• Restorative Dentistry and Endodontics
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• v.43 no.2
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• pp.17.1-17.7
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• 2018

Iatrogenic perforations negatively impact the outcome of endodontic treatments. Studies on prognostic factors showed that perforations in the coronal third of the root with periodontal pocket formation have an unfavorable prognosis. A 36-year-old female was referred for endodontic evaluation of tooth #13 with a history of an iatrogenic perforation, happened 3 years ago. There was a sinus tract associated with perforation, 10 mm probing on the mesial and mesio-palatal, bleeding on probing, radiolucent lesion adjacent to the perforation and complete resorption of the interdental bone between teeth #13 and #12. After the treatment options were discussed, she chose to save the tooth. The tooth was accessed under rubber dam isolation, the perforation site was cleaned and disinfected using 0.5% sodium hypochlorite and sealed with calcium-enriched mixture cement. Eighteen months after treatment the tooth was functional and asymptomatic. The probing depths were normal without bleeding on probing. Radiographically, the interdental crestal bone formed between teeth #13 and #12. Despite all negative prognostic factors in this case (i.e., perforations in the coronal third, pocket formation, and radiolucent lesion), healing was unexpectedly achieved via non-surgical repair of the perforation. Further research on biological aspects of healing in the periodontium following iatrogenic perforations are recommended.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.1-10
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• 2019

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

• Biomolecules & Therapeutics
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• v.29 no.3
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• pp.263-267
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• 2021

Periodontal disease is primarily associated with bacterial infection such as dental plaque. Dental plaque, an oral biofilm harboring a complex microbial community, can cause various inflammatory reactions in periodontal tissue. In many cases, the local bacterial invasion and host-mediated immune responses lead to severe alveolar bone destruction. To date, plaque control, non-surgical, and surgical interventions have been the conventional periodontal treatment modalities. Although adjuvant therapies including antibiotics or supplements have accompanied these procedures, their usage has been limited by antibiotic resistance, as well as their partial effectiveness. Therefore, new strategies are needed to control local inflammation in the periodontium and host immune responses. In recent years, target molecules that modulate microbial signaling mechanisms, host inflammatory substances, and bone immune responses have received considerable attention by researchers. In this review, we introduce three approaches that suggest a way forward for the development of new treatments for periodontal disease; (1) quorum quenching using quorum sensing inhibitors, (2) inflammasome targeting, and (3) use of FDA-approved anabolic agents, including Teriparatide and sclerostin antibody.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.16 no.1
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• pp.41-48
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• 1986

It is known that radiation therapy is a kind of treatment choices of the maxillofacial tumors. This study is designed to investigate the irradiation effects on rat's periodontal tissues as functional tissues which relate to tooth-support, hard tissue formation and destruction. 20 rats (Sprague-Dowley branch, male) were devided into control group of 4 and experimental groupe of 16. Experimental group was singly exposed to Co-60 irradiation with 10 Gy in the head and neck region. Animals were sacrificed on 2 days, 1 week, 2 weeks and 3 weeks after the irradiation. The specimens were observed by histopathological examination employing H-E stain, van-Gieson stain and PA-ACH fluorescent stain. The results were as follows: 1. Cementoblasts and osteoblasts were gradually lost and rearranged along the external surfaces of the cementum and alveolar bone, but osteoclasts were almost not affected. 2. The cell numbers of the periodontal ligament were decreased due to the cellular atrophy and degeneration, but recovered almost normally on the 3rd week after irradiation. 3. The collagen fibers within the periodontal ligament were irregularly oriented, became finer and decreased in number. 4. The vessels of the periodontal ligament were decreased at the initial stage but increased again on the 2nd week after irradiation, and the hemorrhagic appearances, occurred within the tissues, due to the arterial destruction, were lasted until 3 weeks after irradiation. 5. The glycogen within the periodontal ligament was gradually increased and stored in the matrices of the cemental side on the 1st week after irradiation, but recovered almost normally on the 3rd week after irradiation.

• The korean journal of orthodontics
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• v.43 no.2
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• pp.83-95
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• 2013

Objective: To evaluate the changes in cortical bone thickness, alveolar bone height, and the incidence of dehiscence and fenestration in the surrounding alveolar bone of posterior teeth after rapid maxillary expansion (RME) treatment using cone-beam computed tomography (CBCT). Methods: The CBCT records of 20 subjects (9 boys, mean age: $13.97{\pm}1.17$ years; 11 girls, mean age: $13.53{\pm}2.12$ year) that underwent RME were selected from the archives. CBCT scans had been taken before (T1) and after (T2) the RME. Moreover, 10 of the subjects had 6-month retention (T3) records. We used the CBCT data to evaluate the buccal and palatal aspects of the canines, first and second premolars, and the first molars at 3 vertical levels. The cortical bone thickness and alveolar bone height at T1 and T2 were evaluated with the paired-samples t-test or the Wilcoxon signed-rank test. Repeated measure ANOVA or the Friedman test was used to evaluate the statistical significance at T1, T2, and T3. Statistical significance was set at p < 0.05. Results: The buccal cortical bone thickness decreased gradually from baseline to the end of the retention period. After expansion, the buccal alveolar bone height was reduced significantly; however, this change was not statistically significant after the 6-month retention period. During the course of the treatment, the incidence of dehiscence and fenestration increased and decreased, respectively. Conclusions: RME may have detrimental effects on the supporting alveolar bone, since the thickness and height of the buccal alveolar bone decreased during the retention period.

• Journal of Periodontal and Implant Science
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• v.43 no.5
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• pp.227-232
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• 2013

Purpose: The receptor activator of nuclear factor kappa B (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) system plays a significant role in osteoclastogenesis, activation of osteoclasts, and regulation of bone resorption. This study aimed to evaluate the use of the salivary soluble RANKL (sRANKL)/OPG ratio as a diagnostic marker for periodontitis in nonsmokers. Methods: Twenty-five patients with chronic periodontitis and 25 individuals with a healthy periodontium were enrolled in this study. Samples containing 5 mL of unstimulated saliva were obtained from each subject. Salivary sRANKL and OPG concentrations were determined using a standard enzyme-linked immunosorbent assay. Statistical analysis was performed using SPSS ver. 18.0. Results: The levels of sRANKL and OPG were detectable in all of the samples. Positive relationships were found between the plaque index and clinical attachment level and both the salivary concentration of sRANKL and the salivary sRANKL/OPG ratio (P<0.05). The salivary concentration of sRANKL and the sRANKL/OPG ratio were significantly higher in the periodontitis group than in the healthy group (P=0.004 and P=0.001, respectively). In contrast, the OPG concentration showed no significant differences between the groups (P=0.455). Conclusions: These findings suggest that the salivary sRANKL/OPG ratio may be helpful in the screening and diagnosis of periodontitis. However, longitudinal studies with larger populations are needed to confirm these results.

• Journal of Periodontal and Implant Science
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• v.25 no.1
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• pp.1-13
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• 1995

Chlorhexidine and Listerine are widely used in dentistry due to its effectiveness on plaque control and bactericidal action. The effects of these agent on chronic gingivitis and wound healing following surgical periodontal therapy in human has been favorable. Understanding the effects of chlorhexidine and Listerine on human gingival fibroblast will provide the rationale for its use during the healing process of periodontal surgery. The purpose of this study was to compare the effects of chlorhexidine and Listerine on human gingival fibroblast. Human gingival fibroblasts were cultured from the healthy gingiva on the extracted premolar of orthodontic patients. Human gingival fibroblast were trypsinized and cultured in growth medium added range of 0.0012-0.12% chlorhexidine and 1-100% Listerine mouth wash solution. The cell used in this study were between fifth to eighth passage number. The cell morphology were examined by inverted microscope and the cell activity were measured by MIT assay. The Morphology of gingival fibroblast added Chlorhexidine and Listerine at the concentration of all range were became globular and lost their cytoplasmic process. Our results indicate that a 0.0012 concentration of chlorhexidine and 1% concentration of Listerine were shows minimal cytotoxicity, but above these concentraion, there was a significant difference between the cell activity in the experimental group and control group(p

• Journal of Periodontal and Implant Science
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• v.29 no.1
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• pp.31-40
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• 1999

Many factors may affect periodontal changes during the physiologic conditions of woman(e.g. puberty, menstrual cycle, pregnancy, menopause). Recently many research has focused on the immunological changes of host, but the exact mechanism is not clear. Collagen is a major constituent of periodontium, and collagenase specifically digests the collagen and plays a role in destruction of periodontal tissue. So, I suppose that it participates with the cytokines in the inflammation of gingiva and vascular response during the changes of female sex hormones. Because there are some evidences of the existence of the receptors of estrogen and progesterone in the gingiva, it may be a target tissue of female sex hormones. In this experiment, gingival fibroblast and periodontal ligament cell were cultured in the presence of various concentrations of estrogen or progesterone corresponding to the menstrual cycle and pregnancy. Collagenase activity of the supernatant of culture media was determined by Spectrophotometric collagenase assay. The enzyme activity was calculated by the % decrease of the coated collagen. 1. The estrogen at both concentrations had no effect on the activity of collagenase of the gingival fibroblast. 2. The progesterone had some effect on the collagenase activity of the gingival fibroblast at low and high concentration of menstrual cycle, and elevated the enzyme activity at all range of pregnancy concentrations. 3. In periodontal ligament cells, estrogen elevated the enzyme activity at the early pregnancy concentration and progesterone elevated at the concentration just before menstruation. In this experiment, pregesterone elevated the collagenase activity of gingival fibroblast and periodontal ligament cells. But the mechanism of the up-regulation of the enzyme activity was not confirmed. The more experiments of direct effect of progesterone on gingival at the molecular level(e.g. northern blot analysis) can reveal the exact mechanism.

• The Journal of the Korean dental association
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• v.47 no.8
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• pp.479-486
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• 2009

Purpose: The aim of this study was to show the clinical results of combination of Nd-YAP (1340nm) laser therapy with conventional endodontic and periodontal treatment. Materials and Methods: Four patients with chronic advanced periodontitis and endodontic infection were treated with conventional treatment and Nd-YAP laser therapy. Occlusal adjustment and splinting were done for stabilization of the teeth with severe horizontal and vertical mobility. The protocol for periodontal treatment was followed as scaling and root planing, pocket irrigation with 3% $H_2O_2$ and exposure of Nd-YAP laser using 320${\mu}m$ optical fiber with 160mJ/pluse, 30Hz. The other protocol for endodontic treatment was followed as access opening, canal preparation by hand and rotary instrument, canal filling, and exposure of Nd-YAP laser using 200${\mu}m$ optical fiber with 200mJ/pluse, 10Hz and 180mJ/pluse, 5Hz which were used respectively for disinfection and canal filling. The assessments of probing depth, mobility, and radiography were made prior to and after treatment. Result: All of these four clinical cases showed good healing of periodontium, which presented decrease of mobility and pocket depth, and increase of bone regeneration and bone density on the radiography. Conclusion: The bactericidal effect of Nd-YAP laser would provide benefits for improving clinical results that are obtained from conventional therapy.

• The korean journal of orthodontics
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• v.19 no.1 s.27
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• pp.21-44
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• 1989

Incipient changes of the periodontal tissue in the pressure zones of rat molar subjected to the experimental force were studied by the transmission electron microscope. Experimental animals were consisted in 3 control and 21 experimental rats, of which one maxillary first molar was moved buccally with a fixed appliance which were exerting the force of 15 gm. After experimental period of 1 hour, 3 hours, 6 hours, 24 hours, 2 days, 3 days and 7 days, the animal were sacrificed with cardiac perfusion of $2.5\%$ glutaraldehyde in the sodium cacodylate buffer and the experimental teeth with surrounding periodontal structures were processed for electron microscope. At the beginning of the tooth movement, periodontal ligaments of the pressure were compressed and collagenous fibers were arranged parallel to the root of the teeth and cell free zones in company with cell necrosis were followed. Cell free zones at the periodontal ligaments appeared in the 3 hour survival group, and getting severe with time lapse it became widespread in 2-3 day survival group and undermining bone resorption as a healing process was observed in 7 day survival group. Dilatation of mitochondria and swelling of the rER in the fibroblast and other connective tissue cells in the periodontal ligament were observed in the 3 hour survival group, which were characteristics of the incipient changes in the compressed periodontal ligament. Dilatation of nuclear membrane and pyknosis were followed by the destruction of the nucleus and cell membrane. There were no evidence in cell damage or necrosis of the alveolar bone adjacent to the hyalinized area of periodontal ligaments.