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Case Report
Observation of an extracted premolar 2.5 years after mineral trioxide aggregate apexification using micro-computed tomography
Gayeon Lee, Chooryung Chung, Sunil Kim, Su-Jung Shin
Restor Dent Endod 2020;45(2):e4.   Published online November 22, 2019
DOI: https://doi.org/10.5395/rde.2020.45.e4
AbstractAbstract PDFPubReaderePub

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.

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Editorials
Appreciations to peer reviewers in 2018: contributions to the journal, Restorative Dentistry & Endodontics
Byeong-Hoon Cho, Su-Jung Shin
Restor Dent Endod 2019;44(1):e12.   Published online February 18, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e12
PDFPubReaderePub
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Appreciations to peer reviewers in 2017: contributions to the journal, Restorative Dentistry & Endodontics
Byeong-Hoon Cho, Su-Jung Shin
Restor Dent Endod 2018;43(1):e6.   Published online January 12, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e6
PDFPubReaderePub
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Case Reports
Progression of periapical cystic lesion after incomplete endodontic treatment
Jong-Ki Huh, Dong-Kyu Yang, Kug-Jin Jeon, Su-Jung Shin
Restor Dent Endod 2016;41(2):137-142.   Published online February 22, 2016
DOI: https://doi.org/10.5395/rde.2016.41.2.137
AbstractAbstract PDFPubReaderePub

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.

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Esthetic rehabilitation of single anterior edentulous space using fiber-reinforced composite
Hyeon Kim, Min-Ju Song, Su-Jung Shin, Yoon Lee, Jeong-Won Park
Restor Dent Endod 2014;39(3):220-225.   Published online May 19, 2014
DOI: https://doi.org/10.5395/rde.2014.39.3.220
AbstractAbstract PDFPubReaderePub

A fiber-reinforced composite (FRC) fixed prosthesis is an innovative alternative to a traditional metal restoration, as it is a conservative treatment method. This case report demonstrates a detailed procedure for restoring a missing anterior tooth with an FRC. A 44-year-old woman visited our department with an avulsed tooth that had fallen out on the previous day and was completely dry. This tooth was replanted, but it failed after one year. A semi-direct technique was used to fabricate a FRC fixed partial prosthesis for its replacement. The FRC framework and the pontic were fabricated using a duplicated cast model and nanofilled composite resin. Later on, interproximal contact, tooth shape, and shade were adjusted at chairside. This technique not only enables the clinician to replace a missing tooth immediately after extraction for minimizing esthetic problems, but it also decreases both tooth reduction and cost.

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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
Restor Dent Endod 2014;39(1):56-62.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.56
AbstractAbstract PDFPubReaderePub

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.

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Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report
Jong-Ki Huh, Su-Jung Shin
Restor Dent Endod 2013;38(3):160-166.   Published online August 23, 2013
DOI: https://doi.org/10.5395/rde.2013.38.3.160
AbstractAbstract PDFPubReaderePub

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

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Considerations during crown reattachment procedure over the pulpal exposure: case report
Bona Kim, Yoon Lee, Min-Ju Song, Su-Jung Shin, Jeong-Won Park
Restor Dent Endod 2012;37(4):240-244.   Published online November 21, 2012
DOI: https://doi.org/10.5395/rde.2012.37.4.240
AbstractAbstract PDFPubReaderePub

Crown reattachment is the most conservative treatment which can be used to restore fractured tooth, presumably with sufficient strength, while maintaining original contour, incisal translucency, and reducing chair time and cost.

However, in case of crown fracture with pin-point pulp exposure, we should cautiously minimize the irritation to the pulp and consider pre-treatment pulpal status, choice of pulp capping materials, choice of bonding system and treatment sequence during crown reattachment procedures. This case reports the considerations while crown reattachment with direct pulp capping using calcium hydroxide (Dycal, Dentsply Caulk).

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Prevention of tooth discoloration associated with triple antibiotics
Bona Kim, Min-Ju Song, Su-Jung Shin, Jeong-Won Park
Restor Dent Endod 2012;37(2):119-122.   Published online May 18, 2012
DOI: https://doi.org/10.5395/rde.2012.37.2.119
AbstractAbstract PDFPubReaderePub

Regenerative endodontics has a potential to heal a partially necrotic pulp, which can be beneficial for the continued root development and strengthening of immature teeth. For this purpose, triple antibiotic mixture of ciprofloxacin, metronidazole, and minocycline was recommended as intracanal medicament in an attempt to disinfect the root canal system for revascularization of a tooth with a necrotic pulp. However, discoloration of the tooth was reported after applying this. This case shows the idea for preventing the tooth discoloration using a delivery syringe (SW-O-01, Shinwoo dental) to avoid the contact between the clinical crown and the antibiotics.

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Endodontic management of a maxillary lateral incisor with dens invaginatus and external root irregularity using cone-beam computed tomography
Young-Jun Lim, Sook-Hyun Nam, Sung-Ho Jung, Dong-Ryul Shin, Su-Jung Shin, Kyung-San Min
Restor Dent Endod 2012;37(1):50-53.   Published online March 2, 2012
DOI: https://doi.org/10.5395/rde.2012.37.1.50
AbstractAbstract PDFPubReaderePub

Cone-beam computed tomography (CBCT) is a useful diagnostic tool for identification of both internal and external root configurations. This case report describes the endodontic management of a lateral incisor with both dens invaginatus and external root irregularity by using CBCT. Nonsurgical endodontic retreatment was performed on the lateral incisor with dens invaginatus. A perforation through the dens invaginatus and external concavity was repaired using mineral trioxide aggregate. After 18 mon of follow-up, there were no clinical symptoms. Recall radiographs appeared normal and showed healing of the periapical pathosis. The understanding of both internal root canal configuration and external root irregularity using CBCT can ensure predictable and successful results.

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Research Article
Morphological evaluation during in vitro chondrogenesis of dental pulp stromal cells
Choo-Ryung Chung, Ha-Na Kim, Yeul Park, Min-Jeong Kim, Young-Ju Oh, Su-Jung Shin, Yoon-Jeong Choi, Kyung-Ho Kim
Restor Dent Endod 2012;37(1):34-40.   Published online March 2, 2012
DOI: https://doi.org/10.5395/rde.2012.37.1.34
AbstractAbstract PDFPubReaderePub
Objectives

The aim was to confirm the stem cell-like properties of the dental pulp stromal cells and to evaluate the morphologic changes during in vitro chondrogenesis.

Materials and Methods

Stromal cells were outgrown from the dental pulp tissue of the premolars. Surface markers were investigated and cell proliferation rate was compared to other mesenchymal stem cells. Multipotency of the pulp cells was confirmed by inducing osteogenesis, adipogenesis and chondrogenesis. The morphologic changes in the chondrogenic pellet during the 21 day of induction were evaluated under light microscope and transmission electron microscope. TUNEL assay was used to evaluate apoptosis within the chondrogenic pellets.

Results

Pulp cells were CD90, 105 positive and CD31, 34 negative. They showed similar proliferation rate to other stem cells. Pulp cells differentiated to osteogenic, adipogenic and chondrogenic tissues. During chondrogenesis, 3-dimensional pellet was created with multi-layers, hypertrophic chondrocyte-like cells and cartilage-like extracellular matrix. However, cell morphology became irregular and apoptotic cells were increased after 7 day of chondrogenic induction.

Conclusions

Pulp cells indicated mesenchymal stem cell-like characteristics. During the in vitro chondrogenesis, cellular activity was superior during the earlier phase (within 7 day) of differentiation.

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Basic Researchs
Evaluation of canal preparation for apical sealing with various Ni-Ti rotary instruments
Yooseok Shin, Su-Jung Shin, Minju Song, Euiseong Kim
J Korean Acad Conserv Dent 2011;36(4):300-305.   Published online July 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.4.300
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the various NiTi rotary instruments regarding their ability to provide a circular apical preparation.

Materials and Methods

50 single canal roots were selected, cut at the cementodentinal junction and the coronal 1/3 of the canals was flared using Gates Glidden burs. Samples were randomly divided into 5 experimental groups of 10 each. In group I, GT files, Profile 04 and Quantec #9 and #10 files were used. In Group II Lightspeed was used instead of Quantec. In Group III, Orifice shaper, Profile .06 series and Lightspeed were used. In Group IV, Quantec #9 and #10 files were used instead of Lightspeed. In Group V, the GT file and the Profile .04 series were used to prepare the entire canal length. All tooth samples were cut at 1 mm, 3 mm and 5 mm from the apex and were examined under the microscope.

Results

Groups II and III (Lightspeed) showed a more circular preparation in the apical 1mm samples than the groups that used Quantec (Group I & IV) or GT files and Profile .04 series.(Group V)(p < 0.05) There was no significant difference statistically among the apical 3, 5 mm samples. In 5 mm samples, most of the samples showed complete circularity and none of them showed irregular shape.

Conclusions

Lightspeed showed circular preparation at apical 1 mm more frequently than other instruments used in this study. However only 35% of samples showed circularity even in the Lightspeed Group which were enlarged 3 ISO size from the initial apical binding file (IAF) size. So it must be considered that enlarging 3 ISO size isn't enough to make round preparation.

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Matrix metalloproteinase-8 and substance P levels in root canal exudates of nonvital teeth
Su-Jung Shin, Woocheol Lee, Jae-Il Lee, Seung-Ho Baek, Kee-Yeon Kum, Won-Jun Shon, Kwang-Shik Bae
J Korean Acad Conserv Dent 2011;36(3):196-202.   Published online May 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.3.196
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in root canal exudates during root canal treatment (RCT) of nonvital, painful teeth.

Materials and Methods

Patients scheduled for nonsurgical RCT were prospectively selected; the study was performed after obtaining informed consent from the patients and was approved by the Institutional Review Board for Clinical Research of Gangnam Severance Hospital, Yonsei University (3-2008-0118). Canal exudates samples were collected using sterilized paper points from teeth scheduled for RCT across three different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis (p < 0.05).

Results

MMP-8 and SP levels in GCF were decreased during RCT (p < 0.0001), and they showed a weak positive correlation to each other (p < 0.05). Patients'subjective pain levels and the response from percussion test were significantly related to SP level.

Conclusions

This study demonstrated that periradicular inflammation endodontic origin can elevate SP and MMP-8 levels in root canal exudates. Interestingly, SP level of canal exudates showed a possibility of being used as an indicator of pain due to periapical pathosis.

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The evaluation of surface roughness and polishing time between polishing systems
Ye-Mi Kim, Su-Jung Shin, Min-Ju Song, Jeong-Won Park
J Korean Acad Conserv Dent 2011;36(2):119-124.   Published online March 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.2.119
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this experiment was to evaluate four different polishing systems of their polishability and polishing time.

Materials and Methods

4 mm diameter and 2 mm thickness Teflon mold was made. Z-250 (3M ESPE) hybrid composite resin was slightly overfilled and pressed with slide glass and cured with Optilux 501 for 40 sec each side. Then the surface roughness (glass pressed: control group) was measured with profilometer. One surface of the specimen was roughened by #320 grit sand paper and polished with one of the following polishing systems; Sof-Lex (3M ESPE), Jiffy (Ultradent), Enhance (Dentsply/Caulk), or Pogo (Dentsply/Caulk). The surface roughness and the total polishing time were measured. The results were analyzed with one-way ANOVA and Duncan's multiple range test.

Results

The surface roughness was lowest in Pogo, and highest in Sof-Lex. Polishing times were shortest with Pogo, and followed by the Sof-Lex, Enhance and Jiffy.

Conclusions

One-step polishing system (Pogo) is very effective to get the smooth surface in a short time, therefore it can be recommended for final polishing system of the restoration.

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Patients' perception and satisfaction with apicoectomy
Euiseong Kim, Seung-Jong Lee, Jeong-Won Park, Su-Jung Shin
J Korean Acad Conserv Dent 2011;36(2):114-118.   Published online March 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.2.114
AbstractAbstract PDFPubReaderePub
Objectives

This study was aimed to examine the patients' perception and satisfaction with the results of endodontic microsurgery which was apicoectomy with retrofilling.

Materials and Methods

A questionnaire was given to 109 patients, who were recalled after a minimum of 3 months upon endodontic microsurgery in the Department of Conservative Dentistry, Yonsei University. A contingency table and correlation analysis were used to determine if there were any correlations between age/gender and the patients' responses (p = 0.05).

Results

Approximately 60% of respondents answered they had never heard of surgical endodontic procedures. 63.3% of respondents chose the surgical option because they wanted to keep their natural teeth. If the patient required the same procedure on another tooth later, 100 out of 109 respondents answered they would choose microsurgery instead of extraction. Most patients (82.57%) appeared to be satisfied with the surgical procedure.

Conclusions

Endodontic microsurgery consisting of apicoectomy and retrofilling seems to appeal to majority of patients as a satisfactory and valuable treatment choice.

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Comparison of apical transportation and change of working length in K3, NRT AND PROFILE rotary instruments using transparent resin block
Min-Jung Yoon, Min-Ju Song, Su-Jung Shin, Euiseong Kim
J Korean Acad Conserv Dent 2011;36(1):59-65.   Published online January 31, 2011
DOI: https://doi.org/10.5395/JKACD.2011.36.1.59
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study is to compare the apical transportation and working length change in curved root canals created in resin blocks, using 3 geometrically different types of Ni-Ti files, K3, NRT, and Profile.

Materials and Methods

The curvature of 30 resin blocks was measured by Schneider technique and each groups of Ni-Ti files were allocated with 10 resin blocks at random. The canals were shaped with Ni-Ti files by Crown-down technique. It was analyzed by Double radiograph superimposition method (Backman CA 1992), and for the accuracy and consistency, specially designed jig, digital X-ray, and CAD/CAM software for measurement of apical transportation were used. The amount of apical transportation was measured at 0, 1, 3, 5 mm from 'apical foramen - 0.5 mm' area, and the alteration of the working length before and after canal shaping was also measured. For statistics, Kruskal-Wallis One Way Analysis was used.

Results

There was no significant difference between the groups in the amount of working length change and apical transportation at 0, 1, and 3 mm area (p = 0.027), however, the amount of apical transportation at 5 mm area showed significant difference between K3 and Profile system (p = 0.924).

Conclusions

As a result of this study, the 3 geometrically different Ni-Ti files showed no significant difference in apical transportation and working length change and maintained the original root canal shape.

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Biocompatibility of bioaggregate cement on human pulp and periodontal ligament (PDL) derived cells
Choo-Ryung Chung, Euiseong Kim, Su-Jung Shin
J Korean Acad Conserv Dent 2010;35(6):473-478.   Published online November 30, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.6.473
AbstractAbstract PDFPubReaderePub
Objectives

This study was performed to investigate the biocompatibility of newly introduced Bioaggregate on human pulp and PDL cells.

Materials and Methods

Cells were collected from human pulp and PDL tissue of extracted premolars. Cell culture plate was coated either with Bioaggregate or white MTA, then the same number of cells were poured to cell culture dishes. Cell attachment and growth was examined under a phase microscope after 1,3 and 7 days of seeding. Cell viability was measured and the data was analyzed using Student t-test and one way ANOVA.

Results

Both types of cells used in this study were well attached and grew healthy on Bioaggregate and MTA coated culture dishes. No cell inhibition zone was observed in Bioaggregate group. There was no statistical difference of viable cells between bioaggreagte and MTA groups.

Conclusions

Bioaggregate appeared to be biocompatible compared with white MTA on human pulp and PDL cells.

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Case Report
Treatment of crown-root fracture with a modified crown fragment reattachment technique
Chang-Won Song, Min-Ju Song, Su-Jung Shin, Jeong-Won Park
J Korean Acad Conserv Dent 2010;35(5):395-401.   Published online September 30, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.5.395
AbstractAbstract PDFPubReaderePub

The development of adhesive dentistry has allowed that the crown fragment reattachment can be another option in the treatment of crown fracture. However, additional crown lengthening procedure or extrusion of the tooth may be necessary in the treatment of crown root fracture because subgingival fracture line in close proximity to the alveolar bone leads to challenges for restorative procedure and the violation of the biologic width. This case report presents a modified crown fragment reattachment technique of crown root fracture with pulp exposure, which was done without additional crown lengthening procedures. After the endodontic treatment, the patient was treated using a post insertion and the fragment reattachment technique, which made it possible to preserve the space for the biologic width and maintain a dry surgical field for adequate adhesion through the modification of the fractured coronal fragment. Since a coronal fracture was occurred and reattached afterward, it was observed that the coronal fragment was well maintained without the additional loss of periodontal attachment through 2-year follow up.

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Original Articles
THE DYNAMIC CHANGE OF ARTIFICIALLY DEMINERALIZED ENAMEL BY DEGREE OF SATURATION OF REMINERALIZATION SOLUTION AT pH 4.3
Ji-Sook Yi, Bung-Duk Roh, Su-Jung Shin, Yoon Lee, Hyung-Kyu Gong, Chan-Young Lee
J Korean Acad Conserv Dent 2009;34(1):20-29.   Published online January 14, 2009
DOI: https://doi.org/10.5395/JKACD.2009.34.1.20
AbstractAbstract PDFPubReaderePub
Abstract

The purpose of this study is to observe and compare the dynamic change of artificially demineralized enamel by remineralization solutions of different degrees of saturation at pH 4.3.

In this study, 30 enamel specimens were demineralized artificially by lactic acid buffered solution. Each of 10 specimens was immersed in pH 4.3 remineralization solution of three different degrees of saturation (0.22, 0.30, 0.35) for 10 days. After demineralization and remineralization, images were taken by a polarizing microscope (× 100). The density of lesion were determined from images taken after demineralization and remineralization.

During remineralization process, mineral deposition and mineral loss occurred at the same time. After remineralization, total mineral amount and width of surface lesion increased in all groups. The higher degree of saturation was, the more mineral deposition occurred in surface lesion and the amount of mineral deposition was not much in subsurface lesion. Total demineralized depth increased in all groups.

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Evaluation of retrievability using a new soft resin based root canal filling material
Su-Jung Shin, Yoon Lee, Jeong-Won Park
J Korean Acad Conserv Dent 2006;31(4):323-329.   Published online July 31, 2006
DOI: https://doi.org/10.5395/JKACD.2006.31.4.323
AbstractAbstract PDFPubReaderePub

The aim of this study was to evaluate the retrievability of Resilon as a root canal filling material. Twenty-seven human single-rooted extracted teeth were instrumented utilizing a crown down technique with Gates-Glidden burs and ProFile system. In group1 (n = 12) canals were obturated with gutta percha and AH-26 plus sealer using a continuous wave technique and backfilled. In group 2 (n = 15) Resilon was used as a filling material. Then teeth were sealed and kept in 37℃ and 100% humidity for 7 days. For retreatment, the samples were re-accessed and filling material was removed using Gates-Glidden burs and ProFiles. Teeth were sectioned longitudinally to compare the general cleanliness and amount of debris (× 75) using SEM. Chi-square test was used (α = 0.05) to analyze the data. The total time required for removal of filling materials was expressed as mean ± SD (min) and analyzed by the Student t-test (α = 0.05). Required time for retreatment was 3.25 ± 0.32 minutes for gutta percha/AH 26 plus sealer and 3.05 ± 0.34 minutes for Resilon. There was no statistically significant difference between the two experimental groups. There was no significant difference between the groups in the cleanliness of the root canal wall. This study showed that Resilon was effectively removed by Gates-Glidden burs and ProFiles.

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