Among dental traumas, horizontal root fractures are relatively uncommon injuries. Proper initial management and periodical evaluation is essential for the successful treatment of a root-fractured tooth. If pulpal necrosis develops, endodontic treatment is indicated, exclusively for the coronal fragment. Fragment diastases exert a great influence on healing at the fracture line and on pulpal necrosis. An adequately treated root-fractured tooth has a good prognosis. This case report describes the treatment and 2-yr follow up of 3 maxillary central incisors, first with horizontal root fracture, second with horizontal root fracture and avulsion, and third with horizontal root fracture and lateral luxation. All three cases were treated with mineral trioxide aggregate (ProRoot, Dentsply). During 2 yr of follow-up evaluation, the root-fractured teeth of the present patients were well retained in the arch, showing periodontal healing, even after endodontic treatment.

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.

The limited durability of resin-dentin bonds severely compromises the longevity of composite resin restorations. Resin-dentin bond degradation might occur via degradation of water-rich and resin sparse collagen matrices by host-derived matrix metalloproteinases (MMPs). This review article provides overview of current knowledge of the role of MMPs in dentin matrix degradation and four experimental strategies for extending the longevity of resin-dentin bonds. They include: (1) the use of broad-spectrum inhibitors of MMPs, (2) the use of cross-linking agents for silencing the activities of MMPs, (3) ethanol wet-bonding with hydrophobic resin, (4) biomimetic remineralization of water-filled collagen matrix. A combination of these strategies will be able to overcome the limitations in resin-dentin adhesion.

Mandibular premolars show a wide variety of root canal anatomy. Especially, the occurrence of three canals with three separate foramina in mandibular second premolars is very rare. This case report describes the root canal treatment of an unusual morphological configuration of the root canal system and supplements previous reports of the existence of such configuration in mandibular second premolar.

There are considerable in vitro and in vivo evidences for remineralization and demineralization occurring simultaneously in incipient enamel caries. In order to "heal"the incipient dental caries, many experiments have been carried out to determine the optimal conditions for remineralization. It was shown that remineralization is affected by different pH, lactic acid concentrations, chemical composition of the enamel, fluoride concentrations, etc.

Eighty specimens from sound permanent teeth without demineralization or cracks, 0.15 mm in thickness, were immersed in lactic acid buffered demineralization solutions for 3 days. Dental caries with a surface zone and subsurface lesion were artificially produced. Groups of 10 specimens were immersed for 10 or 12 days in lactic acid buffered remineralization solutions consisting of pH 4.3 or pH 6.0, and 100, 50, 25, or 10 mM lactic acid. After demineralization and remineralization, images were taken by polarizing microscopy (x100) and micro-computed tomography. The results were obtained by observing images of the specimens and the density of the caries lesions was determined.

As the lactic acid concentration of the remineralization solutions with pH 4.3 was higher, the surface zone of the carious enamel increased and an isotropic zone of the subsurface lesion was found. However, the total decalcification depth increased at the same time.

In the lactic acid buffer solutions with the lower pH and higher lactic acid concentration, there were dynamic changes at the deep area of the dental carious lesion.

Type II root canal was defined that two canals leave the chamber and merge to form a single canal at short of the apex. The aim of this study was to analyse the master apical file (MAF) size according to various instrumentation techniques in the type II root canal when each canal was enlarged to working length.

Eighty mesial roots of molar with ISO #15 initial apical file (IAF) size in type II root canals were randomly divided into four experimental groups with 20 teeth each. According to enlarging instruments, four groups are: K-FLEXOFILE® (KF), engine-driven Ni-Ti PROTAPER® (PT), HERO Shaper® (HS), K³ ™ (K3). All canals were enlarged to each working length with ISO #30 size: #30 in KF, F3 in PT, .04/30 in HS, and .06/30 in K3. The master apical file (MAF) size was confirmed by tactile sensation and universal testing machine (EZ test, Shimadzu Co., Kyoto, Japan). The mean MAF size was statistically compared using one-way ANOVA and Tukey HSD test at the 0.05 probability level.

These results show that the MAF size was appeared one or two sizes larger than the final enlarging instrument when all canal in type II configuration were enlarged to each working length. Therefore, the clinician have to confirm the apical stop once more after instrumentation of type II root canal.

C-shaped canals are known to present a complex canal anatomy with numerous fins connecting individual canals, thus requiring supplementary effort to accomplish a successful root canal treatment. This study examined the frequency of the C-shaped mandibular second molars and interrelation between the clinical records and radiographs to recognize them treated in the Department of Conservative Dentistry of the Chosun University Dental Hospital during a six-year period (1998 - 2004). This study reviewed the clinical records of 227 patients who underwent root canal treatment of the mandibular second molars. After opening the chamber, those cases with C-shaped orifices in the pulpal floor were selected, and the C-shaped root canal types were classified according to Melton's criteria. Three experienced dentists evaluated the radiographs of the C-shaped mandibular second molar on a viewer using a magnifying glass in order to determine if the root apex was fused or separated, the distal root canal was either centered or mesial shifted in the distal root, and if there was bilateral symmetry in a panorama. In conclusion, there is a high frequency of C-shaped mandibular second molars in Koreans. Simultaneous interpretation of the root shape and distal root canal using the preoperative, working length and post-treatment radiographs is important for diagnosing a C-shaped mandibular second molar.

Straight access cavity design allows the operator to locate all canals, helps in proper cleaning and shaping, ultimately facilitates the obturation of the canal system. However, change in the fracture strength according to the access cavity designs was not clearly demonstrated yet. The purpose of this study was to determine the influence of different access cavity designs on the fracture strength in endodontically treated mandibular anterior teeth.

Recently extracted mandibular anterior teeth that have no caries, cervical abrasion, and fracture were divided into three groups (Group 1 : conventional lingual access cavity, Group 2 : straight access cavity, Group 3 : extended straight access cavity) according to the cavity designs. After conventional endodontic treatment, cavities were filled with resin core material. Compressive loads parallel to the long axis of the teeth were applied at a crosshead speed of 2mm/min until the fracture occurred. The fracture strength analyzed with ANOVA and the Scheffe test at the 95% confidence level.

The results of this study were as follows :

1. The mean fracture strength decrease in following sequence Group 1 (558.90 ± 77.40 N), Group 2 (494.07 ± 123.98 N) and Group 3 (267.33 ± 27.02 N).

Considering advantage of direct access to apical third and results of this study, straight access cavity is recommended for access cavity form of the mandibular anterior teeth.