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.

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Coronal discoloration is a common sequela to traumatic injuries. In subluxation cases, although the injury is not strong enough to rupture the apical vessels, discoloration may appear by tearing thin walls or occluding small capillaries. In absence of infection pulpal regeneration can occur, and as a result discoloration may completely or partially subside. But judging pulpal status by coronal discoloration can be dangerous and it may lead to unnecessary treatment.

This case presents coronal discoloration and recovery following traumatic injury of maxillary anterior teeth. In diagnosing traumatized teeth routine cold tests or electric pulp tests are known to be unreliable, but with the aid of ultrasound doppler imaging, assessing pulp vitality of traumatized teeth can be more accurate.

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• Pulp necrosis following luxated injury to teeth in a patient with uncontrolled type II diabetes mellitus: a case report
  Haneol Shin, Seung-Jong Lee, Il-Young Jung, Chan-Young Lee
  Restorative Dentistry & Endodontics.2012; 37(1): 61.     CrossRef

The purpose of this study was to examine the viability of PDL cells in rat molars by using in vivo MTT assay, which was used to compare fast cryopreservation group by liquid nitrogen (-196℃) with 4℃ cold preservation group.

A total of 74 Sprague-Dawley white female rats of 4 week-old with a body weight of 100 grams were used. The maxillary left and right, first and second molars were extracted as atraumatically as possible under ketamine anesthesia.

Ten teeth of each group were divided as six experimental groups depending upon the preservation. Cryopreservation groups were Group 1 (5% DMSO 6% HES in F medium), Group 2 (10% DMSO in F medium), Group 3 (5% DMSO 6% HES in Viaspan®), Group 4 (10% DMSO in Viaspan®) which were cryopreserved for 1 week and cold preservation groups were Group 5 (F medium), Group 6 (Viaspan®) at 4℃ for 1 week. Immediate extraction group was used as a control. After preservation and thawing, the in vivo MTT assay was processed. Two way ANOVA and Duncan's Multiple Range Test was performed at the 95% level of confidence. Another 2 teeth of each group were treated as the same manner and frozen sections 10 µm thick for microscopic observation.

The value of optical density obtained after in vivo MTT analysis was divided by the value of eosin staining for tissue volume standardization. Group 1, 2 had significantly higher optical density than Group 3 and 4 which had the lowest OD value. Group 6 had higher OD value than in Group 5 (P < 0.05). Histological findings of periodontal ligament cell, after being stained with MTT solution were consistent with the in vivo MTT assay results.

In this study, the groups which were frozen with DMSO as a cryoprotectant and the groups with F medium showed the best results.

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  Sun Mi Jang, Sin-Yeon Cho, Eui-Seong Kim, Il-Young Jung, Seung Jong Lee
  Journal of Korean Dental Science.2016; 9(1): 1.     CrossRef
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  Hee Su Lee, You Sun Lim
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• The evaluation of periodontal ligament cells of rat teeth after low-temperature preservation under high pressure
  Jin-Ho Chung, Jin Kim, Seong-Ho Choi, Eui-Seong Kim, Jiyong Park, Seung-Jong Lee
  Journal of Korean Academy of Conservative Dentistry.2010; 35(4): 285.     CrossRef
• Comparison of viability of oral epithelial cells stored by different freezing methods
  Do-Young Baek, Seung-Jong Lee, Han-Sung Jung, EuiSeong Kim
  Journal of Korean Academy of Conservative Dentistry.2009; 34(6): 491.     CrossRef
• The efficacy of programmed cryo-preservation under pressure in rat periodontal ligament cells
  Young-Eun Lee, Eui-Seong Kim, Jin Kim, Seung-Hoon Han, Seung-Jong Lee
  Journal of Korean Academy of Conservative Dentistry.2009; 34(4): 356.     CrossRef

Periapical cemental dysplasia(PCD) is a condition most commonly seen in the mandibular incisor region. Radiographically it passes through the three phases(osteolytic stage, intermediate stage, and mature stage). At osteolytic stage, the lesion is similar to features associated with granuloma or cyst that arise following pulpal necrosis. So, it is important to confirm the vitality of the pulp to diagnosis.

In this case, it is difficult to confirm the vitality of involved tooth because the tooth was covered with PFG bridge. And it is unusual that the PCD lesion at mandibular incisors has occurred at first and the lesion of mandibular canine and mandibular premolar were occurred afterward.

Use of electric pulp testing elicits painful response in vital teeth. In this study, we examined the excessive time from pain feeling to stimulation disconnection in clinical situation. D626D (Parkell Inc., USA.) scan type electric pulp tester was used in total of 23 young healthy individuals. Each of the right central incisors and first premolars were used as testing teeth. Stimulation disconnection was achieved by EMG in anterior belly of digastric muscle, finger span, and voice and the excessive stimulation time over the sensory threshold was recorded. As a result, we found that the short responses before the stimulation disconnection appeared following order; EMG, finger span, and voice. The EMG disconnection is suggested to be used to reduce the excessive stimulus time in electric pulp testing.

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• Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester
  Myong-Suk Ku, Jin Wook Kim, Young Hoon Jeon, Tae Geon Kwon, Sang Han Lee
  Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011; 37(6): 464.     CrossRef