Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Maxillary lateral incisors usually exhibit a single root with a single canal. However, maxillary lateral incisor teeth with unusual morphology of root canal system are frequently reported. These cases of variable root canal anatomy can be treated well by nonsurgical endodontic methods. A detailed description of root canal morphology is fundamental for successful endodontic treatment. Treatment using an operating microscope, radiographs from different angles, and cone-beam computerized tomography (CBCT) can produce more predictable endodontic outcomes.

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

The objective of this article was to present two nonodontogenic conditions that may mimic odontogenic toothache: trigeminal neuralgia and burning mouth syndrome. Two cases are presented in which one is related to the upper left second premolar and the other is related to the upper left first molar. Both showed pain when chewing. These two cases highlight the complexities involved in diagnosing nonodontogenic toothache. This article demonstrates the importance of having a thorough knowledge of both odontogenic and nonodontogenic toothache, as well as the need for careful evaluation of the nature of the pain and history, clinical and radiographic examinations.

Screw-in effect is one of the unintended phenomena that occurs during the root canal preparation with nickel-titanium rotary files. The aim of this study was to compare the screw-in effect among various nickel-titanium rotary file systems.

Six different nickel-titanium rotary instruments (ISO 20/.06 taper) were used: K3™ (SybronEndo, Glendora, CA, USA), M_two (VDW GmbH, München, Germany), NRT with safe-tip and with active tip (Mani Inc., Shioya-gun, Japan), ProFile® (Dentsply-Maillefer, Ballaigues, Switzerland) and ProTaper® (Dentsply-Maillefer, Ballaigues, Switzerland). For ProTaper®, S2 was selected because it has size 20. Root canal instrumentations were done in sixty simulated single-curved resin root canals with a rotational speed of 300 rpm and single pecking motion. A special device was designed to measure the force of screw-in effect. A dynamometer of the device recorded the screw-in force during simulated canal preparation and the recorded data was stored in a computer with designed software (LCV-USE-VS, Lorenz Messtechnik GmbH, Alfdorf, Germany). The data were subjected to one-way ANOVA and Tukey's multiple range test for post-hoc test. P value of less than 0.05 was regarded significant.

ProTaper® produced significantly more screw-in effects than any other instruments in the study (p < 0.001). K3™ produced significantly more screw-in effects than M_two, and ProFile® (p < 0.001). There was no significant difference among M_two, NRT, and ProFile® (p > 0.05), and between NRT with active tip and NRT with safe one neither (p > 0.05).

From the result of the present study, it was concluded, therefore, that there seems significant differences of screw-in effect among the tested nickel-titanium rotary instruments. The radial lands and rake angle of nickel-titanium rotary instrument might be the cause of the difference.

This study was to investigate the influence of combining composite resins with different elastic modulus, and occlusal loading condition on the stress distribution of restored notch-shaped non-carious cervical lesion using 3D finite element (FE) analysis.

The extracted maxillary second premolar was scanned serially with Micro-CT. The 3D images were processed by 3D-DOCTOR. ANSYS was used to mesh and analyze 3D FE model. A notch-shaped cavity was modeled and filled with hybrid, flowable resin or a combination of both. After restoration, a static load of 500N was applied in a point-load condition at buccal cusp and palatal cusp. The stress data were analyzed using analysis of principal stress.

Results showed that combining method such that apex was restored by material with high elastic modulus and the occlusal and cervical cavosurface margin by small amount of material with low elastic modulus was the most profitable method in the view of tensile stress that was considered as the dominant factor jeopardizing the restoration durability and promoting the lesion progression.

This study was to investigate the influence of composite resins with different elastic modulus, cavity modification and occlusal loading condition on the stress distribution of restored notch-shaped noncarious cervical lesion using 3-dimensional (3D) finite element (FE) analysis.

The extracted maxillary second premolar was scanned serially with Micro-CT. The 3D images were processed by 3D-DOCTOR. ANSYS was used to mesh and analyze 3D FE model. A notch-shaped cavity and a modified cavity with a rounded apex were modeled. Unmodified and modified cavities were filled with hybrid or flowable resin. After restoration, a static load of 500N was applied in a point-load condition at buccal cusp and palatal cusp. The stress data were analyzed using analysis of principal stress.

The results were as follows:

In the unrestored cavity, the stresses were highly concentrated at mesial CEJ and lesion apex and the peak stress was observed at the mesial point angle under both loading conditions.

The purpose of this study was to investigate the function of calcitonin gene-related peptide (CGRP) in regulatory mechanism of pulpal microcirculation with the aim of elucidating neurogenic inflammation.

Experiments were performed on twelve cats under general anesthesia. CGRP was administered through the femoral vein to see the systemic influence and through the external carotid artery to see the local effect. Sympathetic nerve to the dental pulp was stimulated electrically and pulpal blood flow (PBF) was measured with a laser Doppler flowmeter on the canine teeth to the drug administration. The paired variables of control and experimental data were compared by paired t-test and differences with p < 0.05 were considered statistically significant.

Systemic administration of CGRP (0.3 μg/kg) exerted decreases in systemic blood pressure and caused changes in PBF with an initial increase followed by decrease and a more marked second increase and decrease.

Close intra-arterial (i.a.) injection of CGRP (0.03 μ/kg) resulted in slight PBF increase. The effect of CGRP resulted in no significant increase in PBF in the presence of CGRP_8-37.

The electrical stimulation of the sympathetic nerve alone resulted in PBF decreases. The i.a. administration of CGRP following the electrical stimulation of the sympathetic nerve compensated the decreased PBF. Therefore, CGRP effectively blocked the sympathetic nerve stimulation-induced PBF decrease.

Results of the present study have provided evidences that even though the local vasodilatory function of CGRP are weak, CGRP is effectively involved in blocking the vasoconstriction caused by sympathetic nerve stimulation in the feline dental pulp.

The purpose of this study was to evaluate the obturation efficiency of a non-standardized gutta-percha cone in curved root canals prepared with 0.06 taper nickel-titanium instruments.

Sixty simulated curved root canals in clear resin blocks were prepared with crown-down technique using 0.06 taper rotary ProTaper™ and ProFile (Dentsply-Maillefer) until apical canal was size 30. Root canals were randomly divided into 4 groups of 15 blocks and obturated with cold-laterally compacted gutta-percha technique by using either a non-standardized size medium gutta-percha cone or an ISO-standardized size 30 one as a master cone. Gutta-percha area ratio were calculated at apical levels of 1, 3, and 5 mm using AutoCAD 2000 after cross-sectioning, and the data were analyzed with one-way and two-way ANOVAs and Duncan's multiple range test.

Non-standardized size medium cone groups showed significantly higher gutta-percha area ratio than standardized cone groups at all apical levels (p < 0.01).

Non-standardized cone groups used significantly less accessory cones than standardized cone groups (p < 0.01).

The purpose of this study was to evaluate the influence of plugger penetration depth on the apical extrusion of root canal sealer during root canal obturation with Continuous Wave of Condensation Technique.

Root canals of forty extracted human teeth were divided into four groups and were prepared up to size 40 of 0.06 taper with ProFile. After drying, canals of three groups were filled with Continuous Wave of Condensation Technique with System B™ and different plugger penetration depths of 3, 5, and 7 mm from the apex. Canals of one group were filled with cold lateral compaction technique as a control. Canals were filled with non-standardized master gutta-percha cones and 0.02 mL of Sealapex. Apical extruded sealer was collected in a container and weighed. Data was analyzed with one-way ANOVA and Duncan’s Multiple Range Test. 3 and 5 mm penetration depth groups in Continuous Wave of Condensation Technique showed significantly more extrusion of root canal sealer than 7 mm penetration depth group (p < 0.05). However, there was no significant difference between 7 mm depth group in Continuous Wave of Condensation Technique and cold lateral compaction group (p < 0.05).

The result of this study demonstrates that deeper plugger penetration depth causes more extrusion of root canal sealer in root canal obturation by Continuous Wave of Condensation Technique. Therefore, special caution is needed when plugger penetration is deeper in the canal in Continuous Wave of Condensation Technique to minimize the amount of sealer extrusion beyond apex.

The aim of this study was to evaluate the shaping abilities of four different rotary nickel-titanium instruments with anticurvature motion to prepare root canal at danger zone by measuring the change of dentin thickness in order to have techniques of safe preparation of canals with nickel-titanium files.

Mesiobuccal and mesiolingual canals of forty mesial roots of extracted human lower molars were instrumented using the crown-down technique with ProFile, GT™ Rotary file, Quantec file and ProTaper™. In each root, one canal was prepared with a straight up-and-down motion and the other canal was with an anticurvature motion. Canals were instrumented until apical foramens were up to size of 30 by one operator. The muffle system was used to evaluate the root canal preparation. After superimposing the pre- and post-instrumentation canal, change in root dentin thickness was measured at the inner and outer sides of the canal at 1, 3, and 5 mm levels from the furcation. Data were analyzed using two-way ANOVA.

Root dentin thickness at danger zone was significantly thinner than that at safe zone at all levels (p < 0.05).

There was no significant difference in the change of root dentin thickness between the straight up-and-down and the anticurvature motions at both danger and safe zones in all groups (p > 0.05).

ProTaper removed significantly more dentin than other files especially at furcal 3 mm level of danger and safe zones (p < 0.05)

Therefore, it was concluded that anticurvature motion with nickel-titanium rotary instruments does not seem to be effective in danger zone of lower molars.

The purpose of this study was to investigate the influence of NK1 receptor antagonists on the pulpal blood flow (PBF) when applied iontophoretically through the dentinal cavity of the teeth in order to understand whether iontophoretically applied NK1 receptor antagonists can control the pulpal inflammation.

Eleven cats were anesthetized with alpha-chloralose and urethane, and substance P (SP) was administered to the dental pulp through the catheterized lingual artery in doses that caused PBF change without the influence of systemic blood pressure. NK1 receptor antagonists were applied iontophoretically to the prepared dentinal cavity of ipsilateral canine teeth of the drug administration, and PBF was monitored. Data were analyzed statistically with paired t-test.

PBF increase after iontophoretic application of the NK1 receptor antagonists followed by the intra-arterial administration of SP was significantly less than PBF increase after iontophoretic application of the 0.9% saline followed by the intra-arterial administration of SP as a control (p < 0.05).

Iontophoretic application of the NK1 receptor antagonists (0.2~3.4 mM) following the intra-arterial administration of SP resulted in less increase of PBF than the iontophoretic application of the 0.9% saline following the intra-arterial administration of SP as a control (p < 0.05).

Therefore, the results of the present study provide evidences that the iontophoretic application is an effective method to deliver drugs to the dental pulp, and that iontophoretically applied NK1 receptor antagonists block SP-induced vasodilation effectively. The above results show the possibility that the iontophoretical application of NK1 receptor antagonists can control the neurogenic inflammation in the dental pulp.

Nitric oxide (NO) is a small molecule (mol. wt. 30 Da) and oxidative free radical. It is uncharged and can therefore diffuse freely within and between cells across membrane. Such characteristics make it a biologically important messenger in physiologic processes such as neurotransmission and the control of vascular tone. NO is also highly toxic and is known to acts as a mediator of cytotoxicity during host defense.

NO is synthesized by nitric oxide synthase (NOS) through L-arginine/nitric oxide pathway which is a dioxygenation process. NO synthesis involves several participants, three co-substrates, five electrons, five co-factors and two prosthetic groups.

Under normal condition, low levels of NO are synthesized by type I and III NOS for a short period of time and mediates many physiologic processes. Under condition of oxidant stress, high levels of NO are synthesized by type II NOS and inhibits a variety of metabolic processes and can also cause direct damage to DNA. Such interaction result in cytostasis, energy depletion and ultimately cell death. NO has the potential to interact with a variety of intercellular targets producing diverse array of metabolic effects.

It is known that NO is involved in hemodynamic regulation, neurogenic inflammation, re-innervation, management of dentin hypersensitivity on teeth. Under basal condition of pulpal blood flow, NO provides constant vasodilator tone acting against sympathetic vasoconstriction. Substance P, a well known vasodilator, was reported to be mediated partly by NO, while calcitonin-gene related peptide has provided no evidence of its relation with NO.

This review describes the roles of NO in dental pulp in addition to the known general roles of it.

The aim of this study was to investigate the effect of light irradiation modes on polymerization shrinkage, degree of cure and microleakage of a composite resin.

VIP™ (Bisco Dental Products, Schaumburg, IL, USA) and Optilux 501™ (Demetron/Kerr, Danbury, CT, USA) were used for curing Filtek™ Z-250 (3M Dental Products, St. Paul., MN, USA) composite resin using following irradiation modes: VIP™ (Bisco) 200mW/cm² (V2), 400mW/cm² (V4), 600mW/cm² (V6), Pulse-delay (200 mW/cm² 3 seconds, 5 minutes wait, 600mW/cm² 30seconds, VPD) and Optilux 501™ (Demetron/Kerr) C-mode (OC), R-mode (OR).

Linear polymerization shrinkage of the composite specimens were measured using Linometer (R&B, Daejeon, Korea) for 90 seconds for V2, V4, V6, OC, OR groups and for up to 363 seconds for VPD group (n=10, each).

Degree of conversion was measured using FTIR spectrometer (IFS 120 HR, Bruker Karlsruhe, Germany) at the bottom surface of 2 mm thick composite specimens. V2, V4, V6, OC groups were measured separately at five irradiation times (5, 10, 20, 40, 60 seconds) and OR, VPD groups were measured in the above mentioned irradiation modes (n=5, each).

Microhardness was measured using Digital microhardness tester (FM7, Future-Tech Co., Tokyo, Japan) at the top and bottom surfaces of 2mm thick composite specimens after exposure to the same irradiation modes as the test of degree of conversion(n=3, each).

For the microleakage test, class V cavities were prepared on the distal surface of the ninety extracted human third molars. The cavities were restored with one of the following irradiation modes: V2/60 seconds, V4/40 seconds, V6/30 seconds, VPD, OC and OR. Microleakage was assessed by dye penetration along enamel and dentin margins of cavities.

Mean polymerization shrinkage, mean degree of conversion and mean microhardness values for all groups at each time were analyzed using one-way ANOVA and Duncan's multiple range test, and using chi-square test for microleakage values.

The results were as follows:

·Polymerization shrinkage was increased with higher light intensity in groups using VIP™ (Bisco): the highest with 600mW/cm², followed by Pulse-delay, 400mW/cm² and 200mW/cm² groups. The degree of polymerization shrinkage was higher with Continuous mode than with Ramp mode in groups using Optilux 501™ (Demetron/Kerr).

·Degree of conversion and microhardness values were higher with higher light intensity. The final degree of conversion was in the range of 44.7 to 54.98% and the final microhardness value in the range of 34.10 to 56.30.

·Microleakage was greater in dentin margin than in enamel margin. Higher light intensity showed more microleakage in dentin margin in groups using VIP™ (Bisco). The micoleakage was the lowest with Continuous mode in enamel margin and with Ramp mode in dentin margin when Optilux 501™(Demetron/Kerr) was used.