• Restorative Dentistry and Endodontics
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• v.49 no.3
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• pp.28.1-28.12
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• 2024

Objectives: This study aimed to investigate the endodontic characteristics of mandibular premolars with dens evaginatus (DE) that require endodontic treatment. Materials and Methods: Patients who underwent endodontic treatment were enrolled. The inclusion criteria were patients who underwent root canal treatment in the lower permanent teeth with DE and were followed up for at least 1 year. Preoperative clinical and radiographic variables were obtained. The frequency distribution of the preoperative variables was compared using the χ² or Fisher's exact tests. The significance of the change in periapical health index (PAI) and root development stages before and after treatment was examined using the Wilcoxon signed-rank test. Results: A total of 150 teeth of 134 patients with an average age of 15.3 years were included. The percentage distribution comparison of the preoperative variables and obturation techniques revealed significant differences in pulpal and periapical diagnosis, and percussion, and especially regarding age, root development stage, and PAI. Age was the only statistically significant preoperative variable associated with root growth (p < 0.05). Conclusions: Approximately, 60% of DEs requiring endodontic treatment had immature roots. Age being the most significant predisposing factor, early treatment provides the greatest opportunity for full root development.

• Restorative Dentistry and Endodontics
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• v.40 no.2
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• pp.161-165
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• 2015

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

• Restorative Dentistry and Endodontics
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• v.41 no.4
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• pp.283-295
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• 2016

Objectives: In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications. Materials and Methods: HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting. Results: Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups. Conclusions: Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.2
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• pp.174-179
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• 2014

Dens invaginatus is a developmental anomaly resulting from an infolding of the enamel organ into the dental papilla prior to calcification of the dental tissue. Clinical and radiographic presentation of dens invaginatus shows a lot of variation. The classification proposed by Oehlers(1957) is most commonly used among classifications of dens invaginatus. Several treatments have been suggested to treat Type III dens invaginatus where the pulp remains healthy but the invagination is associated with a periodontitis. The top priority objective is to preserve pulp as sound as possible. Thus, if there is no definite evidence of pulpal disease, the conservative access which treat invagination as distinct from the pulp is necessary. But, Endodontic treatment of Type III dens invaginatus has the particular problems associated with achieving adequate chemomechanical debridement of the root canal system and invagination, predictable length control and consistent filling. In this case report, the endodontic treatment limited within invagination was performed for treatment of Type III dens invaginatus, and filling with Mineral Trioxide Aggregate(MTA) resulted in good prognosis.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.441-449
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• 2021

Background: The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. Methods: One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. Results: The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. Conclusion: Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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• pp.309-313
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• 2010

The management of teeth in the line of a mandibular fracture is controversial despite the general agreement that most of these teeth can be preserved. Teeth should be retained if bony attachments are adequate for survival, the tooth is sound and important in maintaining fixation of the fractured segment of bone. Teeth should be removed if they are loose and interfere with the reduction of fragments, are devitalized and potentially a source of wound infection, are damaged beyond their usefulness or may become devital and interfere with healing by becoming infected. However, tooth removal will increase the level of trauma, extend the severity of the wound and require expensive prosthetic treatment. Therefore, it is very important to conserve infected teeth in the line of a mandibular fracture through early primary endodontic treatment (pulp extirpation, canal enlargement and canal opening drainage) and splinting. The basic principles underlying the treatment of pulpless teeth are those underlying general surgery. Therefore, debridement of the infected wound (pulp extirpation and canal enlargement), drainage (canal opening) and gentle treatment of the tissues (occlusal reduction and teeth splinting) are the principles of surgery. This is a representative case report of conservative care by the early endodontic drainage of infected teeth in the line of a mandibular fracture.

• The Journal of the Korean dental association
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• v.50 no.7
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• pp.384-393
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• 2012

Successful treatment of a badly broken down tooth with pulpal disease depends not only on good endodontic therapy, but also on good prosthetic reconstruction of the tooth after endodontic therapy is completed. The ideal treatment of endodontically treated teeth has been widely and controversially discussed. Endocrown is a restorative option for endodontically treated teeth. Endocrown design incorporates the core and short post into the crown as a single restoration. The preparation of endocrown consists of a circular equigingival butt-joint margin and central retention cavity of the entire pulp chamber instead of employing intraradicular posts. This design significantly increases the surface area of the preparation available for cementation. It is particularly useful in young patient teeth for long-term provisional restoration and in teeth with short clinical crowns. This technique represents a promising and conservative method for the treatment of endodontically treated teeth that require long-term protection and stability. Endocrown can be considered as a feasible alternative to full crowns or composite overlays for the restoration of non vital teeth.

• Restorative Dentistry and Endodontics
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• v.44 no.4
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• pp.35.1-35.10
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• 2019

Pulp revascularization is an alternative treatment in immature traumatized teeth with necrotic pulp. However, this procedure has not been reported in horizontal root fractures. This is a case report of a 9-year-old patient with multiple horizontal root fractures in 2 upper central incisors that were successfully treated with pulp revascularization. The patient presented for treatment 2 years after the initial trauma, and revascularization was attempted after the initial treatment with calcium hydroxide had failed. Prior to pulp revascularization, cone-beam computed tomography and autoradiograms demonstrated multiple horizontal fractures in the middle and apical thirds of the roots of the 2 affected teeth. Revascularization was performed in both teeth; platelet-rich plasma (PRP) was used in one tooth (#11) and the conventional method (blood clot) was used in the other tooth (#21). Clinical and radiographic follow-up over 4 years demonstrated pulp calcification in the PRP-treated tooth. Neither of the 2 teeth were lost, and the root canal calcification of tooth #11 was greater than that of tooth #21. This case suggests that PRP-based pulp revascularization may be an alternative for horizontal root fractures.

• Restorative Dentistry and Endodontics
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• v.42 no.2
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• pp.146-151
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• 2017

X-linked hypophosphatemia (XLH) is a hereditary metabolic disease caused by the loss of phosphate through the renal tubules into the urine, and an associated decrease in serum calcium and potassium phosphate. Its dental features include spontaneous dental abscesses that occur in the absence of trauma or dental caries. The aim of this case report was to describe the dental problems of XLH patients and to evaluate limitations in their treatment. A 14 year old male and a 38 year old female with XLH were referred to the Department of Conservative Dentistry for endodontic treatment. The dental findings were periapical abscesses without obvious trauma or caries. Conservative endodontic treatment was performed in teeth with pulp necrosis and abscess. In case 1, the treated teeth showed improvements in bone healing, without clinical symptoms. However, in case 2, the implants and the treated tooth showed hypermobility, and the final restoration was therefore postponed. Early diagnosis, periodic examinations, and communication with the patient's pediatrician are important in the dental management of patients with XLH.

• Restorative Dentistry and Endodontics
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• v.45 no.2
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• pp.4.1-4.6
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• 2020

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.