Trends of Dental Treatment under General Anesthesia and Patterns of Repeated General Anesthesia in Children and Adolescents with Severe Disabilities / 대한소아치과학회지

The aim of this retrospective study was to evaluate the demographic characteristics of pediatric dental patients who underwent dental treatment under general anesthesia (DTGA) at the Seoul National University Dental Hospital from January 2011 through December 2020 and compare the patterns of repeated DTGA between dental patients with severe disabilities (DSD) and non-DSD (healthy or medically compromised patients without DSD). There were 1,857 DTGAs among 1,719 patients (mean age = 5.1 years; males = 59.3%; ASA 2 or above = 52.9%; DSD = 26.8%). Overall, 6.6% of patients underwent repeated DTGA, and the rate of repeated DTGA over a 10-year period was 7.4%. ASA 2 or above (p < 0.0001) and DSD (p < 0.0001) were more likely to undergo repeated DRGA compared to ASA 1 and non-DSD. At both GA1 and GA2, DSD received significantly more restorative treatment on permanent teeth than non-DSD (p = 0.002, p < 0.0001, respectively). There has been an increasing demand for DTGA in pediatric dentistry over the last 10 years. Regular check-ups and preventive oral health care are necessary for pediatric dental patients with severe disabilities to reduce the possibility of repeated DTGA.

Detection of Proximal Caries Lesions with Deep Learning Algorithm / 대한소아치과학회지

This study aimed to evaluate the effectiveness of deep convolutional neural networks (CNNs) for diagnosis of interproximal caries in pediatric intraoral radiographs. A total of 500 intraoral radiographic images of first and second primary molars were used for the study. A CNN model (Resnet 50) was applied for the detection of proximal caries. The diagnostic accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curve, and area under ROC curve (AUC) were calculated on the test dataset. The diagnostic accuracy was 0.84, sensitivity was 0.74, and specificity was 0.94. The trained CNN algorithm achieved AUC of 0.86. The diagnostic CNN model for pediatric intraoral radiographs showed good performance with high accuracy. Deep learning can assist dentists in diagnosis of proximal caries lesions in pediatric intraoral radiographs.

How general anesthetics work: from the perspective of reorganized connections within the brain / 대한마취과학회지

General anesthesia is critical for various procedures and surgeries. Despite the widespread use of anesthetics, their precise mechanisms remain poorly understood. Anesthetics inevitably act on the brain, primarily through the modulation of target receptors. Even if the action is specific to an individual neuron, however, long-range effects can occur due to the tremendous interconnectedness of neuronal activity. The strength of this connectivity can be understood using mathematical models that allow for the study of neuronal connectivity dynamics. These models also allow researchers to develop hypotheses on the candidate mechanisms of action of different types of anesthesia. This review highlights the theoretical background associated with the study of the mechanisms of action of anesthetics. We propose a candidate framework that describes how anesthetics act on the brain and consciousness in general.

Survey on Sedation Training for Pediatric Residents in Training Hospitals / 대한소아치과학회지

The purpose of this study was to investigate current status of sedation training for the residents in pediatric dentistry training institutions and opinions about continuing education after the residency program. Surveys were sent to 18 pediatric dentistry training institutions by e-mail, and the responses were collected and analyzed. Most of the sedation education period for the residents were the 1st-year education (61.1%) and 1 - 3 years of integrated education (55.6%). In terms of an externship, 5 institutions (27.8%) sent their residents to the department of anesthesiology. Second half of the 1st year (50%) was the highest for a resident to use sedation for the first time. The period of supervisor participation varied from not participating at all to whole time throughout the residency program. The sedation training is conducted at all training institutions, but there were variations in the experience that a resident can gain. All training institutions agreed on the necessity of continuing education of the sedation, but there were various opinions regarding time, method, and the period of review course. Overall, this study suggested that continuing education should be consisted of 1 - 2 hours of didactic education every year and clinical skills and simulation training in every 2 - 3 years.

Retrospective study on three-dimensional characteristics of mesiodens using CBCT in pediatric dentistry / 대한소아치과학회지

The purpose of this study was to investigate the three-dimensional characteristics of mesiodens using Cone-beam Computed Tomography(CBCT) and analyze the factors affecting complications and anesthetic methods of extraction. This study evaluated 602 mesiodens of 452 patients who underwent extraction of mesiodens at the department of Pediatric Dentistry in Seoul National University Dental Hospital between 2017 and 2019.The ratio of mesiodens patients over total patient per year was gradually increased over the past 20 years. Mesiodens with labio-palatally horizontal direction while root directing labial were the most common among the mesiodens with horizontal direction. Mesiodens were the most common at the cervical side of the adjacent teeth(37.0%) and mesiodens located in the near-palatal side were observed about 3.83 times higher than the far-palatal side. Most of the mesiodens(82.1%) were in contact with adjacent permanent teeth on all three sides of the CBCT and 46.2% of mesiodens had curved roots. The patient’s age, vertical position, presence of complications, and proximity showed a significant difference in the selection of general anesthesia among anesthetic methods. The direction and vertical position of mesiodens had a significant effect on complications.These results provide a better understanding of mesiodens for establishing an accurate diagnosis and treatment plan.

Dental Characteristics of Microcephalic Osteodysplastic Primordial Dwarfism Type II / 대한소아치과학회지

Microcephalic osteodysplastic primordial dwarfism type II (MOPD II) is an autosomal recessive inherited disorder form of primordial dwarfism, caused by mutations in the pericentrin gene. The purpose of the study was to examine the clinical and radiological features, physicochemical properties and microstructures of the tooth affected with MOPD II.The mandibular 2nd molar was collected from the MOPD II patient. Micro-computerized tomography, scanning electron microscopy, energy dispersive spectrometry and Vickers microhardness analysis were performed on the MOPD II and the normal control.The morphology of the MOPD II tooth appeared to have malformed pulp and root and showed a small size. The mineral density measurement showed that the MOPD II tooth had similar scores in the enamel, but lower scores in the root 1/2 and apical dentin compared to the normal control. The microhardness values were smaller in the cusp enamel, root 1/2 dentin and apical dentin of the MOPD II compared to the normal control.In this study, the dental characteristics and the physicochemical properties of a tooth affected with MOPD II were analyzed to improve understanding of the oral manifestations of the disease and to assist in proper dental treatment by identifying precautions.

Distribution of Pediatric Malocclusion Patients in Seoul National University Dental Hospital / 대한소아치과학회지

A total of 580 patients, who visited and received an orthodontic diagnosis in the Department of Pediatric Dentistry, Seoul National University Dental Hospital from 2017 to 2019, were investigated in this study. The aim of this study was to evaluate skeletal patterns of pediatric orthodontic patients determined with lateral cephalometric analysis and to analyze the relationship between skeletal pattern and probable associated clinical features. Also, the modality of orthodontic treatment for each skeletal classification was investigated to aid in therapeutic decisions.Patients aged 7 year accounted for the largest age group; 54.2% of patients showed a skeletal class I pattern, 22.2% showed a skeletal class II pattern, and 23.6% showed a skeletal class III pattern. Bi-maxillary retrusion for skeletal class I, retruded mandible with normal positioning of the maxilla for skeletal class II, and retrusion of the maxilla with protrusion of the mandible for skeletal class III were the largest subgroups by skeletal pattern. Brachyfacial type accounted for 55.0% of patients, followed by 31.9% of mesofacial type and 13.1% of dolichofacial type. The prevalence of anterior crossbite in the study was 43.3%, higher than that in previous studies.

Clinical Factors Affecting the Results of Regenerative Endodontic Procedure / 대한소아치과학회지

This study retrospectively analyzed the effect of clinical factors on the outcomes of REP(regenerative endodontic procedure). Patients who received the REP using triple antibiotic paste due to trauma or fracture of dens evaginatus from February, 2011 to January, 2020 were included in the study. Finally, 57 teeth in 54 patients were selected.Investigated clinical factors were as follows: intentional bleeding, etiology, and root development stage. Treatment outcomes evaluated were as follows: improvement of subjective symptoms, changes in the periapical lesion, and the amounts of root development after REP. To compensate for differences in angulation and position between repeated radiographic examinations, images were aligned by Turboreg plugin. To evaluate the amounts of root development, apical diameter, root area, and root length were measured by ImageJ software.Among the aforementioned factors, intentional bleeding had no significant effect on treatment results. Regarding the etiology, the increase in the root area and the root length was significantly less in trauma cases than in dens evaginatus fracture cases. Considering root development stage, more immature teeth presented more increase in the root area.

Root and Canal Morphology of Maxillary Primary Molar using CBCT and 3D CT / 대한소아치과학회지

The purpose of this study is to analyze morphological characteristics of maxillary primary molar’s root and root canal. 268 children aged 3 - 7 years (175 boys, 93 girls) who had CBCT (152 children) and 3D CT (116 children) taken in Seoul National University Dental Hospital from January 2006 to April 2020 were included. The number of roots and root canals were analyzed in 1002 teeth without any root resorption or periapical pathologies. Curvature, angulation, length of root and root canal, as well as cross-sectional shapes of the root canal were analyzed in 218 teeth. By using Mimics and 3-Matics software, volume, surface area, and volume ratio of root canal was analyzed in 48 teeth.More than half of maxillary primary molars have 3 roots and 3 root canals. The degree of symmetry of root canal type was about 0.63 (Cohen’s kappa coefficient). The most frequent shape of roots and canals was linear in 1st primary molars and curved in 2nd primary molars. Angulation, length of root and root canals was the largest on palatal roots. Most teeth showed ovoid or round shapes at apex. The largest root canal volume, surface area, volume ratio was found in the palatal roots.

A 20-year Retrospective Study of Pediatric Oral Lesion Biopsy / 대한소아치과학회지

The aim of this study was to provide pathological information of pediatric oral lesions by retrospectively analyzing oral biopsy results from pediatric patients at the Seoul National University Dental Hospital.Biopsy results of all oral lesions from pediatric patients, aged 0 - 16 years, were collected from the files of the Department of Oral Pathology, Seoul National University Dental Hospital from January 2000 to April 2020. The patients were divided into 3 age groups: 0 - 5, 6 - 11 and 12 - 16 years. All oral lesions were classified into three main categories: inflammatory and reactive, tumor or tumor-like and cystic lesions.Among the total of 2928 biopsy specimens, tumor or tumor-like lesions(35.66%) were the most common, followed by inflammatory and reactive lesions(34.29%) and cystic lesions(30.05%). Regardless of the categories used in this study, odontoma was the most frequently found lesion, mucocele and dentigerous cyst being the next common. This study was the first retrospective review of pediatric oral pathology in Korea, and the results from this study may assist in providing informative insight into the pediatric oral pathology for pediatric dentists.

Detecting of Proximal Caries in Primary Molars using Pen-type QLF Device / 대한소아치과학회지

The purpose of this in vivo study was to assess the clinical screening performance of a quantitative light-induced fluorescence (QLF) device in detecting proximal caries in primary molars. Fluorescence loss, red autofluorescence and a simplified QLF score for proximal caries (QS-proximal) were evaluated for their validity in detecting proximal caries in primary molars compared to bitewing radiography.Three hundred and forty-four primary molar surfaces were included in the study. Carious lesions were scored according to lesion severity assessed by visual-tactile and radiographic examinations. The QLF images were analyzed for two quantitative parameters, fluorescence loss and red autofluorescence, as well as for QS-proximal. For both quantitative parameters and QS-proximal, the sensitivity, specificity and area under receiver operating curve (AUROC) were calculated as a function of the radiographic scoring index at enamel and dentin caries levels.Both quantitative parameters showed fair AUROC values for detecting dentine level caries (△F = 0.794, △R = 0.750). QS-proximal showed higher AUROC values (0.757 - 0.769) than that of visual-tactile scores (0.653) in detecting dentine level caries.The QLF device showed fair screening performance in detecting proximal caries in primary molars compared to bitewing radiography.

Characteristics of Intravenous Midazolam Sedation with Nitrous Oxide in Pediatric Dental Treatment / 대한소아치과학회지

Midazolam is a short-acting benzodiazepine that is widely used in pediatric dental sedation. However, its clinical effectiveness as an intravenous sedative agent in children has not been widely documented. A retrospective study was conducted to evaluate the efficacy and safety of intravenous midazolam and nitrous oxide inhalation sedation in pediatric dental treatment.The subjects were 115 patients (118 cases) who received dental treatment under intravenous midazolam and nitrous oxide inhalation sedation. Demographic factors, general health status, sedation time, midazolam and nitrous oxide dosage, and success rate of sedation were evaluated from electronic medical records.Behavioral management was the main reason of choosing sedation. Mean duration of sedation was 56.7 minutes for surgical treatment, and 74.4 minutes for restorative treatment. The initial dosage of intravenous midazolam was 0.051 ± 0.019 mg/kg. In 34 cases (28.8%), additional midazolam of 0.036 ± 0.057 mg/kg was delivered during the treatment. The concentration of nitrous oxide was maintained between 40% and 50%. The success rate of sedation was 99% (n = 117). In 1 case, laryngospasm occurred and the patient was reversed with benzodiazepine antagonist, flumazenil.Intravenous midazolam sedation with nitrous oxide was shown to be clinically effective for the dental treatment in children, if administered by trained personnel and patients are carefully selected in accordance with guidelines.

Regional Distribution and Practice Pattern of Pediatric Dental Clinics in Korea / 대한소아치과학회지

The number of pediatric dental clinics has been increasing due to the development of dentistry and changes in public awareness of professional dental care for children. The purpose of this study was to investigate the present status of pediatric dental clinics in Korea in several respects, including regional distribution.There were 343 pediatric dental clinics (1.91%) among 17,917 dental clinics in Korea. 248 out of 343 private practitioners were board certified pediatric dentists. Of 248 board certified pediatric dentists, 25 displayed the specialty in their clinics’ name. Gyeonggi occupied largest share of the total pediatric dental clinics in Korea, followed by Seoul and Busan. Gangnam-gu occupied largest share of the total pediatric dental clinics in Seoul. Out of all pediatric dental clinics in Korea, 78.7% was run by only one dentist. 90.9% of pediatric dental clinics didn’t do night clinic on weekdays and 26.5% was open until after 15:00 on Saturday.

Association between Developmental Anomalies of Permanent Lateral Incisors and Tooth Eruption Disturbances / 대한소아치과학회지

The purpose of this study was to examine the prevalence of developmental anomalies of permanent lateral incisor and eruption disturbances and analyze the association between two components. Panoramic radiographs of 3984 patients (aged 5 to 13 years) who visited the Department of Pediatric Dentistry of Seoul National University Dental Hospital between November 2016 and October 2017 were screened.The prevalence of developmental anomalies of permanent lateral incisors was 10.2%. The most common developmental anomalies were congenitally missing teeth(66.1%), followed by peg lateralis(33.5%). The prevalence of eruption disturbances was 16.5%. Among the patient with developmental anomalies of permanent lateral incisors, associated eruption disturbances were appeared on 31.1% of patients. Peg lateralis(p It is important for patients with developmental anomalies of lateral incisors to detect associated eruption disturbance early through regular checkup. Diagnosis and treatment plan in view of such relationships is important in order to treat appropriately at the optimal time.

Lateral Cephalometric Measurement of Skeletal Class III malocclusion Patients with Uncertainty / 대한소아치과학회지

The purpose of this study was to calculate uncertainty of orthodontic measurement in skeletal class III malocclusion children using lateral cephalometry analysis software which obtained traceability in previous study. Using this data, standard reference of measurement value for skeletal class III malocclusion was obtained.Lateral cephalometric data was collected from 144 children who visited Pediatric Dentistry from 2017 to 2020 for orthodontic treatment. Orthodontic measurement was analyzed with software which obtained traceability. Type A evaluation of uncertainty and type B evaluation of uncertainty was calculated to obtain combined standard uncertainty and expanded uncertainty. Standard reference of skeletal class III children was compared to standard reference of skeletal class I children.Distribution range for skeletal class III malocclusion children aged 6 to 10 with 95% confidence interval was provided using calculated uncertainty of orthodontic measurement value.

The Effect of Silver Diamine Fluoride on Salivary Biofilm / 대한소아치과학회지

Silver diamine fluoride (SDF) is an effective and efficient agent for arresting dental caries. It can be useful in treating children with behavioral or medical limitations. The purpose of this study was to evaluate the antimicrobial effect of SDF by using salivary biofilm.Pellicle-like saliva coated structure was prepared by using unstimulated saliva. For developing cariogenic biofilm, Streptococcus mutans was added to the mixture of pooled saliva and inoculated into a saliva coated glass or chamber. SDF was applied to cariogenic biofilm to evaluate the antimicrobial effect of SDF. As time passed, total bacteria and S. mutans were reduced after application of SDF (p As a result of experiment using enamel and dentin of primary teeth, it was confirmed that the growth of cariogenic biofilm was inhibited when the SDF was treated (p = 0.029 each).This study showed excellent anti-microbial effect of SDF. And anti-caries effect in clinical practice can be expected.

A Novel RUNX2 Mutation in a Korean Family with Cleidocranial Dysplasia / 대한소아치과학회지

Cleidocranial dysplasia (CCD) is an autosomal-dominant disease characterized by the delayed closure of cranial sutures, defects in clavicle formation, supernumerary teeth, and delayed tooth eruption. Defects in the Runt-related transcription factor 2 (RUNX2), a master regulator of bone formation, have been identified in CCD patients. The aim of this study was to identify the molecular genetic causes in a CCD family with delayed tooth eruption.The 23-year-old female proband and her mother underwent clinical and radiographic examinations, and all coding exons of the RUNX2 were sequenced. Mutational analysis revealed a single nucleotide deletion mutation (NM_001024630.4 : c.357delC) in exon 3 in the proband and her mother. The single C deletion would result in a frameshift in translation and introduce a premature stop codon [p.(Asn120Thrfs*24)]. This would result in the impaired function of RUNX2 protein, which may be the cause of delayed eruption of permanent teeth in the family.

Lateral Cephalometric Measurements of Class I Malocclusion Patients with Uncertainty / 대한소아치과학회지

The aim of this study was to obtain the traceability of the software used to analyze lateral cephalometry and to calculate the uncertainty of the measurements. Furthermore, this study aimed to provide a basis for obtaining standard references for measurement values for orthodontic treatment in children.Cephalometric data were collected from 100 children diagnosed with class I malocclusion between the ages 6 to 13 years who visited the pediatric dentist at Seoul National University Dental Hospital. To ensure traceability, a phantom device was created. Correction values were calculated by measuring the length and angle of the phantom device using the software. Type A uncertainty was calculated by obtaining the standard deviation of cephalometric measurements of 100 persons and the standard error of repeated measurements. Determination of the type B uncertainty was induced by minimum resolution and the position of the head. Using these, the combined standard uncertainty was obtained and the expanded uncertainty was calculated.The results of this study confirm that the currently used software has high accuracy and reliability. Furthermore, the uncertainty of orthodontic measurements in Korean children aged 6 to 13 years was calculated, and distribution range for class I malocclusion with 95% confidence interval was suggested.

Relationship between Pre-Eruptive Buccal Pit Radiolucency and Restoration in Mandibular First Molar / 대한소아치과학회지

Pre-eruptive intracoronal resorption (PEIR) is a developmental defect in the crown of a pre-eruptive tooth. The purpose of this study was to investigate the relationship between the size of the pre-eruptive buccal pit radiolucency, which is suspected as PEIR on a panoramic radiography, and the need for restoration after the eruption of a mandibular first molar.The experimental group included 35 mandibular first molars, in which lesions requiring definite restoration were observed during eruption. The control group consisted of 64 sound mandibular first molars after eruption. The sex, age, tooth position, tooth formation stage, size of the pre-eruptive buccal pit radiolucency, and restoration methods in the experimental group and control group were examined.Compared with the control group, the experimental group showed a statistically significant difference in the size of the buccal pit before eruption. The buccal pit size for predicting the need for restoration was further examined by receiver operating characteristic curve analyses, and the area under the curve was 0.813 ± 0.047.If radiolucency is observed at the buccal pit of the mandibular first molar before eruption, periodic observations and post-eruption examinations are required.

Ratio and Rate of Induced Root Growth in Necrotic Immature Teeth / 대한소아치과학회지

The purpose of this study was to analyze the ratio and rate of apical closure when inducing root growth of necrotic immature permanent teeth using alternative triple antibiotics. 24 permanent teeth in the treatment group and 27 premolars in the control group were retrospectively studied using periapical radiographs for more than 300 days after the first visit. The difference in the growth rate between the two groups was statistically compared using the Mann-Whitney test at a significance level of 0.05. There were no statistically significant differences between the two groups in the first month and during months 1 – 3, 3 – 6, and 6 – 12. After 12 months, the cumulative rate of decrease in the apical foramen width in the treatment group was 50.59% and that in the control group was 71.82%, which revealed a significant difference between the two groups. There were significant differences in the rates of decrease in the apical foramen width after 3, 6 months, and later period in the treatment group, respectively. The cumulative rate of increase in the root dentin area presented no statistically significant differences between the treatment group and control group during the entire period of examination.