• Restorative Dentistry and Endodontics
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• v.37 no.1
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• pp.61-65
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• 2012

Patients with diabetes mellitus show delayed wound healing and increased susceptibility to infection. Therefore, the effects of diabetes on pulpal and periodontal healing should be taken into consideration when treating diabetic dental traumatized patients. This case presents the treatment for dental traumatized 20 yr old female with uncontrolled type II diabetes. The traumatized upper central incisors had showed pulpal healing in early days. However, 7 mon after the trauma, the teeth had been diagnosed with pulp necrosis with apical abscess. Eventually, non surgical root canal treatment on the teeth had been performed.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.2
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• pp.146-158
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• 2002

The purpose of this study was to investigate the effects of Nd:YAG laser on mechanically exposed pulp of dog by the observation of pulpal inflammatory change and heal process including dentinal bridge, structural changes of fibroblasts of thr remaining vital pulp tissue. In experimental group 1, the exposed pulps were irradiated with Nd:YAG laser(3W, 30Hz, 0.2sec) for $2{\sim}3$ second followed by capped with aluminium tin foil. In group 2 and group 3, the exposed pulps were irradiated with Nd:YAG laser via contact(Group 2) and non-contact(Group 3) methods followed by capped with calciumhydroxide paste. The animal were sacrificed at the intervals of 3, 7, 14 and 30days for histologic evaluation. The results were as follows : 1. The dentinal bridges were formwd more fast and broadly in the experimental group 1 and 2 than other groups, but there were no histologic differences in the degree of their formation among control group, experimental group 1. 2. Odontoblastic activities at amputated pulp was increased in the experimental group 2, 3 than other group but there no histologic difference in the odontblastic activitiy among control group, experimental group 1. 3. The infalmmation was severe at the postoperative 1 week of all groups, but its condition subsideed with time elapsed. At the postoperative 3, 7 days, its condition in experimental group 2, 3 were less severe than in the group 1. 4. There were no histologic differences between the experimental group 2 and 3 according to the degree of dentin bridge formation.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.4
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• pp.399-406
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• 2011

Traumatic injury on tooth occurs frequently among trauma patients, and mainly occurs on tooth with premature roots which influences pulp tissue, periodontal ligament, alveolar bone, and Hertwig's epithelial root sheath. According to the degree of trauma, a number of kinds of healing process can be observed, such as complete re-vascularization of pulp, root canal obliteration, growth suspension of root apex, and invasion of alveolar bone into root canal, and there can be some complications such as necrotic change of inflammatory root resorption and partial pulp necrosis due to pulp necrosis toward complete necrosis. In this clinical case, 3 patients who had traumatic injury showed root growth suspension and alveolar bone invasion into root canal due to proliferation of periodontal ligament cell and osteocyte at the base of extraction socket into pulp chamber because of the injury on Hertwig's epithelial root sheath. If intrusion of alveolar bone into root canal due to injury on Hertwig's epithelial root sheath after having traumatic injury doesn't show any complication, the pulp may be considered to have normal vitality and doesn't need any further treatment, therefore differential diagnosis is very necessary. However, it may be accompanied with suspension of root growth, therefore, additional trauma during the treatment of injured tooth should not be applied.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.1
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• pp.123-130
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• 2018

In the root fracture, pulp necrosis tends to involve only the coronal fragment, while the pulp in the apical fragment remains vital. The prognosis of endodontic treatment of the apical fragment is poor due to the possibility of overfilling of the space between the fragments and difficulty in removing necrotic tissue. In the present cases, endodontic treatment of the apical fragment of root fracture was performed. However, in reendodontic treatment, resistance was felt at the fracture site and access to the root canal in the apical fragment was difficult. Therefore, the calcium hydroxide was periodically exchanged only in the coronal fragment without further treatment in the apical fragment and the canal of the coronal fragment was finally filled with Gutta-percha. Regular observation revealed no radiologic complications in the apical fragment. In some cases, we can observe good healing pattern such as absorption of calcium hydroxide and pulp canal obliteration of apical fragment in the long term.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.2
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• pp.200-206
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• 2016

Root fracture is defined as a fracture involving the dentin, cementum, and pulp. Most fractures occur in the maxillary anterior teeth between the ages of 11 and 20 years old. The treatment for root fracture in permanent teeth involves the reduction and fixation of the displaced coronal segment. When signs of pulp necrosis or inflammatory root resorption are present, root canal therapy should be performed. Since most apical fragments maintain pulp vitality, root canal therapy is typically limited to coronal fragments. However, it's too difficult to achieve a proper apical stop on coronal fragment. Intentional replantation involves performing root apex treatment outside the mouth after intentional extraction of the tooth in a controlled environment and then replanting it. The objective is 'perfect' root canal therapy. Intentional replantation may be used in cases of failed typical root canal therapy, problematic endodontic retreatment due to the existing restoration or a calcified root canal, and when apical surgery is contraindicated because of a lack of reasonable approaches. In this case, intentional replantation was carried out to treat a horizontal root fracture in a maxillary central incisor with a calcified root canal due to previous trauma. We achieved a clinically and functionally satisfactory result.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.43-50
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• 2012

The concept of revascularization of necrotic pulps regained interest and became an alternative conservative treatment option for young permanent teeth with immature roots. Revascularization of immature teeth with apical periodontitis depends mainly on disinfection of the canal. Since the infection of the root canal system is considered to be polymicrobial, a combination of drugs would be needed to treat the diverse flora. A triple antibiotic mixture of metronidazole, ciprofloxacin, and minocycline was used as an intracanal medicament. However, discoloration was developed after applying the triple antibiotic mixture. It is believed that the marked discoloration is related to the use of minocycline. The aim of this article was to present cases of coronal discoloration after triple antibiotic therapy in immature tooth and was treated with bleaching technique to control coronal discoloration. In conclusion, revascularization by using triple antibiotics promotes a paradigm shift in treating endodontically involved permanent teeth. However, we should understand that triple antibiotics containing minocycline induces tooth discoloration. Further research to prevent coronal discoloration should be investigated and suggested for the safe use of triple antibiotics.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.2
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• pp.174-180
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• 2012

In case of an immature tooth with necrotic pulp, regeneration of pulp tissue into a canal would be the ideal outcome. It may be capable of promoting the continuation of normal root development. Platelet-rich fibrin has been suggested as a potentially ideal scaffold for regenerative endodontic treatment. Immature permanent teeth of young children were diagnosed with pulp necrosis and apical abscess as the result of clinical and radiographic examination. After removal of necrotic pulp, canal was irrigated with 5.25% NaOCl and dried with paper point. A triple antibiotic mixture was placed in canal space in 3 weeks. After removal of the antibiotic mixture, the platelet-rich fibrin was injected into the canal space with MTA placed directly over the platelet-rich fibrin clot. The coronal region was restored by composite resin. On the basis of short-term results of the present 3 cases, regeneration of vital tissues appears to be possible in a tooth with necrotic pulp and a periapical lesion. Also, platelet-rich fibrin proves to be potentially an ideal scaffold for this procedure. Therefore, long-term clinical observation and examination about this treatment using platelet-rich fibrin in immature permanent teeth of young children are considered to be necessary.

• Restorative Dentistry and Endodontics
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• v.35 no.6
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• pp.436-444
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• 2010

Objectives: This study aimed to assess prospectively the clinical outcome of nonsurgical endodontic treatment and identify patient- and tooth-related factors, rather than treatment-related factors, that were the best predictors of this outcome. Materials and Methods: The inception cohort comprised 441 teeth (320 patients) and 175 teeth (123 patients) were followed up for 1-2 years. Age, gender, presence of medical disease, number of canals, previous endodontic treatment, presence of sensitivity and pain, pulp vitality, swelling or sinus tract of pulpal origin on the gingiva, periapical radiolucency and tendency of unilateral bite on the affected tooth were recorded at treatment start. Results: The outcome was classified on the basis of periapical radiolucency as healed or non healed. The overall healed rate in these cases, including nonsurgical retreatment, was 81.1%. Four tooth-related factors had a negative impact in the bivariate analysis: previous endodontic treatment, necrotic pulp, preoperative gingival swelling or sinus tract of pulpal origin, and preoperative periapical radiolucency. Stepwise logistic regression analysis including patient-, tooth-related factors and level of the root canal filling as a treatment-related factor showed that preoperative gingival lesion (odds ratio [OR]: 4.4; p = 0.005), preoperative periapical radiolucency (OR: 3.6; p = 0.011), and $\leq$ 1-2 mm under root filling length (OR: 9.6; p = 0.012) were significant predictors of failure. Conclusions: A preoperative gingival lesion of pulpal origin can influence the outcome of nonsurgical endodontic treatment in addition to preoperative periapical radiolucency.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.3
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• pp.385-390
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• 2003

Traumatic injuries in the young permanent dentition are common, but root fractures, defined as fractures involving dentin, cementum and pulp, are relatively uncommon. Appropriate management of root fracture involves repositioning the coronal portion of the tooth fragment and firm immobilization with a splint for 2 to 3 month. Root canal treatment should not be initiated until the sign of necrosis or resorption are apparent because in most cases, the apical fragments maintain their vitality. The following case report describes a patient with root fractures injured three times over the period of 7 years. The results, clinically and radiographically, were acceptable, but long term periodic evaluation is required.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.84-89
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• 2012

The radicular cyst is the most common odontogenic cyst which is caused by pulpal inflammation, pulp death, and secondary to trauma or dental caries. Usually, the radicular cyst is asymptomatic, but a secondary inflammation can cause pain, swelling and redness. Getting larger, the radicular cyst can cause facial asymmetry and paresthesia by pressure on nerves. It requires conservative endodontic treatment or surgical approach. When the size of cyst is large or invasion of the adjacent tissue is not expected, cyst enucleation is carried out. And most of the case can be completely cured and shows low recurrence. In these radicular cysts cases, by cyst enucleation or apicoectomy after root canal treatment simultaneously, the infected teeth can be preserved successfully.