• Proceedings of the KACD Conference
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• 2003.11a
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• pp.608-608
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• 2003

The main objectives of root canal therapy are cleaning and shaping and then obturating the root canal system in 3 dimensions to prevent reinfection. Many instrumentation techniques and devices, supported by an irrigation system capable of removing pulp tissue remnants and dentin debris, have been proposed to shape root canals. But current regimens in chemomechanical debridement using instrumentation and irrigation with NaOCl are not predictably effective in root canal disinfection. These findings are not surprising because the root canal system is complex and contains numerous ramifications and anatomical irregularities. The microorganisms in root canals not only invade the anatomic irregularities of the root canal system but also are present in the dentinal tubules. Therefore further disinfection with an effective antimicrobial agent may be necessary and it well1mown that use of intracanal medication will lower bacterial count in infected root canals. Calcium hydroxide has a long history of use in endodontics, and more attention has been given to the use of calcium hydroxide as intracanal dressing for the treatment of infected pulp. However, when treatment is completed in one visit, no intracanal medications other than intracanal irrigants are used. Recently, a mixture of a tetracycline isomer, an acid, and a detergent(MTAD), has been introduced as a final rinse for disinfuction of the root canal system. It has been shown that MTAD is able to remove the smear layer with minimal erosive changes on the surface of dentin, and is effective against Enterococcus faecalis, a microorganism resistant to the action of other antimicrobial medications. In another study, the ability of MTAD was investigated to disinfect contaminated root canals with whole saliva and compared its efficacy to that of NaOCl Based on the results, it seems that MTAD is significantly more effective than 5.25% NaOCl in eradicating bacteria from infected root canals. In the cytotoxicity evaluation, MTAD is less cytotoxic than engenol, 3% $H20_2,\;Ca(OH)_2$ paste, 5.25% NaGCl, Peridex, and EDTA and more cytotoxic than 2.63%,1.31% and 0.66% NaOCl. Is it promising or transient?

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.3
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• pp.576-583
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• 2005

Tooth formation is a complex developmental process that is mediated through a series of reciprocal epithelial-mesenchymal interactions. Several signal pathways and transcription factors have been implicated in regulating molar crown development, but relatively little is known about the regulation of root development. It was reported that NFI-C knockout mice showed abnormal root formation with normal crown. The aims of this study are to elucidate how the NFI-C regulate the determine of root shape and odontoblasts differentiation. We carried out immunohistochemistry using cytokeratin to investigate the role of Hertwig's epithelial root sheath and DSPP mRNA in-situ hybridization to conform the nature of root dentin during root development in NFI-C knockout mice. Cytokeratin reacted with all the HERS cells and the continuity of cytokeratin positive cells between the HERS cells and enamel epithelium was lost in the cervical region both wild and K/O types. After root dentin deposition cytokeratin positive-HERS cells showed irregularity and loss of polarity in the cervical region in K/O type. DSPP mRNA was strongly expressed in odontoblasts of crown and root dentin in wild type mice, whereas expression of DSPP mRNA was restricted in odontoblast of crown dentin in the K/O type. During root formation in NFI-C knockout mice, HERS normally grow out of the crown but fail to induce odontoblast differentiation in root portion. These results suggest that NFI-C may play important roles in odontoblast differentiation during root dentin formation.

• Proceedings of the KACD Conference
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• 2001.05a
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• pp.259-259
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• 2001

;A new root canal instrument and instrumentation technique: a preliminary report. Cleaning and shaping the root canal system has been and continues to be a challenge for even the most experienced endodontist. Curved. narrow canals. in particular. cause difficulties for the beginner as well as the specialist. A new instrument designed to incorporate new concepts was developed to ameliorate the problems in cleaning and shaping root canal systems. This new instrument has been given the name of SW (Senia and Wildey). The new SW instrument uses controlled right and left rotational forces. This motion was used to clean and shape simulated root canals in plastic blocks and root canals in extracted teeth. Instrumentation appeared to be easier. faster. and more precise than with conventional instruments. especially in curved canals where there was remarkable reduction of canal transportation. A mechanical version of the SW instrument was also developed. It was used to flare the coronal portion of the root canal system. Wildey WL. Senia ES., Oral Surg Oral Med Oral Pathol1989 Feb:67(2):198-207 Another look at root canal instrumentation. Several aspects of root canal instrumentation need additional research. Various factors must be considered in an analysis of instrumentation of the root canal system: the dentin that is cut: the technique used to cut it: the design of the instruments: the material and manufacturing process used to make the instruments: the irrigant used during the procedure: and the anatomic configuration of the root canal system. An analysis of these factors clearly indicates that existing root canal instruments and techniques are less than ideal and. in fact. do not accomplish what is expected of them. Root canals must be properly. but. at the same time. destructive and unnecessary removal of dentin should be kept to a minimum. The Flex-R and Canal Master instruments were developed to address some of the shortcomings of existing instruments and techniques. More scientifically based research is needed to fully evaluate these new instruments and techniques and to develop future instruments. Wildey WL; Senia ES. Montgomery S., Oral Surg Oral Med Oral Pathol1992 Oct:74(4):499-50799-507

• Journal of Korean Dental Science
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• v.17 no.2
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• pp.92-104
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• 2024

Managing multiple non-carious cervical lesions (NCCLs) with gingival recession and dentin hypersensitivity can be challenging. Herein, we present two cases of successful treatment procedure for multiple NCCLs with gingival recession and dentin hypersensitivity using an envelope coronally advanced flap with CTG and composite resin restoration. Through the combined approach of restorative and periodontal procedure, both patients showed adequate extent of gingival coverage and esthetic outcome based on the Modified Root Coverage Esthetic Score (MRES) at 6 months postoperatively. Also, dentin hypersensitivity was reduced effectively during the follow up period. Although the pocket depth slightly increased in patient 1, possibly due to the amount of restoration located sub-gingivally, pocket depth remained within 3 mm. This suggest that re-establishing the clinical CEJ and performing partial restoration is advantageous for periodontal tissue and is expected to contribute to maintain gingival height in the long term. These case reports emphasize the efficacy of the combined approach for treating multiple NCCLs with gingival recession and dentin hypersensitivity, highlighting the importance of careful restoration planning for optimal clinical and aesthetic outcomes.

• Restorative Dentistry and Endodontics
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• v.25 no.4
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• pp.527-535
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• 2000

The purpose of this study was to evaluate effects of smear layer and dentin primers on the sealing ability of root canals. 126 extracted human teeth with single, straight canals and mature apices were used. The Samples were first classified into six groups as follows: presence of smear layer; absence of smear layer; Scotchbond Bond Multi-Purpose; All Bond 2; Mac Bond 2; Clearfil Liner Bond 2. A Positive control was also established. All teeth except the control group were then obturated with thermoplasticized gutta-percha and AH26. Electrochemical and dye penetration technique were later used to evaluate the degree of micro leakage through the root canal. Seventy teeth were then immersed in a 1% potassium chloride solution and An external power supply(DC 10 V) was then applied to the circuit for the electrochemical microleakage test. The degree of Microleakage was determined over period of 28 days before being evaluated. In total, 48 teeth were submitted to the dye infiltration technique. All specimen were suspended in 2% methylene blue dye for 1 week before being longitudinally split. The degree of dye infiltration was measured under a stereo microscope at ${\times}10$ magnification and evaluated. The results were as follows: 1. Apical microleakage increased throughout the test period in all group and one group having a smear layer showed a dramatic increase under electrochemical test (p<0.05). In the group having smear layer, the degree of apical microleakage was the highest, and the micro leakage was much higher than in the smear layer removed group in electrochemical test (p<0.05). Scotchbond Multi-Purpose, All Bond 2, Mac Bond 2 and Clearfil Liner Bond 2 showed lower micro leakage than one group having smear layer. The All Bond 2 and Clearfil Liner Bond 2 treated groups showed the lowest microleakage in electrochemical test (p<0.05). 2. There was no significant difference between the experimental groups in dye penetration technique. These results suggested that the removal of the smear layer from root canal and concomitantly the application of dentin primer into root canal could improve the sealing ability of root canal obturation.

• Journal of Periodontal and Implant Science
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• v.23 no.2
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• pp.283-299
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• 1993

The purpose of this study was to observe early connective tissue attachment on dentin surface treated with citric acid, tetracycline, and fibrin sealants and compare their conditioning effects on dentin surface. Experimental dentin blocks conditioned with citric acid, tetracycline or fibrin sealant, and only root planned control block were surgically implanted in the pouch under buccal mucoperiosteal flaps of left mandible, right maxilla, left maxilla, right mandible of 18 male rabbits. Rabbits were sacrificed after 1 and 6 hours, 1, 3, 7 and 14 days after implantation and then specimens including dentin block and surrounding soft tissue were obtained, and prepared for light and transmission electron microscopic examination. 1 and 6 hours after dentin block implantation, there was plasma proteins adsorption followed by fibrin clot formation and no differences among specimens. At the 1-day observation interval, delicate fibrin network was observed in the all groups, and there were proliferative fibroblasts, angiogenesis and macrophage in the all 3-day specimens. Cellular aggregates and abundant connective tissue adhered dentin surface and tetracycline or citric acid treated group showed much proliferative fibroblast and abundant collagen fibers at 1 week. But at 2 week, citric acid treated group showed much proliferative fibroblast and abundant collagen fibers. These observations suggested that new connective tissue attachment to dentin was initiated by the adsorption of plasma proteins to the dentin surface and followed by fibrin clot formation. Tetracycline and citric acid seemed to make dentin surface more biologically favorable for the connective tissue attachment.

• The Journal of Korean Academy of Prosthodontics
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• v.31 no.1
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• pp.1-10
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• 1993

The purpose of this study was to evlauate the microleakage of 3 dentin bonding agents using different dentin pretreatment method under simulated physilogic pressure in cementing the porcelain laminate veneer. Noncarious 60 human maxillary molars were selected and randomly assigned to 4 groups of 15 each. The group with the margin placed on the enamel was classified as the control and the groups with the margin placed on root surface were subdivided into 3 groups according to the dentin bonding agents used. The group using All Bond 2 was classified as experimental group 1, the group using Scotchbond MP was classified as experimental group 2, and the group using Gluma was classified as experimental group 3. Roots were removed at 3mm below the cementoenamel junction, and reductions of the teeth for the porcelain laminate veneer were done on the mesial 1/2 of the buccal surface of each teeth. The pulp was extirpated and the pulp chamber was cleaned with 37% phosphoric acid for the patency of dentinal tubule. Under simulated physiologic pressure, porcelain laminate veneers were cemented to the teeth using each dentin bonding agent and luting cement. After cementation, all samples were stored at 36t in water for 24 hours and thermocycled for 1500 cycles, then immersed in 0.5% basic fuchsin solution and the teeth were sectioned longitudinally by using diamond saw and the extent of microleakage was measured. The following results were obtained, 1. Microleakage was observed in a few samples of control group but all the samples of experimental groups. 2. The control group showed the less extent of microleakage than the experimental groups. In experimental groups the experimental group 1 & the experimental group 2 showed similiar extent of microleakage and the experimental group 3 showed the greater extent of microleakage than other groups. Conclusively, practicing the porcelain laminate veneers in the clinic, although the margin of the porcelain laminate veneer should be placed on enamel, in the case that it is inevitable to place the margin of the porcelain laminate veneer on the root surface, it is recommened to use dentin bonding agents which use no dentin pretreatment or a dentin pretreatment which can leave the smear plugs.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.195-201
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• 2015

Objectives: The use of chitosan nanoparticles (CNPs) in endodontics is of interest due to their antibiofilm properties. This study was to investigate the ability of bioactive CNPs to remove the smear layer and inhibit bacterial recolonization on dentin. Materials and Methods: One hundred bovine dentin sections were divided into five groups (n = 20 per group) according to the treatment. The irrigating solutions used were 2.5% sodium hypochlorite (NaOCl) for 20 min, 17% ethylenediaminetetraacetic acid (EDTA) for 3 min and 1.29 mg/mL CNPs for 3 min. The samples were irrigated with either distilled water (control), NaOCl, NaOCl-EDTA, NaOCl-EDTA-CNPs or NaOCl-CNPs. After the treatment, half of the samples (n = 50) were used to assess the chelating effect of the solutions using portable scanning electronic microscopy, while the other half (n = 50) were infected intra-orally to examine the post-treatment bacterial biofilm forming capacity. The biovolume and cellular viability of the biofilms were analysed under confocal laser scanning microscopy. The Kappa test was performed for examiner calibration, and the non-parametric Kruskal-Wallis and Dunn tests (p < 0.05) were used for comparisons among the groups. Results: The smear layer was significantly reduced in all of the groups except the control and NaOCl groups (p < 0.05). The CNPs-treated samples were able to resist biofilm formation significantly better than other treatment groups (p < 0.05). Conclusions: CNPs could be used as a final irrigant during root canal treatment with the dual benefit of removing the smear layer and inhibiting bacterial recolonization on root dentin.

• Journal of Periodontal and Implant Science
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• v.29 no.2
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• pp.401-415
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• 1999

Root surfaces affected by periodontal disease undergo various forms of changes. Cementum exposure from gingival recession may result in absorption of calcium, phosphorus, and fluoride and subsequent hypermineralization and increased radiodensity. Although some reports have suggested that inorganic content with root cementum might show various changes depending upon age or extent of periodontal disease, but no consensus can be reached regarding the the distribution of various elements. The present study examines the difference in mineral content between healthy and periodontal diseased roots by analyzing three areas per tooth along the root surface in cervico-apical direction using electron probe and scanning electron microscope. Healthy tooth that was extracted for orthodontic purpose was used as control. Experimental teeth include those with periodontal pocket depth exceeding 6mm and those with gingival recession and periodontal pocket depth of 2-4mm. Levels of Ca, P, Mg and Na were measured using wavelength dispersive x-ray spectrometer at three areas per tooth. The examined areas were located apical to cemento-enamel junction in control and periodontal ligament-depleted areas in experimental teeth. The corresponding areas were also examined with scanning electron microscope(x70) The results are as follows. 1. Minerals were detected in order of Ca, P, Mg and Na. In all root surfaces, levels of Ca and P were higher in dentin than in cementum. 2. Level of Mg was twice as high in dentin than in cementum. There was no significant difference in the level of Mg and Na between normal and periodontal diseased roots or between the various locations in the same root. 3. Level of Ca and P in the surface cementum showed no difference between normal and periodontal diseased root, although the areas in dentin with high level of either ion also showed high level of corresponding ion in cementum. 4. Difference in the Ca and P content between various locations within the same root was noted, although no coherent pattern existed. These results suggest that although the mineral content of the root cementum in periodontitis-affected tooth is affected by exogenous ions from saliva and food, but there was no difference in the mineral contents between normal and periodontally diseased root.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.54-67
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• 1998

The purposes of this study were to evaluate the efficiency of dentin cutting and root-end cavity preparation, and to determine the incidence of tooth crack when root-end retrograde cavity preparation was done with. ultrasonic diamond instruments. To evaluate the efficiency of dentin cutting, ultrasonic diamond and stainless steel instruments were applied to 20 exposed bovine dentin surfaces perpendicularly or parallely at the low, and medium power settings for 1 minute ($Miniendo^{TM}$, EIE, CA, U.S.A.). The resultant cavity depth was measured. To evaluate the efficiency of cavity preparation and to investigate the incidence of tooth crack, 165 mesiobuccal, distobuccal and palatal root-ends of extracted human maxillary first molars were resected by 3 mm perpendicularly to the long axis of tooth using a slow speed diamond saw after root canal preparation and filling. Retrocavities were prepared using a ultrasonic diamond instrument or a stainless steel one of the low- or medium power settings of 2 or 6. Time consumed and the number of strokes used for the cavity preparation were measured and the incidence of tooth cracks was evaluated under a stereomicroscope. The results were as follows: Both at the low and medium power settings, and both with perpendicularly- and parallely applied tips to dentin, diamond instruments showed higher dentin cutting efficiency than stainless steel ones did (p<0.01). When tips were applied to dentin perpendicularly, both diamond instrument and stainless steel one showed higher cutting efficiency with medium power setting than with low power one (p<0.01). Both at the low- and medium power settings, both diamond instrument and stainless steel one showed higher cutting efficiency when tips were applied perpendicularly to dentin surface than applied parallely (p<0.01). At the medium power setting, the number of stroke and time consumed were less with diamond instrument than with stainless steel one (p<0.05) for the retrograde cavity preparation. At the low power setting, diamond instrument induced less tooth cracks than stainless steel one did (p<0.01).