• Restorative Dentistry and Endodontics
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• 제48권2호
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• pp.17.1-17.8
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• 2023

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.

• Restorative Dentistry and Endodontics
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• 제47권3호
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• pp.34.1-34.12
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• 2022

Objectives: This study aimed to evaluate the success rate of endodontic treatments performed by undergraduate students and the factors associated with the outcome. Materials and Methods: A follow-up of 3 to 8 years after root canal filling was carried out in 91 patients. At the follow-up visits, medical and dental history questionnaires were applied along with clinical and radiographic examinations. Data collected in the clinical exam included: the presence of pain, swelling, sinus tract, mobility, tenderness to palpation and percussion, periodontal probing profile, and type/quality of coronal restoration. Postoperative and follow-up radiographs were digitalized and analyzed by 2 trained and calibrated examiners to assess periapical healing. The treatment outcome was based on strict clinical and radiographic criteria and classified as success (absence of any clinical and radiographic sign of apical periodontitis) or failure (other combination). Logistic regression was used to investigate the impact of clinical and radiographic variables on endodontic treatment outcomes at a 5% significance level. Results: The success rate of endodontic treatments was 60.7%. The only risk factor significantly associated with failure was the presence of a periapical lesion on the postoperative radiograph (odds ratio, 3.35; 95% confidence interval, 1.17-9.54). Conclusions: The success rate of endodontic treatments performed by undergraduate students was low and was jeopardized by the presence of a periapical lesion on the postoperative radiograph.

• Imaging Science in Dentistry
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• 제54권3호
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• pp.257-263
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• 2024

Purpose: The purpose of this study was to classify mandibular molar furcation involvement (FI) in periapical radiographs using a deep learning algorithm. Materials and Methods: Full mouth series taken at East Carolina University School of Dental Medicine from 2011-2023 were screened. Diagnostic-quality mandibular premolar and molar periapical radiographs with healthy or FI mandibular molars were included. The radiographs were cropped into individual molar images, annotated as "healthy" or "FI," and divided into training, validation, and testing datasets. The images were preprocessed by PyTorch transformations. ResNet-18, a convolutional neural network model, was refined using the PyTorch deep learning framework for the specific imaging classification task. CrossEntropyLoss and the AdamW optimizer were employed for loss function training and optimizing the learning rate, respectively. The images were loaded by PyTorch DataLoader for efficiency. The performance of ResNet-18 algorithm was evaluated with multiple metrics, including training and validation losses, confusion matrix, accuracy, sensitivity, specificity, the receiver operating characteristic (ROC) curve, and the area under the ROC curve. Results: After adequate training, ResNet-18 classified healthy vs. FI molars in the testing set with an accuracy of 96.47%, indicating its suitability for image classification. Conclusion: The deep learning algorithm developed in this study was shown to be promising for classifying mandibular molar FI. It could serve as a valuable supplemental tool for detecting and managing periodontal diseases.

• 대한치과의사협회지
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• 제51권10호
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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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• 제42권1호
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• pp.65-71
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• 2017

A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2003년도 제120회 추계학술대회 제 5차 한ㆍ일 치과보존학회 공동학술대회
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• pp.591-591
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• 2003

Apical periodontitis is inflammation of the periodontium caused by infection of the pulp canal system. Moreover, a dental periradicular lesion occurs as a periradicular tissue reaction to bacterial infection and consists of periradicular inflammation with alveolar bone destruction and root resorption, a consequence of the interaction between oral flora and the existing host defenses. Many investigations dealing with the pathogenesis and history of periradicular lesions have described histologically, immunologically, biochemically the development of the periradicular lesion；but none of these studies have shown any correlation between this lesion and several factors, the whole body disease in the worldwide.(omitted)

• 대한치과의사협회지
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• 제57권7호
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• pp.392-402
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• 2019

The most important part of everyday root canal treatment is diagnosis about the morphology of tooth, root and root canal. Usually this procedure is performed by visual examination and radiographic (panoramic/periapical) examination. However, 2-dimentional radiography has several limitations such as imposition of anatomic structures including buccal/lingual root canals and distortion of images. Recently, owing to the increased interest in dental implant and affordable cost of CBCT equipment, CBCT has been introduced widely in local dental clinics. CBCT is characterized by their lower radiation dose and shorter exposure time than conventional CT scan, and ability of 3-dimentional reconstruction of the dento-alveolar structure. Also in endodontic field, the data from CBCT could be very helpful in diagnosing complex root canal anatomy, apical periodontitis, cause of failure and in determining treatment plan. However, there are some limitations such as radiation dose and artifact. Therefore, clinicians should know about indication, advantages and limitations of CBCT, and properly use it for successful root canal treatment to save the natural teeth.

• Restorative Dentistry and Endodontics
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• 제47권2호
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• pp.24.1-24.15
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• 2022

Objectives: Regenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students. Materials and Methods: Clinical and radiographic data of 27 patients, aged 10-22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified. Results: A total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00-0.63 mm in the anterior teeth, 2.85-1.48 mm of the mesial root, and 2.73-2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth. Conclusions: A favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.

• Journal of Periodontal and Implant Science
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• 제49권2호
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• pp.90-104
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• 2019

Purpose: The aim of this study was to evaluate clinical and radiographic changes and the survival rate after periodontal surgery using deproteinized bovine bone mineral (DBBM) with 10% collagen or DBBM with a collagen membrane in endo-periodontal lesions. Methods: A total of 52 cases (41 patients) with at least 5 years of follow-up were included in this study. After scaling and root planing with or without endodontic treatment, periodontal regenerative procedures with DBBM with 10% collagen alone or DBBM with a collagen membrane were performed, yielding the DBBM + 10% collagen and DBBM + collagen membrane groups, respectively. Changes in clinical parameters including the plaque index, bleeding on probing, probing pocket depth, gingival recession, relative clinical attachment level, mobility, and radiographic bone gains were evaluated immediately before periodontal surgical procedures and at a 12-month follow-up. Results: At the 12-month follow-up after regenerative procedures, improvements in clinical parameters and radiographic bone gains were observed in both treatment groups. The DBBM + 10% collagen group showed greater probing pocket depth reduction ($4.52{\pm}1.06mm$) than the DBBM + collagen membrane group ($4.04{\pm}0.82mm$). However, there were no significant differences between the groups. Additionally, the radiographic bone gain in the DBBM + 10% collagen group ($5.15{\pm}1.54mm$) was comparable to that of the DBBM + collagen membrane group ($5.35{\pm}1.84mm$). The 5-year survival rate of the teeth with endo-periodontal lesions after periodontal regenerative procedures was 92.31%. Conclusions: This study showed that regenerative procedures using DBBM with 10% collagen alone improved the clinical attachment level and radiographic bone level in endo-periodontal lesions. Successful maintenance of the results after regenerative procedures in endo-periodontal lesions can be obtained by repeated oral hygiene education within strict supportive periodontal treatment.

• Restorative Dentistry and Endodontics
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• 제49권3호
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• pp.31.1-31.11
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• 2024

Objectives: The present study investigated the prevalence of mechanical allodynia (MA) in healthy teeth adjacent and contralateral to endodontically diseased teeth. Materials and Methods: This cross-sectional study included 114 patients with symptomatic irreversible pulpitis and apical periodontitis in permanent mandibular first molars who possessed healthy teeth adjacent and contralateral to the endodontically diseased tooth. The mechanical sensitivity of the teeth was determined by percussion testing. The presence or absence of pain on percussion in the teeth adjacent and contralateral to the endodontically diseased tooth and the tooth distal to the contralateral symmetrical tooth was recorded according to coding criteria. The prevalence of MA was computed as a percentage, and binary logistic regression analysis was done. The Fisher exact test and Mann-Whitney U test were used for binary and ordinal data. Results: Age and sex did not influence the prevalence of MA. An increased prevalence of MA was found in patients with higher levels of spontaneous pain (p < 0.001). The prevalence of allodynia was 57% in teeth adjacent to endodontically diseased teeth and 10.5% in teeth contralateral to endodontically diseased teeth. In addition, on the ipsilateral side, there were more painful sensations distal to the diseased tooth than mesially. Conclusions: Despite being disease-free, teeth adjacent and contralateral to endodontically diseased teeth exhibited pain on percussion. There was a direct association between the severity of the patient's pain and the presence of MA.