• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.1
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• pp.3-10
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• 2014

The inferior alveolar nerve (IAN) block is the most frequently used mandibular injection technique for achieving local anesthesia for restorative and surgical procedures. However, The IAN block does not always result in successful anesthesia, especially pulpal anesthesia. Lidocaine is used as a "standard" local anesthetic for the inferior alveolar nerve. Articaine recently joined Korean market as a form of dental cartridge. It has an advantage of superior diffusion through bony tissue. A variety of trial was performed to improve the success rate of inferior alveolar nerve block. In this review, the recent update related with inferior alveolar nerve block anesthesia will be discussed on the anatomical consideration, anesthetic agent, technique, and complications.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.4
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• pp.265-272
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• 2024

Effective pain management is crucial for the successful performance of various endodontic procedures. Painless treatments are made possible by anesthetizing the tooth to be treated using various nerve-block techniques. However, certain circumstances necessitate supplemental anesthetic techniques to achieve profound anesthesia, especially in situations involving a "hot tooth" in which intrapulpal anesthesia (IPA) is employed. IPA is a technique that involves the injection of an anesthetic solution directly into the pulp tissue and is often utilized as the last resort when all other anesthetic techniques have been unsuccessful in achieving complete pulpal anesthesia. This review focuses on the IPA procedure and the factors that influence its success. Additionally, the advantages, limitations, disadvantages, and future directions of IPA are discussed.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.4
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• pp.519-528
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• 2002

It is not a rare occasion that certain dental procedures involving tooth reduction being peformed under inadequate water cooling due to a variety of reasons. This situation could possibly inflict the critical insult to the pulpal tissue of indicated tooth. The purpose of this experiment was to study the pattern of diffusion of external heat produced during routine dental procedures into the pulpal tissue. 30 stone blocks containing three lower second primary molars were used for certain restorative procedures and the temperature of the indicated tooth surface was measured by thermography(Inframetrics 600) and further used as a baseline data for the finite element analysis model fabrication designed in order to evaluate the pattern of thermal diffusion. The ranges of highest surface temperature measured from several dental procedures under water cooling and non-water cooling were $30.8^{\circ}C{\sim}43.6^{\circ}C$ and $51.2^{\circ}C{\sim}103.4^{\circ}C$ respectively. Among procedures studied, crown preparation showed the highest value and amalgam removal showed the lowest. Comparisons between data measured under water cooling and non-water cooling conditions have shown the statistically significant difference(p<0.05). All the non-cooling conditions have shown the relatively larger increment of temperature change at the pulp horn area than the cooling conditions. The results of this study strongly indicate that the water coolant is the essential element in restorative procedures for the maintenance of healthy pulp. Further related studies involving more procedures and conditions are recommended.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.316-327
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• 1998

This study was designed to examine the tissue levels of interleukin-$1{\alpha}$(IL-$1{\alpha}$), interleukin-$1{\beta}$(IL-$1{\beta}$) and tumor necrosis factor-${\alpha}$(TNF-${\alpha}$) in inflamed human dental pulps and periapical lesions, and to determine the relationship between each cytokine and pulpal and periapical pathosis. The pulps used in this experiment, were obtained in routine endodontic treatment and the periapical lesions in periapical surgery after clinical diagnoses were performed. These specimens were divided into four groups as normal pulp group(control group, n=9), acute pulpitis group(n=g), chronic pulpitis group(n= 10) and periapical lesion group(n= 18) and stored in liquid N2. For extract preparation, tissues were finely minced with a scalpel, and the fragments were incubated in $0.5m\ell$ homogenizing buffer (0.1 mol/L potassium chloride, 0.02 mol/L TRIS; pH=7.6) for two hours and grinded with glass homogenizer. Debris was removed by centrifugation and supernatants were immediately tested with enzymelinked immunosorbent assay (ELISA, R&D Co., Minneapolis, USA). Following results were obtained; 1. The concentrations of IL-$1{\alpha}$ in all experimental groups were significantly higher than in control group(p<0.05). And the concentrations of IL-$1{\alpha}$ in periapical lesion group were somewhat higher than in two pulpitis groups, but the differences among those groups were not stastically significant (p>0.05). 2. The concentrations of IL-$1{\beta}$ in all experimental groups were significantly higher than in control group (p<0.05), and all the experimental groups expressed similar concentrations. 3. The concentrations of TNF-${\alpha}$ in all experimental groups were higher than in control group but only the differences between chronic pulpitis group and control group were statistically significant(p<0.05). And the concentrations of TNF-${\alpha}$ in acute and chronic pulpit is groups were higher than in periapical lesion group but only the differences between chronic pulpitis group and periapical lesion group were statistically significant (p<0.05). 4. There was significant correlation only between IL-$1{\alpha}$ and IL-$1{\beta}$ in periapical lesion group (p<0.05).

• Restorative Dentistry and Endodontics
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• v.30 no.3
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• pp.193-203
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• 2005

The induction of the IL-8 and MCP-1 by the stimulation of Substance P and TNF-${\alpha}$ (IL-8 agonist) and the specificity for SP using Spantide (SP antagonist) in the dental pulp tissues was measured quantitatively. In addition, the secretion of the IL-8 in the human dental pulp tissue 36 hrs after the stimulation of SP was observed after the stimulation of SP qualitatively. According to this study the results were as follows: 1. There was the significant IL-8 induction at 36 h after SP (10$^{-4}$M) stimulation of the pulp tissue comparing with the unstimulated dental pulp tissues (p < 0.05) . IL-8 irnmunostaining was weakly detected along the periphery of the pulp tissue after Mock stimulation and IL-8 immunostaining was detected around the fibroblast in the pulp tissue 36h After SP (10$^{-4}$M) stimulation, 2. The secretion of MCP-1 from the dental pulp tissues comparing with Mock stimulation was induced at 36 hrs after TNF-$\alpha$ (40 ng/ml) stimulation, but no induction with SP(10$^{-4}$M) TNF-${\alpha}$ (40 ng/ml) did not induce the IL-8 secretion from the pulp tissue, weak IL-8 imrnunostaining was detected along the periphery of the pulp tissue 3. Spantide (10$^{-5}$M) inhibited IL-8 induction from the pulp tissues 36 h after SP (10$^{-4}$M) stimulation These results suggest that SP significantly induces IL-8 recruiting neutrophils in localized human dental pulp tissue MCP-1 appears to be less involved in the early establishment of pulpal inflammation in response to irritation such as mechanical insult of dentin. SP may have positive relation with the inflammation of the human dental pulp tissues.

• Restorative Dentistry and Endodontics
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• v.14 no.2
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• pp.49-64
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• 1989

The purpose of this study was to evaluate the effect of several materials on the healing process of apical wound. Sixteen mandibular premolars obtained from 4 healthy dogs were used for this study. Under general anesthesia, the pulpal chamber of each tooth was opened and the pulps were extirpated. The root canals were then instrumented with H-file and irrigated with physiologic saline solution ; the apices were purposely perforated and enlarged with the engine K-reamer. In the experimental groups, apical wounds were filled with one of calcium hydroxide, hydroxylapatite, and tricalcium phosphate materials, mixture of each materials and physiologic saline solution, with a lentulo spiral. In the control group, apical wounds were not filled with any material. All the root canals were filled by the lateral condensation technique with gutta-percha cone and ZOE sealer. The access opening of all the teeth were closed with amalgam. On the 10, 20, 40 and 60th day after experiment, experimental animals were sacrificed. Segments of jaws, each containing one tooth, were fixed in 10% formalin solution and decalcified in Plank-Rychlo solution. The specimens were embedded in paraffin and serially sectioned to an average thickness of $6{\mu}m$. The sections were stained by hematoxylin-eosin and Masson's trichrome stain method and examined under light microscope. The results were as follows : 1. In the experimental groups, the new bone formations were observed in apical wounds. 2. Fourty days later, apical wounds were healed by granulation tissue in the experimental groups, but were not healed by granulation tissue in the control group, and the healing process of experimental groups were more rapid than that of control group. 3. Sixty days later, chronic inflammation disappeared in the experimental groups, and the materials used showed biologic affinity to the periapical tissue. 4. In all the groups, the resorption of cementum appeared on the 10th and 20th day after experiment, and the deposition of cementum appeared on the 40th and 60th day after experiment, especially showing narrowness of apical foramen due to newly formed cementum in calcium hydroxide group. 5. Calcum hydroxide and tricalcium phosphate particles were gradually resolved, but hydroxylapatite particles were not resolved through the experimental period.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.137-146
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• 2020

Background: Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. Methods: This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. Results: The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. Conclusion: It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.

• Restorative Dentistry and Endodontics
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• v.36 no.2
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• pp.149-153
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• 2011

As the dental pulp is encased with a rigid, noncompliant shell, changes in pulpal blood flow or vascular tissue pressure can have serious implication for the health of pulp. Numerous studies have demonstrated that orthodontic force application may influence both blood flow and cellular metabolism, leading degenerative and/or inflammatory responses in the dental pulp. The aim of this case report is to present a case about tooth with chronic periapical abscess which showed normal vital responses. Excessive orthodontic force is thought to be the prime cause of partial pulp necrosis. Owing to remaining vital tissue, wrong dianosis can be made, and tooth falsely diagnosed as vital may be left untreated, causing the necrotic tissue to destroy the supporting tissuses. Clinician should be able to utilize various diagnostic tools for the precise diagnosis, and be aware of the endodontic-orthodontic inter-relationship.

• Restorative Dentistry and Endodontics
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• v.25 no.2
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• pp.289-298
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• 2000

Carbamide peroxide is usually used for vital teeth bleaching at home. Complications such as tooth hypersensitivity and/or gingival irritation are frequently reported. Therefore, this study was performed to evaluate any possible histological changes in pulp and periodontal tissue by carbamide peroxide bleaching gel in rats. 10% and 15% carbamide peroxide containing nightguard for upper molar were worn for 4 hours a day. The rats were sacrificed after 1 day, 2 days, 3 days, 4 days and 6 days application of carbamide peroxide respectively. The results were as follows : Mild infiltration of inflammatory changes below the junctional epithelium and hyperplasia of epithelium were observed in both 10% and 15% carbamide peroxide treated groups. In all experimental groups, odontoblasts were changed from columnar to cuboidal shape and/or obliterated and the focal loss of predentin was observed in pulp horn. With increasing time of application, these changes were more remarkable, but limited in pulp horn. Inflammatory reactions, vacuolar changes and hyaline degenerations of the pup tissue were also observed in some cases. These results suggested that carbamide peroxide gel used in home bleaching could cause reversible pulpal irritation.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.2
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• pp.318-332
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• 2000

The purpose of this study was to investigate the effects of demineralized freeze-dried bone (DFDB) on mechanically exposed pulp of dog by evaluating the pulpal inflammation and healing process, formation of dental hard tissue, and structural changes of fibroblasts of the remaining pulp tissue. Teeth of 4 dogs, weighing 10kg, were used in this study. Class V cavities were prepared followed by exposed the pulp tissue mechanically by sterilized round bur. In control group, exposed pulps were capped with calcium hydroxide paste followed by sealed with IRM. In experimental groups, the exposed pulps of one group were capped with the collagen and those of the other group were capped with DFDB. All cavities were sealed with same manor as control group. The animals were sacrificed at the intervals of 3, 7, 14, and 28 days for histopathlogic evaluation. The specimens were observed by the light microscope and trans-electron microscope. The results were as follows: 1. Pulp necrosis was not observed in all groups. Inflammatory response was disappeared from 1 week in control group and group 2. But it was not disappeared until 2 weeks and also irregular arrangement of odontoblasts was showed at the lateral walls of root canal just beneath the amputated site of the pulp in group 1. 2. Dentinal bridge was formed incompletely at 2 weeks but it was formed completely at 4 weeks in control group. Odontoid tissue was also found in control group at 4 weeks from treatment. Amputated site of pulp was encapsulated with fibrous tissue and odontoblast and dentinal bridge was not found in group 1. Preodontoid tissue and reparative dentin which were formed by odontoblast differentiated around DFDB were found, but dentinal bridge was not found in group 2. 3. Cell with large basophillic-stained nuclei infiltrated to amputated site and DFDB at 1 week from treatment in control group and group 2. They were found more in group 2 than in control group. Odontoblasts arranged more regularly and reparative dentin was found more as time elapsed. 4. Dentin-formative odontoblasts which showed ultramicrostructure of cytoplasm with polarized nucleus, rEM, Golgi complex, secretory granules, secretion of organic matrix in control of group and group 2. In regards to above results, the demineralized freeze-dried bone(DFDB) induce odontoblastic differentiation and further come up to the dentin formation in amputated pulp.