Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.

The purposes of this study were firstly to investigate the any formation of precipitate after interaction between ALX and NaOCL and secondarily to analyze the PCA formation by using time of flight secondary ion mass (TOF-SIM) spectrometry. Mass spectrometry analysis was performed for the mixture of 0.5% ALX and 5.25% NaOCl. As controls, 2.5% CHX with 5.25% NaOCl and 1% PCA solutions were used. Any formation of precipitates in 10 tested solutions was evaluated by naked eye. Results of mass spectrum showed that the typical peak of PCA was not detected in mixed solution of ALX and NaOCl, whereas CHX/NaOCl mixture showed the same peak that found in the PCA spectrum. Precipitate formation was only observed in CHX/NaOCL mixture. The present TOF-SIM spectrometry results indicated that ALX can be a useful root canal irrigant combined with NaOCl during canal instrumentation. Further study is necessary to confirm the antimicrobial effect of ALX against endodontic pathogen before its clinical application as an endodontic irrigant.

Protein microarray or protein chips is potentially powerful tools for analysis of protein-protein interactions. APin cDNA was previously identified and cloned from a rat odontoblast cDNA library. The purpose of this study was to investigate the APin-protein interactions during ameloblast differentiation. Protein microarray was carried with recombinant APin protein and MEF2, Aurora kinase A, BMPR-IB and EF-hand calcium binding protein were selected among 74 interacting proteins. Immortalized ameloblast cells (ALCs) were transfected with pCMV-APin construct and U6-APin siRNA construct. After transfection, the expression of the mRNAs for four proteins selected by protein micoarrays were assessed by RT-PCR.

The results were as follows:

1. APin expression was increased and decreased markedly after its over-expression and inactivation, respectively.

2. Over-expression of the APin in the ALCs markedly down-regulated the expression of MEF2 and Aurora kinase A, whereas their expression remained unchanged by its inactivation.

3. Expression of BMPR-IB and EF-hand calcium binding protein were markedly increased by the overexpression of the APin in the ALCs, whereas expression of BMPR-IB remained unchanged and expression of EF-hand calcium binding protein was markedly decreased by its inactivation.

These results suggest that APin plays an important role in ameloblast differentiation and mineralization by regulating the expression of MEF2, Aurora kinase A, BMPR-IB and EF-hand calcium binding protein.