• Restorative Dentistry and Endodontics
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• v.41 no.1
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• pp.63-67
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• 2016

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

• Restorative Dentistry and Endodontics
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• v.38 no.2
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• pp.59-64
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• 2013

Apical surgery cuts off the apical root and the crown-to-root ratio becomes unfavorable. Crown-to-root ratio has been applied to periodontally compromised teeth. Apical root resection is a different matter from periodontal bone loss. The purpose of this paper is to review the validity of crown-to-root ratio in the apically resected teeth. Most roots have conical shape and the root surface area of coronal part is wider than apical part of the same length. Therefore loss of alveolar bone support from apical resection is much less than its linear length.The maximum stress from mastication concentrates on the cervical area and the minimum stress was found on the apical 1/3 area. Therefore apical root resection is not so harmful as periodontal bone loss. Osteotomy for apical resection reduces longitudinal width of the buccal bone and increases the risk of endo-perio communication which leads to failure. Endodontic microsurgery is able to realize 0 degree or shallow bevel and precise length of root resection, and minimize the longitudinal width of osteotomy. The crown-to-root ratio is not valid in evaluating the prosthodontic prognosis of the apically resected teeth. Accurate execution of endodontic microsurgery to preserve the buccal bone is essential to avoid endo-perio communication.

• Restorative Dentistry and Endodontics
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• v.38 no.4
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• pp.227-233
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• 2013

Objectives: The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. Materials and Methods: A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. Results: All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. Conclusions: This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable.

• Restorative Dentistry and Endodontics
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• v.47 no.3
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• pp.27.1-27.14
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• 2022

Objectives: This systematic review and meta-analysis aimed to assess the association of cigarette smoking with the prevalence of post-endodontic apical periodontitis in humans. Materials and Methods: We searched through PubMed/Medline, Web of Science, and Scopus from inception to December 2020. Risk of bias was performed by using the Newcastle-Ottawa Scale for cross-sectional, cohort, and case-control studies. We performed the statistical analysis in Review Manager 5.3 (RevMan 5.3). Results: 6 studies met the inclusion criteria for qualitative and quantitative synthesis. Statistical analysis of these studies suggests that there were no differences in the prevalence of post endodontic apical periodontitis (AP) when comparing non-smokers vs smoker subjects regarding patients (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.31-1.49; I2 = 58%) and teeth (OR, 1.71; 95% CI, 0.99-2.93; I2 = 72%). Conclusions: Our findings suggest that there was no association between cigarette smoking and post-endodontic apical periodontitis, as we did not find statistical differences in the prevalence of post-endodontic AP when comparing non-smokers vs smoker subjects. Therefore, smoking should not be considered a risk factor associated with endodontic failure.

• Restorative Dentistry and Endodontics
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• v.36 no.6
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• pp.465-476
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• 2011

In current endodontic practice, introduction of operating microscope, ultrasonic instruments, and microinstruments has induced a big change in the field of surgical retreatment. In this study, we aimed to offer key steps of endodontic microsurgery procedure compared with traditional root-end surgery, and to evaluate factors influencing success and failure based on published articles. Endodontic microsurgery is a surgical procedure performed with the aid of a microscope, ultrasonic instruments and modern microsurgical instruments. The microscope provides magnification and illumination - essential for identifying minute details of the apical anatomy. Ultrasonic instruments facilitate the precise root-end preparation that is within the anatomical space of the canal. Modern endodontics can therefore be performed with precision and predictability, thus eliminating the disadvantages inherent in traditional periapical surgery such as large osteotomy, beveled apicoectomy, inaccurate root-end preparation and the inability to observe isthmus. Factors influencing the outcomes of endodontic microsurgery may be diverse, but standardization of procedures can minimize its range. Among patient and tooth-related factors, periodontal status and tooth position are known to be prognostic, but there are only few articles concerning this matter. High-evidence randomized clinical trials or prospective cohort studies are needed to confirm these findings.

• The Journal of the Korean dental association
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• v.48 no.10
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• pp.729-737
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• 2010

The use of cone-beam computed tomography(CBCT) image has been increased. Usually, the dentists use this images for the implant or orthodontic treatment. In this article, CBCT examples for oral surgery and endodontics are presented. CBCT is very useful when dentists extract teeth or provide endodontic treatment. The disadvantage of the CBCT image is also discussed simply. Clinicians could provide higher quality of medical care with CBCT.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.5
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• pp.471-477
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• 2001

Failure to use effective methods of reduction, fixation, and immobilization may lead to nonunion with osteomyelitis, owing to the compound nature of most fractures of the mandible. Nonunion results in fibrous pseudoarthrosis at the fracture site with instability that, once formed, does not improve spontaneously. Once the nonunion with osteomyelitis secondary to fractures has become established, intermaxillary fixation and drainage of infected tissue should be instituted as early as possible, because the fixation & drainage enhances the patient comfort and hinders ingress of microorganisms & debris by movement of bone fragments. The authors treated three cases of nonunion with osteomyelitis by intermaxillary fixation, incision & persistent drainage on the previous fistula site and endodontic drainage of infected teeth in the fracture site of mandible. The localization & sequestration of the infected bone around the fracture was better performed persistently by natural homeostatic mechanism in $8{\sim}10$ weeks and the bony union was then attained without bone grafting.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.203-208
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• 2010

Tremors are trembling movements and are seen in association with alcoholic intoxication, certain drugs, thyrotoxicosis, multiple sclerosis, hysteria, and nervous tension. Dental fears, such as, pain, drill, unknown, dependency, helplessness, mutilation and oral change, induce the neuroendocrine response (release of epinephrine and norepinephrine, etc). The clinical manifestations of epinephrine or other vasopressor overdose include : anxiety, tenseness, restlessness, throbbing headache, tremor, perspiration, weakness, dizziness, pallor, palpitation and respiratory difficulty. Signs of local anesthetic overdose appear clinically whenever the anesthetic level in the blood rises to an appropriate level in an individual. The clinical signs of moderate overdose levels include : talkativeness, apprehension, excitability, slurred speech, tremor and muscular twitching. This is a case report about the severe tremor care after the endodontic treatment under right mandibular block anesthesia in a 56-years old female patient.

• Journal of Korean Dental Science
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• v.3 no.2
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• pp.12-19
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• 2010

Despite the latest advancement made in its techniques and devices/apparatuses and the resulting rising expectation in the field of dental surgery, apicoectomy performed in the molar teeth remains a technical challenge and lacks evidence substantiated by long-term follow-up studies. This study sought to investigate the treatment outcomes and post-operative success rate in the root-end resected molar teeth accompanied by a high level of surgical risks due to their close proximity to the mandibular canal and maxillary sinus. A total of 68 patients who received treatment at Livingwell Dental Hospital between 2004 and 2010 and underwent apical surgery in the maxillary or mandibular molar area were enrolled in this study. A total of 160 roots collected from 75 molar teeth were subjected to surgical endodontic treatment and subsequently evaluated clinically as well as radiographically. Based on the results of the study, the clinical success rate was found to be 78.8% in cases involving radiological healing. Likewise, 90.7% of the roots recorded a robust clinical survival rate, but with incomplete healing as shown by radiography. The results indicate that the apical procedure involving molar teeth is a prognosis-friendly method that promises positive outcomes and higher success rate based on long-term follow-up observations.

• Restorative Dentistry and Endodontics
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• v.40 no.4
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• pp.306-313
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• 2015

Objectives: Molecular mechanism of the pathogenicity of Enterococcus faecalis (E. faecalis), a suspected endodontic pathogen, has not yet been adequately elucidated due to limited information on its virulence factors. Here we report the identification of in vivo expressed antigens of E. faecalis by using a novel immunoscreening technique called change-mediated antigen technology (CMAT) and an experimental animal model of endodontic infection. Materials and Methods: Among 4,500 E. coli recombinant clones screened, 19 positive clones reacted reproducibly with hyperimmune sera obtained from rabbits immunized with E. faecalis cells isolated from an experimental endodontic infection. DNA sequences from 16 of these in vivo-induced (IVI) genes were determined. Results: Identified protein antigens of E. faecalis included enzymes involved in housekeeping functions, copper resistance protein, putative outer membrane proteins, and proteins of unknown function. Conclusions: In vivo expressed antigens of E. faecalis could be identified by using a novel immune-screening technique CMAT and an experimental animal model of endodontic infection. Detailed analysis of these IVI genes will lead to a better understanding of the molecular mechanisms involved in the endodontic infection of E. faecalis.