• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.104-111
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• 1994

Necrotizing fascitis is a severe soft tissue infection characterized by extensive necrosis of superficial fascia, suppurative fascitis, vascular thrombosis, widespread undermining of surrounding tissues. Associated systemic problems are widespread undermining of surrounding tissues, Associated systemic problems are common, with chronic alcoholism and diabetes being most prominent. Most commonly this disease presents in the extremities, trunk, and perineum. Necrotizing fascitis of dental origing is rare and its fulminating clinical course is not well documented in the dental literature. The present report is a case of necrotizing fascitis following vital extirpation of the pulp in a patient with uncontrolled diabetes mellitus and liver cirrhosis. Originally throught to be caused by hemolytic streptococcus organism or stphylococcus aureus, advances in anaerobic culturing have shown it to be a synergistic bacterial infection involving aerobic and ovligate anaerobes. it is relatively rare in relatively rare in haea and neck regions. If it was not diagnosed and treated in early stages, necrotizing fascitis can be potentially fetal, with a mortality rate approaching 40%. It's treatment requires early recognition, prompt and aggressive surgical debriment and proper supportive cares, such as, antibiotic therapy, fluid resuscitation and correction of metabolic and electrolyte disorder, resolving of the underlying systemic disease. Recently, we experienced two cases of necrotizing fascitis in cervicofacial region, One patient was 60 years old male with uncontrolled Diabetes Mellitus and other patient was 48 years old with steroid therapy during 30 years. Local surgical wound healing was successful but, patients were died after admission, because of lung abscess, gastrointestinal bleeding, septic shock and respiration hold.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.1
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• pp.43-46
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• 2017

Patients with cerebral palsy have higher risk of traumatic dental injuries because of clinical characteristics, such as, ataxia, large overjet and lip incompetency. Especially, intrusive luxation has rare occurrence but higher incidence of complications. It can be treated by expecting re-eruption, orthodontic reposition, and surgical reposition. Clinicians should be aware of management and follow-up in dealing with cerebral palsy patients who are exposed by intrusive luxation, due to their involuntary movement. This case report describes a 9-year-old male patient with cerebral palsy and epilepsy who experienced intrusion of maxillary permanent central incisor. After one-month follow-up, waiting for spontaneous eruption, pulp necrosis on maxillary permanent central incisor had proceeded. Therefore, surgical reposition with resin wire splint and apexification was performed under conscious sedation with midazolam. After two months, removal of resin wire splint was done. Gutta percha filling and composite resin restoration were performed after sixteen months. During five-year follow-up ankylosis and partial root resorption were observed. But there was no significant complications.

• Restorative Dentistry and Endodontics
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• v.25 no.4
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• pp.606-618
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• 2000

Dental pulp infection is most commonly caused by extensive dental caries, and some bacterial species invade root canals; bacterial components and products are thought to be associated with the pathogenesis of periapical periodontitis. A principle driving force behind pulpal disease response appears to lie in the host immune system's to bacteria and their products. We examined the production of interleukin $1{\beta}$ (IL-$1{\beta}$) and tumor necrosis factor ${\alpha}$(TNF-${\alpha}$) from human peripheral mononuclear cells, lymphocytes and monocytes stimulated by heat-killed Acitnobacillus actinomycetemcomitans (ATCC 29523), Porphyromonas gingivalis (ATCC 33277) and Prevotella intermedia (ATCC 25611), and also by their sonicated bacterial extracts (SBE), respectively. The effects of three strains of heat-killed bacteria and their SBEs on the morphology of cultured blood cell lines HL-60 (KCLB 10240) and J774A.1 (KCLB 40067) were observed under the inverted microscope. Ultrastructural changes of J774A.1 exposed to heat-killed P. intermedia and its SBE were investigated using transmission electron microscopy. Production of IL-$1{\beta}$ was reduced in human peripheral mononuclear cells after stimulation by sonic bacterial extracts of A. actinomycetemcomitans, P. gingivalis, and P. intermedia. Heat-killed and sonic extract of P. gingivalis inhibited the production of TNF-${\alpha}$ in peripheral mononuclear cells. Production of TNF-${\alpha}$ was inhibited in peripheral monocytes after stimulation by sonic extracts of A. actinomycetemcomitans, P. gingivalis, and P. intermedia. HL-60 and J 774A.1 cells showed granular degeneration after treatment with heat-killed and sonic extracts of A. actinomycetemcomitans, P. gingivalis, and P. intermedia Chromatin margination and shrinkage were observed in 774A.1 treated with heat-killed P. intermedia. Cell wall structure and organelles were destroyed and vacuoles were formed in cytoplasm in J774A.1 treated with P. intermedia sonic extract. These results suggest that A actinomycetemcomitans, P gingivalis and P intermedia may have an important role in the formation and progression of pulpal diseases via both modulation of production of IL-$1{\beta}$ and TNF-${\alpha}$ from blood mononuclear cells and cytopathic effects.

• Journal of dental hygiene science
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• v.21 no.4
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• pp.243-250
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• 2021

Background: Endodontic sealers or their toxic components may become inflamed and lead to delayed wound healing when in direct contact with periapical tissues over an extended period. Moreover, an overfilled sealer can directly interact with adjacent tissues and may cause immediate necrosis or further resorption. Therefore, the treatment outcome conceivably depends on the endodontic sealer's biocompatibility and osteogenic potential. This study aimed to evaluate the cell viability and osteogenic effects of four different sealers in osteoblastic cells. Methods: AH Plus (resin-based sealer), Pulp Canal Sealer EWT (zinc oxide-eugenol sealer), BioRoot RCS (calcium silicate-based sealer), and Well-Root ST (MTA-based calcium silicate sealer) were mixed strictly according to the manufacturer's instructions, and dilutions of sealer extracts (1/2, 1/5 and 1/10) were determined. Cell viability was measured using the water-soluble tetrazolium-8 (WST-8) assay. Differentiation was assessed by alkaline phosphatase (ALP) activity and mineralized nodule formation by Alizarin Red S staining. Results: The cell viability of the extracts derived from the sealers excluding Well-Root ST was concentration dependent, with sealer extracts having the least viability at a 1/2 dilution. At sealer extract dilution of 1/10, the test groups showed the same survival rate as that control group, with the exception of BioRoot RCS. Among all experimental groups, BioRoot RCS showed the highest cell viability after 48 hours. The ALP activity was significantly higher in a concentration-dependent manner. Furthemore, all four materials promoted ALP activity and mineralized nodule formation compared to the control at 1/10 dilutions. Conclusion: This is the first study to highlight the differences in biological activity of these four materials. These results suggest that the composition of root canal sealers appears to alter the form of biocompatibility and osteoblastic differentiation.

• Proceedings of the KACD Conference
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• 2001.05a
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• pp.247-251
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• 2001

;A dental developmental anomaly is defined as an isolated aberration in tooth form, caused by a disturbance or abnormality which occurred during tooth development. There are numerous types of dental anomalies, and a considerable variation in the extent of the defects occurs with each type. Teeth with these anomalies pose unique challenges. Since the defects are not always apparent clinically, they can confuse diagnosticians investigating the etiology of pulpal pathosis. When endodontic treatment is required, the defects often hinder access cavity preparation and canal instrumentation. Treatment planning also becomes more challenging, since the defects can create complicated periodontal problems, and the malformed teeth can be difficult to restore, particularly those weakened by endodontic therapy. Fusion is defined as the joining of two developing tooth germs resulting in a single large tooth structure. The incidence of fusion is < 1% in the Caucasian population, and it is believed that physical force or pressure produces contact of the developing teeth. Clinically and radiographically, a fused tooth usually appears as one large crown with at least partially separated roots and root canals. There may be a vertical groove in the tooth crown delineating the originally separate crowns. Dens invaginatus is a deep surface invagination of the crown or root that is lined by enamel. Teeth in both maxillary and mandibular arches may be affected, but the permanent maxillary lateral incisor is the tooth most commonly involved. Studies have revealed an incidence ranging from 0.25% to as high as 10%. The invagination ranges from a slight pitting to an anomaly occupying most of the crown and root. The invagination frequently communicates with the oral cavity, allowing the entry of irritants and microorganism either directly into pulpal tissues or into an area that is deparated from pulpal tissues by only a thin layer of enamel and dentin. This continuous ingress of irritants and the subsequent inflammation usually lead to necrosis of the adjacent pulp tissue and then to periapical or periodontal abscesses. If the invagination extends from the crown to the periradicular tissue and has no communication with the root canal system, the pulp may remain vital. Recommended treatment of fused tooth and dens invaginatus has been reported in the endodontic literature. This case report describes the endodontic treatment of a maxillary laterl incisors having fused crown and dens invaginatus.natus.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.2
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• pp.318-332
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• 2000

The purpose of this study was to investigate the effects of demineralized freeze-dried bone (DFDB) on mechanically exposed pulp of dog by evaluating the pulpal inflammation and healing process, formation of dental hard tissue, and structural changes of fibroblasts of the remaining pulp tissue. Teeth of 4 dogs, weighing 10kg, were used in this study. Class V cavities were prepared followed by exposed the pulp tissue mechanically by sterilized round bur. In control group, exposed pulps were capped with calcium hydroxide paste followed by sealed with IRM. In experimental groups, the exposed pulps of one group were capped with the collagen and those of the other group were capped with DFDB. All cavities were sealed with same manor as control group. The animals were sacrificed at the intervals of 3, 7, 14, and 28 days for histopathlogic evaluation. The specimens were observed by the light microscope and trans-electron microscope. The results were as follows: 1. Pulp necrosis was not observed in all groups. Inflammatory response was disappeared from 1 week in control group and group 2. But it was not disappeared until 2 weeks and also irregular arrangement of odontoblasts was showed at the lateral walls of root canal just beneath the amputated site of the pulp in group 1. 2. Dentinal bridge was formed incompletely at 2 weeks but it was formed completely at 4 weeks in control group. Odontoid tissue was also found in control group at 4 weeks from treatment. Amputated site of pulp was encapsulated with fibrous tissue and odontoblast and dentinal bridge was not found in group 1. Preodontoid tissue and reparative dentin which were formed by odontoblast differentiated around DFDB were found, but dentinal bridge was not found in group 2. 3. Cell with large basophillic-stained nuclei infiltrated to amputated site and DFDB at 1 week from treatment in control group and group 2. They were found more in group 2 than in control group. Odontoblasts arranged more regularly and reparative dentin was found more as time elapsed. 4. Dentin-formative odontoblasts which showed ultramicrostructure of cytoplasm with polarized nucleus, rEM, Golgi complex, secretory granules, secretion of organic matrix in control of group and group 2. In regards to above results, the demineralized freeze-dried bone(DFDB) induce odontoblastic differentiation and further come up to the dentin formation in amputated pulp.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.27.1-27.8
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• 2018

Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.2
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• pp.326-333
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• 2003

The appropriate treatment for eruption guide of impacted teeth necessitates the formulation of a comprehensive treatment plan, which is dependent upon a number of factors such as the condition of the deciduous teeth, dental and skeletal relationship, dental age of the patient, willingness of the patient to undergo extensive dental treatment and financial considerations. If the etiology of the eruption disturbance has been identified, the elimination of the causes and various procedures can be used for eruption guide. Particularly the transplantation is a valuable alternative to extraction of impacted teeth, where surgical exposure and subsequent orthodontic realignment are difficult or impossible. This report present three cases of autotransplantation of impacted maxillary canine. As the result in these cases, atraumatic removal of donor tooth during operation is prerequisite to an optimal clinical result. Due to a high possibility of pulp necrosis, endodontic treatment of fully developed transplanted teeth should be undertaken. In complex case, autotransplantation can save time and less expensive than orthodontic forced eruption. Recipient socket should be prepared to a size that is slightly larger than the root of the donor tooth, and can be prepared with open or close procedure depends on root size of donor tooth and buccolingual width at transplantion site.

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.2
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• pp.194-199
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• 2017

This study investigated the prognosis of luxation injuries in primary teeth treated with splinting. This study retrospectively analyzed 92 children with luxation injuries to their primary teeth who were treated with splints between 2010 and 2015. Prognoses were analyzed in patients who had been followed for more than 6 months. The prognoses with splinting were based on clinical and radiographic evaluations performed during the follow-up examinations. The mean patient age was 42.1 months, and 67.4% were male. The most common cause of luxation injury was falling, and the mean splint duration was 2.4 weeks. The success rate of splinting was 58.9%. The highest rate of success was achieved following subluxation, while repositioning and splinting of lateral luxation had the lowest rate of success. Pulp necrosis was the most common unfavorable prognosis in the luxation injuries. Depending upon the type of luxation, splint therapy had acceptable prognoses and might be a feasible treatment option.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.4
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• pp.642-651
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• 2008

This study was carried out to give basic information of traumatic injuries of primary and permanent teeth which can be used for diagnosis and management of injured teeth. From January 2003 to July 2007, 570 children with 1394 teeth who came to pediatric dentistry and emergency center of Chonnam National University Hospital due to the traumatized teeth participated in this study. The following data were investigated. : age, sex, causes and places of trauma, position of injured teeth, types of injury, and treatment at the first visit. 1. Trauma prevailed at the age of 1, $6{\sim}8$, $17{\sim}18$ and the rate of males was more likely to be higher than the rate of females(1.9 : 1). 2. The main cause of injury is a fall-down injury for primary and mixed dentition, but is a traffic accident and fighting for permanent dentition, respectably. The place of injury for primary dentition is mainly home(45.3%), while street for mixed and permanent dentition. 3. The position of injured teeth according to the area in the mouth is mainly maxillary anterior teeth in both case of primary and permanent teeth and especially, the ratio of central incisors is high. 4. The periodontal tissue injury occurred the most frequently in the primary and the permanent teeth, but the ratio of hard tissue injury in the permanent teeth increased, compared with the primary teeth. 5. Among treatments at the first visit, observation without actual treatment comprised 75.6% in the primary teeth and 55.4% in the permanent teeth, respectably. The pulp necrosis occurred in 20.3% of the primary teeth and 26.6% of the permanent teeth in the case of the periodontal tissue injuries, respectably.