• Restorative Dentistry and Endodontics
• /
• v.36 no.3
• /
• pp.196-202
• /
• 2011

Objectives: The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in root canal exudates during root canal treatment (RCT) of nonvital, painful teeth. Materials and Methods: Patients scheduled for nonsurgical RCT were prospectively selected; the study was performed after obtaining informed consent from the patients and was approved by the Institutional Review Board for Clinical Research of Gangnam Severance Hospital, Yonsei University (3-2008-0118). Canal exudates samples were collected using sterilized paper points from teeth scheduled for RCT across three different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis (p < 0.05). Results: MMP-8 and SP levels in GCF were decreased during RCT (p < 0.0001), and they showed a weak positive correlation to each other (p < 0.05). Patients' subjective pain levels and the response from percussion test were significantly related to SP level. Conclusions: This study demonstrated that periradicular inflammation endodontic origin can elevate SP and MMP-8 levels in root canal exudates. Interestingly, SP level of canal exudates showed a possibility of being used as an indicator of pain due to periapical pathosis.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.3
• /
• pp.481-488
• /
• 2009

Buckley's formocresol was first introduced as a pulp medicament in 1904, and since 1930, it has been the treatment of choice for primary molar pulpotomies. Formocresol has fixation effect of pulp tissue and high clinical success rate. But side effect such as displacement and loss of permanent successor, amelogenesis imperfecta, cyst formation, mutation by general absorption, possibility of cancer induction have been reported. Of those, dentigerous cyst can form in the periradicular region after formocresol pulpotomy caused by an alteration of the reduced enamel epithelium, which result in fluid accumulation between the epithelium and the tooth crown. The present case describes a 6-year-old girl who had accidentally discovered in the panoramic radiograph a single, well-defined, radioluscent area enclosing the second unerupted mandibular premolar. The second left primary molar had been pulpotomizied 3 year before. Surgical treatment was carried out, the primary molar was extracted and cystectomy was performed under local anesthesia. In the extracted second primary molar, formocresol cotton pellet was left in the pulp chamber. Histologic study confirmed the suspected diagnosis of dentigerous cyst. This report present a case of dentigerous cyst associated with inadequate formocresol pulpotomized deciduous molar.

• Proceedings of the KACD Conference
• /
• 2001.05a
• /
• pp.247-251
• /
• 2001

;A dental developmental anomaly is defined as an isolated aberration in tooth form, caused by a disturbance or abnormality which occurred during tooth development. There are numerous types of dental anomalies, and a considerable variation in the extent of the defects occurs with each type. Teeth with these anomalies pose unique challenges. Since the defects are not always apparent clinically, they can confuse diagnosticians investigating the etiology of pulpal pathosis. When endodontic treatment is required, the defects often hinder access cavity preparation and canal instrumentation. Treatment planning also becomes more challenging, since the defects can create complicated periodontal problems, and the malformed teeth can be difficult to restore, particularly those weakened by endodontic therapy. Fusion is defined as the joining of two developing tooth germs resulting in a single large tooth structure. The incidence of fusion is < 1% in the Caucasian population, and it is believed that physical force or pressure produces contact of the developing teeth. Clinically and radiographically, a fused tooth usually appears as one large crown with at least partially separated roots and root canals. There may be a vertical groove in the tooth crown delineating the originally separate crowns. Dens invaginatus is a deep surface invagination of the crown or root that is lined by enamel. Teeth in both maxillary and mandibular arches may be affected, but the permanent maxillary lateral incisor is the tooth most commonly involved. Studies have revealed an incidence ranging from 0.25% to as high as 10%. The invagination ranges from a slight pitting to an anomaly occupying most of the crown and root. The invagination frequently communicates with the oral cavity, allowing the entry of irritants and microorganism either directly into pulpal tissues or into an area that is deparated from pulpal tissues by only a thin layer of enamel and dentin. This continuous ingress of irritants and the subsequent inflammation usually lead to necrosis of the adjacent pulp tissue and then to periapical or periodontal abscesses. If the invagination extends from the crown to the periradicular tissue and has no communication with the root canal system, the pulp may remain vital. Recommended treatment of fused tooth and dens invaginatus has been reported in the endodontic literature. This case report describes the endodontic treatment of a maxillary laterl incisors having fused crown and dens invaginatus.natus.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.39 no.2
• /
• pp.181-185
• /
• 2012

Dens invaginatus is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. The most widely used classification of dens invaginatus is the system described by Oehler categorizes invaginations into three classes as determined by how far they extend radiographically from the crown into the root. Oehler's classification type III is that the invagination extends through the root and communicates with the periodontal ligament. There is usually no communication with the pulp. In Type III lesions, any infection within the invagination can lead to an inflammatory response within the periodontal tissues giving rise to a 'peri-invagination periodontitis'. In the cases presented here, we treated two patients who were refered for 'peri-invagination periodontitis' on maxillary lateral incisor with Oehler's type III invagination by different approaches each, and they have shown satisfactory outcomes. Although there are several approaches to the management of dens invaginatus, the most important objective is to preserve the health of the pulp, which can be achieved by early diagnosis and the prophylactic treatment regardless of severity. When disease has developed, decision has to be made whether to treat the invagination and the pulp separately.

• Restorative Dentistry and Endodontics
• /
• v.25 no.1
• /
• pp.1-16
• /
• 2000

It is difficult to treat the endodontic apical perforation successfully. In this study, we hypothesized that the application of PDGF-BB and IGF-I into periapical perforation site may accelerate periapical healing and lead to bone deposition. And the specificity of osteonectin in periapical healing was investigated. The experiments were performed on the upper and lower 51 premolar teeth of 4 beagle dogs. The pulp chamber of each tooth was opened and the dental plaque was inserted into the canal for developing the periapical lesion for 5 weeks. Then, the roots were artificially perforated at the apex with the number 4 profile of .06 taper. In each step, standard periapical radiographs were taken to compare the size of lesion each other. The radiographs were scanned and analyzed by image analysis system. The mean and standard deviation of periradicular radiolucency ratios were calculated in each group. ANOVA was used for comparison. 51 premolars were grouped into 3 groups; control group, calcium hydroxide-treated group and calcium hydroxide plus growth factors-treated group. In the control group, the apical perforations were not sealed and obturated with gutta-percha and ZOE sealer by lateral condensation technique. In the experimental groups, the apical perforation were sealed with calcium hydroxide and with/without $4{\mu}g$ of PDGF-BB & IGF-I in cellulose gel and obturated by lateral condensation technique. Fluorescent bone markers were used to measure new bone formation. Following 2, 4, 12 weeks after experiment the dogs were sacrificed and histologic sections were prepared. Each tooth block including periapical lesion was sectioned mesiodistally. One half of the sections were decalcified with 6% nitric acid and processed by standard paraffin embedding technique. The sections were stained by hematoxylin and eosin, and immunostained for osteonectin. Histomorphometrical measurement of neoformed bone was performed using a light microscope. And the other half of the sections were prepared by undecalcified preparation, and confocal laser scanning microscopic investigations were done.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.40 no.1
• /
• pp.31-38
• /
• 2024

Dens in dente is a developmental anomaly resulting from infolding of the enamel organ into dental papilla prior to calcification of dental tissue. The pulpal tissue of the tooth can be vulnerable for bacterial invasion through direct exposure to the oral cavity or through defective enamel and dentin of the infolding part, thereby increasing the possibility of pulpal necrosis and subsequent apical periodontitis. Treatment planning of teeth with dens invaginatus may be difficult due to the complex root canal morphology. Therefore, thorough knowledge of anatomical variations of dens invaginatus is of great importance for proper treatment planning. The focus of this case report is on Oehler's type II and III dens invaginatus. The infolding of type III dens invaginatus extends beyond the crown and CEJ. Bacterial invasion through the infolding can easily cause inflammation of the pulpal and periradicular tissue. This case report presents endodontic treatment of type II and III dens invaginatus with the aid of CBCT.