• Restorative Dentistry and Endodontics
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• 제20권1호
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• pp.55-70
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• 1995

Periapical lesions develop as a result of immunopathologic response to irritants from infected root canal systems. Removal of these irritants from the root canal system and sealing the root canal space may induce he31ing of the periapical lesions. 83 periapical lesions diagnosed as periapical abscess, periapical granuloma, chronic nonspecific inflammation, fibrosis and periapical Cyst were evaluated for the distribution of immunoglobulin containing cells. The influence of the state of root canal treatment on the distribution of immunoglobulin containing cells has evaluated. All lesions were divided into a group with no treatment, a group with canal enlargement, a group filled with gutta percha, and a group filled with Vitapex(calcium hydroxide). The distribution of immunoglobulin-containing cells according to the presence of pain and fistula was also evaluated. The following results were obtained. 1. Statistically significant difference in the distribution of immunoglobulin-containing cells among periapical abscess, periapical granuloma, chronic nonspecific inflammation/fibrosis and periapical cyst were found.(Kruskal-Wallis analysis, P<0.05) The number of immunoglobulin-containing cells in fibrosis was remarkably lower than that of periapical abscess, granuloma and cyst. 2. IgM and IgA containing cells were predominantly observed in periapical abscesses and periapical cysts, respectively. 3. All periapical lesions showed a large number of IgG containing cells followed by IgM, IgA and IgE containing cells. 4. There was a decrease in all Ig-containing cells in the group with canal filling compared to groups without treatment or with enlargement. That is, there is a decrease in Ig-containing cells as treatment progresses. 5. No significant correlation existed between the presence of pain and fistula and the distribution of immunoglobulin containing cells in periapical lesions.(t-test) Results appear to support that immune response are actively involved in the development and progress in periapical lesions. The fact that distribution of immunoglobulins differ according to the state of endodontic treatment suggests that root canal treatment may alter the humoral immune response of the periapical lesions.

• 대한치과의사협회지
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• 제55권8호
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• pp.565-573
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• 2017

Root canal perforations are defined as the communication between the pulp cavity, the periodontal tissue and alveolar bone. The occurrence of perforations during endodontic treatment is reported to range from 2.3%~12%, which is not a complication rarely happens. Perforations have iatrogenic or pathological etiologies that involve caries or resorption. It leads to inflammation and the destruction of periodontal fibers and alveolar bone, followed by periodontal defects. Mineral trioxide aggregate (MTA) is currently the most indicated material for repair of root perforation, because of its favorable biocompatibility and sealing ability. Using magnification with dental operating microscope enhance the accessibility and visibility to manage the root perforation. It is important to diagnose and repair perforations immediately if possible.

• Journal of Periodontal and Implant Science
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• 제54권2호
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• pp.65-74
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• 2024

Purpose: This longitudinal cohort study aimed to evaluate the relationship between osteonecrosis of the jaw and pulp and periapical disease in patients who were administered bisphosphonates. Methods: Using data from a nationwide cohort, we examined the association among dental caries, pulp and periapical disease, and osteonecrosis of the jaw in women aged >50 years who received bisphosphonates for more than 1 year between 2002 and 2015. Because of ambiguities in the diagnosis of osteonecrosis of the jaw in population-based data, we operationally defined and categorized the condition into established and potential osteonecrosis of the jaw. Results: Pulp and periapical disease significantly increased the development of both established and potential osteonecrosis of the jaw (hazard ratio, 2.21; 95% confidence interval, 1.40-3.48; and hazard ratio, 2.22; 95% confidence interval, 1.65-2.98, respectively). Root canal treatment did not have any influence on the development of osteonecrosis of the jaw. Conclusions: Pulp and periapical disease may be a major risk factor for osteonecrosis of the jaw. The study findings suggest that patients should undergo regular dental examinations to detect pulp and periapical disease before or during the administration of bisphosphonates and that root canal treatment should be considered to decrease the risk of osteonecrosis of the jaw.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2001년도 춘계학술대회
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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.

• Restorative Dentistry and Endodontics
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• 제36권3호
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• pp.196-202
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• 2011

연구목적: 근관 치료를 전후로 근관 삼출액을 추출하여 MMP-8과 SP의 양을 측정하고 근관 치료에 따른 변화 및 이들간이 상관관계를 보는 것을 본 연구의 목적으로 하였다. 연구 재료 및 방법: 치수괴사, 혹은 이전 근관 치료 후 치근단 병소가 있어서 근관 치료가 예정된 35개의 치아를 대상으로 하였으며, 근관 치료 첫날, 2주 후, 4주 후 paper point를 이용하여 근관 삼출액을 채취하였다. MMP-8과 SP의 양은 enzyme-linked immunosorbent assay (ELISA)를 이용하여 정량 하였다. 삼출액의 채취 시점에 따른 MMP-8, SP 양의 변화 및 환자의 통증 정도, 임상증상에 따른 MMP-8, SP의 변화는 mixed model을 이용하여 통계 분석하였으며 MMP-8과 SP의 상관관계는 Pearson correlation coefficient를 구하여 분석하였다(p < 0.05). 결과: 근관치료가 진행됨에 따라 MMP-8, SP의 양은 유의성 있게 감소하였으며(p < 0.0001), 환자의 통증이나 타진검사 시 반응이 SP의 발현에 영향을 주는 것으로 나타났다. MMP-8의 경우 SP와 미약한 양의 상관관계가 있었지만 환자의 증상이나 다른 임상검사와 상관관계가 발견되지 않았다. 결론: 본 실험에서 사용된 paper point를 이용한 근관 삼출액의 채취를 통하여 치근단 염증과정에서 발현되는 MMP-8, SP를 검출할 수 있었으며 특히 SP의 경우 환자의 증상과 보다 관련이 깊은 것으로 나타났다.

• 한국치위생학회지
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• 제18권4호
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• pp.423-432
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• 2018

Objectives: Calcium hydroxide, a root canal temporary sealer, has long been used and it has anti-bacterial and anti-inflammatory activity. To investigate the properties of a newly developed calcium hydroxide paste comprising silicon-substituted hydroxyapatite (Si-HA), we examined the anti-inflammatory activity of the new calcium hydroxide paste in RAW 264.7 macrophages stimulated by lipopolysaccharide (LPS), which causes infection of the root canal. Methods: The test materials, including Calcipex II as control group and the newly developed TRC paste, were extracted from cell culture media and then diluted for experiment. In LPS-stimulated RAW 264.7 cells, the cytotoxicity and nitric oxide (NO) production of test materials were measured by MTT assay and Griess reagents, respectively. Also, the expression of the inducible nitric oxide synthase (iNOS) was assessed by western blotting. Results: The IC50 values of Calcipex II and TRC paste were $17.6mg/m{\ell}$ and $13.5mg/m{\ell}$, respectively. The level of NO, increased by LPS, was dose-dependently inhibited more by TRC paste than Calcipex II treatment. In addition, iNOS expression was decreased by 71% and 92% at concentrations of $2mg/m{\ell}$ and $20mg/m{\ell}$ of TRC paste, respectively. Conclusions: We demonstrated that the Si-HA calcium hydroxide paste has a slightly improved anti-inflammatory property and further studies are needed before clinical recommendations are proposed.

• Journal of Oral Medicine and Pain
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• 제36권3호
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• pp.199-205
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• 2011

근관치료 중 수동 또는 엔진구동파일을 사용하다 과도한 기구 조작을 하게 되면, 근관충전제, 드레싱제 그리고 근관세척제가 근관에서 나와 하악관으로 확산될 수 있다. 이 때 환자는 통증, 지각과민, 지각감퇴, 무감각, 이상감각 등을 호소하게 될 것이다. 이런 문제들은 근관충전제에 포함되어 있으면서 생체적합성이 떨어지는 물질들에 의한 비가역적인 손상을 피하기 위해 가능한 빨리 해결되어야 한다. 비록 근관치료와 관련하여 발생한 하치조신경의 손상을 치료하는 진료지침이 비교연구 되어 있는 것이 없으나, 이 합병증에 대한 통상의 치료는 통증과 염증을 조절하는 것이고, 가능하다면 수술적인 치료로 근원을 처치하는 것이다. 그러나, 비수술적인 치료로 통증을 완전히 개선하거나 감소시키고 또는 감각이상을 치료하는 것이 보고되어왔다. 가바펜틴(gabapentin) 또는 프리가발린(pregabalin) 같은 항간질제는 신경병증 통증의 치료에 이용되어 왔다. 이번 논문에서는 하악 우측 제 2대구치의 근관치료 후의 하치조신경의 손상과 이에 대해 프레드니솔론과 가바펜틴으로 비외과적 치료를 시행한 것과 임상적으로 신경감각검사와 신경전류인지역치검사(Neurometer)를 통해 경과관찰을 시행하였다.

• Restorative Dentistry and Endodontics
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• 제39권1호
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• pp.63-67
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• 2014

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.

• 구강회복응용과학지
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• 제40권1호
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• pp.31-38
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• 2024

치내치(dens in dente)는 치아 조직이 석회화되기 전에 발생하는 발달 이상이다. 치내치의 치수 조직은 구강에 직접 노출되거나 함입 부위의 법랑질 및 상아질 결함을 통해 노출될 수 있으며, 세균 감염에 취약하다. 이에 따라 치내치는 치수 괴사와 그에 따른 치근단 치주염의 가능성이 높아 진다. 치내치가 있는 치아의 치료는 복잡한 근관 형태로 인해 어려움이 있을 수 있다. 그러므로, 치내치의 해부학적 변이에 대한 세부적인 파악은 적절한 치료계획을 위해 상당히 중요하다. 본 증례보고는 Oehler의 제 2형과 제 3형 치내치(dens invaginatus)에 대해 다룬다. 2형 치내치는 함입이 백악-법랑 경계 하방으로 연장되어 치근 내로 함입되어 있으나, 치주인대와 교통하지 않으며, 3형 치내치는 함입부가 치관에서 백악법랑경계(CEJ)를 넘어 연장된다. 함입부를 통한 세균 침입은 치수 및 치근 주위 조직의 염증을 쉽게 일으킬 수 있다. 본 증례보고는 CBCT를 이용한 제 2형 및 제 3형 치내치의 근관 치료 과정을 보고하고자 한다.

• Restorative Dentistry and Endodontics
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• 제37권2호
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• pp.123-126
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• 2012

기계적 또는 세균 부산물에 의한 만성자극이 치아에 지속적으로 가해질 경우 치근단 부위로 치수 신경 섬유의 sprouting이 증가하고 neuropeptide, cytokine의 분비가 촉진되어 파골세포의 활성도가 증가하게 된다. 이로 인해 생활치에서 치근단 병소가 발생가능하며, 이러한 기전을 이해하고 자극원을 제거해주는 보존적 치료만으로도 자연치유를 기대할 수 있을 것이다.