Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical ‘bone-window technique’ using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess.Periapical lesions were confirmed using cone-beam computed tomography (CBCT).Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.

Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical ‘bone-window technique’ using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess.Periapical lesions were confirmed using cone-beam computed tomography (CBCT).Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.

OBJECTIVES: To achieve pulp-dentin complex regeneration with tissue engineering, treatment efficacies and safeties should be evaluated using in vivo orthotopic transplantation in a sufficient number of animals. Mice have been a species of choice in which to study stem cell biology in mammals. However, most pulp-dentin complex regeneration studies have used large animals because the mouse tooth is too small. The purpose of this study was to demonstrate the utility of the mouse tooth as a transplantation model for pulp-dentin complex regeneration research. MATERIALS AND METHODS: Experiments were performed using 7-week-old male Institute of Cancer Research (ICR) mice; a total of 35 mice had their pulp exposed, and 5 mice each were sacrificed at 1, 2, 4, 7, 9, 12 and 14 days after pulp exposure. After decalcification in 5% ethylenediaminetetraacetic acid, the samples were embedded and cut with a microtome and then stained with hematoxylin and eosin. Slides were observed under a high-magnification light microscope. RESULTS: Until 1 week postoperatively, the tissue below the pulp chamber orifice appeared normal. The remaining coronal portion of the pulp tissue was inflammatory and necrotic. After 1 week postoperatively, inflammation and necrosis were apparent in the root canals inferior to the orifices. The specimens obtained after experimental day 14 showed necrosis of all tissue in the root canals. CONCLUSIONS: This study could provide opportunities for researchers performing in vivo orthotopic transplantation experiments with mice.
Animals ; Biology ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Edetic Acid ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Inflammation ; Male ; Mammals ; Mice ; Necrosis ; Pulpitis ; Regeneration ; Safety ; Stem Cells ; Tissue Engineering ; Tooth

OBJECTIVES: In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications. MATERIALS AND METHODS: HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting. RESULTS: Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups. CONCLUSIONS: Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.
Antigens, Differentiation ; Blotting, Western ; Dental Pulp* ; Digestion ; Humans* ; In Vitro Techniques* ; Mesenchymal Stromal Cells ; Methods* ; Polymerase Chain Reaction ; Stem Cells* ; Tissue Engineering

Pressure root resorption can be observed during the eruption of permanent dentition, especially of the maxillary canines (affecting lateral incisors) and mandibular third molars (affecting mandibular second molars). Since the cause of root resorption of the adjacent affected teeth is evident, treatment simply involves extraction of the impacted tooth. However, there have been few reports on the prognosis of the remaining resorbed tooth, as dentists often choose to extract them when damage due to root resorption is observed. We report a case involving a tooth that was severely resorbed due to pressure from an adjacent impacted tooth. After extraction of the impacted tooth, the remaining tooth retained vital pulp and survived as a functional tooth.
Dentists ; Dentition, Permanent ; Humans ; Molar* ; Molar, Third* ; Prognosis ; Root Resorption* ; Tooth ; Tooth, Impacted

PURPOSE: The purpose of the present retrospective cohort study was to investigate the incidence of sinus perforation during endodontic microsurgery and to assess healing of cases with sinus perforation. MATERIALS AND METHODS: Clinical and radiographic records were collected from patients who were treated with endodontic microsurgery in the Microscope Center of the Department of Conservative Dentistry at Yonsei University College of Dentistry, Seoul, Korea, between March 2001 and January 2016. To determine the incidence of sinus perforation, all cases involving maxillary premolar and molar teeth were assessed, and cases with perforation of maxillary sinus during the procedure were counted. To assess the outcome of the endodontic microsurgery, cases with sinus perforation were recalled at least 1 year after surgery. RESULT: Two hundred and forty-nine maxillary premolars and molars were treated with endodontic microsurgery. Among these cases, 16 cases had sinus perforations. Overall incidence of sinus perforation was 6.4%. Thirteen cases with sinus perforation were followed up for 1 year after endodontic microsurgery. Outcome assessment revealed that 2 of 13 cases with sinus perforation had failed. The success rate of endodontic microsurgery with sinus perforation was 84.6%. CONCLUSION: Endodontic surgery performed using microsurgical techniques decreases the risk of sinus perforation. Predictable outcomes of endodontic microsurgeries and healing of sinus membrane can be expected with adequate treatment steps and careful periodic follow-ups in cases with maxillary sinus perforations.
Bicuspid ; Cohort Studies ; Dentistry ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Maxillary Sinus* ; Membranes ; Microsurgery* ; Molar ; Retrospective Studies ; Seoul ; Tooth

The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.
Animals ; Appointments and Schedules ; Calcium Hydroxide* ; Dental Pulp Cavity* ; Endodontics ; Humans ; Outcome Assessment (Health Care)

The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.
Animals ; Appointments and Schedules ; Calcium Hydroxide* ; Dental Pulp Cavity* ; Endodontics ; Humans ; Outcome Assessment (Health Care)

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.
Animals ; Calcium Sulfate ; Collagen ; Epinephrine ; Foreign-Body Reaction ; Hemostatics ; Ischemia ; Microsurgery* ; Population Characteristics ; Prognosis

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