Evaluation of sleep quality and stress response in patients requiring dental prosthetic treatment / 대한치과보철학회지

Purpose@#The purpose of this study is to investigate the stress response and sleep state of the new patients who visit the hospital for prosthodontic treatment due to tooth loss to make reference to further treatment direction. @*Materials and methods@#Examinations, consultations, and surveys were conducted on 236 patients (94 males, 142 females, and 24-86 years old), who newly registered at the department of prosthodontics at Pusan national university hospital, for 2 years from 2018. The number of remaining teeth, edentulous arch, possibility of mastication, and future prosthetic treatment directions were recorded. The visual analogue scale (VAS), stress response inventory (SRI) and Insomnia severity index (ISI) were used as tools to measure patient’s subjective discomfort, stress response, and sleep status. @*Results@#Among the entire prosthodontic patient group, the average value of ‘fatigue’ was significantly higher among the 7 items of SRI, and the value of ‘aggression’ was significantly lower (P<.001). There are a significant difference between the edentulous and full dentition in the oral discomfort value measured by VAS (P=.004). In cases where less than 20 teeth remain, mastication is impossible, and patients who are planning treatment with removable prostheses, VAS value and ‘depression’ and ‘fatigue’ values in SRI were higher than those in the reverse case (P<.05).The patients showed severe level in VAS value have high value of ‘tension’, ‘somatization’, ‘depression’, ‘fatigue’and ‘frustration’in SRI than non-serious patients (P<.05). Clinical insomnia occurred in 11.4% of all patients, and women had significantly lower sleep quality than men (P=.044). Patients with insomnia showed significantly higher scores on the VAS value and all 7 SRI items than those of normal sleepers (P<.05). @*Conclusion@#The new prosthetics had high ‘fatigue’ value among the 7 items of SRI. The oral condition, number of residual teeth and mastication function and clinical insomnia affected oral discomfort and the stress response.

The significance of diagnosis and treatment planning in periapical lesion overfilled with calcium hydroxide paste

Calcium hydroxide has been widely used for root canal dressing material in endodontic treatment. This report describes that when the accurate diagnosis and proper nonsurgical endodontic retreatment is applied to periapical lesion with accidentally extruded calcium hydroxide paste, the lesion can be successfully treated. Overfilled calcium hydroxide can affect the healing process, so the overextension of calcium hydroxide agent should be avoided.

Evaluation of sleep quality and stress response in patients requiring dental prosthetic treatment / 대한치과보철학회지

Purpose@#The purpose of this study is to investigate the stress response and sleep state of the new patients who visit the hospital for prosthodontic treatment due to tooth loss to make reference to further treatment direction. @*Materials and methods@#Examinations, consultations, and surveys were conducted on 236 patients (94 males, 142 females, and 24-86 years old), who newly registered at the department of prosthodontics at Pusan national university hospital, for 2 years from 2018. The number of remaining teeth, edentulous arch, possibility of mastication, and future prosthetic treatment directions were recorded. The visual analogue scale (VAS), stress response inventory (SRI) and Insomnia severity index (ISI) were used as tools to measure patient’s subjective discomfort, stress response, and sleep status. @*Results@#Among the entire prosthodontic patient group, the average value of ‘fatigue’ was significantly higher among the 7 items of SRI, and the value of ‘aggression’ was significantly lower (P<.001). There are a significant difference between the edentulous and full dentition in the oral discomfort value measured by VAS (P=.004). In cases where less than 20 teeth remain, mastication is impossible, and patients who are planning treatment with removable prostheses, VAS value and ‘depression’ and ‘fatigue’ values in SRI were higher than those in the reverse case (P<.05).The patients showed severe level in VAS value have high value of ‘tension’, ‘somatization’, ‘depression’, ‘fatigue’and ‘frustration’in SRI than non-serious patients (P<.05). Clinical insomnia occurred in 11.4% of all patients, and women had significantly lower sleep quality than men (P=.044). Patients with insomnia showed significantly higher scores on the VAS value and all 7 SRI items than those of normal sleepers (P<.05). @*Conclusion@#The new prosthetics had high ‘fatigue’ value among the 7 items of SRI. The oral condition, number of residual teeth and mastication function and clinical insomnia affected oral discomfort and the stress response.

Evaluation of Patients with Sensory Disturbance after Dental Treatment / 대한법의학회지

The Korean Dental Association recommends a disability rate (DR) of 1%-3% in the judgment of physical disability owing to sensory disturbance (SD) after dental treatment; however, criteria for deciding the exact percentage have not been suggested. Therefore, this study aims to provide practical criteria in the application of forensic physical disability evaluation by comparing the results of SD using the current perception threshold (CPT) test. A total of 324 patients with SD who visited the Department of Oral Medicine at Pusan National University Dental Hospital between January 2013 and August 2020, underwent the test. The eight stages, as a result of the CPT value, were reorganized as follows: profound sensory loss, very severe and severe as “severe group”, advanced and moderate as “moderate group”, mild and very mild as “mild group”, and normal as “normal group” The analysis of variance (ANOVA) test was used to calculate the statistical difference in the CPT values at 2000 Hz, 250 Hz, and 5 Hz among the four groups. There were significant statistical differences in the average values of CPT among the four groups (P<0.001). Additionally, a significant statistical difference in the CPT value between the affected and nonaffected sides of the patients was observed among the four groups (P<0.001).Therefore, based on the results of this study, the rationale for applying DR from 1%-3% was in accordance with the severity of the mandibular nerve injury.

Local Injection of Growth Hormone for Temporomandibular Joint Osteoarthritis

PURPOSE: Osteoarthritis (OA) of the temporomandibular joint (TMJ) elicits cartilage and subchondral bone defects. Growth hormone (GH) promotes chondrocyte growth. The aim of this study was to evaluate the efficacy of intra-articular injections of GH to treat TMJ-OA.MATERIALS AND METHODS: Monosodium iodoacetate (MIA) was used to induce OA in the TMJs of rats. After confirming the induction of OA, recombinant human GH was injected into the articular cavities of rats. Concentrations of GH and IGF-1 were measured in the blood and synovial fluid, and OA grades of cartilage and subchondral bone degradation were recorded by histological examination and micro-computed tomography.RESULTS: MIA-induced OA in the rat TMJ upregulated insulin-like growth factor-1 (IGF-1) rather than GH levels. GH and IGF-1 concentrations were increased after local injection of GH, compared with controls. Locally injected GH lowered osteoarthritic scores in the cartilage and subchondral bone of the TMJ.CONCLUSION: Intra-articular injection of GH improved OA scores in rat TMJs in both cartilage and subchondral bone of the condyles without affecting condylar bone growth. These results suggest that intra-articular injection of human GH could be a suitable treatment option for TMJ-OA patients in the future.

Conservative and esthetic approach in crown fracture of maxillay anterior tooth: tooth fragment reattachment

Crown fractures are the most frequent traumatic injuries to permanent teeth and mainly involve the maxillary incisors due to their exposed position in the dental arch. One option for managing crown fractures, when the tooth fragment is present and in good condition, is reattachment of the fragment to its original position. This paper reports on three crown fracture cases in which successful esthetic and functional results were achieved by reattachment of the tooth fragment.

Maxillary complete denture and mandibular All-on-4 implant restoration considering maintenance: a case report

In the case of edentulous patients, the total amount of occlusal force is dispersed by the keratinized gingiva during mastication, in result, causing lower masticatory and chewing efficiency. In particular, the mandibular area has more side effects such as pain than the maxilla has. It gets worse when the patient has more absorption of alveolar bone, but the implant treatment is often interrupted due to the existence of the inferior alveolar nerve. In this case, a patient treated with the all-on-4 method by placing the implant in the anterior part of mandible and with the conventional complete denture for the maxilla has maintained without complications and was satisfied with the restoration both functionally and esthetically.

Guided tissue regeneration therapy after root canal therapy for long standing periodontal-endodontic combined lesion in the mandibular anterior area: case report

When inflammatory products are found in both periodontal and pulpal tissues simultaneously, a periodontal-endodontic combined lesion is established. The treatment of periodontal-endodontic combined lesions includes root canal therapy and periodontal regenerative procedure for resolution of both the apical and marginal inflammatory lesions. The present study reports the treatment of periodontal-endodontic combined lesions in the mandibular anterior area with root canal therapy, followed by guided tissue regeneration therapy. Teeth with severe bone destruction in each case could be preserved, without extraction, over a 3-year period. Therefore, it appears that treatment of periodontal-endodontic combined lesions in the mandibular anterior area using guided tissue regeneration technique after root canal therapy may provide clinical advantages.

Implant overdenture of mandible with severe unilateral atrophy: Report of two cases / 대한치과보철학회지

There are several unfavorable conditions regarding alveolar bone condition that may compromise the denture patient's satisfaction. Chewing efficiency may not be satisfactory when alveolar bone is deficient, and the denture stability could hardly be achieved when alveolar bone shape is irregular. Implant overdenture can be useful to provide satisfactory denture experience compared to conventional denture. The attachment for implant overdenture can be classified into bar attachment and solitary attachment. When the positions of the implants are in the mandibular anterior region, bar attachment may be favorable to obtain a rigid support of the entire denture. When implants are distributed both on anterior and posterior region, a solitary attachment could be considered for ease of removal and maintenance. This report presents implant overdenture cases with the patients that had unilateral mandibular alveolar bone atrophy conditions. Different abutments were chosen based on the individual patient's mandibular alveolar bone condition and the treatments were successful in terms of patient satisfaction.

Age Estimation Based on Pulp Chamber Size of Mandibular First Molars from Intraoral Periapical Radiographs in Korean / 대한법의학회지

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

Age Estimation Based on Pulp Chamber Size of Mandibular First Molars from Intraoral Periapical Radiographs in Korean / 대한법의학회지

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

Pattern analysis of patients with temporomandibular disorders resulting from unilateral mastication due to chronic periodontitis

PURPOSE: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. METHODS: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. RESULTS: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. CONCLUSIONS: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.

Conservative and esthetic closure of maxillary midline diastema without creating "black triangle" using direct resin composite

Anterior diastemas are common esthetic problems. One of the challenges in clinical esthetic dentistry is closing anterior diastemas without creating “black triangles” between the teeth. The success of a restorative treatment in anterior teeth depends on the esthetic integration between soft tissues and hard tissues. This report describes the successfully accomplished diastema closure case by producing the emergence profile with natural contours at the gingival-tooth interface and then generating of gingival recontouring process.

Spontaneous teeth migration after periodontal treatment in the patients with drug-induced gingival enlargement

Anticonvulsants, calcium channel blockers and immunosuppressants are representative drugs related with gingival enlargement. Clinical signs and symptoms caused by drug-induced gingival enlargment frequently appear within 1 to 3 months after medication. At initial stage, it is limited to attached gingiva but may extend coronally and interfere with esthetics, mastication and speech. Interproximal spaces are common beginning area and pathologic teeth migration could be occurred by the lesion. Withdrawal or substitution of medication would be the most effective treatment of drug-induced gingival enlargement. However, periodontal treatment and further supportive periodontal therapy should be provided where change in medication is impossible. The present study reports the cases which show the resolution of inflammation with spontaneous teeth migration without change in medication. In all cases discussed in this report could be efficiently managed with proper periodontal treatment and further supportive periodontal therapy.

An Assessment of Radiological Age Estimation Method Using Mandibular First Molars in Korean Adults / 대한법의학회지

Age estimation is important in the practice of forensic science to establish the identity of human remains, as well as with living persons. Particularly in Korea, age estimation in adults has been increase in the demand for incorrect birth records in order to be entitled to civil liability, social benefits, employment. The reduction of pulp cavity size as a result of secondary dentin deposit with increasing age could be used to estimate age. This regressive change can be analyzed using radiological techniques; thus, a variety of methods for dental age estimation based on this approach have been proposed. The purpose of this study is to evaluate the concurrence between the Drusini's method and the Jeon's method using the mandibular first molar on orthopantomographs (OPGs) in Korean adults. A total of 232 OPGs (91 females and 141 males) of Korean individuals with ages ranging from 20 to 69 years were analyzed using Drusini's method and Jeon's method. Our results revealed that the correlation of the two methods with age was statistically significant (r=0.501). Both Drusini's method and Jeon's method showed significant correlation with chronological age, and Jeon's method showed a greater correlation with chronological age (r=0.738) than Drusini's method (r=0.586). The mean absolute error was 7.99 years for Jeon's method and 9.79 years for Drusini's method. Our results demonstrate that Jeon's method using the mandibular first molar on OPGs is a practical and suitable method for age estimation in Korean adults.

Implant impression using closed mouth impression technique: a case report

Closed mouth impression technique by using bite tray is preferred for single tooth impression taking. However, for implant impression taking, open mouth impression technique by using single arch tray is generally used whether it is for single implant or multiple implant. Closed mouth impression technique by using bite tray can save time and materials. It also decreases the chance of error occurrence when a model is mounted on an articulator. In this case report, we tried to show a satisfying result of fabricating single implant fixed prosthodontics after bite tray impression taking by using two different copings for closed mouth impression.

Management for traumatic neuropathy after dental treatment

Whereas a somatic pain notifies tissue damage, a neuropathic pain presents disorder of the nerve itself. The causes of neuropathic pains are trauma, infection, chronic irritation by adjacent tissue and so on. The iatrogenic trauma or infection also causes traumatic neuropathy, which may exert a bad influence on doctor-patient relationship. Some of related dental treatments are implantation (directly or indirectly through heating), root canal treatment, teeth extraction, block anesthesia, mandibular surgery. If inappropriate management is performed after nerve trauma, there will be many chances to develop chronic neuropathy for the patient. It is important that the sign of nerve trauma have to be caught by the practitioner as soon as possible and treated properly.