Abstract : This study to examined whether enamel matrix derivative (EMD) could induce reparative dentin formation without eliciting adverse side effects in direct pulp capping and pulpotomy model in pigs. Pulpotomy was performed on 72 lower incisors in 24 adult miniature swine. The exposed pulp tissue was treated with EMD or covered with a calcium hydroxide paste. Experimental teeth were examined by light microscopy and expression of dentin related proteins in the pulps was investigated by immunohistochemistry, using antibodies against type Ⅰ collagen and DSP. In all EMD treated teeth a substantial amount of reparative dentin formation was observed. The amount of reparative dentin in calcium hydroxide treated teeth was significantly smaller than that in EMD treated teeth. Immunohistochemistry demonstrated that the expression of proteins related to dentin formation in the wounded pulp tissue was about 2 weeks advanced in EMD treated teeth. These results demonstrate the potential of EMD as a biologically active pulp-dressing agent that specifically induces pulpal wound healing and dentin formation in pulpotomized teeth without affecting the normal function of the remaining pulp.

Abstract : This article reports the case of a mandibular first premolar with three distinct canals and a deep mesial lateral groove. A left mandibular first premolar requiring root canal treatment was found to have two buccal and one lingual root canals. Meticulous examination of the pulp chamber using endodontic microscopy and fiberscopy assisted the identification of extra canals. The tooth had an anomaly in the shape of the root, that is, a deep groove on the mesial root surface revealed by computed tomography. This case demonstrates a rare anatomical configuration and supplements previous reports on the existence of such configurations in mandibular first premolars. Knowledge of the existence of such a configuration may occasionally enable successful treatment of cases that might otherwise have ended in failure.

Abstract : The ultimate purpose of endodontic surgery is both to remove infectious sources and to regenerate periapical tissue including new attachment apparatus. Recently, the guided tissue regeneration (GTR) technique can be successfully adapted to endodontic surgery which makes it possible to regenerate injured periapical tissue. In this case report, we describe endodontic surgery for a mandibular second premolar tooth whose root apex was exposed in the oral cavity because of intact dehiscence and exaggerated periapical lesion. The GTR method using absorbable membrane in conjunction with free connective tissue grafts (FCTG) was performed. Ten months later, the exposed root apex was completely covered with keratinized gingiva. In addition, regenerated periodontal ligament space and alveolar bone was shown by a radiographic photograph. We thus achieved a satisfactory prognosis from a hopeless tooth in which the periapical soft tissue was severely injured by using the GTR technique and FCTG.

Abstract : Before the acceptance of endodontic treatment, a huge caries tooth has been often left without any treatment for a long time. A few patients first visit a dental office due to the appearance of intolerable strong toothache. In these cases, the biologic width of tooth is frequently invaded by subgingival caries. These caries cause various troubles for attaining the final prosthesis after root canal treatment. Furthermore these teeth took not only dental movement (inclination, extrusion) but also inadequate occlusal plane.

 In this case report, we reported a patient who was treated with a comprehensive approach in a narrow sense, where MTM, periodontal surgical treatment and implant were performed for preservation to arrange the periodontal environment and occlusal plane from the root canal treatment until the final prosthesis. These treatment recovered the purpose of esthetic and the occlusal reconstruction on a oral unit.