Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

A study on the compatibility between one-bottle dentin adhesives and composite resins using micro-shear bond strength

OBJECTIVES: This study was performed to determine whether the combined use of one-bottle self-etch adhesives and composite resins from same manufacturers have better bond strengths than combinations of adhesive and resins from different manufacturers. MATERIALS AND METHODS: 25 experimental micro-shear bond test groups were made from combinations of five dentin adhesives and five composite resins with extracted human molars stored in saline for 24 hr. Testing was performed using the wire-loop method and a universal testing machine. Bond strength data was statistically analyzed using two way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Two way ANOVA revealed significant differences for the factors of dentin adhesives and composite resins, and significant interaction effect (p < 0.001). All combinations with Xeno V (Dentsply De Trey) and Clearfil S3 Bond (Kuraray Dental) adhesives showed no significant differences in micro-shear bond strength, but other adhesives showed significant differences depending on the composite resin (p < 0.05). Contrary to the other adhesives, Xeno V and BondForce (Tokuyama Dental) had higher bond strengths with the same manufacturer's composite resin than other manufacturer's composite resin. CONCLUSIONS: Not all combinations of adhesive and composite resin by same manufacturers failed to show significantly higher bond strengths than mixed manufacturer combinations.

Biologic response of local hemostatic agents used in endodontic microsurgery

Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.

Inhibition of Streptococcus mutans biofilm formation on composite resins containing ursolic acid

OBJECTIVES: To evaluate the inhibitory effect of ursolic acid (UA)-containing composites on Streptococcus mutans (S. mutans) biofilm. MATERIALS AND METHODS: Composite resins with five different concentrations (0.04, 0.1, 0.2, 0.5, and 1.0 wt%) of UA (U6753, Sigma Aldrich) were prepared, and their flexural strengths were measured according to ISO 4049. To evaluate the effect of carbohydrate source on biofilm formation, either glucose or sucrose was used as a nutrient source, and to investigate the effect of saliva treatment, the specimen were treated with either unstimulated whole saliva or phosphate-buffered saline (PBS). For biofilm assay, composite disks were transferred to S. mutans suspension and incubated for 24 hr. Afterwards, the specimens were rinsed with PBS and sonicated. The colony forming units (CFU) of the disrupted biofilm cultures were enumerated. For growth inhibition test, the composites were placed on a polystyrene well cluster, and S. mutans suspension was inoculated. The optical density at 600 nm (OD600) was recorded by Infinite F200 pro apparatus (TECAN). One-way ANOVA and two-way ANOVA followed by Bonferroni correction were used for the data analyses. RESULTS: The flexural strength values did not show significant difference at any concentration (p > 0.01). In biofilm assay, the CFU score decreased as the concentration of UA increased. The influence of saliva pretreatment was conflicting. The sucrose groups exhibited higher CFU score than glucose group (p < 0.05). In bacterial growth inhibition test, all experimental groups containing UA resulted in complete inhibition. CONCLUSIONS: Within the limitations of the experiments, UA included in the composite showed inhibitory effect on S. mutans biofilm formation and growth.

Maxillary first molar with an O-shaped root morphology: report of a case / 国际口腔科学杂志·英文版

This case report is to present a maxillary first molar with one O-shaped root, which is an extended C-shaped canal system. Patient with chronic apical periodontitis in maxillary left first molar underwent replantation because of difficulty in negotiating all canals. Periapical radiographs and cone-beam computed tomography (CBCT) were taken. All roots were connected and fused to one root, and all canals seemed to be connected to form an O-shape. The apical 3 mm of the root were resected and retrograde filled with resin-modified glass ionomer. Intentional replantation as an alternative treatment could be considered in a maxillary first molar having an unusual O-shaped root.

Invasive cervical resorption: treatment challenges

Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.

Re-establishment of occlusion after unilateral condylar fracture

Complications resulting from condylar fracture include occlusal disturbance due to loss of leverage from temporomandibular joint (TMJ). In general, closed reduction with active physical training has been performed, and under favorable circumstances, adaptation occurs in attempt to restore the articulation. The patient in this case report had unilateral condylar fracture accompanied with multiple teeth injuries, but he was left without any dental treatment for 1 mon which led to unrestorable occlusal collapse. Fortunately, delayed surgical repositioning of dislocated maxillary anterior teeth followed by consistent long-term physical training has been proved successful. Normal occlusion and satisfactory remodeling of condyle were obtained on 10 mon follow-up.

Pre-prosthetic minor tooth movement with elastic separating ring & provisional restoration modification: case report

Proximal caries or coronal defect in posterior teeth may result in the loss of proximal space and drifting of neighboring teeth, which makes restoration difficult. Inability to restore proper contours and to align tooth axis properly are commonly encountered problems when planning tooth restoration. Moreover, tilted teeth aggravate periodontal tissue breakdown, such as pseudo-pocket, and angular osseous defect. The purpose of this case presentation is to describe a simple technique for inducing minor tooth movement with orthodontic separating ring and provisional restoration modification. This method was used to create crown placement space on mesially tilted molar. This method is easy, simple and efficient technique which could be used in interproximal space gaining in selected situation.

Influence of three different preparation designs on the marginal and internal gaps of CEREC3 CAD/CAM inlays / 대한치과보존학회지

The aim of this study was to evaluate the marginal and internal gaps in CEREC3 CAD/CAM inlays of three different preparation designs. CEREC3 Inlays of three different preparation designs (n = 10) were fabricated according to Group I-conventional functional cusp capping/shoulder preparation, Group II-horizontal reduction of cusps and Group III-complete reduction of cusps/shoulder preparation. After cementation of inlays, the bucco-lingual cross section was performed through the center of tooth. Cross section images of 20 magnifications were obtained through the stereomicroscope. The gaps were measured using the Leica application suite software at each reference point. Statistical analysis was performed using one-way ANOVA and Tukey's test (alpha<0.05). The marginal gaps ranged from 80.0 to 97.8 microm for Group I, 42.0 to 194.8 microm for Group II, 51.0 to 80.2 microm for Group III. The internal gaps ranged from 90.5 to 304.1 microm for Group I, 80.0 to 274.8 microm for Group II, 79.7 to 296.7 microm for Group III. The gaps of each group were the smallest on the margin and the largest on the horizontal wall. For the CEREC3 CAD/CAM inlays, the simplified designs (groups II and III) did not demonstrate superior results compared to the traditional cusp capping design (group I).

Effects of anticurvature filing on danger zone width in curved root canals / 대한치과보존학회지

The aim of this study was to compare the effects of anticurvature filing with stainless steel k-file versus nickel-titanium ProFile in the shaping of mesial root canals of extracted mandibular molars. A total of 60 canals from 30 mesial roots of mandibular molar teeth were randomly assigned to three groups with n=20 each. They were prepared with different instruments and methods: The first group with stainless steel k-file and circumferential filing, the second with precurved stainless steel k-file and anticurvature filing and the third with ProFile (.06 taper) and anticurvature filing. Using a micro-computed tomography system (skyscan-1076, SKYSCAN, Antwerpen, Belgium), pre-and post-operative specimens were scanned. Subsequently, canal images were superimposed and changes in root dentin thickness were measured at distal side (danger zone) of the canal. The data was analyzed using a one-way ANOVA and the comparison of means was conducted using a post hoc multiple comparison Tukey test. There were significant differences in the change of root dentin thickness at the 7.5~8.5mm level between group 1 and 2, 3.5~6mm level between group 1 and 3 and 3.5~6mm level between group 2 and 3(n=20, P<0.05).

The influence of cavity configuration on the microtensile bond strength between composite resin and dentin / 대한치과보존학회지

This study was conducted to evaluate the influence of the C-factor on the bond strength of a 6th generation self-etching system by measuring the microtensile bond strength of four types of restorations classified by different C-factors with an identical depth of dentin. Eighty human molars were divided into four experimental groups, each of which had a C-factor of 0.25, 2, 3 or 4. Each group was then further divided into four subgroups based on the adhesive and composite resin used. The adhesives used for this study were AQ Bond Plus (Sun Medical, Japan) and Xeno III (DENTSPLY, Germany). And composite resins used were Fantasista (Sun Medical, Japan) and Ceram-X mono (DENTSPLY, Germany). The results were then analyzed using one-way ANOVA, a Tukey's test, and a Pearson's correlation test and were as follows. 1. There was no significant difference among C-factor groups with the exception of groups of Xeno III and Ceram-X mono (p < 0.05). 2. There was no significant difference between any of the adhesives and composite resins in groups with C-factor 0.25, 2 and 4. 3. There was no correlation between the change in C-factor and microtensile bond strength in the Fantasista groups. It was concluded that the C-factor of cavities does not have a significant effect on the microtensile bond strength of the restorations when cavities of the same depth of dentin are restored using composite resin in conjunction with the 6th generation self-etching system.

In vitro evaluation of the consistency of two electronic apex locators / 대한치과보존학회지

The purpose of this study was to evaluate the consistency of two electronic apex locators in vitro model. Materials consisted of fifty two extracted premolars and two electronic apex locators; Root ZX (J. Morita, Osaka, Japan) and E-Magic Finder Deluxe (S-Denti, Cheonan, Korea). After access preparation, the teeth were embedded in a saline-mixed alginate model. Canal lengths of each tooth were measured at "0.5" and "Apex" mark of the apex locators, respectively so that each tooth had two measurements from 0.5 and Apex points. The file was fixed at final measurement using a glass ionomer cement. The apical 4 mm from the apex was exposed to measure the distance from the file tip to the major apical foramen of each tooth. Average distances and standard deviations were used to evaluate the consistency. Results showed that all measurements of both Root ZX and E-Magic Finder located the major foramen the range of +/- 0.5 mm level. Both apex locators showed better consistency at Apex mark than at 0.5 mark. The average distance of file tip-major foramen was - 0.18 mm at 0.5 mark and - 0.07 mm at Apex mark in Root ZX, - 0.25 mm at 0.5 mark and - 0.02 mm at Apex mark in E-Magic Finder. Standard deviation was 0.21 at 0.5 mark and 0.12 at Apex mark in Root ZX, 0.12 at 0.5 mark and 0.09 at Apex mark in E-Magic Finder.

The influence of pH and lactic acid concentration on the formation of artificial root caries in acid buffer solution / 대한치과보존학회지

The purpose of this study is to compare and to evaluate the effect of pH and lactic acid concentration on the progression of artificial root caries lesion using polarizing microscope, and to evaluate the morphological changes of hydroxyapatite crystals of the demineralized area and to investigate the process of demineralization using scanning electron microscope. Artificial root caries lesion was created by dividing specimens into 3 pH groups (pH 4.3, 5.0, 5.5), and each pH group was divided into 3 lactic acid concentration groups (25 mM, 50 mM, 100 mM). Each group was immersed in acid buffer solution for 5 days and examined. The results were as follows: 1. Under polarized microscope, the depth of lesion was more effected by the lactic acid concentration rather than the pH. 2. Under scanning electron microscope, dissolution of hydroxyapatite crystals were increased as the lactic acid concentration increased and the pH decreased. 3. Demineralized hydroxyapatite crystals showed peripheral dissolution and decreased size and number within cluster of hydroxyapatite crystals and widening of intercluster and intercrystal spaces as the pH decreased and the lactic acid concentration increased. 4. Under scanning electron microscope evaluation of the surface zone, clusters of hydroxyapatite crystals were dissolved, and dissolution and reattachment of crystals on the surface of collagen fibrils were observed as the lactic acid concentration increased. 5. Under scanning electron microscope, demineralization of dentin occurred not only independently but also with remineralization simultaneously. In conclusion, the study showed that pH and lactic acid concentration influenced the rate of progression of the lesion in artificial root caries. Demineralization process was progressed from the surface of the cluster of hydroxyapatite crystals and the morphology of hydroxyapatite crystals changed from round or elliptical shape into irregular shape as time elapsed.

The comparison of relative reliability on biaxial and three point flexural strength testing methods of light curing composite resin / 대한치과보존학회지

The possibility of applying a bi-axial flexure strength test on composite resin was examined using three point and bi-axial flexure strength tests to measure the strength of the light-cured resin and to compare the relative reliability using the Weibull modulus. The materials used in this study were light-curing restorative materials, MICRONEW(TM), RENEW(R) (Bisco, Schaumburg, USA). The bi-axial flexure strength measurements used the piston-on-3-ball test according to the regulations of the International Organization for Standardization (ISO) 6872 and were divided into 6 groups, where the radius of the specimens were 12 mm (radius connecting the 3-balls: 3.75 mm), 16 mm (radius connecting the 3-balls: 5 mm), and the thickness were 0.5 mm, 1 mm, 2 mm for each radius. The bi-axial flexure strength of the MICRONEW(TM) and RENEW(R) were higher than the three point flexure strength and the Weibull modulus value were also higher in all of the bi-axial flexure strength groups, indicating that the bi-axial strength test is relatively less affected by experimental error. In addition, the 2 mm thick specimens had the highest Weibull modulus values in the bi-axial flexure strength test, and the MICRONEW(TM) group showed no significant statistical difference (p > 0.05). Besides the 2 mm MICRONEW(TM) group, each group showed significant statistical differences (p < 0.05) according to the thickness of the specimen and the radius connecting the 3-balls. The results indicate that for the 2 mm group, the bi-axial flexure strength test is a more reliable testing method than the three point flexure strength test.

Diagnosis of periapical cemental dysplasia / 대한치과보존학회지

Periapical cemental dysplasia(PCD) is a condition most commonly seen in the mandibular incisor region. Radiographically it passes through the three phases(osteolytic stage, intermediate stage, and mature stage). At osteolytic stage, the lesion is similar to features associated with granuloma or cyst that arise following pulpal necrosis. So, it is important to confirm the vitality of the pulp to diagnosis. In this case, it is difficult to confirm the vitality of involved tooth because the tooth was covered with PFG bridge. And it is unusual that the PCD lesion at mandibular incisors has occurred at first and the lesion of mandibular canine and mandibular premolar were occurred afterward.

In vitro micro-shear bond strength of five composite resins to dentin with five different dentin adhesives / 대한치과보존학회지

The purpose of this study was to compare and to evaluate the combination use of 5 kinds of dentin adhesive systems and 5 kinds of composite resins using micro-shear bond test. Five adhesive systems (Prime & Bond NT (PBN), Onecoat bond (OC), Excite (EX), Syntac (SY), Clearfil SE bond (CS)) and five composite resins (Spectrum (SP), Synergy Compact (SC), Tetric Ceram (TC), Clearfil AP-X (CA), Z100 (Z1)) were used for this study (5 x 5 = 25group, n = 14/group). The slices of horizontally sectioned human tooth were bonded with each bonding system and each composite resin, and tested by a micro-shear bond strength test. These results were analyzed statistically. The mean micro-shear bond strength of dentin adhesive systems were in order of CS (22.642 MPa), SY (18.368 MPa), EX (14.599 MPa), OC (13.702 MPa), PBN (12.762 MPa). The mean bond strength of self-etching primer system group (CS, SY) in dentin was higher than that of self-priming adhesive system groups (PBN, EX, OC) significantly (P<0.05). The mean bond strength of composite resins was in order of SP (19.008 MPa), CA (17.532 MPa), SC (15.787 MPa), TC (15.068 MPa), Z1 (14.678 MPa). Micro-shear bond strength of SP was stronger than those of other composite resins significantly (P < 0.05). And those of TC and Z1 were weaker than other composite resins significantly (P < 0.05). No difference was found in micro-shear bond strength of composite resin in self-etching primer adhesive system groups (CS, SY) statistically. However, there was significant difference of micro-shear bond strength of composite resin groups in self-priming adhesive systems group (PBN, EX, OC). The combination of composite resin and dentin adhesive system recommended by manufacturer did not represent positive correlation. It didn't seem to be a significant factor.

In vivo quantitative analysis of remineralization effect of remineralization solution "R" of incipient enamel dental caries / 대한치과보존학회지

Dental caries is a chronic disease that causes the destruction of tooth structure by the interaction of plaque bacteria, food debris, and saliva. There has been attempts to induce remineralization by supersaturating the intra-oral environment around the surface enamel, where there is incipient caries. In this study, supersaturated remineralized solution "R" was applied to specimens with incipient enamel caries, and the quantitative ananlysis of remineralization was evaluated using microradiography. Thirty subjects volunteered to participate in this study. Removable appliances were constructed for the subjects, and the enamel specimen with incipient caries were embedded in the appliances. The subjects wore the intra-oral appliance for 15 days except while eating and sleeping. The removable appliance were soaked in supersaturated solution "R", saline, or Senstime(R) to expose the specimen to those solutions three times a day, 5 minutes each time. After 15 days, microradiography was retaken to compare and evaluate remineralization. The results were as the following: 1. The ratio of remineralized area to demineralized area was significantly higher in the supersaturated solution "R" and Senstime(R) than in the saline. (p<0.05) 2. Remineralization in the supersaturated buffer solution "R" occurred in the significantly deeper parts of the tooth, compared to the Senstime(R) group containing high concentration of fluoride.(p<0.05) As in the above results, the remineralization effect of remineralized buffer solution "R" on incipient enamel caries has been proven. For clinical utilization, further studies on soft tissue reaction and the effect on dentin and cementum are necessary. In conclusion compared to commercially available fluoride solution, remineralization solution "R" showed better remineralization effect on early enamel caries lesion, so it is considered as effecient solution for clinical application.