• 제목/요약/키워드: Necrotic pulp

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과도한 교정력에 의한 부분 치수괴사: 증례보고 (Partial pulp necrosis caused by excessive orthodontic force)

  • 김민영;이승종;정일영;김의성
    • Restorative Dentistry and Endodontics
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    • 제36권2호
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    • pp.149-153
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    • 2011
  • 치수는 견고한 치질에 의해 둘러싸여 있기 때문에 치수 혈류나 혈압의 변화는 치수건강에 심각한 위해를 입힐 수 있다. 여러연구에서 치아에 가해지는 교정력이 치수의 혈류 및 세포대사에 변화를 주어 퇴행성/염증성의 치수반응을 일으킬 수 있음이 밝혀졌다. 이 논문의 목적은 만성 치근단 농양을 가진 치아가 명확한 치수생활력 반응을 나타낸 증례에 대해 보고하는 것이다. 이는 치수가 부분적으로 괴사된 상태였기 때문이며 이것의 주 원인은 과도한 교정력인 것으로 판단된다. 남아있는 생활 치수 조직때문에 잘못된 진단이 이뤄지고, 이러한 경우 적절할 치료가 이뤄지지 않음에 따라 괴사조직이 지속적으로 치아주변조직을 파괴하게 될 수 있다. 임상가는 이러한 경우에 있어 여러 진단도구들을 활용하여 정확한 진단을 해야하며 근관-교정 간의 상호작용에 대해 숙지하고 있어야 할 것이다.

Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation

  • Baek, Sang Oon;Suh, Hyo Wan;Lee, Jun Yong
    • Archives of Plastic Surgery
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    • 제45권1호
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    • pp.62-68
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    • 2018
  • Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

Clinical and radiographic outcomes of regenerative endodontic treatment performed by endodontic postgraduate students: a retrospective study

  • Hadi Rajeh Alfahadi;Saad Al-Nazhan; Fawaz Hamad Alkazman;Nassr Al-Maflehi; Nada Al-Nazhan
    • Restorative Dentistry and Endodontics
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    • 제47권2호
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    • pp.24.1-24.15
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    • 2022
  • Objectives: Regenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students. Materials and Methods: Clinical and radiographic data of 27 patients, aged 10-22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified. Results: A total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00-0.63 mm in the anterior teeth, 2.85-1.48 mm of the mesial root, and 2.73-2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth. Conclusions: A favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.

치수 및 치근단 질환에서의 단백분해효소 및 단백분해효소 억제제의 활성도에 관한 연구 (A STUDY ON THE ACTIVITY OF PROTEINASE AND PROTEINASE INHIBITOR IN PULPAL AND PERIAPICAL PATHOSES)

  • 김진우;;임성삼
    • Restorative Dentistry and Endodontics
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    • 제25권4호
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    • pp.509-526
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    • 2000
  • It is known that injuries to the dentin have a corresponding inflammatory effect on the pulp and these inflammatory effects frequently result in pulpal pathoses due to progressive degradation of pulpal connective tissue. It was supposed that the tissue degradation in different inflammatory process was controlled by proteinase activity and antiproteinase activity. Therefore, the purpose of this study was to examine the pulp and periapical pathoses in terms of the activities of proteinase and proteinase inhibitor, 37 pulpal tissues were divided by clinical diagnostic criteria into normal pulp, acute inflamed pulp, and chronic inflamed pulp, and then those groups were subdivided by histopathological findings into 5 pulpal pathoses groups, i.e. normal pulp (P1, n=8), chronic pulpitis with fibrotic change (P2, n=2), chronic pulpitis with dystrophic calcification (P3, n=11), chronic pulpitis with pulp abscess (P4, n=7), acute pulpitis with necrotic change (P5, n=4), 26 periapical tissues were also divided by ordinary histopathological findings into 3 periapical pathoses group, i.e., granuloma (A1, n=17), cyst (A2, n=2) and abscess (A3, n=7). The activities of proteinases (cathepsin G, MMP-3) and proteinase inhibitors (${\alpha}1$-AT, TIMP-1 and, SLPI) were evaluated by RT-PCR and immunohistochemical methods. The results were as follows. 1. Generally, the intensity of immunohistochemical staining of proteinases and proteinase inhibitors increased in P2 and P5 groups compared to P1 group. 2. The immunohistochemical stain of proteinases and proteinase inhibitors was intensely detected in P2 group, showing low inflammatory reaction and low tissue degradation, but it was reduced in P3 and P4 groups, showing severe tissue degradation. 3. The distribution of proteinases and proteinase inhibitors in pulpal pathoses was consistently presented by immunohistochemical staining, while the expression of proteinase and/or proteinase inhibitors mRNAs in pulpal pathoses was occasionally detected by RT-PCR methods. 4. RT-PCR of proteinase and proteinase inhibitors was usually positive in P2, showing rare tissue degradation, but it was almost negative in P3 and P4, showing severe tissue degradation. 5. We presume that the reason why the level of proteinase and proteinase inhibitors was so sparse in RT-PCR method is due to the abrupt decrease of mRNA synthesis or degradation of synthesized mRNA of proteinase and/or proteinase inhibitors depend on the inflammatory reaction and/or on the degradation of pulp tissues(P3, P4). 6. Pulpal pathoses groups showed significant lower RT-PCR detection of proteinases and proteinase inhibitors than the periapical pathoses group(p<0.05), and there is no significant difference among the periapical pathoses groups(p>0.05).

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감염된 미성숙 영구치에서 platelet-rich fibrin과 double antibiotic paste를 이용한 치수 재혈관화 : 증례 보고 (Pulp Revascularization of Infected Immature Permanent Teeth Using Platelet-Rich Fibrin and Double Antibiotic Paste : Case Report)

  • 전상윤;이난영;이상호
    • 대한소아치과학회지
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    • 제40권3호
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    • pp.216-222
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    • 2013
  • 감염된 미성숙 영구치의 치수치료에 있어 줄기세포의 분화를 유도하는 생활조직의 재생과 지속적인 치근형성을 도모하는 방향으로 패러다임이 전환되고 있는데, 여기에서는 소독, 스캐폴드(scaffold), 그리고 폐쇄가 중요하다. 소독을 위해 triple antibiotics가 널리 사용되고 있으며, 스캐폴드로써 기존의 혈병대신 platelet-rich fibrin의 사용이 보고되었다. 본 증례보고에서는 치외치 파절에 의해 치수가 감염된 미성숙 영구치에서 platelet-rich fibrin을 스캐폴드로써 이용한 치수 재혈관화를 시행하였다. 발수와 근관세척 후 첫 증례에서 국소적 항생제의 적용 없이 platelet-rich fibrin을 단독 사용하였고 두 번째와 세 번째 증례에서는 국소적 항생제 적용 후 platelet-rich fibrin을 적용하였는데 모두 양호한 치유 결과를 얻었다.

미성숙 영구치의 치근파절시, 전체 근관치료 후 근단 파절편의 예후 (Prognosis of the Apical Fragment of Root Fractures after Root Canal Treatment of Both Fragments in Immature Permanent Teeth)

  • 이제식;남순현
    • 대한소아치과학회지
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    • 제45권1호
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    • pp.123-130
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    • 2018
  • 치근 파절시, 치수괴사는 주로 치관부 파절편에서만 일어나며 근단측은 생활력을 유지한다. 치근단 파절편의 근관치료는 파절편간 사이 공간의 과잉충전의 높은 가능성 및 잔여 괴사조직 제거의 어려움으로 예후가 좋지 않다. 본 증례에서는 통상적인 치료와는 다르게 치근단 파절편의 근관치료가 이루어졌다. 하지만 재근관 치료시 치근파절 부위에서 저항성과 치근단 파절편 근관으로 접근의 어려움이 있었다. 따라서 추가적인 치료 없이, 치관부 파절편만의 수산화칼슘의 교체 및 정기적인 관찰이 시행되었으며, 최종적으로 근관 충전을 시행하였다. 정기적인 관찰결과 치근단 파절편에서 방사선학적 합병증은 관찰되지 않았으며, 일부 증례에서는 장기적으로 치근단 파절편의 수산화칼슘의 흡수 및 근관 협착 등의 양호한 치유 형태를 보였기에 보고하고자 한다.

외상 후 근관내로의 치조골 함입 (INVASION OF ALVEOLAR BONE INTO ROOT CANAL AFTER TRAUMATIC INJURY)

  • 임예진;김영진;김현정;남순현
    • 대한소아치과학회지
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    • 제38권4호
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    • pp.399-406
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    • 2011
  • 영구치의 외상성 손상은 전체 외상 환자 중 높은 빈도로 발생하며 사고의 대부분은 치근이 미완성되어 있는 시기에 발생하여 치수, 치주인대, 치조골, Hertwig 상피 근초(HERS)에 다양한 영향을 주게 된다. 손상 정도에 따라 치수의 완전한 재혈관화, 근관 석회화, 근관내 치조골 함입 등의 다양한 치유 양상을 나타내며, 치근단의 성장 정지 및 치수 괴사로 인한 염증성 치근 흡수 등의 합병증을 나타낼 수 있다. 본 증례에서는 미성숙 영구치 치근단을 가진 세 환아에서 외상에 의한 Hertwig 상피 근초의 손상으로 발치와 기저부에 존재하는 치근막 세포와 골세포의 치수강내로의 증식으로 인해 치근 발육 정지 및 근관내로의 치조골 함입을 나타내어 보고하고자 한다. 외상 후 Hertwig 상피 근초의 손상에 의한 근관내로의 치조골 함입 치유 양상은 치수는 정상적인 기능을 하는 것으로 생각되며, 유착 등의 합병증이 동반되지 않는 경우 특별한 치료를 필요로 하지 않으므로 감별 진단이 요구되며, 외상 받은 치아의 치료시 Hertwig 상피 근초에 대한 부가적인 외상을 가하지 않도록 주의해야 한다.

개에서 디스템퍼 바이러스와 톡소플라즈마의 혼합 감염 (Co-infection of Canine Distemper Virus and Toxoplasma gondii in a Dog)

  • 강홍원;강상철;양형석;배종희;김재훈
    • 한국임상수의학회지
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    • 제21권1호
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    • pp.80-82
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    • 2004
  • A 3 month-old male dog with clinical signs of anorexia, soft stool, ocular and nasal discharge, cough and respiratory distress was submitted to the Cheju National University for diagnosis. At necropsy, tan to pulp]e-red sublobar to lobar consolidations were presented in apical and cardiac lobe of lung. Histopathologically, severe diffuse bronchointerstitial pneumonia with necrotic bronchiolitis was noted in the lung. The demyelinating encephalitis and astrocytosis were presented in cerebellum and cerebrum. Numerous round, ovoid or cluster of tachyzoites were also identified in alveolar lumen, alveolar wall and cytoplasm of macrophages in the lung. The orgasnisms were demonstrated as Toxoplasma (T) gondii by immunohistochemistry. Intranuclear or intracytoplasmic eosinophilic inclusion bodies were seen in the glial cells of the cerebellum. Canine distemper virus (CDV) specific antigens were demonstrated in the cerebellum by the immunohistochemistry. In our knowledge, this is believed to be the first confirmed report of co-infection of CDV and T gondii in dog in Korea.

임상가를 위한 특집 1 - 재생 근관 치료 (Regenerative Endodontic Treatment)

  • 정일영
    • 대한치과의사협회지
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    • 제51권10호
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    • pp.542-550
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    • 2013
  • The immature teeth with apical periodontitis present considerable challenges to clinicians. Therefore, new treatment protocols have been suggested to overcome the problems encountered in traditional methods. Regenerative treatment (revascularization) is one of such methods. Many case reports on the revascularization of infected immature teeth have been published, and in most of them, immature teeth with even a periapical abscess continued root formation after the disinfection of the root canal system. We now believe that this continued root formation is not an exceptional incident. As a result, it appeared that apexification has been giving way to a revascularization technique, which is a new option, in treating necrotic immature teeth. These new methods appear to be based on the healing potential of stem cells. The potential of healing or regeneration of stem cells, which are located around teeth, seems to be greater than we thought before. This review summarizes the current techniques for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis.

Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report

  • Al-Tammami, Musaed Fahad;Al-Nazhan, Saad A.
    • Restorative Dentistry and Endodontics
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    • 제42권1호
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    • pp.65-71
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    • 2017
  • A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.