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When a tooth shows discoloration and does not respond to the cold test or electric pulp test (EPT) after a traumatic injury, its diagnosis can be even more difficult due to the lack of proper diagnostic methods to evaluate its vitality. In these case reports, we hope to demonstrate that ultrasound Doppler might be successfully used to evaluate the vitality of the tooth after trauma, and help reduce unnecessary endodontic treatments. In all three of the present cases, the teeth were discolored after traumatic injuries and showed negative responses to the cold test and EPT. However, they showed distinctive vital reactions in the ultrasound Doppler test during the whole observation period. In the first case, the tooth color returned to normal, and the tooth showed a positive response to the cold test and EPT at 10 wk after the injury. In the second case, the tooth color had returned to its normal shade at 10 wk after the traumatic injury but remained insensitive to the cold test and EPT. In the third case, the discoloration was successfully treated with vital tooth bleaching.
Diagnosis ; Hope ; Methods ; Tooth Bleaching ; Tooth Discoloration ; Tooth* ; Ultrasonography*

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Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II.

Jin Woo KIM ; Kyung Mo CHO ; Se Hee PARK ; Soh Ra PARK ; Sang Shin LEE ; Suk Keun LEE

Restorative Dentistry & Endodontics.2014;39(1):63-67. doi:10.5395/rde.2014.39.1.63

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.
Apoptosis ; Biopsy ; Cytoplasm ; Dental Pulp Cavity* ; Eosine Yellowish-(YS) ; Epithelial Cells ; Exocytosis ; Foreign Bodies ; Granuloma, Foreign-Body ; Hematoxylin ; Humans ; Inflammation ; Lymphocytes ; Macrophages ; Male ; Maxillary Sinus* ; Maxillary Sinusitis* ; Middle Aged ; Molar ; Mucous Membrane ; Neutrophils ; Periapical Granuloma

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Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups.

Jae Hyung LIM ; Ji Hyun LEE ; Su Jung SHIN

Restorative Dentistry & Endodontics.2014;39(1):56-62. doi:10.5395/rde.2014.39.1.56

A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease.
Dental Pulp Cavity ; Diagnosis* ; Diagnostic Errors ; Follow-Up Studies* ; Methods ; Periodontal Diseases* ; Tooth*

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Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion.

Lata GOYAL

Restorative Dentistry & Endodontics.2014;39(1):51-55. doi:10.5395/rde.2014.39.1.51

The term "endo-perio" lesion has been proposed to describe the destructive lesion resulting from inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. In most of the cases, clinical symptoms disappear following successful endodontic therapy. However failure after conventional root canal treatment calls for surgical intervention. A 35 year old male patient with endo-perio lesion in right maxillary lateral incisor was treated with platelet rich fibrin (PRF) and alloplastic bone substitute after conventional endodontic therapy. At the end of 6 months there was gain in clinical attachment, increased radiographic bone fill and reduction in probing depth which was maintained till 18 month follow-up. Present case report aims to evaluate the efficacy of PRF and alloplastic bone substitute in the management of intrabony defect associated with endo-perio lesion in maxillary lateral incisor because the healing potential of PRF and bone graft has not been widely studied in endodontics. The use of PRF allows the clinician to optimize tissue remodelling, wound healing and angiogenesis by the local delivery of growth factors and proteins. The novel technique described here enables the clinician to be benefited from the full regenerative capacity of this autologous biologic material.
Blood Platelets* ; Bone Regeneration ; Bone Substitutes* ; Dental Pulp Cavity ; Endodontics ; Fibrin* ; Follow-Up Studies ; Humans ; Incisor ; Intercellular Signaling Peptides and Proteins ; Male ; Periodontium ; Transplants ; Wound Healing

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Asymmetry in mesial root number and morphology in mandibular second molars: a case report.

Gurudutt NAYAK ; Shashit SHETTY ; Rhitu SHEKHAR

Restorative Dentistry & Endodontics.2014;39(1):45-50. doi:10.5395/rde.2014.39.1.45

Ambiguity in the root morphology of the mandibular second molars is quite common. The most common root canal configuration is 2 roots and 3 canals, nonetheless other possibilities may still exist. The presence of accessory roots is an interesting example of anatomic root variation. While the presence of radix entomolaris or radix paramolaris is regarded as a typical clinical finding of a three-rooted mandibular second permanent molar, the occurrence of an additional mesial root is rather uncommon and represents a possibility of deviation from the regular norms. This case report describes successful endodontic management of a three-rooted mandibular second molar presenting with an unusual accessory mesial root, which was identified with the aid of multiangled radiographs and cone-beam computed tomography imaging. This article also discusses the prevalence, etiology, morphological variations, clinical approach to diagnosis, and significance of supernumerary roots in contemporary clinical dentistry.
Cone-Beam Computed Tomography ; Dental Pulp Cavity ; Dentistry ; Diagnosis ; Molar* ; Prevalence

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Cytotoxicity of newly developed pozzolan cement and other root-end filling materials on human periodontal ligament cell.

Minju SONG ; Tae Sun YOON ; Sue Youn KIM ; Euiseong KIM

Restorative Dentistry & Endodontics.2014;39(1):39-44. doi:10.5395/rde.2014.39.1.39

OBJECTIVES: The purpose of this study was to evaluate in vitro cytotoxicity of the pozzolan cement and other root-end filling materials using human periodontal ligament cell. MATERIALS AND METHODS: Endocem (Maruchi), white ProRoot MTA (Dentsply), white Angelus MTA (Angelus), and Super EBA (Bosworth Co.) were tested after set completely in an incubator at 37degrees C for 7 days, Endocem was tested in two ways: 1) immediately after mixing (fresh specimens) and 2) after setting completely like other experimental materials. The methods for assessment included light microscopic examination, cell counting and WST-1 assay on human periodontal ligament cell. RESULTS: In the results of microscopic examination and cell counting, Super EBA showed significantly lower viable cell than any other groups (p < 0.05). As the results of WST-1 assay, compared with untreated control group, there was no significant cell viability of the Endocem group. However, the fresh mixed Endocem group had significantly less cell viability. The cells exposed to ProRoot MTA and Angelus MTA showed the highest viability, whereas the cells exposed to Super EBA displayed the lowest viability (p < 0.05). CONCLUSIONS: The cytotoxicity of the pozzolan cement (Endocem) was comparable with ProRoot MTA and Angelus MTA. Considering the difficult manipulation and long setting time of ProRoot MTA and Angelus MTA, Endocem can be used as the alternative of retrofilling material.
Cell Count ; Cell Survival ; Humans* ; Incubators ; Methods ; Periodontal Ligament* ; Pemetrexed

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Antibacterial effect of self-etching adhesive systems on Streptococcus mutans.

Seung Ryong KIM ; Dong Hoon SHIN

Restorative Dentistry & Endodontics.2014;39(1):32-38. doi:10.5395/rde.2014.39.1.32

OBJECTIVES: In this study, we evaluated the antibacterial activity of self-etching adhesive systems against Streptococcus mutans using the agar diffusion method. MATERIALS AND METHODS: Three 2-step systems, Clearfil SE Bond (SE, Kuraray), Contax (CT, DMG), and Unifil Bond (UnB, GC), and three 1-step systems, Easy Bond (EB, 3M ESPE), U-Bond (UB, Vericom), and All Bond SE (AB, BISCO) were used. 0.12% chlorhexidine (CHX, Bukwang) and 37% phosphoric acid gel (PA, Vericom) were used as positive controls. RESULTS: The antibacterial activity of CHX and PA was stronger than that of the other groups, except SE. After light activation, the inhibition zone was reduced in the case of all 2-step systems except CT. However, all 1-step systems did not exhibit any inhibition zone upon the light activation. CONCLUSIONS: SE may be better than CT or UnB among the 2-step systems with respect to antibacterial activity, however, 1-step systems do not exhibit any antibacterial activity after light curing.
Adhesives* ; Agar ; Chlorhexidine ; Diffusion ; Methods ; Streptococcus mutans* ; Streptococcus*

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Micro-CT evaluation of internal adaptation in resin fillings with different dentin adhesives.

Seung Hoon HAN ; Sung Ho PARK

Restorative Dentistry & Endodontics.2014;39(1):24-31. doi:10.5395/rde.2014.39.1.24

OBJECTIVES: The purpose of present study was to evaluate the internal adaptation of composite restorations using different adhesive systems. MATERIALS AND METHODS: Typical class I cavities were prepared in 32 human third molars. The teeth were divided into the following four groups: 3-step etch-and-rinse, 2-step etch-and-rinse, 2-step self-etch and 1-step self-etch system were used. After the dentin adhesives were applied, composite resins were filled and light-cured in two layers. Then, silver nitrate solution was infiltrated, and all of the samples were scanned by micro-CT before and after thermo-mechanical load cycling. For each image, the length to which silver nitrate infiltrated, as a percentage of the whole pulpal floor length, was calculated (%SP). To evaluate the internal adaptation using conventional method, the samples were cut into 3 pieces by two sectioning at an interval of 1 mm in the middle of the cavity and they were dyed with Rhodamine-B. The cross sections of the specimens were examined by stereomicroscope. The lengths of the parts where actual leakage was shown were measured and calculated as a percentage of real leakage (%RP). The values for %SP and %RP were compared. RESULTS: After thermo-mechanical loading, all specimens showed significantly increased %SP compared to before thermo-mechanical loading and 1-step self-etch system had the highest %SP (p < 0.05). There was a tendency for %SP and %RP to show similar microleakage percentage depending on its sectioning. CONCLUSIONS: After thermo-mechanical load cycling, there were differences in internal adaptation among the groups using different adhesive systems.
Adhesives* ; Composite Resins ; Dentin* ; Humans ; Methods ; Molar, Third ; Silver Nitrate ; Tooth

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