• Restorative Dentistry and Endodontics
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• v.40 no.2
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• pp.155-160
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• 2015

Objectives: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Materials and Methods: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

• Imaging Science in Dentistry
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• v.52 no.2
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• pp.209-217
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• 2022

Purpose: The aim of this study was, firstly, to determine the concordance of ultrasonographic and histopathological diagnoses in patients in whom apical resection was already indicated. Secondly, this study aimed to determine whether lesions were periapical granulomas or cysts, and to compare them after root canal treatment using ultrasonography and periapical radiographs. Materials and Methods: In the first stage of the study, ultrasonographic and histopathologic diagnoses of 10 lesions were compared. Secondly, the periapical radiographs and ultrasonographic images of 44 lesions were measured. The presence of internal vascularity was determined by ultrasonographic color and power Doppler modes. Follow-up examinations of healing after root canal treatment were performed using ultrasonography and periapical radiographs, and these modalities were compared. Results: In the periapical granuloma and cyst groups, the measurement values decreased for all variables. There was no significant difference in the dimensional changes of lesions between the 2 groups, and ultrasonography and periapical radiographs were compatible. The pre-diagnoses were compared with histopathological diagnoses and were found to be compatible. Conclusion: The ultrasonographic color and power Doppler techniques could be an effective method for diagnosing periapical lesions as cysts or granulomas. After root canal treatment of granulomas and cysts, the dimensional shrinkage and healing patterns appear to be similar. Ultrasonography and periapical radiographs were consistent in terms of dimensional comparisons, and ultrasonography may be an alternative method for follow-up of the healing of periapical lesions.

• Restorative Dentistry and Endodontics
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• v.21 no.1
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• pp.339-352
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• 1996

Many dentists have been taken an interest in restoration of severly damaged teeth after endodontic treatment and it is a true that there are lots of studies about it. In these days, although we have used Para-Post, pins, threaded steel post, cast gold post and core, and so on, as a method of restoration frequently, it has been in controversy with the effects of them on the teeth and surrounding periodontal tissue. In this study, we assume that the crown of the upper 1st premolar was severly damaged, and after the root canal therapy, two most common types of restoration were carried out ; 1) coronal-radicular amalgam restoration, 2) after setting up the Para-Post, restore with amalgam core and gold crown. After restoration, in order to present the concentration of stress at internal portion of the tooth and the surrounding periodontal tissue, we doveloped a 2-dimensional finite element model of labiopalatal section, then loaded forces from 2 long perpendicular to the lingual incline of buccal ridge an the middle point, parallel to the long direction axis of tooth at the fossa-were applied. The analyzed results were as follows : 1. Stress of the normal first premolar was concentrated on the most weakest anatomical structure, that is, cervical area, and no stress on the bifurcated area of the canal. 2. Crown restoration after root canal therapy causes large stress concentration on the bifurcated area of the canal. This stress concentration has larger value in case of lateral movement of mandible, and there are decrease in the stress concentration compared with natural tooth. 3. Coronal-radicular amalgam restoration method transports more stress to the tooth structure than restoration using Para-Post. 4. There are more stress concentration around Para-Post in the case of lateral movement, and we have more favo rable result when restored with Para-Post. 5. Generally, stress in the lateral movement is larger than stress in the perpendicular load.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.379-390
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• 1998

In endodontic treatment, calcium hydroxide has been used as intracanal medicament. Although calcium hydroxide should be removed thoroughly before permanent root canal filling, no effective method for its removal has been reported. Because of irregularity of root canal walls, root curvatures and anatomic variations, it is insufficient to remove calcium hydroxide from the canal wall only by mechanical instrumentation Considering the chemical effects of irrigants on calcium hydroxide, $Ca^{++}$ dissolving effect from two calcium hydroxide products is investigated, using dis- tilled water, NaOCl, citric acid and EDTA. Vitapex$^{(R)}$ 0.1g and calcium hydroxide 0.03g were dissolved in distilled water, 5% NaOCl, 50% citric acid and 17% EDTA respectively, at 1, 3, 5, 10min. time interval. The solution was filtered using filter paper(pore size $5{\mu}m$) and $Ca^{++}$ concentration was determined by ion chromatography. The result were as follows : 1. Distilled water, NaOCl, citric acid and EDTA abstracted more $Ca^{++}$ from calcium hydroxide than Vitapex$^{(R)}$ except NaOCl 1, 5, 10 time interval. 2. EDTA and citric acid abstracted more $Ca^{++}$ from Vitapex$^{(R)}$ and calcium hydroxide than distilled water or NaOCl. The overall result support the view that water-based calcium hydroxide product is easily removed than oil-based calcium hydroxide product and EDTA, citric acid are more effective in $Ca^{++}$ elution than NaOCl or distilled water.

• The Journal of the Korean dental association
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• v.51 no.10
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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.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.659-664
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• 2004

Dens invaginatus is a developmental variation resulting from invasination of the tooth crown of root before calcification. Teeth most affected are maxillary lateral incisors. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Root canal therapy may present severe problems because of the complex anatomy of the teeth. So, the early diagnosis of such malformation is crucial and a preventive approach has been recommended. This report describes three cases of dens invaginatus treatment.

• Journal of Periodontal and Implant Science
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• v.43 no.3
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• pp.136-140
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• 2013

Purpose: The aim of this study was to identify a role for endodontic intervention in enhancing the regenerative potential of the periodontal ligament when combined with periodontal treatment in seriously involved teeth with a secondary endodontic component. Methods: Patients who exhibited radiolucency extending to the periapical region, abnormal electric pulp testing values, and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Intentional root canal treatment was applied to those teeth in which the apical lesions were presumed to communicate with those of the periodontal lesion of the teeth that remained vital. In all three selected cases, regenerative periodontal therapy incorporating either bone graft or guided tissue regeneration was instituted 3 months after the endodontic intervention. Results: Remarkable enhancement in radiographic density was noticeable around the affected teeth as evidenced by changes in radiopacity. There was a significant reduction in the probing pocket depth and gain in the clinical attachment level. Chewing discomfort gradually disappeared from the commencement of the combined treatment. Conclusions: An intentional endodontic intervention may be a worthwhile approach for the sophisticated management of teeth suffering from serious attachment loss and alveolar bone destruction with concomitant secondary endodontic involvement.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.3
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• pp.264-269
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• 2015

Although sodium hypochlorite is the most frequently used canal irrigant during endodontic treatment, its complications are not as well recognized as its effectiveness. This report demonstrates that sodium hypochlorite extrusion during endodontic treatment can cause severe complications. A 5-year-old boy experienced immediate pain and swelling, ecchymosis in surrounding tissues, and profuse bleeding from the root canal during endodontic treatment, because of accidental extrusion of sodium hypochlorite. The patient was hospitalized, and analgesics and antibiotics were prescribed. Accidental extrusion of the irrigating solution occurs more frequently in teeth with immature apices, root resorption, and apical perforations; therefore, caution is needed. When such complications occur, proper management and medications are needed.

• Restorative Dentistry and Endodontics
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• v.49 no.2
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• pp.13.1-13.7
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• 2024

Chronic osteomyelitis with proliferative periostitis, known as Garre's osteomyelitis, is a type of osteomyelitis characterized by a distinctive gross thickening of the periosteum of bones. Peripheral reactive bone formation can be caused by mild irritation or infection. Garre's osteomyelitis is usually diagnosed in children and young adults, and the mandible is more affected than the maxilla. The following is a case report of a 12-year-old female patient with Garre's osteomyelitis of the mandible due to an infection of a root canal-treated tooth. Without surgical intervention, the patient's symptoms were relieved through nonsurgical root canal re-treatment with long-term calcium hydroxide placement. A cone-beam computed tomography image obtained 6 months after treatment completion displayed complete healing of the periapical lesion and resolution of the peripheral reactive buccal bone. Due to the clinical features of Garre's osteomyelitis, which is characterized by thickening of the periosteum, it can be mistaken for other diseases such as fibrous dysplasia. It is important to correctly diagnose Garre's osteomyelitis based on its distinctive clinical features to avoid unnecessary surgical intervention, and it can lead to minimally invasive treatment options.

• Imaging Science in Dentistry
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• v.52 no.3
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• pp.245-258
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• 2022

Purpose: This study compared the root canal anatomy between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) images before and after biomechanical preparation and root canal filling. Materials and Methods: Isthmus-containing mesial roots of mandibular molars(n=14) were scanned by micro-CT and 3 CBCT devices: 3D Accuitomo 170 (ACC), NewTom 5G (N5G) and NewTom VGi evo (NEVO). Two calibrated observers evaluated the images for 2-dimensional quantitative parameters, the presence of debris or root perforation, and filling quality in the root canal and isthmus. The kappa coefficient, analysis of variance, and the Tukey test were used for statistical analyses(α=5%). Results: Substantial intra-observer agreement (κ=0.63) was found between micro-CT and ACC, N5G, and NEVO. Debris detection was difficult using ACC (42.9%), N5G (40.0%), and NEVO (40%), with no agreement between micro-CT and ACC, N5G, and NEVO (0.05<κ<0.12). After biomechanical preparation, 2.4%-4.8% of CBCT images showed root perforation that was absent on micro-CT. The 2D parameters showed satisfactory reproducibility between micro-CT and ACC, N5G, and NEVO (intraclass correlation coefficient: 0.60-0.73). Partially filled isthmuses were observed in 2.9% of the ACC images, 8.8% of the N5G and NEVO images, and 26.5% of the micro-CT images, with no agreement between micro-CT and ACC, and poor agreement between micro-CT and N5G and NEVO. Excellent agreement was found for area, perimeter, and the major and minor diameters, while the roundness measures were satisfactory. Conclusion: CBCT images aided in isthmus detection and classification, but did not allow their classification after biomechanical preparation and root canal filling.