• Journal of Dental Anesthesia and Pain Medicine
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• 제23권3호
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• pp.135-141
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• 2023

Background: The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar. Methods: Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min. Results: Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05). Conclusion: According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권5호
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• pp.262-269
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• 2023

Objectives: Anterior maxillary sinus wall fractures are common in all types of maxillofacial trauma. They can result in various complications, including injury to the surrounding nerves. Owing to its anatomy, trauma to the maxillary antrum can result in injury to the middle superior alveolar nerve (MSAN) and the anterior superior alveolar nerve (ASAN). The purpose of this study is to evaluate neurosensory deficits (NSD) present in maxillary gingiva, incisors, and premolars after injury to the anterior wall of the maxillary antrum. Materials and Methods: This prospective study was conducted among 39 patients sustaining unilateral fractures of the anterior maxillary sinus wall. Clinical neurosensory tests including two-point discrimination and fine touch discrimination were performed to classify the extent of nerve injuries as mild, moderate, severe, or anesthetic. Additional temperature discrimination and pulpal sensibility tests (electric pulp testing and cold testing) were carried out. A comparison of radiographic fracture patterns and severity of nerve injury was done. Testing was carried out immediately after trauma and at 2-month follow-up. Results: More than half of the patients assessed in the study group presented with NSD of the teeth and gingiva after trauma. The incidence of deficits varied with the type of test used to measure them. Most frequently, patients presented with both loss of two point as well as fine touch discrimination thresholds. Severe nerve injuries were associated with loss of temperature discrimination clinically and displaced fractures radiographically. There was no significant relationship between the recovery of pulpal and gingival sensation. The patterns of injury and recovery in ASAN and MSAN were similar. Conclusion: NSD after trauma to the maxillary antrum is relatively common. Clinical loss of temperature discrimination and radiographic signs of fracture lines passing through the canalis sinuosus are predictors of persistent and severe oral NSD.

• 대한치과재료학회지
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• 제44권2호
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• pp.187-195
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• 2017

Formocresol (FC)은 치수절단술에 일반적으로 사용되어 온 재료이지만, 재료의 독성 때문에 현재 calcium hydroxide나 mineral trioxide aggregate (MTA)가 치수절단술에 널리 사용되고 있다. 최근 레진계열 calcium silicate 제재인 Theracal LC가 치수 이장재로 개발이 되었으며, 이는 광중합을 통해 경화되기 때문에 사용이 편리해서 MTA를 적용할 수 없는 치아에 사용할 수 있다. 이번 연구의 목적은 FC, MTA 및 Theracal LC를 각각 치수절단술 후에 적용했을 경우 경조직 형성 능력과 치수반응을 비교하는 것이다. Sprague Dawley Rat의 상악 대구치 치수절단술 후 FC, MTA 및 Theracal LC를 적용하였다. 경조직 형성 여부를 확인하기 위해 Skyscan을 사용해 마이크로 컴퓨터 단층촬영(micro CT) 이미지를 획득하고, he matoxylin and e osin (H&E) 염색을 하여 조직학적 반응을 확인하였다. Dentin matrix protein-1 (DMP-1)의 발현을 확인하기 위해 면역형광 염색을 시행하였다. FC를 사용한 시편에서는 경조직 형성이 관찰되지 않았으며, 치수절단술이 시행된 인접면에 염증반응이 관찰되었고 DMP-1발현은 확인되지 않았다. MTA와 Theracal LC를 사용한 시편에서는 경조직 형성이 관찰되었고 DMP-1의 발현이 확인되었다. 결론적으로, MTA나 Theracal LC를 사용한다면 남아있는 치수의 생활력과 기능을 유지시켜 보다 좋은 치료 예후를 기대할 수 있을 것으로 사료된다.

• 대한소아치과학회지
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• 제34권4호
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• pp.651-657
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• 2007

치아종은 치성 종양 중 가장 흔한 형태로 증상이 없는 경우가 대부분이며 종종 영구치의 매복이나 맹출지연을 유발한다. 이는 치아를 구성하는 법랑질, 상아질, 백악질, 치수로 구성되며, 형태에 따라 복합 치아종과 복잡 치아종으로 구분된다. 복합 치아종은 다수의 작고 치아와 유사한 형태를 지니며 상악 전치부에 호발하고, 복잡 치아종은 무정형의 치성조직으로 구성되어 있으며 전체 치아종의 약 25%를 차지하고 하악 구치부에 호발한다. 치아종의 병인은 확실치는 않으나 국소적인 외상, 감염, 유전적 요인이 관여할 것이라 추측된다. 치료는 보존적인 외과적 적출술이 추천되며 재발은 거의 없다. 다음의 두 증례는 각각 하악 제 1대구치와 하악 측절치의 맹출 지연을 주소로 본원에 내원한 환아들로, 매복치 상방의 복잡 치아종을 외과적 적출술을 시행하고 매복치의 외과적 노출 및 교정적 견인을 시행하여 양호한 결과를 보였기에 보고하는 바이다.

• 구강회복응용과학지
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• 제22권2호
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• pp.173-180
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• 2006

Objectives The aim of this study is to compare the quality of root canal preparation completed using MFile-$System^{(R)}$ instrument ( Komet, Gebr.Brsaseler, Germany) and conventional stainless steel file in the canals of Maxillary molar teeth that had a canal curvature between $25^{\circ}$ or more Materials & Methods Buccal canals of 24 first and second maxillary molar teeth, extracted for periodontal and prosthetic reasons were used. Tissue fragments and calcified debris were removed from teeth by scaling and the teeth were stored in 10% formalin solution for 24 hour. Then, teeth were stored in saline until used. To be included the roots had to have completed formed apices and angle of curvature ranging between $25^{\circ}$ or more according to the criteria described by Schneider(1971). Palatal and Second mesiobuccal canals were not included. Teeth were embedded into transparent acrylic. The teeth were randomly divided into two experimental groups. All teeth were scanned by Dental CT (PSR9000N, Asahi, Japan) to determine the root canal shape before instrumentation. Image slices were prepared from the apical end point to the pulp chamber. The first two sections were 2 mm from the apical end of root and 2 mm below the orifice. Further section was recorded, dividing the distance between the sections of apical and coronal levels into two equal lengths. 12 teeth were instrumented using stainless steel fileand another 12 teeth were instrumented using MFile-$System^{(R)}$. Following the completion of the instrumentation, the teeth were again scanned and compared with the cross sectional images taken prior to canal preparation. Amount of transportation and centering ability was assessed. Student's t-test was used for statistical analysis. Result Less transportation occurred with MFile-$System^{(R)}$ rotary instrumentation than stainless steel instrument. MFile-$System^{(R)}$ had better centering ability than stainless steel instrument. Conclusion MFile-$System^{(R)}$ rotary instrumentation transported canals less and had good centering ability.

• 대한장애인치과학회지
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• 제8권2호
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• pp.127-133
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• 2012

EDS는 관절의 과운동성, 피부의 과신장, 조직 약화 등을 임상적 특징으로 하는 유전 질환이다. 피부, 골격, 근육, 인대, 점막, 혈관 등을 구성하는 교원질의 합성 과정과 관련된 유전자의 결함으로 결합조직이 비정상적으로 변하므로 신체 전반에 걸쳐 그 증상이 나타난다. 구강 영역에서도 교원 질과 관련된 조직에 영향을 받게 된다. 구강 점막, 치주 조직, 측두하악관절 및 치아 경조직에 문제가 발생할 수 있으므로, 총체적이고 정기적인 구강관리가 이루어져야 한다. 이번 증례와 같이 EDS에 의해 치아의 맹출 장애가 발생하고, 치은비대, 유착, 매복, 선천적 결손치, 부정교합 등이 관찰되는 경우에도 구강 위생 관리와 함께 장기적인 계획 하에 맹출 관리 및 치료가 요구된다. EDS 환아의 치과 치료시에는 질환의 원인과 전신적 특징에 대한 이해를 바탕으로, 비정상적 교원질 대사에 의해 약화된 점막과 치주조직, 지혈 관리, 반흔 형성 및 측두하악관절에 대한 종합적인 고려와 지속적인 관리가 필요하다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.27.1-27.8
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• 2018

Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

• Restorative Dentistry and Endodontics
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• 제44권4호
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• pp.38.1-38.8
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• 2019

Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.

• Imaging Science in Dentistry
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• 제47권2호
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• pp.129-133
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• 2017

Dentinogenesis imperfecta is a dominant autosomal hereditary disorder of dentin formation that affects the deciduous and permanent teeth. Its etiology is characterized by inadequate cell differentiation during odontogenesis. The clinical characteristics of dentinogenesis imperfecta are discolored teeth with a translucency that varies from gray to brown or amber. Radiographically, the teeth exhibit pulp obliteration, thin and short roots, bell-shaped crowns, and periapical bone rarefaction. The aim of this report was to present a case of dentinogenesis imperfecta type II that was followed up over a 17-year period. This report also presents scanning electron microscopy images of the enamel and dentin, showing that both were altered in the affected teeth. The disease characteristics and the treatments that were administered are reported in this study to guide dentists with respect to the need for early diagnosis and adequate follow-up to avoid major sequelae.

• Journal of Periodontal and Implant Science
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• 제39권3호
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• pp.375-381
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• 2009

Purpose: Root resection can be a valuable procedure when the tooth in question has a high strategic value. The prognosis of root resection has been well documented in previous studies, but the results focused on the palatal root resection have not been discussed in depth. I represent here the short term effectiveness of palatal root resection of maxillary first molars. Methods: Palatal root resection was performed on maxillary first molars of three patients. All the palatal roots were floating state on the radiographic finding and showed full probing depth and purulent exudation at initial examination. Reduction of palatal cusp and occlusal table was performed concomitantly. Endodontic therapy was completed after root resection. Results: Compromised maxillary first molars were treated successfully by palatal root resection in 3 cases. The mobility of resected tooth was decreased a little bit. The probing pocket depth of remaining buccal roots was not increased compared to initial depth. All the patients satisfied with comfort and cost effective results and the fact they could save their natural teeth. Conclusions: Within the above results, palatal root resection is an effective procedure treating compromised maxillary first molar showing advanced palatal bone loss to root apex with or without pulp involvement when proper case selection is performed.