• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.181-189
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• 2019

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.6
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• pp.387-395
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• 2020

Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Method: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

• Imaging Science in Dentistry
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• v.51 no.1
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• pp.49-54
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• 2021

Purpose: This study was conducted to establish age- and sex-specific reference standards for pterygoid hamulus(PH) dimensions using cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans of 1,000 patients(493 males and 507 females) were retrospectively assessed in coronal sections for length and width measurements of the PH by 3 investigators. The study data were divided into 3 age groups(group 1: <20 years, group 2: 20-50 years, group 3: >50 years). Length and width were compared using one-way analysis of variance and the t-test for age and sex, respectively. Results: The length of the PH on the right side significantly increased from group 1 (6.11±1.47mm), through group 2 (6.65±1.67 mm) to group 3 (6.99±1.79 mm) and on the left side from group 2 (6.58±1.63) to group 3 (6.98±1.70). The width of the PH significantly decreased from group 1 (1.81±0.39 mm) to group 2 (1.61±0.39 mm) on the right side, and similarly from 1.87±0.36mm to 1.67±0.37mm on the left side. PH length (7.18±1.81mm on the right side and 7.10±1.72 mm on the left side) and width (1.68±0.38 mm on the right side and 1.74±0.36 mm on the left side) were significantly greater in males than in females. Conclusion: The length of the PH increased with age, whereas width first decreased and then increased. Length and width measurements were significantly higher in males than in females. These findings will aid in the diagnosis of untraceable pain in the oropharyngeal region related to altered PH morphology.

• Imaging Science in Dentistry
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• v.52 no.1
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• pp.93-101
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• 2022

Purpose: This study compared the effectiveness of complementary metal-oxide semiconductors (CMOS) and photostimulable phosphor (PSP) plates as intraoral imaging systems in terms of time efficacy, patient comfort, and subjective image quality assessment in real clinical settings. Materials and Methods: Fifty-eight patients (25 women and 33 men) were included. Patients were referred for a full-mouth radiological examination including 1 bitewing radiograph (left and right) and 8 periapical radiographs for each side (left maxilla/mandible and right maxilla/mandible). For each patient, 1 side of the dental arch was radiographed using a CMOS detector, whereas the other side was radiographed using a PSP detector, ensuring an equal number of left and right arches imaged by each detector. Clinical application time, comfort/pain, and subjective image quality were assessed for each detector. Continuous variables were summarized as mean±standard deviation. Differences between detectors were evaluated using repeated-measures analysis of variance. P<0.05 was accepted as significant. Results: The mean total time required for all imaging procedures with the CMOS detector was significantly lower than the mean total time required for imaging procedures with PSP (P<0.05). The overall mean patient comfort scores for the CMOS and PSP detectors were 4.57 and 4.48, respectively, without a statistically significant difference (P>0.05). The performance of both observers in subjectively assessing structures was significantly higher when using CMOS images than when using PSP images for all regions (P<0.05). Conclusion: The CMOS detector was found to be superior to the PSP detector in terms of clinical time efficacy and subjective image quality.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.187-195
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• 2022

Background: This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments. Methods: Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients' age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients' sex, age, and dental department were statistically identified. Results: There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig's disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components. Conclusion: The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.3
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• pp.321-347
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• 1994

Muscle spindle afferents from masseter muscle were labelled by the intra-axonal HRP injection and were processed for light microscopic reconstruction. Regions containing terminal arbors scattered in the central portion of the masseteric motor neuron pool (type I a) and those restricted to 2-3 small portion of it (type II) were selected and processed for electronmicroscopic analysis with serial sections. The shape of the labelled boutons was dome or elongated shape. Scalloped or glomerulus shape with peripherial indentation containing pre or postsynaptic neuronal propiles, which is occasionally found in the trigeminal main sensory nucleus and spinal dorsal horn, was not observed. Both type Ia and type II boutons had pale axoplasm and contained clear, spherical vesicles of uniform size(dia : 49-52nm) and occasionally large dense cored vesicles(dia : 87-118nm). The synaptic vesicles were evenly distributed throughout the boutons although there was a slight tendency of vesicles to accumulate at the presynaptic site. The average of short and long diameter(short D. + long D./2) of type I a bouton was smaller than that of type II bouton. All the labelled boutons, which showed prominent postsynaptic density, large synaptic area and multiple synaptic contact, made asymmetrical synaptic contact with postsynaptic neuronal propiles. Most of the type Ia and type II boutons made synaptic contact with only one neuronal propile and boutons which shows synaptic contact or more neuronal propiles was not observed. Most of the type Ia boutons(87.2%) were presynaptic to the soma or proximal dendrite and a few remainder(12.8%) made synaptic contact with dendritic shaft or distal dendrite. In contrast, majority of type II boutons showed synaptic contact with dendritic shaft and remainder with soma or proximal dendrite. In conclusion, terminal boutons which participate in the excitatory monosynaptic jaw jerk reflex made synaptic contact with more proximal region of the neuron, and showed very simple synaptic connection, compared with those from the primary afferenst in the other region of the central nervous system such as spinal dorsal horn and trigeminal main sensory nucleus which assumed to be responsible for the mediating pain, tactile sensation, sensory processing or sensory discrimination.

• Journal of Oral Medicine and Pain
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• v.34 no.1
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• pp.1-9
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• 2009

Liver transplantation is definitive treatment for the patients suffering from hepatitis, severe liver cirrhosis and liver cancer. In these patients, systemic infections under immunosuppression may occur easily. Therefore, primary object of dental treatments before liver transplantation is absolute removal of oral infection source. In addition, comprehensive dental management plan is essential for success of liver transplantation. The present study has been performed to investigate decayed, missing and filled permanent teeth index(DMFT index), degree of oral hygiene, past medical history, need of dental treatment, completion of dental treatment need and time interval between dental visit and operation date of liver transplantation in liver transplant candidates. Obtained results were as follows; 1. Decayed teeth of the patients were 2.68, missing teeth were 4.02 and filled teeth were 3.42. DMFT index was 10.12. 2. Twenty percents of patients showed moderate to severe food impactions, 42.2% of patients had moderate to heavy calculus and 37.8% of patients displayed gingival inflammation with swelling. 3. Patients needed periodontal treatments more than any other dental treatments. Periodontal treatments were needed for 88.9% of patients, operative & endodontic treatments were 46.7% of patients and 33.3% of patients needed for oral & maxillofacial surgical treatments. 4. Among 90 patients, time interval between scheduled operation date of liver transplantation and dental visit was within 2 weeks for 32.2% of patients, within 1 week for 20.0% of patients. In conclusion, most liver transplant candidates needed dental treatments for removal of potential infection sources. However because of insufficient interval between dental visit and operation date, they had taken liver transplantation procedures without comprehensive dental management. Development of preventive and comprehensive dental management program is mandatory for these patients. Cooperative interdisciplinary management will play a positive role for successful liver transplantation.

• Journal of Oral Medicine and Pain
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• v.32 no.3
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• pp.337-346
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• 2007

This study aimed to evaluate a relation of bruxism with clinical effects of botulinum toxin type A(BTX-A) injection. 5 bruxers and 5 nonbruxers with bilateral masseter hypertrophy were participated in this study. After injecting 25 unit of BTX-A(Allergen Inc, $Botox^{(R)}$) into each masseter muscle, the thickness of masseter(Mm) and anterior temporalis(Ta) muscles was measured by ultrasonography and the maximum bite force was evaluated during a 9-month period. Self-estimation on the recovery of occlusal force during mastication was done as well. Regardless of presence of bruxsim, all subjects showed significantly reduced Ms thickness(p<0.001) and maximum bite force at $1^{st}$ molars(p=0.027) with their peak at 3 months after injection, which then started to return. No significant difference was observed in Ta thickness and the bite force at the central incisors. While self-estimated occlusal force was the least at 2 weeks after injection and then rapidly returned to the baseline level with full recovery at the time of 6 to 9 months after injection, the maximum bite force measured by bite force recorder did not recover the original value, particularly in the nonbruxer group. It is assumed that nocturnal bruxism can influence recovery of atrophic masseter and decreased occlusal force due to BTX-A injection. These findings suggest a need of occlusal appliance to control bruxism or clenching habit for longer clinical effect of BTX-A injection.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.87-106
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• 2005

In order to evaluate the mechanism of transmission as well as processing of sensory information originating from low-threshold mechanoreceptor in oral and maxillofacial region at primary synaptic region of trigeminal nervous system, vibrissa afferent fibers of adult cat were labeled with intra-axonal HRP injection. Serial sections containing labeled boutons were obtained from the piece of trigeminal interpolar nucleus. Under electron microscope, total 30 labeled boutons were observed, and ultrastructural characteristics, frequency of occurence, synaptic organizations of vibrissa afferent terminals were analysed. The results were as follows: 1. Labeled boutons contained clear, spherical synaptic vesicles with diameter of 45$\sim$55nm. They formed asymmetrical synapse with dendrites showing definite postsynaptic density, larger synaptic cleft, multiple synaptic structures at various regions. With unlabeled axon terminals(p-ending) containing polymorphic synaptic vesicles, they formed symmetrical synapse showing indefinite postsynaptic density and narrower synaptic area. 2. Each labeled bouton formed 1 to 15 synapses, the average of 4.77$\pm$3.37 contacts per labeled bouton, with adjacent neuronal profiles. Relatively complex synaptic organization, which formed synapses with more than 5 neuronal profiles, was observed in a large number(46.7%, n=14) of labeled boutons. 3. Axo-somatic synapse was not observed. The number of axo-dendritic synapse was 1.83$\pm$1.37 per labeled bouton. Majority(85.0%) of axo-dendritic synapses were formed with dendritic shafts, nonprimary dendrites(n=47, 1.57$\pm$1.38/1 bouton), however, synapses formed with primary dendrites(n=6, 0.20$\pm$0.41/1 bouton) or dendritic spines(n=2, 0.07$\pm$0.25/1 bouton) were rare. 4. 76.7%(n=23) of labeled boutons formed axo-axonic synapse (2.93$\pm$2.36/1 bouton) with p-endings containing pleomorphic vesicles. Synaptic triad, in which p-endings formed synapses with labeled boutons and dendrites adjacent to the labeled boutons simultaneoulsy, were also observed in 60.0%(n=18) of labeled boutons. From the above results, vibrissa afferent terminals of adult cat showed distinctive synaptic organization in the trigeminal interpolar nucleus, thus, suggests their correlation with the function of the trigeminal interpolaris nucleus, which participates in processing of complex sensory information such as two-point discrimination and motivational-affective action. Further studies on physiologic functions such as quantitative analysis on ultrastructures of afferent terminals and nerve transmitters participating in presynaptic inhibition are required.

• Implantology
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• v.22 no.4
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• pp.242-254
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• 2018

The aim of the current study was to evaluate the results of horizontal guided bone regeneration (GBR) with xenograf t (deproteinized bovine bone mineral, DBBM), allograf t (irradiated allogenic cancellous bone and marrow), titanium membrane, resorbable collagen membrane, and advanced platelet-rich fibrin (A-PRF) in the anterior maxilla. The titanium membrane was used in this study has a three-dimensional (3D) shape that can cover ridge defects. Case 1. A 32-year-old female patient presented with discomfort due to mobility and pus discharge on tooth #11. Three months after extracting tooth #11, diagnostic software (R2 GATE diagnostic software, Megagen, Daegu, Korea) was used to establish the treatment plan for implant placement. At the first stage of implant surgery, GBR for horizontal augmentation was performed with DBBM ($Bio-Oss^{(R)}$, Geistlich, Wolhusen, Switzerland), irradiated allogenic cancellous bone and marrow (ICB $cancellous^{(R)}$, Rocky Mountain Tissue Bank, Denver, USA), 3D-titanium membrane ($i-Gen^{(R)}$, Megagen, Daegu, Korea), resorbable collagen membrane (Collagen $membrane^{(R)}$, Genoss, Suwon, Korea), and A-PRF because there was approximately 4 mm labial dehiscence after implant placement. Five months after placing the implant, the second stage of implant surgery was performed, and healing abutment was connected after removal of the 3D-titanium membrane. Five months after the second stage of implant surgery was done, the final prosthesis was then delivered. Case 2. A 35-year-old female patient presented with discomfort due to pain and mobility of implant #21. Removal of implant #21 fixture was planned simultaneously with placement of the new implant fixture. At the first stage of implant surgery, GBR for horizontal augmentation was performed with DBBM ($Bio-Oss^{(R)}$), irradiated allogenic cancellous bone and marrow (ICB $cancellous^{(R)}$), 3D-titanium membrane ($i-Gen^{(R)}$), resorbable collagen membrane (Ossix $plus^{(R)}$, Datum, Telrad, Israel), and A-PRF because there was approximately 7 mm labial dehiscence after implant placement. At the second stage of implant surgery six months after implant placement, healing abutment was connected after removing the 3D-titanium membrane. Nine months after the second stage of implant surgery was done, the final prosthesis was then delivered. In these two clinical cases, wound healing of the operation sites was uneventful. All implants were clinically stable without inflammation or additional bone loss, and there was no discomfort to the patient. With the non-resorbable titanium membrane, the ability of bone formation in the space was stably maintained in three dimensions, and A-PRF might influence soft tissue healing. This limited study suggests that aesthetic results can be achieved with GBR using 3D-titanium membrane and A-PRF in the anterior maxilla. However, long-term follow-up evaluation should be performed.