• Restorative Dentistry and Endodontics
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• v.38 no.4
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• pp.258-262
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• 2013

The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

• Journal of dental hygiene science
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• v.23 no.3
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• pp.225-235
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• 2023

Background: This study aimed to analyze the effects of periodontal treatment and individual- and tooth-related factors on tooth extraction in people with disabilities. Methods: The Korea National Health Insurance claims data of individuals with disabilities aged 40~64 years with chronic periodontitis in 2008 were obtained. Of these, data on the disabled who underwent scaling/root plaining, subgingival curettage/periodontal surgery, or non-periodontal treatments, and data on their teeth were selected. The extraction of 716,688 teeth from 39,097 patients was tracked until 2018, and the patient- and tooth-level factors related to tooth loss were identified using a mixed-effect logistic regression analysis. Results: Data from approximately 17% of the teeth were extracted during a follow-up period of approximately 11 years. Among the tooth-level variables, scaling/root planing treatment at baseline and periodontal treatment during the follow-up period were associated with a lower risk of tooth loss (odds ratio=0.692 and 0.769, respectively, p<0.001). Non-vital teeth increased the risk of tooth loss by 3.159 times (p<0.001). Among the patient-level variables, females were less likely to have lost their teeth than males, and those with orthopedic impairment or brain lesions/mental disabilities, a higher age group, lower income level, or residents in medium/small cities or rural areas were more likely to have lost their teeth (p<0.001). Conclusion: Through approximately 11 years of follow-up, scaling or root planing, experience with periodontal treatment at least once, female sex, older age, lower income, smaller residential areas, type of disability, and pulp vitality were found to be associated with tooth loss in individuals with disabilities aged 40~64 years with chronic periodontitis. To prevent tooth loss in individuals with disabilities, it is necessary to establish a dental treatment plan that considers the timing of periodontal treatment and the characteristics of the patient and teeth.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.305-309
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• 2009

Dens evaginatus is a dental anomaly most commonly seen in premolar teeth in which a tubercle or protuberance projects from either the center of the occlusal surface or the buccal triangular ridge. These tubercles are easily fractured from mastication as the tooth erupts and frequently leads to pulp necrosis as a common complication. To prevent these sequelae, prophylactic treatment soon after the tooth starts erupting is essential. These preventive treatments include, selective grinding and protection of the tubercle by pit and fissure sealant. When the tooth does shows signs of pulp necrosis and apical periodontitis, endodontic procedures are needed. Apexification and apexogenesis are usually the treatment of choice for the affected teeth which have immature apices. Apexogenesis is a vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end. It involves removal of the inflamed pulp and the placement of calcium hydroxide on the remaining healthy pulp tissue. This case report describes an atypical apexogenesis of a mandibular premolar which showed to be a dens evaginatus. The tooth which was treated with calcium hydroxide shows good results and is planned for permanent root canal filling.

• Restorative Dentistry and Endodontics
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• v.47 no.4
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• pp.42.1-42.11
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• 2022

Objective: This study investigated the effects of various concentrations of sodium hypochlorite (NaOCl) on human whole-blood clotting kinetics, the structure of the blood clots formed, and transforming growth factor (TGF)-β1 release. Materials and Methods: Human whole blood was collected from 5 healthy volunteers and divided into 4 groups: CG (control, 0.5 mL of blood), BN_0.5 (0.5 mL of blood with 0.5 mL of 0.5% NaOCl), BN₃ (0.5 mL of blood with 0.5 mL of 3% NaOCl), and BN_5.25 (0.5 mL of blood with 0.5 mL of 5.25% NaOCl). The effects of NaOCl on clotting kinetics, structure of fibrin and cells, and release of TGF-β1 were assessed using thromboelastography (TEG), scanning electron microscopy (SEM), and enzyme-linked immunosobent assay, respectively. Statistical analysis was conducted using the Kruskal Wallis and Mann-Whitney U tests, followed by the post hoc Dunn test. A p value < 0.05 indicated statistical significance. Results: The blood samples in BN_0.5 and BN₃ did not clot, whereas the TEG of BN_5.25 showed altered clot formation. Samples from the CG and BN₃ groups could only be processed with SEM, which showed that the latter lacked fibrin formation and branching of fibers, as well as clumping of red blood cells with surface roughening and distortion. TGF-β1 release was significantly highest in BN₃ when all groups were compared to CG (p < 0.05). Conclusions: Each concentration of NaOCl affected the release of TGF-β1 from blood clots and altered the clotting mechanism of blood by affecting clotting kinetics and cell structure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.6
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• pp.593-598
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• 2008

Arsenic trioxide is one of the 'tooth pulp devitalizing agents' used through the dental history when anaesthesia was not available. But owing to its capacity to kill cells in surrounding tissues, the use of arsenic trioxide in vital pulpotomy has been reduced. Arsenic trioxide can cause necrosis of gingiva, bone which can cause osteomyelitis of the jaws. But some dentists still continue to use arsenic trioxide in their endodontic practices. The purpose of this article is to present arsenic trioxide induced osteomyelitis on maxilla and treatment process.

• International Journal of Oral Biology
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• v.36 no.3
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• pp.117-122
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• 2011

Endothelial cells are a vital constituent of most mammalian organs and are required to maintain the integrity of these tissues. These cells also play a major role in angiogenesis, inflammatory reactions, and in the regulation of thrombosis. Angiogenesis facilitates pulp formation and produces the vessels which are essential for the maintenance of tooth homeostasis. These vessels can also be used in bone and tissue regeneration, and in surgical procedures to place implants or to remove cancerous tissue. Furthermore, endothelial cell regeneration is the most critical component of the tooth generation process. The aim of the present study was to stimulate endothelial regeneration at a site of acute cyclophosphamide (CP)-induced endothelial injury by treatment with human umbilical cord-derived endothelial/mesenchymal stem cells (hEPCs). We randomly assigned 16 to 20-week-old female NOD/SCID mice into three separate groups, a hEPC ($1{\times}10^5$ cells) transplanted, 300mg/kg CP treated and saline (control) group. The mice were sacrificed on days 5 and 10 and blood was collected via the abdominal aorta for analysis. The alanine transaminase (ALT), aspartate aminotransferase (AST), serum alkaline phosphatase (s-ALP), and albumin (ALB) levels were then evaluated. Tissue sections from the livers and kidneys were stained with hematoxylin and eosin (HE) for microscopic analysis and were subjected to immunohistochemistry to evaluate any changes in the endothelial layer. CP treatment caused a weight reduction after one day. The kidney/body weight ratio increased in the hEPC treated animals compared with the CP only group at 10 days. Moreover, hEPC treatment resulted in reduced s-ALP, AST, ALT levels compared with the CP only group at 10 days. The CP only animals further showed endothelial injuries at five days which were recovered by hEPC treatment at 10 days. The number of CD31-positive cells was increased by hEPC treatment at both 5 and 10 days. In conclusion, the CP-induced disruption of endothelial cells is recovered by hEPC treatment, indicating that hEPC transplantation has potential benefits in the treatment of endothelial damage.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.104-111
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• 1994

Necrotizing fascitis is a severe soft tissue infection characterized by extensive necrosis of superficial fascia, suppurative fascitis, vascular thrombosis, widespread undermining of surrounding tissues. Associated systemic problems are widespread undermining of surrounding tissues, Associated systemic problems are common, with chronic alcoholism and diabetes being most prominent. Most commonly this disease presents in the extremities, trunk, and perineum. Necrotizing fascitis of dental origing is rare and its fulminating clinical course is not well documented in the dental literature. The present report is a case of necrotizing fascitis following vital extirpation of the pulp in a patient with uncontrolled diabetes mellitus and liver cirrhosis. Originally throught to be caused by hemolytic streptococcus organism or stphylococcus aureus, advances in anaerobic culturing have shown it to be a synergistic bacterial infection involving aerobic and ovligate anaerobes. it is relatively rare in relatively rare in haea and neck regions. If it was not diagnosed and treated in early stages, necrotizing fascitis can be potentially fetal, with a mortality rate approaching 40%. It's treatment requires early recognition, prompt and aggressive surgical debriment and proper supportive cares, such as, antibiotic therapy, fluid resuscitation and correction of metabolic and electrolyte disorder, resolving of the underlying systemic disease. Recently, we experienced two cases of necrotizing fascitis in cervicofacial region, One patient was 60 years old male with uncontrolled Diabetes Mellitus and other patient was 48 years old with steroid therapy during 30 years. Local surgical wound healing was successful but, patients were died after admission, because of lung abscess, gastrointestinal bleeding, septic shock and respiration hold.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.85-92
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• 2000

Common dental procedures(dental extraction & minor operation) are potentially stress-inducing in many patients, especially medically compromised patients. The body's response to dental stress involves the cardiovascular system(an increase in cardiovascular workload), the respiratory organ and the endocrine system(change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment : do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given Though the stress reduction protocol above was applied to the dental extraction in medically compromised patients with the advanced infected teeth, the final responsibility for the complications(syncope, bleeding & infection, etc.) in a patient rests with the dentist who ultimately treats him. For the prevention of postextraction complications & poor prognosis, the authors treated the advanced infected teeth with the pulp extirpation, opening drainage through the canal and complete occlusal reduction. The final extraction and wound closure were then done after $1{\sim}2$ weeks. The final prognosis was comfortable without common complications.

• Proceedings of the KACD Conference
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• 2001.05a
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• pp.247-251
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• 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
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• v.39 no.4
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• pp.397-403
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• 2012

The vitality of immature tooth could be lost by dental caries, trauma and fracture of malformed tooth. The vitality loss might lead to halt of the development of the root. The recommended endodontic treatment for a non-vital immature permanent tooth is apexification. Apexification is a method of inducing apical closure through the formation of mineralized tissue in the apical pulp region. Calcium hydroxide is the material of choice for apexification. Long-term exposure to calcium hydroxide may form the apical hard tissue, but weaken the dentin due to its alkaline nature and thus make the roots more susceptible to fracture. It is important to preserve any weakened tooth, so a permanent restoration is needed to reinforce teeth that are prone to fracture. The purpose of this case report was to describe the treatment for reinforcing immature teeth treated with long-term calcium hydroxide. In these cases, the apexes of teeth were sealed with MTA plugs and the root canals were restored with composite resin and fiber post.