nerve injuries due to invasive dental procedures such as implant surgery and extraction is one of the most serious issues in dentistry and may provoke medico-legal problems. Thus, for objective and reliable assessment of nerve injury, a need of QST (quantitative sensory testing) is emphasized and thermal threshold test is an essential part of QST, reported to have acceptable reliability in the orofacial region. This pilot study aimed to evaluate thermal thresholds for limited cases of trigeminal nerve injures. The study investigated 18 clinical cases with trigeminal nerve injuries who visited Department of Oral Medicine, Dankook Univeristy Dental Hospital during the period from May 2011 to Oct 2012. Thermal thresholds was measured by Thermal Sensory Analyzer, TSA-II (Medoc, Israel). Their CDT(cold detection threshold) was significantly decreased in the affected sides compared to the unaffected sides. Other parameters such as WDT(warm detection threshold), CPT(cold pain threshold) and HPT(heat pain threshold) did not show statistical difference between the affected and unaffected sides. Further researches are required to compare thermal thresholds relative to types of nerve deficits such as thermal hyper- or hypoesthesia and hyper- or hypoalgesia for larger sample.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.2
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• pp.171-178
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• 2012

Botulinum toxin type A (BoNT-A) has been applied successfully to treat chronic migraine, dystonia, spasticity and temporomandubular disorders(TMDs) as well as frontal wrinkle and glabella wrinkle. Recently it has been reported that BoNT-A, reversibly blocks presynaptic acetylcholine release, also inhibits the release of substance P, CGRP(calcitonin gene related peptide) and glutamate related to peripheral sensitization and neurogenic inflammation in sensory nerve, In this study we reviewed animal nerve injury model such as rat and rabbit and identify the analgesic effect and mechanism of nerve injury pain after dental treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.6
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• pp.384-393
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• 2012

The trigeminal nerve, one of the cranial nerves, innervates the maxillofacial area and has three branches: the ophthalmic, maxillary, and mandibular nerves. Paresthesia, due to damages to the inferior alveolar nerve and mental nerve (branches of the mandibular nerve), is quite frequent in dental implants and third molar extractions. As medical disputes are increasing, it is necessary to formulate an objective and reasonable disability evaluation. When evaluating the frequent rate of impairment for inferior alveolar nerve damage, it may be reasonable to follow the criteria for the rate of maxillofacial impairment of the American Association of Oral and Maxillofacial Surgeons (AAOMS) - the most scientific and reputable criteria based on the American Medical Association (AMA). Therefore, the Committee of Guides for Maxillofacial Impairment Ratings, in the Korean Association of Oral and Maxillofacial Surgeons (KAOMS), is trying to suggest more reasonable and realistic guidelines for evaluating impairments by reviewing the current evaluation criteria and those of AMA and AAOMS.

• Journal of Oral Medicine and Pain
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• v.34 no.4
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• pp.379-385
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• 2009

The purpose of this study was to present basic data that is needed in comprehension of dysesthesia after mandibular nerve injury and grasp meaning. We analyzed medical records of 59 patients who were diagnosed as dysesthesia after mandibular nerve injury from January 2007 to July 2009. The results are summarized as follows. 1. The most frequent cause was implant surgery (59%) and the most frequent injured branch of mandibular nerve was inferior alveolar nerve(81%). 2. The period passed after nerve injury showed significant interrelationship with level of pain. Visual Analogue Scale(VAS) increased from 4.82 to 6.91 after 6 month. 3. The period passed after nerve injury did not show significant interrelationship with recovery of dysesthesia. But, when conservative treatment was offered at earlier stage, ratio of patients who showed recovery of symptom tended to increase. 4. In computed tomography, level of invasion into inferior alveolar nerve canal did not show significant interrelationship with level of pain and recovery of dysesthesia. Conclusively, in the patients with dysesthesia of mandibular nerve, inferior alveolar nerve injury by dental implant surgery dominated most significant problem. Although level of invasion into inferior alveolar nerve is the most important factor to initiation of dysesthesia, there are other various factors exert more influence on the level of pain or recovery of dysesthesia. Therefore, begining conservative therapy at earlier stage is encouraged. Also, because nerve injuries can occur without direct invasion into nerve canal, so leaving enough safe space from nerve canal is needed for prevention of indirect nerve injury.

• Journal of Acupuncture Research
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• v.24 no.6
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• pp.69-73
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• 2007

목적 : X-ray를 통해 안면마비에 다용되는 예풍과 안면통에 다용되는 하관에서의 안전한 자침 깊이에 대하여 고찰하여 보고자 하였다. 방법 : 건강한 지원자들에게 원치 않을 경우 언제든지 시험을 중지할 권리가 있다는 것을 공지한 후, 시험에 동의한 남녀 각각 2명의 피험자들을 대상으로 대학병원 침구과 전문의가 예풍과 하관을 직자(直刺)($40mm{\times}0.35mm$ 일회용 침)하였다. 피험자의 이상 반응 유무를 살피며 안면신경 혹은 삼차신경이 지나가는 경로로 알려진 깊이까지 진침(進鎬)하였다. 유침(留鍼) 상태에서 Skull X-ray의 AP view와 Lateral view를 촬영하였다. 결과 : 피험자들은 침병이 피부에 도달 하는 동안(40mm 직자) 자침 혈위에서 중창감(重脹感)을 자각하였으며, 추후 어떠한 이상 반응도 보이지 않았다. 결론 : 안면마비와 안면통의 효율적인 치료를 위하여 안면신경과 삼차신경에 근접할 수 있는 혈위인 예풍과 하관에서의 40mm 직자는 신경염이나 뇌 손상과 같은 이상 반응을 유발하지 않았다.

• Applied Microscopy
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• v.42 no.1
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• pp.27-33
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• 2012

Transient receptor potential ankyrin 1 (TRPA1), responding to noxious cold (${\leq}17^{\circ}C$) and pungent compounds, is implicated in nociception, but little is known about the coexpression of TRPA1 and other channels or receptors involved in the nociception in craniofacial regions. To address this issue, we characterized the TRPA1-immunopositive (+) neurons in the rat trigeminal ganglion (TG) and investigated their colocalization with other proteins known to be expressed in nociceptive neurons, such as transient receptor potential vanilloid (TRPV1) and $P2X_3$ receptor, using light microscopic immunofluorescence labeling method with TRPA1 and TRPV1 or $P2X_3$ antisera. The majority of TRPA1+ neurons costained for TRPV1 (TRPV1+/TRPA1+; 58.8%, 328/558) and 41.2% only expressed TRPA1 but not TRPV1. The TRPV1+/TRPA1+ neurons were small and medium sized. In addition, we investigated the colocalization of TRPA1 with $P2X_3$, a nonselective cation channel activated by ATP that may be released in the extracellular space as a result of tissue damage and inflammation. Among all TRPA1+ TG neurons, 26.1% (310/1186) costained for $P2X_3$, whereas 73.9% (876/1186) of TRPA1+ neurons did not coexpress $P2X_3$. $P2X_3$+/TRPA1+ neurons were predominantly small and medium sized. These results suggest that TRPA1+ neurons coexpressing TRPV1 or $P2X_3$ are involved in specific roles in the transmission and processing of orofacial nociceptive information by noxious cold, heat, and inflammation.

• Journal of Oral Medicine and Pain
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• v.32 no.2
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• pp.187-200
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• 2007

This study attempted to contribute to the clinical application of implant operation by making a quantitative nerve examination using a neurometer for the evaluation of sensory disturbances that could be incurred after the implantation in the dental clinics, and it intended to establish an objective guideline in the evaluation of sensory nerve after the operation of implant. An inspection was performed with the frequencies of 2000Hz, 250 Hz and 5 Hz before and after the operations of tooth implant using $Neurometer^{(R)}$ CPT/C (Neurotron, Inc. Baltimore, Maryland, USA) for 44 patients who had performed an implant operation among the patients coming to Daejeon Sun Dental Hospital in 2006 and 30 people for control group. The measuring sites were maxillary nerve ending and mandibular nerve ending of trigeminal nerve according to the implant operating regions. The current perception threshold (CPT) by each nerve fiber was specifically responded under the electric stimulation of 2000 Hz in case of $A{\beta}$ fiber and of 250 Hz in case of $A{\delta}$ fiber and of 5Hz in case of C fiber. The CPT test could be performed to assess the damages of peripheral nerve in the trigeminal nerve area and it stimulated selective nerve fibers by generating the electricity of specific frequency in the peripheral nerve area. The nerve fibers with varied thickness were responsive selectively to the electric stimulation with different frequencies; accordingly, they applied the electric stimulation with different frequencies and the reaction threshold of $A{\beta},\;A{\delta}$ and C fibers selectively responsive to each electric current could be individually evaluated. In the assessment through the CPT, the increase and decrease of the CPT could be measured so that sensory disturbances such as hyperaesthesia or hypoaesthesia could be diagnosed. This study could obtain the following results after the assessment of the CPT before and after the implant operation. 1. In the assessment before and after the implant operation, the CPT in the frequencies of 2000 Hz, 250 Hz, 5 Hz for maxillary branch increased on the whole after the operation and the CPT for mandibular branch in the $A{\beta}$-fiber(2000 Hz) and C-fiber(5 Hz )after the operation increased statistically significantly. 2. For the groups of patients with medically compromised or its subsequent medicinal prescription, there were no significant differences before and after the implant operation and for the control groups, significantly high CPT was shown after the implant operation in the left $A{\beta}$-fiber(2000 Hz) and C-fiber(5 Hz). 3. In the comparison of the measured value of the CPT before the operation between the control group and the implant operation group, the latter group had a significantly high measured value of the CPT in the right $A{\beta}$-fiber(2000 Hz) and C-fiber(5 Hz) and there were significant differences in $A{\beta}$-fiber(2000 Hz) in the CPT assessment after the implant operation for the control group. 4. Male participants had higher CPT than female counterparts; however, there were no statistic significances. In the CPT evaluation before and after implant operation, there were no statistical differences in the male group while the right C-fiber(5 Hz) and left $A{\beta}$-fiber(2000Hz) were significantly high in the female group. 5. In the comparison between the group who complain sensory disturbance and the other group, the CPT increased on the whole in the former group, but there were no statistical significances. In the groups, whom there was an increase in VAS, the CPT after the implant operation in the right C-fiber(5 Hz) increased significantly; meanwhile, in case that the VAS mark was '0' before and after the operation, the CPT after the operation in the left $A{\beta}$-fiber(2000 Hz) increased significantly. This study suggested that the CPT measurements using $Neurometer^{(R)}$ CPT/C, provide useful information of objective and quantitative sensory disturbances for tooth implantation.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.1
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• pp.25-31
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• 2001

The purpose of this study was to investigate the distribution and fluorescence intensity of vasoactive intestinal polypeptide immunoreactive (VIP-IR) cells in rat trigeminal ganglion following pulp extirpation of rat mandibular molar. The animals were divided into control group(n=6) and experimental group(n=6). The experimental animals were sacrificed at 14 days after pulp extirpation. The trigeminal ganglion was removed and immersed in the 4% paraformaldehyde in 0.1M phosphate buffer. Serial frozen sections about $20{\mu}m$ in thickness were cut with a cryostat. The immunofluorescence staining was performed. The rabbit anti-VIP(1 : 8,000) was used as primary antibody and fluorescene isothiocynate(FITC) conjugated anti-rabbit IgG(1 : 80) as secondary antibody. The slides were observed under confocal laser scanning microscope (CLSM). Unprocessed optical sections were obtained and stored on a optical disk. Color pictures were printed by a video copy processor. The results were as follows; 1. The positive ratio of VIP-IR cells in mandibular part of trigeminal ganglion were 7.40% in control group and 28.42% in experimental group(14 days after pulp extirpation). 2. The relative fluorescence intensity of VIP-IR cells in mandibular part of trigeminal ganglion were 87.78 in control group and 138.65 in experimental group. The relative fluorescence intensity of experimental group was 58% higher than that of control group. 3. In optical serial section analysis of VIP-IR cells of experimental group, most of the 9 sections showed high fluorescence intensity. At high magnification, axons of the experimental group displayed greater VIP-IR than in the control group, and the positive cells were mainly of medium size. The result indicate that number and fluorescence intensity of VIP-IR cells were increased in the mandibular part of trigeminal ganglion following pulp extirpation of mandibular molar, and it suggests that VIP could play a role in processing of nociception.