• Restorative Dentistry and Endodontics
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• v.43 no.2
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• pp.16.1-16.9
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• 2018

Objectives: Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments. Materials and Methods: This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area. Results: Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals. Conclusions: Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment.

• Journal of Veterinary Clinics
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• v.36 no.2
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• pp.106-108
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• 2019

This clinical report describes hemisection and endodontic treatment of first molar tooth and mandible fracture repair in a dog. A 10 years old spayed female shih-tzu was diagnosed as left mandibular fracture by oral examination and dental radiography. First, partial odontectomy of mesial root of mandibular first molar placed in fracture line was performed, and then endodontic treatment of distal root and bone graft in extraction site was performed. Thereafter the fracture region was fixed with interdental wiring and acryl resin splint. Mandibular fracture site was healed without any complications, observed for 19 weeks follow-up period. Upon this result, this case is proving that fractured mandible can be treated successfully with hemisection followed by bone graft, interdental wiring and acryl resin splint to preserve the remaining tooth for mastication rather than tooth extraction.

• Restorative Dentistry and Endodontics
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• v.38 no.4
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• pp.187-193
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• 2013

Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.

• Restorative Dentistry and Endodontics
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• v.44 no.1
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• pp.7.1-7.10
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• 2019

Apical periodontitis is a biofilm-mediated infection. The biofilm protects bacteria from host defenses and increase their resistance to intracanal disinfecting protocols. Understanding the virulence of these endodontic microbiota within biofilm is essential for the development of novel therapeutic procedures for intracanal disinfection. Both the disruption of biofilms and the killing of their bacteria are necessary to effectively treat apical periodontitis. Accordingly, a review of endodontic biofilm types, antimicrobial resistance mechanisms, and current and future therapeutic procedures for endodontic biofilm is provided.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.2
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• pp.158-169
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• 2022

The purpose of this study was to analyze treatment methods, results, timings and clinical signs and symptoms in failed cases of each treatment method of dens evaginatus on the premolar areas. In this study, 151 patients and 417 teeth were included. Resin restoration and direct pulp capping as preventive treatment and pulp revascularization, apexification and conventional endodontic treatment as endodontic treatment were included for treatment methods. In the preventive resin restoration, successful results were shown in the intact tubercles and also effective when the tubercles were fractured. In the direct pulp capping, resolved clinical symptoms and growth of the roots were shown when there was only pain during chewing without apical lesion. Apical lesion was the most common pretreatment signs and symptoms of the pulp revascularization, apexification and conventional endodontic treatment. In the pulp revascularization, successful results was obtained in most cases. But in some cases, root length or root wall thickness was not increased. Effective results were shown both of the apexification and conventional endodontic treatment. In order to increase success rate of preventive treatment of dens evaginatus, resin restoration was required to be done when tubercle did not occluded or in the presence of intact tubercles. When tubercle was fractured, root development stage and pulp condition should be considered for successful treatment.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.2
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• pp.250-256
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• 2018

Dental avulsion, defined as the complete displacement of a tooth from the alveolar bone with consequent loss of the blood and nerve supply, was reported as one of the most severe dental injuries. Avulsion can cause tissue ischemia, which leads to pulp necrosis. Apexification is a conventional treatment method that induces an apical calcified barrier in immature roots with pulp necrosis. However, root development characterized by an increase in the root thickness and length cannot be achieved by apexification. The purpose of this case report was to describe the radiographic and clinical outcomes of regenerative endodontic treatment for the avulsed and necrosed permanent tooth with an immature root after replantation in a 5-year-old girl; the treatment was performed using a mixture of ciprofloxacin, metronidazole and cefaclor, CollaTape and Biodentine.

• Journal of the korean academy of Pediatric Dentistry
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• v.23 no.3
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• pp.688-696
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• 1996

Garre's osteomyelitis is a unique form of osteomyelitis characterized rediographically by localized thickening of the periosteum and deposition of laminated subperiosteal bone. The most common inciting factor is a mandibular infection in permanent first molar with necrotic pulp. This disease occurs primarily in children and to date in all instances it has occured only in mandible. It usually results in hard swelling over the jaws, producing facial asymmetry with little or no pain. The overlying skin is normal but can occasionally be inflammed mostly when pain is present. Palpation reveals a usually smooth, bone-hard lesion which feel like an inherent part of the mandible. Unlike other forms of osteomyelitis, there is no marked increase in fever, white bloods cell count, sedimentation rate or alkaline phosphatase value. The treatment of Garre's osteomyelitis usually consist of elimination of the sourses of infection, i.e., either extration of an offending infected teeth or root canal therapy. This treatment almost always results in resolution of the Garre's osteomyelitis. Resistant cases have involved secondary surgery, i.e., decortication and sequestrectomy. This report presents three cases of Garre's osteomyelitis resolved by endodontic treatment. Cliniqtl examination revealed swelling on the face with no tenderness. Periapical radiograph showed deep caries lesion extending into pulp chamber and periapical radiolucency. Occlusal radiograph showed an enlargement of bone and stretching the periosteum. A clinical diagnosis of the Garre's osteomyelitis was made. Endodontic treatment was accomplished with conventional method and restored facial symmetry. Long-term check-ups are necessary to evaluate the results of endodontic treatment.

• Imaging Science in Dentistry
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• v.35 no.2
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• pp.91-96
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• 2005

Purpose : To investigate the change of bone healing process after endodontic treatment of the tooth with an apical lesion by fractal analysis. Materials and Methods Radiographic images of 35 teeth from 33 patients taken on first diagnosis, 6 months, and 1 year after endodontic treatment were selected. Radiographic images were taken by JUPITER Computerized Dental X-ray $System^{(R)}$. Fractal dimensions were calculated three times at each area by Scion Image $PC^{(R)}$ program. Rectangular region of interest $(30\times30)$ were selected at apical lesion and normal apex of each image. Results : The fractal dimension at apical lesion of first diagnosis $(L_0)$ is $0.940{\pm}0.361$ and that of normal area $(N_0)$ is $1.186{\pm}0.727(p<0.05)$. Fractal dimension at apical lesion of 6 months after endodontic treatment $(L_1)$ is $1.076{\pm}0.069$ and that of normal area $ (N_1)$ is $1.192{\pm}0.055(p<0.05)$. Fractal dimension at apical lesion of 1 year after endodontic treatment $(L_2)$ is $1.163{\pm}0.074$ and that of normal area $(N_2)$ is $1.225{\pm}0.079(p<0.05)$. After endodontic treatment, the fractal dimensions at each apical lesions depending on time showed statistically significant difference. And there are statistically significant different between normal area and apical lesion on first diagnosis, 6 months after, 1 year after. But the differences were grow smaller as time flows. Conclusion : The evaluation of the prognosis after the endodontic treatment of the apical lesion was estimated by bone regeneration in apical region. Fractal analysis was attempted to overcome the limit of subjective reading, and as a result the change of the bone during the healing process was able to be detected objectively and quantitatively.

• Restorative Dentistry and Endodontics
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• v.41 no.4
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• pp.262-270
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• 2016

Objectives: This study aimed to evaluate the healing rate of non-surgical endodontic treatment between C-shaped and non-C-shaped mandibular second molars. Materials and Methods: Clinical records and radiological images of patients who had undergone endodontic treatment on mandibular second molars between 2007 and 2014 were screened. The periapical index scoring system was applied to compare healing outcomes. Information about preoperative and postoperative factors as well as the demographic data of the patients was acquired and evaluated using chi-square and multinomial logistic regression tests. Results: The total healing rate was 68.4%. Healing rates for the mandibular second molar were 70.9% in C-shaped canals (n = 79) and 66.6% in non-C-shaped ones (n = 117). The difference was not statistically significant. Conclusions: The presence of a C-shaped canal in the mandibular second molar did not have a significantly negative effect on healing after treatment. Instead, proper pulpal diagnosis and final restoration were indicated as having significantly greater influence on the healing outcomes of C-shaped and non-C-shaped canals, respectively.

• Journal of Dental Rehabilitation and Applied Science
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• v.35 no.1
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• pp.46-54
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• 2019

When inflammatory products are found in both periodontal and pulpal tissues simultaneously, a periodontal-endodontic combined lesion is established. The treatment of periodontal-endodontic combined lesions includes root canal therapy and periodontal regenerative procedure for resolution of both the apical and marginal inflammatory lesions. The present study reports the treatment of periodontal-endodontic combined lesions in the mandibular anterior area with root canal therapy, followed by guided tissue regeneration therapy. Teeth with severe bone destruction in each case could be preserved, without extraction, over a 3-year period. Therefore, it appears that treatment of periodontal-endodontic combined lesions in the mandibular anterior area using guided tissue regeneration technique after root canal therapy may provide clinical advantages.