• Journal of the korean academy of Pediatric Dentistry
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• v.48 no.1
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• pp.77-94
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• 2021

The purpose of this study was to investigate the three-dimensional characteristics of mesiodens using Cone-beam Computed Tomography(CBCT) and analyze the factors affecting complications and anesthetic methods of extraction. This study evaluated 602 mesiodens of 452 patients who underwent extraction of mesiodens at the department of Pediatric Dentistry in Seoul National University Dental Hospital between 2017 and 2019. The ratio of mesiodens patients over total patient per year was gradually increased over the past 20 years. Mesiodens with labio-palatally horizontal direction while root directing labial were the most common among the mesiodens with horizontal direction. Mesiodens were the most common at the cervical side of the adjacent teeth(37.0%) and mesiodens located in the near-palatal side were observed about 3.83 times higher than the far-palatal side. Most of the mesiodens(82.1%) were in contact with adjacent permanent teeth on all three sides of the CBCT and 46.2% of mesiodens had curved roots. The patient's age, vertical position, presence of complications, and proximity showed a significant difference in the selection of general anesthesia among anesthetic methods. The direction and vertical position of mesiodens had a significant effect on complications. These results provide a better understanding of mesiodens for establishing an accurate diagnosis and treatment plan.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.2
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• pp.95-98
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• 2017

Due to hypodontia, poor oral hygiene, and significantly more prevalent periodontal disease, patients with Down syndrome show higher incidence of edentulism. Oral rehabilitation of such patients is imperative but challenging as high rates of prosthesis failure are reported due to malocclusion, high masticatory force, and parafunctional habits. As CAD/CAM(Computer-Aided Design and Computer Aided Manufacturing) is the recent trend in prosthodontics, this report discusses the application of CAD/CAM in a Down syndrome patient. A 25-year-old patient with Down syndrome was presented to the Department of Pediatric Dentistry, Yonsei University Dental Hospital for oral examination. 5 maxillary teeth were missing, 3 were fully impacted, and 4 had grade III mobility. The patient underwent general anesthesia for extraction of impacted and mobile teeth, implant surgery, and final impression for prosthesis. Afterwards, CAD/CAM was used to design and manufacture a 10-unit zirconia bridge. However the bridge was fractured after 18 months due to the patient's bruxism and high masticatory force. Final impression taking, bite registration, cast fabrication, cast scanning, and prosthesis designing were not needed as CAD/CAM data remained. Previous CAD/CAM design was used to remanufacture the zirconia bridge. Down syndrome patients have malocclusion, high masticatory force, and parafunctional habits which increase the possibility of prosthesis fracture. CAD/CAM is beneficial for Down syndrome patients as previous digital records can be utilized for prosthesis repair or remake. In detail, application of CAD/CAM in remanufacturing decreases patient's discomfort of impression taking, shortens and simplifies dental laboratory procedures, and reduces clinician's effort of taking detailed final impressions or accurate bite registration. In conclusion, oral rehabilitation using CAD/CAM provides not only satisfactory levels of comfort, stability, and esthetics, but also easier repair or remake compared to conventional prostheses.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.3
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• pp.313-319
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• 2016

Wolf-Hirschhorn syndrome (WHS), associated with the deletion of the short arm of chromosome 4, causes multiple congenital malformations. Patients suffer from various deformities, including mental and growth disorders, epilepsy, hypotonia, congenital heart defects, and atypical craniofacial features. The "Greek warrior helmet appearance" is the most characteristic feature, with a prominent glabella, high arched eyebrow, broad nasal bridge, and hypertelorism. Cleft lip with or without cleft palate is observed in 30% of patients. Dental structure anomalies also exist including multiple tooth agenesis and over-retained primary molars caused by MSX1 gene impairment, and cone-shaped and taurodontic teeth. This case, a 9-year-old girl with WHS, showed intellectual disability, delayed growth development, previous occurrence of seizures, otitis media, and the typical facial features of WHS. Dental findings included multiple congenital missing teeth, over-retained primary teeth, and severe caries on the primary molars. Dental treatments were performed under general anesthesia. This report documents the characteristics of WHS, including general and oral features, and discusses the importance of oral hygiene and preventive dental management.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.2
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• pp.199-205
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• 2012

Although the stainless steel crowns have been recognized as the most effective and durable form of restoration for primary molars, they have been regarded by many dentists as having definite demerits such as invasive nature of procedural complexity and behavioral aspects of children. As an alternative to conventional technique of stainless steel crown restoration, the Hall technique was first introduced in 1988, which is characterized by just pushing the pre-contoured, cement filled crown form onto the abutment molar with no local anesthesia, no caries removal, no tooth preparation. According to several reports, this can slow, arrest, or even reverse the progress of caries. In addition, its atraumatic feature gives less discomfort and stress to children than conventional one, which is thought excellent especially in younger children. Also, It has been reported to be effective and acceptable to dentist, child patients and their parents. In this case study, three children with age of 4 years 5 months, 4 years 10 months, 6 years 4 months were treated with stainless steel crowns using Hall technique on first primary molar respectively. The teeth were free from pulpal, periapical pathology. After follow up of about 3 to 6 months period, the results showed clinically successful outcomes without any marked complication in pulp, tooth or soft tissue till now. But, it should be kept in mind that this technique is not proper to every child, every carious molar, or every dentist. Thorough distinction of indicated cases and continuous follow-up check is highly required. Conclusively, Hall technique might be an effective and realistic minimally invasive alternative for the carious primary molars especially in younger or disabled children, despite potential doubts on its efficacy and some definite limitations.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.23-28
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• 2019

People with intellectual disabilities (ID) usually have poor oral health status and are susceptive to have more caries than general populations. Even when the patients get regular dental treatment, their dental conditions are usually not good for some additional factors. In this presentation, we show dental follow-up care of two patients who have multiple caries. The first case is a 16-year-old boy who has a unilateral facial paralysis with ID. As the lack of controlling of the muscles resulted in interfering with the self-cleansing, it would be associated with a higher incidence on the affected side. Endodontic treatment and caries treatment as restoration was performed. Due to loss of posterior occlusal support on right side, we planned to recover the right posterior relationship by full coverage restorations. In second case, a 20-year-old boy has been on a long-term follow up. Caries treatment, periodontal treatment, and prosthetic treatment were performed under several times of general anesthesia. He has been treated more than 8 years and gets a regular check at 1-month intervals, however, high dental caries susceptibility has been retained. These cases present that dentists should perform more aggressive treatment and be involved in providing better maintenance of patients with intellectual disabilities with multiple caries in adolescence. In other words, it is necessary to suggest a customized preventive strategy for patients with ID.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.1
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• pp.38-42
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• 2014

A tracheostomy tube serves as airway management for patients whose respiration is impeded due to inflammation, tumor, or traumatic events. If the patients who have tracheostomy tube, visit dental clinic for dental treatments, we should consider the underlying general condition of patients and then make treatment plans according to their state. A 22-Year old male patient, who had tracheostomy tube on his neck, came to our department for comprehensive dental treatment. Mild mental retardation was observed and he was taking anti-convulsant drugs for the prevention of epileptic seizure. Multiple advanced dental caries, hopeless teeth, and impacted third molars were also observed by clinical and radiographic examination. Due to the risk of epileptic seizure and low cooperativity to tolerate the treatment, general anesthesia was recommended by physician, and the anti-convulsant drug was administrated during procedure. In this case, we aimed to report the multidisciplinary approach for the dental treatment of patient having a tracheostomy tube.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.379-388
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• 2019

Background: In dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar. Methods: We recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use. Results: In this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05). Conclusion: The postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.1
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• pp.27-33
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• 2017

Purpose: Gastrostomy is commonly used procedures to provide enteral nutrition support for severely handicapped patients. This study aimed to identify and compare outcomes and complications associated with percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG). Methods: A retrospective chart review of 51 patients who received gastrostomy in a single tertiary hospital from January 2000 to May 2016 was performed. We analyzed the patients and the complications caused by the procedures. Results: Among the 51 patients, 26 had PEG and 25 had SG. Four cases in the SG group had fundoplication for gastroesophageal reflux disease. PEG and SG groups were followed up for an average of 29 months and 44 months. Major complications occurred in 19.2% of patients in the PEG group and 20.0% in the SG group, but significant differences between the groups were not observed. Minor complications occurred in 15.4% of patients in the PEG group and 52.0% in the SG group. Minor complications were significantly lower in the PEG group than in the SG group (p=0.006). The average use of antibiotics in the PEG and SG groups was 6.2 days and 15.7 days (p=0.002). Thirteen patients died of underlying disease but not related to gastrostomy, and only one patient died due to complications associated with general anesthesia. Conclusion: The duration of antibiotics use and incidence of minor complications were significantly lower in the PEG group than those in the SG group. Early PEG could be recommended for nutritional supports.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.1
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• pp.31-37
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• 2016

Background: The definition of evidence-based clinical practice guidelines (CPGs) is "statements that are systematically developed to assist in the doctors' and patients' decision-making in certain situations." This study aims to establish the concept of evidence-based CPGs and investigate the development status to seek measures to apply evidence-based methods to CPG development for dental sedation in Korea. Methods: The study conducted systematic searching methods based on evidence-based CPGs. Articles published between 1995 to 2015 were searched on a Korean database and the international database PubMed. The search was based on keywords related to four subjects (dentistry, clinical practice, guideline, recommendation). Two authors independently reviewed the searched articles to determine their analysis inclusion and the convergence stages, and to arrive at a conclusion through discussion. Results: A total of 65 Korean CPGs were included. There were 51 medical guidelines, of which seven were dental and seven were Oriental medicine. Conclusions: As a basic direction for the development of evidence-based CPGs, this work suggests the following: increased awareness; consensus on the need to supply evidence-based development methods; education, computerization, and systematic observation of evidence-based CPG development methods; continuous research development and distribution of CPGs; and creation of a database for Korean clinical dentistry practice outcomes

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.295-304
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• 2022

Background: The first dental experience is vital in molding a child's attitude towards dentistry and dental outcomes. The cooperation of a child during dental treatment is essential to render successful and high-quality treatment. Dental anxiety is common in children undergoing dental treatment. The success of pediatric dental treatments and patient comfort depends on controlling the levels of patient anxiety in clinical settings. This study aimed to compare the effectiveness of the recorded maternal voice and virtual cognitive tool (Roogies application) in the management of pediatric dental patients. Methods: The study was carried out with children aged of 4-7 years [n = 80, (40 male and 40 female)], without any past dental history, and were randomly allocated into two groups. After informed consent was obtained, the entire procedure was explained to the parents. Anxiety was assessed pre-, during, and post-treatment by measuring pulse rate, and recording Venham Picture Test (VPT) scores. Group A [n = 40; 20 boys and 20 girls)] was provided with a headphone that played a recorded maternal voice. Group B [n = 40; 20 boys and 20 girls)] was administered the virtual cognitive tool. After conditioning the children, oral prophylaxis was performed for both groups. A comparative evaluation was conducted for each treatment session. Results: The intra-group comparison of VPT scores and heart rate for patients assigned to the recorded maternal voice showed a statistically significant difference in dental anxiety (P-value ≤0.001). Conclusion: This study demonstrated that a reduction in dental anxiety with the help of recorded maternal voice forms an important component of non-pharmacological behavior management. Alternatively, the use of a virtual cognitive tool as an anxiety-reducing technique can also be advocated.