• Restorative Dentistry and Endodontics
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• v.42 no.4
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• pp.290-300
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• 2017

Objectives: This study investigated the removal efficacy and cytotoxicity of a newly developed calcium hydroxide paste (cleaniCal, Maruchi) using N-2-methyl-pyrrolidone (NMP) as a vehicle in comparison with ApexCal (Ivoclar Vivadent) and Calcipex II (Nishika), which use different vehicles such as polyethylene glycol and propylene glycol, respectively. Materials and Methods: Thirty maxillary premolars with oval-shaped canals were divided into 3 groups and the teeth were filled with one of the pastes. After removal of the paste, micro-computed tomographic (${\mu}$-CT) imaging was obtained to assess the volume of residual paste in the root canal of each tooth. The teeth were then split longitudinally and the area of the paste-coated surface was evaluated by stereomicroscopy. The cytotoxicity of each product was assessed using an agar overlay assay. The effect of each vehicle on cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed using one-way analysis of variance and Tukey's tests to detect any significance (p < 0.05). Results: In the ${\mu}$-CT and stereomicroscopic analysis, cleaniCal exhibited less remnants of medicament than ApexCal and Calcipex. cleaniCal showed a higher cytotoxicity than the other pastes in the agar overlay assay. Furthermore, NMP exhibited lower cell viability compared to the other vehicles. Conclusions: cleaniCal showed better removal efficacy compared to the other products. However, clinicians should be aware of the higher cytotoxicity of the NMP-based material and consider its possible adverse effects on periradicular tissue when it is overfilled.

• Proceedings of the KACD Conference
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• 2002.11a
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• pp.720-720
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• 2002

A number of investigations have shown that the presence of bacteria is prerequisite for developing pulpal and/or periradicular pathosis. Depending on the stage of pulpal pathosis, various species of bacteria can be cultured from infected root canals. Kakehashi et al. showed that exposure of pulpal tissue in germ-free rats was characterized by minimal inflammation and dentinal bridging while exposure of pulpal tissue in conventional rats with normal oral flora was characterized by pulpal necrosis, chronic inflammation, and periapical lesions. Currently used methods of cleaning and shaping, especially rotary instrumentation techniques, produce a smear layer that covers root canal walls and the openings to the dentinal tubules. The smear layer contains inorganic and organic substances that include fragments of odontoblastic processes, microorganisms, their by products and necrotic materials. Because of its potential contamination and adverse effect on the outcome of root canal therapy, it seems reasonable to suggest removal of the smear layer for disinfection of the entire root canal system. Presence of this smear layer prevents penetration of intracanal medications into the irregularities of the root canal system and the dentinal tubules and also prevents complete adaptation of obturation materials to the prepared root canal surfaces. Removal of the smear layer by an intracanal irrigant and placement of an antibacterial agent in direct contact with the content of dentinal tubules should allow disinfection of this complex system and better outcome for the root canal therapy. A new solution, which was a mixture of a tetracycline, an acid, and a detergent(MTAD), was developed in the Department of Endodontics, Dental School. Lorna Linda University, USA. It has been demonstrated that MTAD was an effective solution for the removal of the smear layer and does not significantly change the structure of the dentinal tubules when used as a final irrigant in conjunction with 1 % NaOCl as a root canal irrigant. Studies are in progress to compare the anti- microbial properties of this newly developed solution with those of sodium hypochlorite and EDTA that are currently used to irrigate the root canals and remove the smear layer from the surfaces of instrumented root canals.canals.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.2
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• pp.335-340
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• 2007

Primary teeth and the permanent successor must be understood as interdependent units, where each one of them interacts with and depends upon the other. The spread of pulpal inflammation in primary teeth to the periradicular tissues can lead to early eruption, enamel hypoplasia or hypocalcification, developmental arrest of permanent successor. Also the periapical inflammation cause permanent tooth displacement in various direction. We describe here two clinical cases of displaced permanent successor caused by periapical lesion of mandibular primary molar in children.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.640-646
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• 2009

In case of luxation injuries, loss of tooth vitality is common. And in case of trauma in the immature permanent teeth, precise diagnosis of pulp necrosis is very difficult. That is because limitation in distinguishing between normal dental papilla in immature permanent teeth, transient apical breakdown(TAB), which is part of normal healing process, and apical radiolucency in pulp necrosis. Especially in non-vital immature permanent tooth, the treatment is complex and requires long time. This clinical case report shows that severely infected immature teeth with periradicular periodontitis can undergo healing and apexogenesis or maturogenesis with no definative treatment or after conservative treatment. In the cases reported, we emphasize the considerable power of regeneration of the tooth, probably due to its large number of undifferentiated mesenchymal cells in the dental papilla, pulp tissue, periodontal ligament tissues. Thus, when endodontic treatment in immature permanent teeth, over instrumentation is not recommend for preserve the apical vital stem cells.

• Journal of the korean academy of Pediatric Dentistry
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• v.40 no.3
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• pp.216-222
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• 2013

Paradigm shift in management of infected immature permanent teeth has occurred. The new concept of the treatment includes minimal or no intracanal instrumentation, disinfection with triple antibiotic paste and sealing with mineral trioxide aggregate. This regenerative endodontic treatment promotes differentiation of periradicular stem cells that induce regeneration of vital tissue and continuation of root formation. Thorough disinfection and three-dimensional scaffold are important in this new concept of the treatment. Platelet-rich fibrin has been reported as 'new scaffold' instead of blood clot, which had been used in the past. Triple antibiotics can be used to disinfect the tooth but may lead to complications including discoloration. Three cases of infected immature permanent tooth caused by dens evaginatus fracture are presented. After removal of necrotic pulp and thorough intracanal irrigation, only platelet-rich fibrin was applied to the root canal in the first case. In the other cases, topical antibiotics was used for disinfection and platelet-rich fibrin for scaffold. In all the cases, the opening was sealed with mineral trioxide aggregate. All the cases showed proper healing of inrabony lesion and some lengthening of root. According to these cases, regenerating vital tissue of the infected immature permanent tooth can be achieved with disinfection and application of platelet-rich fibrin.

• Restorative Dentistry and Endodontics
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• v.25 no.1
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• pp.63-70
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• 2000

The properties of ideal retrograde filling materials include the ability to seal the root canal system in three dimensions and well tolerated by periradicular tissues. Biocompatibility testing has been done mainly with cytotoxicity tests using cell culture. Little attention has been paid to the potential adverse influence on the inflammatory and immune reaction in the periapical tissue. The purpose of this study was to investigate the effects of retrograde filling materials on human mononuclear cells in vitro. Freshly mixed and set specimens from six materials (Z100, Tetric Ceram, Fuji II, Fuji II LC, F2000, Compoglass Flow, and ZOE) were eluated with cell culture medium for 24 hours. Cytotoxic effects of these extracts were evaluated by determining cell viability and enzyme activity using MTT and lactate dehydrogenase (LD). The production of inflammatoy bone resorptive cytokine, TNF-${\alpha}$ was measured from human peripheral blood mononuclear cells (PBMC) exposed to the extracts by means of Endogen Human TNF-${\alpha}$ ELISA kit (Wobrun, MA, U.S.A.). Eluates and diluted (1 : 10) eluates with cell culture medium from freshly mixed Fuji IT had cytotoxic effects on mononuclear cells using MTT and LD. However, eluates from set Fuji II were not cytotoxic. Eluates form set ZOE exhibited cytotoxicity with LD test. TNF-${\alpha}$ levels were high in eluates from freshly mixed Fuji II and Z100. Diluted eluates from freshly mixed Z100 and F2000 stimulated the production of TNF-${\alpha}$. However, there were no significant difference in TNF-${\alpha}$ levels compared to controls. These results indicate that some materials could possibly stimulate bone resorption in the periapical tissue by means of the production of bone resorptive cytokine.

• Restorative Dentistry and Endodontics
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• v.29 no.6
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• pp.498-503
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• 2004

The properties of ideal root canal sealers include the ability of sealing the total root canal system and no toxic effects to periradicular tissues. Cytotoxicity test using cell culture is a common screening method for evaluation of the biocompatibility of root canal sealers. The purpose of this study was to investigate the cytotoxic effect of newly developed resin-based sealer (Adseal 1, 2, and 3) comparing with those commercial resin-based sealers (AH26 and AH Plus), ZOE-based sealers (Tubliseal EWT, Pulp Canal Sealer EWT) and calcium hydroxide based sealer (Sealapex), An indirect contact test of cytotoxicity by agar diffusion was performed according to the international standard ISO 10993-5. L929 fibroblast cells were incubated at $37^{\circ}C$ in humidified 5% $CO_2-containing$ air atmosphere. The freshly mixed test materials were inserted into glass rings of internal diameter 5 mm and height 5 mm placed on the agar. After the 24 hrs incubation period, the decolorization zones around the test materials were assessed using an inverted microscope with a calibrated screen. A Decolorization Index was determined for each specimen. Adseal 1. 2, and 3 did not exert any cytotoxic effects, whereas AH26, AH Plus, Tubliseal EWT, Pulp Canal Sealer EWT, and Sealapex produced mild cytotoxicity.

• The korean journal of orthodontics
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• v.51 no.3
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• pp.199-216
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• 2021

Objective: The aim of this systematic review was to evaluate the complications and side effects associated with the clinical use of orthodontic miniscrews by systematically reviewing the best available evidence. Methods: A survey of articles published up to March 2020 investigating the complications associated with miniscrew insertion, in both the maxilla and mandible, was performed using 7 electronic databases. Clinical studies, case reports, and case series reporting complications associated with the use of orthodontic miniscrew implants were included. Two authors independently performed study selection, data extraction, and risk-of-bias assessment. Results: The database survey yielded 24 articles. The risk-of-bias assessment revealed low methodological quality for the included studies. The most frequent adverse event reported was root injury with an associated periradicular lesion, vitality loss, pink discoloration of the tooth, and transitory loss of pulp sensitivity. Chronic inflammation of the soft tissue surrounding the miniscrew with mucosal overgrowth was also reported. The other adverse events reported were lesion of the buccal mucosa at the insertion site, soft-tissue necrosis, and perforation of the floor of the nasal cavity and maxillary sinus. Adverse events were also reported after miniscrew removal and included secondary bleeding, miniscrew fracture, scars, and exostosis. Conclusions: These findings highlight the need for clinicians to preliminarily assess generic and specific insertion site complications and side effects.

• Restorative Dentistry and Endodontics
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• v.46 no.3
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• pp.31.1-31.13
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• 2021

Objectives: To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods: The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results: Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions: Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE.

• Restorative Dentistry and Endodontics
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• v.31 no.2
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• pp.86-95
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• 2006

The purpose of this clinical study is to assess whether calcium hydroxide as an intracanal medication affects post-treatment pain in teeth especially odontogenic pain which comes from inflammation of the pulp and periradicular tissues when compared with no intracanal medication. From 213 patients who has been treated 237 root canals due to significant pain (moderate-to-severe) we recorded their age, sex, treated tooth, degree of pain, pre-operative states of the tooth. We classified patients into 2 test group; Group 1 (not gain intracanal $Ca(OH)_2$), Group 2 (gain intracanal $Ca(OH)_2$). Through the survey from the patients, we let them write down the occurrence and degree of post-treatment pain in 4hours, 2days, 7days after treatment as none, mild, moderate or severe. The followings were evaluated ; the overall incidence of flare-ups, the overall incidence of post-treatment pain in each group at each time period , the incidence of post-treatment pain in each group at each time period as related to pre-operative states of the teeth These were compared statistically with Chi-square analysis (p < 0.05). Under the condition of this investigation, no difference was observed in the incidence of post-treat-ment pain between the two groups. Therefore, $Ca(OH)_2$ as intracanal medication had no effect on preventing or decreasing the post-treatment pain.