• Restorative Dentistry and Endodontics
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• 제40권2호
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• pp.161-165
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• 2015

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

• Restorative Dentistry and Endodontics
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• 제41권4호
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• pp.283-295
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• 2016

Objectives: In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications. Materials and Methods: HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting. Results: Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups. Conclusions: Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.

• 대한소아치과학회지
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• 제41권2호
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• pp.174-179
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• 2014

치내치란 치아 조직의 석회화가 일어나기 이전에 법랑기가 치유두 내로 함입되어 나타나는 발육성 이상을 말한다. 치내치는 임상적, 방사선학적으로 다양한 변이를 나타내며, 치내치의 여러 분류법 중 Oehlers(1957)가 제안한 분류법이 가장 널리 이용되고 있다. 치수는 건강한 채로 남아 있으나 함입부가 치주염과 연관된 Type III 병소를 치료하는데 다양한 술식들이 설명되어져왔다. 가장 우선시 되어야 하는 목표는 가능하다면 치수를 건전하게 보존하는 것이며, 치수질환의 명백한 증거가 없다면, 함입부를 치근과 별개로 치료하는 보존적인 접근법이 필요하다. 그러나, Type III 치내치의 근관치료는 근관과 함입의 충분한 잔사제거, 재현가능한 근관장의 조절, 일관된 충전등을 충분히 달성하기 어렵다는 문제점이 있다. 본 증례는 치근단 병소를 보이는 Type III 치내치의 치료에 함입부에만 제한된 보존적 근관치료 및 Mineral Trioxide Aggregate(MTA)를 이용한 폐쇄를 통해 양호한 결과를 얻었기에 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.441-449
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• 2021

Background: The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. Methods: One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. Results: The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. Conclusion: Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.309-313
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• 2010

The management of teeth in the line of a mandibular fracture is controversial despite the general agreement that most of these teeth can be preserved. Teeth should be retained if bony attachments are adequate for survival, the tooth is sound and important in maintaining fixation of the fractured segment of bone. Teeth should be removed if they are loose and interfere with the reduction of fragments, are devitalized and potentially a source of wound infection, are damaged beyond their usefulness or may become devital and interfere with healing by becoming infected. However, tooth removal will increase the level of trauma, extend the severity of the wound and require expensive prosthetic treatment. Therefore, it is very important to conserve infected teeth in the line of a mandibular fracture through early primary endodontic treatment (pulp extirpation, canal enlargement and canal opening drainage) and splinting. The basic principles underlying the treatment of pulpless teeth are those underlying general surgery. Therefore, debridement of the infected wound (pulp extirpation and canal enlargement), drainage (canal opening) and gentle treatment of the tissues (occlusal reduction and teeth splinting) are the principles of surgery. This is a representative case report of conservative care by the early endodontic drainage of infected teeth in the line of a mandibular fracture.

• 대한치과의사협회지
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• 제50권7호
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• pp.384-393
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• 2012

Successful treatment of a badly broken down tooth with pulpal disease depends not only on good endodontic therapy, but also on good prosthetic reconstruction of the tooth after endodontic therapy is completed. The ideal treatment of endodontically treated teeth has been widely and controversially discussed. Endocrown is a restorative option for endodontically treated teeth. Endocrown design incorporates the core and short post into the crown as a single restoration. The preparation of endocrown consists of a circular equigingival butt-joint margin and central retention cavity of the entire pulp chamber instead of employing intraradicular posts. This design significantly increases the surface area of the preparation available for cementation. It is particularly useful in young patient teeth for long-term provisional restoration and in teeth with short clinical crowns. This technique represents a promising and conservative method for the treatment of endodontically treated teeth that require long-term protection and stability. Endocrown can be considered as a feasible alternative to full crowns or composite overlays for the restoration of non vital teeth.

• Restorative Dentistry and Endodontics
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• 제44권4호
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• pp.35.1-35.10
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• 2019

Pulp revascularization is an alternative treatment in immature traumatized teeth with necrotic pulp. However, this procedure has not been reported in horizontal root fractures. This is a case report of a 9-year-old patient with multiple horizontal root fractures in 2 upper central incisors that were successfully treated with pulp revascularization. The patient presented for treatment 2 years after the initial trauma, and revascularization was attempted after the initial treatment with calcium hydroxide had failed. Prior to pulp revascularization, cone-beam computed tomography and autoradiograms demonstrated multiple horizontal fractures in the middle and apical thirds of the roots of the 2 affected teeth. Revascularization was performed in both teeth; platelet-rich plasma (PRP) was used in one tooth (#11) and the conventional method (blood clot) was used in the other tooth (#21). Clinical and radiographic follow-up over 4 years demonstrated pulp calcification in the PRP-treated tooth. Neither of the 2 teeth were lost, and the root canal calcification of tooth #11 was greater than that of tooth #21. This case suggests that PRP-based pulp revascularization may be an alternative for horizontal root fractures.

• Restorative Dentistry and Endodontics
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• 제42권2호
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• pp.146-151
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• 2017

X-linked hypophosphatemia (XLH) is a hereditary metabolic disease caused by the loss of phosphate through the renal tubules into the urine, and an associated decrease in serum calcium and potassium phosphate. Its dental features include spontaneous dental abscesses that occur in the absence of trauma or dental caries. The aim of this case report was to describe the dental problems of XLH patients and to evaluate limitations in their treatment. A 14 year old male and a 38 year old female with XLH were referred to the Department of Conservative Dentistry for endodontic treatment. The dental findings were periapical abscesses without obvious trauma or caries. Conservative endodontic treatment was performed in teeth with pulp necrosis and abscess. In case 1, the treated teeth showed improvements in bone healing, without clinical symptoms. However, in case 2, the implants and the treated tooth showed hypermobility, and the final restoration was therefore postponed. Early diagnosis, periodic examinations, and communication with the patient's pediatrician are important in the dental management of patients with XLH.

• Restorative Dentistry and Endodontics
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• 제45권2호
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• pp.4.1-4.6
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• 2020

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.

• Restorative Dentistry and Endodontics
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• 제32권2호
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• pp.95-101
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• 2007

개의 치수에 MTA, calcium hydroxide 및 calcium sulfate로 치수복조 후 치수 반응을 서로 비교하여 MTA와 calcium sulfate가 임상적으로 치수복조제로서 사용 가능할 것인가를 구명하고자 본 연구를 시행하였다. 8개월 된 2마리 개의 24개의 치아가 본 연구에 사용되었다 전신 마취하에 고속 핸드피스를 사용하여 멸균된 #2 round bur로 치경부에 와동을 형성한 후 치수를 노출시켰다. MTA, calcium hydroxide 및 calcium sulfate를 치수노출부에 도포하였다. 와동 부위는 IRM으로 가봉하고 광중합레진으로 수복하였다. 처리 2개월 후, 전신 마취하에 희생시킨 후 조직학적으로 관찰하였다. MTA처리군에서는 치수 노출부위에 경조직의 상아질교가 형성되었으며 새로 형성된 상아질교 하방에 조상아세포가 새로 형성되었다. 치수충혈과 함께 국소적 인 혈관 증식 이 나타났으며 치수에 염증반응은 나타나지 않았다. Calcium hydroxide로 처리한 군은 상아질교 하방에 조상아세포가 관찰되지 않았으며 만성 염증반응이 다양하게 나타났다. Calcium sulfate로 처리한 군은 경조직의 상아질교가 관찰되었으며, 상아질교 하방에 조상아세포 층이 새로 관찰되었다. 몇몇의 중성구 침윤과 함께 미약한 정도의 만성염증반응이 관찰되었다. 이상의 결과에서 MTA가 calcium hydroxide및 calcium sulfate에 비해 치수에 생체친화적임을 시사하며 기계적 치수노출시 치수복조제로 사용할 수 있음을 시사한다.