• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.2
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• pp.188-196
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• 2015

Endodontic management of an immature permanent tooth with dens invaginatus poses a challenge to efficient treatment planning for the clinicians. Because it is difficult to shape, disinfect, and seal the canal space effectively, teeth with complex root canal structures often require particularly extensive and thorough treatment approaches. The purpose of this case report was to share clinical insight from the results of short-term follow-ups after regenerative endodontic treatment with a dens invaginatus. Two immature maxillary lateral incisors with Oehlers type I and III dens invaginatus and infected necrotic pulp were treated using regenerative endodontic procedures. For the type III dens invaginatus case, an unusual approach toward redesigning the complex internal structure was taken, in order to have sufficient infection control and sealing. Cone-beam computed tomography (CBCT) and a surgical operating microscope were used to aid visualization and treatment. As a result, regenerative endodontic treatment appears to be effective for managing immature permanent teeth with complex dens invaginatus, and can lead not only to clinical and radiographic resolution, but also increased thickness of the dentinal walls.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.195-201
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• 2015

Objectives: The use of chitosan nanoparticles (CNPs) in endodontics is of interest due to their antibiofilm properties. This study was to investigate the ability of bioactive CNPs to remove the smear layer and inhibit bacterial recolonization on dentin. Materials and Methods: One hundred bovine dentin sections were divided into five groups (n = 20 per group) according to the treatment. The irrigating solutions used were 2.5% sodium hypochlorite (NaOCl) for 20 min, 17% ethylenediaminetetraacetic acid (EDTA) for 3 min and 1.29 mg/mL CNPs for 3 min. The samples were irrigated with either distilled water (control), NaOCl, NaOCl-EDTA, NaOCl-EDTA-CNPs or NaOCl-CNPs. After the treatment, half of the samples (n = 50) were used to assess the chelating effect of the solutions using portable scanning electronic microscopy, while the other half (n = 50) were infected intra-orally to examine the post-treatment bacterial biofilm forming capacity. The biovolume and cellular viability of the biofilms were analysed under confocal laser scanning microscopy. The Kappa test was performed for examiner calibration, and the non-parametric Kruskal-Wallis and Dunn tests (p < 0.05) were used for comparisons among the groups. Results: The smear layer was significantly reduced in all of the groups except the control and NaOCl groups (p < 0.05). The CNPs-treated samples were able to resist biofilm formation significantly better than other treatment groups (p < 0.05). Conclusions: CNPs could be used as a final irrigant during root canal treatment with the dual benefit of removing the smear layer and inhibiting bacterial recolonization on root dentin.

• Restorative Dentistry and Endodontics
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• v.45 no.2
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• pp.23.1-23.12
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• 2020

Objectives: This study aimed to summarize the outcome of in vitro studies comparing the antibacterial effectiveness of QMix with other irrigants against Enterococcus faecalis. Materials and Methods: The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using 3 electronic databases: PubMed, Scopus, and EBSCOhost until October 2019. The additional hand search was performed from the reference list of the eligible studies. The risk of bias of the studies was independently appraised using the revised Cochrane Risk of Bias tool (RoB 2.0). Results: Fourteen studies were included in this systematic review. The overall risk of bias for the selected studies was moderate. QMix was found to have a higher antimicrobial activity compared to 2% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), mixture of tetracycline isonomer, an acid and a detergent (MTAD), 0.2% Cetrimide, SilverSol/H2O2, HYBENX, and grape seed extract (GSE). QMix had higher antibacterial efficacy compared to NaOCl, only when used for a longer time (10 minutes) and with higher volume (above 3 mL). Conclusions: QMix has higher antibacterial activity than 17% EDTA, 2% CHX, MTAD, 0.2% Cetrimide, SilverSol/H2O2, HYBENX, GSE and NaOCl with lower concentration. To improve the effectiveness, QMix is to use for a longer time and at a higher volume.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.40-48
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• 1999

This study was designed to examine the specificities of the designed primers for F. nucleatum and F. necrophorum and to compare the PCR results using clinical samples with those of the anaerobic culture method. F. nucleatum and F. necrophorum spp. are frequently isolated in infected root canals, and they are related to periapical diseases. F. nucleatum(VPI 10197) and F. necrophorum(ATCC 25286) were used as references for PCR reaction, and thirty five teeth with one canal and periapical lesion were used. The samples were cultured anaerobically and identified using Rapid ID 32A(BioMerieux Vitek, Inc., France) as biochemical battery. In the GenBank database, species-specific PCR primers(nuc1/nuc2 primers for F. nucleatum and nec1/nec2 primers for F. necrophorum) were designed from the 16S ribosomal DNA(rDNA) sequences of F. nucleatum(accession number M58683) and F. necrophorum(accession number AF044948). PCR procedures of F. nucleatum(VPI 10197) and F. necrophorum (ATCC 25286) were simulated on a computer software. Amplify(v.1.2${\beta}$ for Macintosh). 820 bps and 817 bps of nucleotides were expected, respectively. Using extracted DNAs with QiaAmp tissue kit(Qiagen co., Germany), PCR was done. The results were as follows : 1. The nuc1/nuc2 primers produced an amplicon of 820 bps and the nec1/nec2 primers produced an amplicon of 817 bps. 2. The nuc1/nuc2 primers and the nec1/nec2 primers were specific and did not react with species other than the designated ones(i.e. nuc1/nuc2 primers did not produce amplicons for F. necrophorum, and vice versa.). And the PCR products of Porphyromonas endodontalis(ATCC 35406), Porphyromonas gingivalis(ATCC 33277), Prevotella intermedia(ATCC 25611), and Prevotella nigrescens(ATCC 33563), frequently isolated in infected root canals and periapical lesions, were not amplified by the primers specific for Fusobacterium nucleatum and Fusobacterium necrophorum. 3. This method utilizing PCR could detect F. nucleatum and F. necrophorum in clinical samples, while anaerobic culture method could detect neither.

• Restorative Dentistry and Endodontics
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• v.30 no.5
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• pp.409-422
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• 2005

The aim of this study was to identify the bacteria isolated from acute endodontic lesions by cell culture and 16S rDNA sequencing. The necrotic pulpal tissue was collected from 17 infected root canals, which were diagnosed as being either an acute pulpitis or acute periapical abscess. Samples were collected aseptically from the infected pulpal tissue of the infected root canals using a barbed broach and a paper point. The cut barbed broaches and paper points were transferred to an eppendorf tube containing 500 ul of 1 XPBS. The sample solution was briefly mixed and plated onto a BHI-agar plate containing $5\%$ sheep blood. The agar plates were incubated in a $37^{\circ}C$ anaerobic chamber for 7 days. The bacteria growing on the agar plate were identified by 16S rRNA coding gene (rDNA) cloning and sequencing at the species level. Among the 71 colonies grown on the agar plates, 56 strains survived and were identified. In dental caries involving the root canals, Streptococcus spp. were mainly isolated. Actinomyces, Clostridia, Bacteroides and Fusobacteria were isolated in the periapical lesion without dental caries. Interestingly, two new Actinomyces spp. (ChDC B639 and ChDC B631) were isolated in this study. These results showed that there was diversity among the species in endodontic lesions, This suggests that an endodontic infection is a mixed infection with a polymicrobial etiology. These results may offer the bacterial strains for pathogenesis studies related to an endodontic infection.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.1
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• pp.44-50
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• 2011

An immature tooth with infected pulp has numerous potential complications. Conventional apexification with calcium hydroxide has several disadvantages, including susceptibility to tooth fracture. This method does not promote continual root development. Pulp revascularization of a necrotic, immature permanent tooth will allow further development of the root and dentinal structure. Disinfection of the root canal system is a prerequisite for pulp revascularization and tissue regeneration. A combination of antibiotic drugs (ciprofloxacin, metronidazole, and minocycline) is effective for disinfection of necrotic pulp, and has been used successfully in regenerative endodontic treatment. These case reports involve the treatment of 3 immature permanent teeth with necrotic pulp using a 3-Mix paste and mineral trioxide aggregate. All cases showed the notable apical maturation with closure of the apex and increased thickness of dentinal walls. This approach suggests a paradigm shift in treating endodontically involved immature permanent teeth from the traditional apexification with calcium hydroxide to the conservative approach by providing a favorable environment for tissue regeneration.

• 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.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.84-89
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• 2012

The radicular cyst is the most common odontogenic cyst which is caused by pulpal inflammation, pulp death, and secondary to trauma or dental caries. Usually, the radicular cyst is asymptomatic, but a secondary inflammation can cause pain, swelling and redness. Getting larger, the radicular cyst can cause facial asymmetry and paresthesia by pressure on nerves. It requires conservative endodontic treatment or surgical approach. When the size of cyst is large or invasion of the adjacent tissue is not expected, cyst enucleation is carried out. And most of the case can be completely cured and shows low recurrence. In these radicular cysts cases, by cyst enucleation or apicoectomy after root canal treatment simultaneously, the infected teeth can be preserved successfully.

• Restorative Dentistry and Endodontics
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• v.28 no.2
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• pp.178-183
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• 2003

The purpose of this study was to investigate the frequency of 7 putative pathogens in endodontic infections. The specimens were collected from infected pulpal tissue of patients who were referred for root canal treatment to the department of conservative dentistry, Chosun University Samples were collected aseptically using a barbed broach and a paper point. The cut barbed broaches and paper points were transferred to an eppendorf tube containing 500 ml of 1 X PBS. DNAs were extracted from the samples by direct DNA extraction method using lysis buffer (0.5% EDTA, 1% Triton X-100). Identification of 7 putative pathogens was performed by PCR based on 16S rDNA. The target species were as follows : Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, and Treponema denticola. Our data revealed that the prevalence of P. endodontalis was found in 88.6% (39/54), P. ginivalis 52.3% (23/44), P. nigrescens 18.2% (8/44), P intermedia 15.9% (7/44) B. forsythus 18.2% (8/44), A. actinomycetemcomitans 3.3% (1/44), T. denticola 25% (l1/44) of the samples. The high prevalence of P. endodontalis and P. ginivalis suggests that they may play an important role in the etiology of endodontic infections.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.131-138
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• 2006

A mixture of metronidazole, ciprofloxacin and minocycline(3Mix) in distilled water or in a root canal sealer were used to disinfect the infected endodontic and periapical lesions. It has been well acknowledged in recent literature that minocycline, a semisynthetic tetracycline derivative, causes discolorations in adult teeth and various other collagenous tissues. In these cases, pulp treatments were finished successfully using a combination of antibiotics but severe discolorations of the teeth were observed. Discolored non-vital posterior tooth was treated using the prosthodontic procedure. And anterior tooth was successfully treated using the walking bleach technique. Bleaching was performed by temporarily placing a mixture of sodium perborate and distilled water into the pulp chamber. There were significant esthetic improvement.