• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.3
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• pp.276-283
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• 2011

Recently, undifferentiated stem cells which exist in dental papillae of immature permanent teeth were newly discovered and these stem cells appear to be the origin of ameloblasts associated with the formation of root dentin. When treating immature permanent teeth, the preservation of these stem cells induce the continuous formation of the root. Therefore, it is reported that minimal invasion to periapical region in immature permanent teeth with periapical inflammation resulted in good-healing pattern in clinical and radiographic examination. In this case, a 10 year-old boy(mandibular right premolar) and a 8 year-old girl(maxillary left premolar) who visited the department of pediatric dentistry at Chosun University Dental Hospital were diagnosed with pulp necrosis and periapical abscess in clinical and radiographic examination. Endodontic instrumentation to the periapical region was limited and MTA(Mineral Trioxide Aggregate) was applied into the pulp canal. The periodic checks showed healing of periapical abscess and the development and growth pattern of roots. In permanent teeth with pulp necrosis and periapical abscess, preservation of pulp and dental papillae in the periapical region showed good prognosis during the periodic examinations. Therefore, a lot of clinical examination and long-term evaluation of conservative pulp treatment in immature permanent teeth are expected to be necessary.

• The Journal of the Korean dental association
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• v.51 no.10
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• pp.542-550
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• 2013

The immature teeth with apical periodontitis present considerable challenges to clinicians. Therefore, new treatment protocols have been suggested to overcome the problems encountered in traditional methods. Regenerative treatment (revascularization) is one of such methods. Many case reports on the revascularization of infected immature teeth have been published, and in most of them, immature teeth with even a periapical abscess continued root formation after the disinfection of the root canal system. We now believe that this continued root formation is not an exceptional incident. As a result, it appeared that apexification has been giving way to a revascularization technique, which is a new option, in treating necrotic immature teeth. These new methods appear to be based on the healing potential of stem cells. The potential of healing or regeneration of stem cells, which are located around teeth, seems to be greater than we thought before. This review summarizes the current techniques for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis.

• Restorative Dentistry and Endodontics
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• v.3 no.1
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• pp.17-21
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• 1977

After a vital pulpotomy in dogs' teeth, the responses of the remaining pulp tissue under calcium hydroxide and formocresol were studied histologically. The class I and V cavities were prepared on the teeth and the pulp was amputated. Calcium hydroxide and formocresol were placed over the amputated tissue and the cavities were sealed with zine oxide eugenol cement and zinc phosphate cement. Animals. were sacrifice after 1, 2, and 3 weeks following the operation. The teeth were decalcfied, sectioned and stained with hematoxylin and eosin. Microscopic examination reveals as follows; 1. Healing of the pulp at the amputation site did not occur in the pulps treated with formocresol. 2. At one week, a thin layer of darker staining tissues just below the necrotic zone was presented in the pulps treated with formocresol. In this stage the tissues beneath the darker staining layer were normal. 3. At two weeks, the cells of the palest staining layer were showed indistinct nucleus which suggested the karyolysis and the karyorrhexis in the pulps treated with formocoresol. As reached to the middle third of the pulp, the odontoblasts were scarcely evident or missed in this stage. 4. At three weeks, the necrotic zone was reached to the middle third of the pulp canal. The cells beneath the zone showed massive infiltration of inflammatory cells in the pulps treated with formocresol. 5. Dentin bridge in the control group was deposited below the necrotic zone from the two. weeks later. 6. Normal tissues were observed ill the apical third of all. the dental pulps in all case of calcium hydroxide and formocresol.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.640-646
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• 2009

In case of luxation injuries, loss of tooth vitality is common. And in case of trauma in the immature permanent teeth, precise diagnosis of pulp necrosis is very difficult. That is because limitation in distinguishing between normal dental papilla in immature permanent teeth, transient apical breakdown(TAB), which is part of normal healing process, and apical radiolucency in pulp necrosis. Especially in non-vital immature permanent tooth, the treatment is complex and requires long time. This clinical case report shows that severely infected immature teeth with periradicular periodontitis can undergo healing and apexogenesis or maturogenesis with no definative treatment or after conservative treatment. In the cases reported, we emphasize the considerable power of regeneration of the tooth, probably due to its large number of undifferentiated mesenchymal cells in the dental papilla, pulp tissue, periodontal ligament tissues. Thus, when endodontic treatment in immature permanent teeth, over instrumentation is not recommend for preserve the apical vital stem cells.

• Restorative Dentistry and Endodontics
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• v.43 no.4
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• pp.36.1-36.12
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• 2018

Objectives: Direct pulp capping is a treatment for mechanically exposed pulp in which a biocompatible capping material is used to preserve pulpal vitality. Biocompatibility tests in animal studies have used a variety of experimental protocols, particularly with regard to the exposure site. In this study, pulp exposure on the occlusal and mesial surfaces of molar teeth was investigated in a rat model. Materials and Methods: A total of 58 maxillary first molars of Wistar rats were used. Forty molars were mechanically exposed and randomly assigned according to 3 factors: 1) the exposure site (occlusal or mesial), 2) the pulp-capping material (ProRoot White MTA or Bio-MA), and 3) 2 follow-up periods (1 day or 7 days) (n = 5 each). The pulp of 6 intact molars served as negative controls. The pulp of 12 molars was exposed without a capping material (n = 3 per exposure site for each period) and served as positive controls. Inflammatory cell infiltration and reparative dentin formation were histologically evaluated at 1 and 7 days using grading scores. Results: At 1 day, localized mild inflammation was detected in most teeth in all experimental groups. At 7 days, continuous/discontinuous calcified bridges were formed at exposure sites with no or few inflammatory cells. No significant differences in pulpal response according to the exposure site or calcium-silicate cement were observed. Conclusions: The location of the exposure site had no effect on rat pulpal healing. However, mesial exposures could be performed easily, with more consistent results. The pulpal responses were not significantly different between the 2 capping materials.

• Restorative Dentistry and Endodontics
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• v.47 no.4
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• pp.41.1-41.20
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• 2022

Objectives: This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT). Materials and Methods: Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12-24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance. Results: All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth. Conclusions: Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes.

• Restorative Dentistry and Endodontics
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• v.10 no.1
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• pp.93-101
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• 1984

The experimental study was made to investigate the effect of the "Heliosit" composite resin on the dental pulp. The 36 class V cavities were prepared on the healthy permanent teeth of 3 days, and were divided into 5 groups and filled with the experimental filling materials. Control group: Zinc Oxide-Eugenol cement filling Experimental groups: Group 1: Dentin Adhesit application & Heliosit filling with or without dycal base Group 2: Heliosit filling with or without dycal base Group 3: Durafill filling with dycal base Group 4: Hipol filling with dycal base Animals were sacrificed after 1 weeks, 2 weeks, and 4 weeks following operation. The teeth were decalcified, sectioned and stained with hematoxylin and eosin. The results obtained form this study were as follows: 1. All experimental group showed slight pulp response. 2. Dentin Adhesit group showed minimal pulp response in both dycal bases and no base cases. 3. In group 2, mild pulp response was found in early stage and repairing process was found as the time elapsed. In no base cases, healing process was delayed slightly. 4. There was little difference in the result among Heliosit group, Durafill group and Hipol group.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.843-848
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• 1998

Pulpotomy is a frequently used treatment modality in primary teeth. It is method by which infected coronal pulp is removed while retaining vital radicular pulp. Since its introduction in 1930 by Sweet formocresol remains the most popular medicament for this treatment. However, despite its outstanding bactericidal properties, formocresol is known to cause adverse tissue reactions. Theoretically, formocresol disinfects and fixes radicular pulp and thus prevents infection and internal resorption. In reality, however, it leads to chronic inflammation and is sometimes responsible for failures through abscess formation and internal root resorption. Also, Myers et al., in 1978, reported on the systemic distribution of FC and other studies have followed with reports of its immunological, mutagenic and carcinogenic effects. Much effort has, therefore, focused on the development of alternative medicaments and techniques. Since its introduction in 19C, ferric sulfate proven itself as an effective hemostatic agent and is used as an astringent in dentistry. In 1988, Landau and Johnsen suggested ferric sulfate be used as a medicament in pulpotomy and many studies have focused on it to overcome the toxic effects of FC. Ferric sulfate acts through its ferric ion and iron ion, which react with blood protein leading to aggregation. The aggregated protein acts to plug the blood vessels, causing mechanical hemostasis. As blood clot formation is minimal, there is reduced inflammation of radicular pulp and enhanced healing. There are no reports regarding its systemic distribution. This is a report of cases treated by the author using pulpotomy with ferric sulfate.

• Restorative Dentistry and Endodontics
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• v.43 no.3
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• pp.28.1-28.16
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• 2018

This study investigated the latest findings and notions regarding 'triple antibiotic paste' (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.

• Restorative Dentistry and Endodontics
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• v.22 no.2
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• pp.519-535
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• 1997

The responses of human pulp fibroblastic cells to Ga-As Semi-Conductor-Dens-Bio Laser (Frequency: 5 Hz~10,000 Hz Model: SD-101A RCA, U.SA)) were examined in vitro using pulp fibroblastic cells obtained from the pulp tissue of human tooth. The mitogenic effect of soft laser was assessed by measuring the MTT assay. The morphologic effect for soft laser showed under the scanning and transmission electron microscopy. The results as follows; 1. The mitogenic response of the soft laser was not observed until 4th time of radiation, while the mitogenic response at 4th time increased mitogenic effect by as much as 1.7 fold compared to the control value. 2. The mitogenic response of the soft laser on pulp fibroblast differ from the mitogenic response on other fibroblasts. 3. In scanning electron microscopic study, The microvilli of cell surface increased gradually with width and length after laser radiation, it demonstrate that development of microvilli have close connection with differentiation of cells. 4. Under the transmission electron microscope, The laser-treated cells maintained their elongated shape and a high degree of cellular polarization. The large cell body containing a well developed Golgi complex, a large number of profiles of rough endoplasmic reticulum, and great numbers of mitochondria. 5. The laser-treated cells maintained the long straight bundles of closely apposed microfilaments or individual filaments forming a cross-linked network. These findings suggest that the laser may have important roles in promotion of pulp healing and consequently may be useful for clinical application in pulp regenerative procedures.