• 한국치위생학회지
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• 제24권3호
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• pp.219-227
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• 2024

연구목적: 치수는 신경과 혈관을 포함하고 있는 부위로 다양한 자극이나 세균에 의해 염증이 생기면 이를 치수염이라고 한다. 치수염은 말초 신경조직 변화와 심한 통증을 유발하는 질환으로 만성적 통증을 유발하나, 삼차신경절의 신경세포 활성화와 특정 나트륨 채널(Nav1.7) 발현 사이의 관계는 잘 알려져 있지 않다. 이에 본 연구에서는 실험적으로 유도된 치수염이 말초신경에서 Nav1.7 나트륨 채널의 발현을 활성화시켜, 삼차신경절의 뉴런을 활성화함으로써 통증을 유발한다는 사실을 발견하고 이를 조절하는 신호기전을 규명하고자 하였다. 연구방법: 실험동물(Male C57BL/6 생쥐, 6주, 20-25 g)의 상악 제1대구치 치수에 AITC를 처리하여 급성 치수염을 유발하고, 3일 후 실시간 광영상 이미지를 이용하여 삼차신경절의 뉴런 활성화를 측정 및 비교 분석하였다. 단백질 분석을 통해 뇌간(SpVc)에서 치수염 통증유발 신호조절기전에 관여하는 여러가지 단백질들(p-ERK, c-FOS, TRPA1, p-CRMP2)의 발현을 관찰하였다. 연구결과: 시공간적 광영상 이미지를 통해 삼차신경절의 뉴런세포들은 대조군과 비교 시 급성 치수염 모델에서 흥분성 활성화가 유도되어 신경학적 변화가 일어남을 관찰하였다. 또한 조직학 및 분자생물학적 결과를 통해 치수염으로 인한 특정 나트륨 채널(Nav1.7)의 증가가 통증을 유발한다는 사실을 확인하였다. 또한, ProTxII(Nav1.7의 선택적 억제 약물) 처리를 통해 뉴런의 과흥분성 활성이 억제됨에 따라, 치수염이 삼차신경절에서 나트륨 채널(Nav1.7)의 증가를 유도하고 이러한 특정 나트륨 채널을 효과적으로 제어하면 치수염의 통증을 줄이는 방법이 될 것이라 생각된다. 결론: 본 연구의 결과를 통해 과 발현된 특정 나트륨 채널(Nav1.7)을 억제하면 삼차신경절에서 통각 신호 처리를 조절하고 치수염에 의해 유발되는 통증을 효과적으로 조절할 수 있음을 시사한다.

• Restorative Dentistry and Endodontics
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• 제16권1호
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• pp.236-244
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• 1991

Numerous studies have been focused on the immunologic aspects of inflamed pulp and periapical tissues. The purpose of this study was to evaluate levels of serum IgG and IgM in patients of acute pulpitis and acute apical abscess using Enzyme-Linked Immunosorbent Assay. Streptococcus mutans, Streptococcus sanguis, Bacteroides intermedius and Bacteroides gingivalis were grown for use as antigen and they were harvested by centrifugation. The patients were divided into 3 groups; patients of acute apical abecess, acute pulpitis and normal control 5 patients of each group were selected and their blood was obtained via intravenous puncture. Sera were prepared by centrifugation of each blood samples. Then serum antibodies were measured by modified ELISA. The following results were obtained; 1. Serum IgM levels of patients with acute pulpitis and acute apical abscess seemed to be slightly higher than those of normal control 2. Serum IgG levels of patients with acute apical abscess were slightly higher than those of normal control 3. Serum IgG and IgM levels of acute apical abscess patients and serum IgM levels of acute pulpitis were highest to Bacteroides gingivalis.

• Restorative Dentistry and Endodontics
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• 제25권2호
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• pp.193-201
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• 2000

Prostaglandins (PGs) and Leukotrienes (LTs) have been implicated in the genesis of pulpal and periapical inflammation. In this study, the relationships among $PGE_2$, 6-keto-PG $F_1{\alpha}$ (a stable metabolite of $PGI_2$) and $LTB_4$ concentrations in inflamed pulp and periapical lesions were discussed. Pulp tissue were obtained in routine endodontic treatment and periapical lesions in periapical surgery after clinical diagnoses were made. These specimens were divided into four groups as normal pulp group (Control group), acute pulpitis group, chronic pulpitis group, and periapical lesion group. Pulp tissue and periapical lesions were stored in liquid nitrogen. The concentration of $PGE_2$, $PGI_2$ and $LTB_4$ were measured with ELISA. The data were analyzed by one-way ANOVA. Significantly higher levels of $PGE_2$, 6-keto-PG $F_1{\alpha}$ a and $LTB_4$ were found in acute pulpitis group than chronic pulpitis group and periapical lesion group(p<0.05). Periapical lesion group showed significantly higher mean concentrations of $PGE_2$ and $LTB_4$ than chronic pulpitis group. In control and chronic pulpitis group, significant higher levels of $PGI_2$ than $PGE_2$ and $LTB_4$ were found. These results suggested that the high levels of $PGE_2$ and $LTB_4$ in periapical lesions may be due to rich endothelium., fibroblast and lymphocyte known as the main producers of $PGE_2$ and $LTB_4$. $PGI_2$ may be thought to one of the most abundant PGs in normal pulp tissue.

• Journal of Periodontal and Implant Science
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• 제29권1호
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• pp.95-102
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• 1999

The purpose of this study was to observe histopathologically the influence of advanced periodontitis on pulp tissue, and to conclude the correlation between the results with clinical manifestations. The samples were teeth with over 7mm pocket depth and over 50% radiographic bone loss. These were diagnosed to have very poor prognosis and thus planned to be extracted. Those with any of following conditions were excluded from the samples, loss of vitality, periapical pathology, restoration or prosthesis, dental caries, and attrition or abrasion. It was because these conditions could affect pulp without any correlation with periodontal disease. For the experiment, 17 teeth from 11 patients were selected. Average age of patient was 47. Each tooth was examined for following categoris; pocket depth, gingival recession, electric pulp test, mobility, percussion test, sensitivity test. The extracted teeth were fixed buffered neutral formalin solution. It was decalcified using 4% nitric acid. Sliced histological samples observed using light microscope, for pulp status, and severeity of inflammation. 4 samples were excluded due to histologic sample discrepency. Thus 13 samples were subject to observation. 4 showed normal conditions. Focal reversable pulpitis was shown in 5 samples. Chronic pulpitis was observed 1 sample. Pulpal abscess was observed in 3 samples.

• Restorative Dentistry and Endodontics
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• 제21권1호
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• pp.353-359
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• 1996

The purpose of this study was to investigate the concentrations of Leukotriene B4 in relation to the clinical symptom of pulpitis in human dental pulp. Pulps obtained from 3 groups of teeth: normal uniflamed teeth(N=22), asymptomatic teeth with deep caries or large restorations(N = 21) and symptomatic teeth with the clinical diagnosis of irreversible pulpitis(N = 15). Pulps were dissected from normal un inflamed teeth and extirpated from asymptomatic and symptomatic teeth during routine endodontic treatment and stored in liquid nitrogen ($-70^{\circ}C$). The levels of Leukotriene B4 in individual or pooled pulps were measured by radioimmunoassay and the mean levels of each group were compared statistically(Kruskall-Wallis oneway ANOVA test). The results were as followings : 1. In normal pulp, low levels of Leukotriene B4 were measured. 2. In pulps from asymptomatic and symptomatic teeth had significantly higher levels of Leukotriene B4 than normal pulps(p<0.01). 3. The levels of Leukotriene B4 in pulps from symptomatic teeth were significantly higher than those of pulps from asymptomatic teeth(p<0.01). These results suggest that Leukotriene B4 play a cretain role in inflammatory process of dental pulp and have a relationship with clinical symptoms of pulpitis.

• 미생물학회지
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• 제53권2호
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• pp.129-130
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• 2017

Streptococcus gordonii는 그람 양성이면서, 통성 혐기성, 및 비운동성 구균이다. S. gordonii는 사람의 구강 내 정상세균 총의 하나이고, 치면 생체막 형성의 선구적 세균 종이다. S. gordonii는 감염성 심내막염과 패혈성관절염 뿐만 아니라 유치의 치수염에 연관이 있다. S. gordonii KCOM 1506 (= ChDC B679) 균주가 사람 급성치수염 병소에서 분리되었으며 그 유전체 염기서열을 해독하여 보고한다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권4호
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• pp.269-282
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• 2021

This review aimed to assess and compare the outcomes of the anesthetic efficacy of inferior alveolar nerve block (IANB) and Gow-Gates mandibular nerve block (GGMNB) in patients with symptomatic irreversible pulpitis. A descriptive systematic review of quantitative research was conducted wherein the "Preferred Reporting Items for Systematic Reviews (PRISMA)" was adopted, and the Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome (PICO) criteria were used to structure the research question. A literature search was performed using PubMed/Medline, Cochrane Library, Google Scholar, and Ovid. Selection criteria were applied for populations over nine years of age, of either sex, with irreversible pulpitis, and articles published in English regarding conventional IANB or IANB and Gow-Gates techniques between 2009 and 2019. Prospective randomized clinical trials or randomized controlled trials were included in the review, in which anesthetic efficacy or success was measured. After screening, four articles were included. Three studies were randomized clinical trials, and two were randomized controlled trials. The validity and reliability of the individual studies were examined. There was evidence of the higher efficacy of the GGMNB technique than that of the IANB technique. However, both techniques can be mastered through training.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권1호
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• pp.1-10
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• 2022

Background: Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients. This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, "What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?" Methods: A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration "Risk of Bias" tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias. Results: After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia. Conclusion: According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.

• Restorative Dentistry and Endodontics
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• 제46권1호
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• pp.9.1-9.9
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• 2021

Objectives: This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS). Materials and Methods: This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests. Results: The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP. Conclusions: Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권6호
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• pp.323-341
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• 2019

Background: Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials. Methods: Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality. Results: Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia. Conclusion: Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.