Purpose: Improvements in adhesive resins have allowed the restoration of vertically-fractured teeth. We investigated the strength of reconstructed roots as well as roots reconstructed on an abutment, and the outcome of the adhesive reconstruction/replantation of vertically-fractured teeth.
 Methods: Experiment 1: The roots of bovine anterior teeth frozen after extraction were cut at their center parallel to the root axis. After applying Superbond C & B (SB), thermal or mechanical stress was applied before testing. Microtensile bond strength was measured, and the fractured cross-section surface was observed by scanning electron microscopy. Experiment 2: A post hole was created along the root canal, and a metal post was inserted into the hole. Vertical pressure was applied to the metal post in order to measure the initial fracture strength. Adhesive reconstruction was performed using SB. Reconstructed root fracture strength was measured when a metal post or a resin post was pressed vertically. The reconstructed root fracture strengths were compared with the initial fracture strengths, and the percent decrease was defined as the value of the sample (comparison value). The reconstructed root fracture strength after application of a thermal cycle (TC) of 5-55°C was measured, and a comparison value was calculated. Experiment 3: The initial fracture strength was measured as described in Experiment 2. After posts were bonded to reconstructed teeth, reconstructed root fracture strengths were measured in order to calculate comparison values. The results obtained were analyzed by one-way analysis of variance and Tukey’s HSD method (α=0.05).
 Results: No significant difference was observed in the tensile bond strength among the groups. Although a significant difference was found in comparison values depending on the presence of TC loading, no significant differences were observed among different post materials. The risk of refracture in the metal post at the reconstruction site was high, whereas the risk of refracture in the resin post was low.
 Conclusions: The durability of the root with adhesive reconstruction was less than 25% for stress parallel to the dental axis compared with that of the sound root. The risk of refracture in the metal post at the reconstruction site was high, whereas the risk of refracture in the resin post was low.

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 Purpose: Many patients experience fear and anxiety towards dental treatment. It is important to reduce the fear and anxiety of local anesthesia for safe and effective dental treatment, because systemic complications frequently occur during local anesthesia. Music sedation is thought to be a convenient method for supporting safe and effective dental treatment, but this method has not been fully investigated in the dental field. The purpose of this study was to evaluate the effect of music sedation during local anesthesia for healthy young adults by measuring the variance of autonomic nervous function (ANF) using a novel system we developed.
 Methods: The study subjects were 22 healthy young volunteers (mean age 26.5±1.9 years). A music sedation phase and no-music sedation phase were performed on each subject. The sequence of these phases was randomly allocated to the subjects using a central allocation method. First, subject anxiety towards dental treatment was evaluated using Corah’s Dental Anxiety Scale. In the no-music sedation phase, the monitoring system was used to assess blood pressure (BP), heart rate (HR), and ANF for 5 minutes prior to anesthesia (pre-anesthesia) in both the sitting and supine positions, 2 minutes during administration of local anesthesia, and 5 minutes after anesthesia (post-anesthesia) in the supine position. In the music sedation phase, the same measurements were taken in each stage after the beginning of music sedation. Furthermore, subject anxiety pre- and post-anesthesia was evaluated using a visual analog scale (VAS). ANF was evaluated by analyzing the low-frequency (LF) and high-frequency (HF) spectral components of ECG R-R intervals. The ratio of LF to HF (LF/HF) reflects sympathetic nervous function (SNF). Statistical analyses were conducted using the Friedman test and Wilcoxon signed-rank test with a significance level of 5%.
 Results: BP, HR, and VAS showed little variance throughout the procedure. LF/HF showed a significantly lower value during local anesthesia than in the pre-anesthesia sitting position and a significantly lower value during the pre-anesthesia sitting position and supine position in the music sedation phase compared with the no-music sedation phase.
 Conclusion: In healthy young adults, SNF decreases significantly in the sitting and supine positions before local anesthesia with music sedation compared with no-music sedation.

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 Purpose: Sodium metaphosphate has been added to dentifrices and chewing-gums for inhibiting the staining of teeth. As sodium metaphosphate may easily bind to hydroxyapatite, it may block or inhibit stain adsorption to hydroxyapatite. In-office bleaching has been widely used. In the treatment, it is recommended to avoid dark-color foods and drinks for 24 hours after bleaching to prevent discoloration of the tooth-surface. If sodium metaphosphate was applied to the enamel after bleaching, it might be expected to inhibit staining caused by dark-color foods and drinks. In addition, if sodium metaphosphate forms a stable membrane by chemical reaction with enamel hydroxyapatite, the effect of staining inhibition might be expected to continue for a long time. Therefore, the present study evaluated the inhibition effect after bleaching and investigated the adsorption of sodium phosphate on enamel after in-office bleaching using a spectrophotometer, and XRD and FTIR analyses.
 Methods: Twenty-four extracted human upper incisors were treated with Hi-Lite, and then tooth-surface color was determined by a spectrophotometer. The teeth were then divided into four groups: 1) Untreated control group (Con), 2) Polished with Merssage (Mer), 3) Applied with Butler Fluodent Foam A (Flu), 4) Immersed in human saliva containing 1% sodium metaphosphate for 35 min (SMP). Con, Mer, Flu were then immersed in human saliva at 37°C for 120 min, and SMP was immersed for 85 min. After that, all groups were stored in 1.4% coffee at 37°C. Color measurement was performed at 24, 48 and 72 h. The color change between before and after immersion in coffee was expressed by ΔE*, ΔL*, Δa* and Δb*. Additionally, SEM observation of the enamel surface and XRD and FTIR analyses of hydroxyapatite after immersion in 1% sodium metaphosphate were performed.
 Results: Regarding ΔL* at 24 h, ΔL* of SMP was smaller than those of the other groups, which confirmed the staining inhibition effect of SMP. According to SEM, sodium metaphosphate was observed as a thin film on enamel, however, there was no evidence of chemical reaction between hydroxyapatite and sodium metaphosphate by XRD and FTIR analyses.
 Conclusion: Sodium metaphosphate provided a staining inhibition effect for bleached teeth during storage in coffee for 24 h. However, no evidence of chemical reaction between sodium metaphosphate and bleached enamel was found under the conditions of the present study.

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 Purpose: With the recent advent of many 1-step adhesive systems, clinicians’preferences have also been shifting to these systems in the clinics, although these adhesives are reported to produce lower bond strength compared to 2- or 3-step adhesives. Most of the 1-step adhesives are universal adhesives usable either in a self-etching mode or in a total-etching mode with a prior phosphoric acid etching step. Furthermore, the bond strength of total-etch adhesives to moist dentin was found to be higher than that of dry dentin in a number of studies. The purpose of this study was to evaluate the bond performance of a universal adhesive to dentin with different etching strategies using micro-tensile bond strength (μTBS) to dentin, SEM and TEM.
 Methods: Two adhesive systems were used: CLEARFIL Universal Bond (CUB) and 2-step self-etch adhesive CLEARFIL Mega Bond (CMB). K-ETCHANT Syringe (Ech) was used as an etching agent. Flat dentin surfaces of human molars were exposed and polished using #600 SiC paper under running water. The prepared dentin surfaces were then subdivided into the following four groups: MB (CMB in self-etch mode, the control), NE (CUB without Ech), ED (CUB applied in dry conditions following Ech), and EW (CUB applied in wet conditions following Ech). After resin composite build-up, each specimen was sectioned after being immersed in water at 37°C for 24 hours to obtain beams with a bonded area of 1 mm². The μTBS test was performed at a cross-head speed of 1 mm/min using half of the beams from each group; the other half of the beams were tested after 6 months. The data were analyzed by one-way analysis of variance and Tukey’s test.
 Results: Only ED showed significantly lower μTBS after 6 months compared to that at 24 hours. There was no significant difference between the four groups at 24 hours and at 6 months. CUB showed stable adhesion durability regardless of the strategy.
 Conclusion: CLEARFIL Universal Bond (CUB) showed sufficient dentin bond strength in both the self-etch and total-etch strategies. In terms of bond durability, wet bonding to acid-etched dentin may be preferred over bonding to dry acid-etched dentin.

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 Purpose: The effects of fiber posts on polymerization of composite resin were evaluated using a fiber post/composite resin core restoration system (i-TFC System).
 Methods: After filling artificial root canals with a light-curing resin, two types of fiber posts, either optical fiber or stainless steel fiber, were inserted. After irradiation at light source angles of 0, 30, 60, and 90° relative to the post axis, the amount of polymerized resin and the polymerization depth were measured.
 Results: The amount of polymerized resin was sufficient with optical fiber, but not in those with stainless steel fiber. Also, composite resin had sufficient polymerization depth in deep areas of the root canal in the fiber posts with optical fiber even at an irradiation angle of 30°.
 Conclusion: These results suggest that fiber posts with optical fiber are advantageous for the polymerization of composite resin on the apical side of the root canal.

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 Purpose: The Er: YAG laser shows excellent performance in hard tissue cutting, and is used in clinical dentistry. However, the cutting efficiency is far inferior to high-speed rotation devices, resulting in increased treatment time. Our study constructed a prototype tip with a spray-type irrigation system to improve the cutting efficiency. The prototype tip has become commercially available, and is marketed under the name “CS600F”. The present study investigated the cutting volume of human dentin, as well as the tip head wear, wear rate, and output using the CS600F.
 Methods: Sound human molars were used as samples. A smooth dentin surface was exposed by trimming the tooth with a model trimmer, and then polishing the surface with waterproof abrasive paper up to 2000 grit. The laser was moved evenly across a 4×4 mm area on the sample surface by moving the stage 0.5 mm/s, with 10 cycles of laser irradiation. Irradiation distances were set at 0.5, 1.0, and 2.0 mm. Samples irradiated with the C600F were defined as the control group, and those irradiated with the CS600F were defined as the atomized spray group. Each sample and tip head was observed under a microscope to measure the dentin cutting volume and tip head wear volume, and the tip head wear rate was calculated (n=3). Output power from the tip head after irradiation was measured and compared with the output power from the tip head set before irradiation.
 Results: Dentin cutting volume and tip head wear rate were significantly higher in the atomized spray group compared with the control group. However, tip head wear and output showed no significant differences between the two groups (p≧0.05).
 Conclusion: The use of atomized spray irrigation may improve the dentin cutting volume without any change in the extent of tip wear during dentin cutting. There was no change in the tip head output after 10 cycles of irradiation in either the conventional or atomized spray irrigation systems.

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 Purpose: The purpose of the present study was to clarify the remineralization effects for tooth enamel using calcium phosphate based paste (AP paste) containing tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA) that was designed using the principle of calcium phosphate cement. The study compared control and experimental groups in terms of the Ca/P ratio and crystal growth using artificially demineralized tooth enamel.
 Methods: Extracted human permanent teeth were used in this study. Enamel samples having experimental windows were demineralized with 50 mmol/l acetic acid for three days. AP paste was then applied to the windows three times a day for two weeks. The samples were embedded in epoxy resin and sectioned. The highly polished sections were observed by back-scattered electron imaging. Semi-quantitative analysis was also performed for Ca, P and F elements using an electron probe micro analyzer (EPMA). The samples were evaluated from crystal morphological observations using transmission electron microscopy (TEM).
 Results: EPMA analysis confirmed that Ca, P and F elements obviously percolated into and accumulated in enamel. The Ca/P ratio of the demineralized and the AP paste applied enamel were 1.38-1.42 and 1.57-1.65, respectively. Apparent crystal growth was observed in demineralized enamel crystals, indicating remineralization of demineralized tooth enamel tissue.
 Conclusion: TTCP and DCPA in the paste released calcium and phosphate ions, and the ions clearly promoted crystal growth in demineralized tooth enamel. Thus, it is considered that the AP paste would strongly promote tooth enamel calcification as a biocompatible material.

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 Purpose: Resin-based root canal sealers are claimed to show a high bond strength to root canal dentin, whereas removal of these materials may pose difficulties during root canal retreatment. Thus, a 4-META-containing resin-based root canal sealer with an improved removability (MetaSEAL Soft) has been developed, although its biocompatibility has not yet been fully elucidated. This study aimed to evaluate the biocompatibility of the root canal sealer by means of implantation into rat subcutaneous tissue followed by an immunohistochemical assessment of the density of infiltrating inflammatory cells.
 Methods: MetaSEAL Soft was used as the test material, and an epoxy resin-based sealer (AH Plus) and a zinc oxide-eugenol sealer (Canals) were employed as control materials. Sterilized PTFE tubes were filled with freshly mixed sealers and immediately implanted into the dorsal subcutaneous tissue of 4-week-old male Wistar rats (n=5 in each observation period). Empty PTFE tubes served as controls. After 7, 14 and 28 days, the connective tissue surrounding the implants was dissected, fixed with 4% paraformaldehyde for 24 hours, and processed for frozen sections. Then, the sections were histologically observed after hematoxylin and eosin (H-E) staining, or immunoperoxidase staining using CD68 and CD43 to immunolocalize macrophages and neutrophils, respectively. The density of CD68- and CD43-positive cells were quantified in the connective tissue in contact with the tube opening and analyzed statistically with one-way analysis of variance and Bonferroni Dunn test (α=0.05).
 Results: Observation of H-E-stained sections revealed infiltration of inflammatory cells predominantly around the tube opening in all the materials at 7 days, whereas the inflammation gradually subsided and implants were encapsulated with fibrous connective tissues with time. Particles of MetaSEAL Soft were very frequently dispersed in the tissue, and persisted for 28 days. The quantitative analysis revealed that Canals-implanted tissue showed significantly higher density of CD68-positive cells than control tissue at 7 days. At 14 and 28 days, however, there were no significant differences in the density of CD68-positive cells among the test materials. Regarding CD43-positive cells, MetaSEAL Soft-implanted tissue showed significantly lower density compared with Canals-implanted tissue at 7 and 14 days, whereas no significant differences were detected among the test materials at 28 days.
 Conclusion: In rat subcutaneous connective tissue, the 4-META-containing resin-based root canal sealer induced milder infiltration of neutrophils compared with a zinc oxide-eugenol sealer.

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 Purpose: Root canal preparation was performed on the maxillary lateral incisor having a complicated root canal morphology, although it is a single root canal, by using the instruments for a dental engine, and a study was performed for analyzing the efficiency and the aspect of the cutting surface.
 Methods: 20 pieces of human extracted maxillary lateral incisors were classified into four groups, and root canal preparation was performed by using a small Ni-Ti WaveOne file and a RECIPROC R25 file, and an ERT file made of stainless steel as the instruments for the dental engine, and a K-file made of stainless steel as a hand instrument. In addition to the measurement of working time required for cutting, the cutting ratio and cutting quantity of the root canal wall were calculated, and the aspect of the root canal cutting portion was analyzed. Further, the root canal was observed with an SEM.
 Results: Working time was as follows: 34.3 seconds with WaveOne, 58.4 seconds with RECIPROC, 250.0 seconds with ERT file, and 825.0 seconds with K-file for the hand. The cutting ratios on the route canal wall surface were: 79.6% with ERT file, 78.8% with RECIPROC, 78.4% with WaveOne, and 58.1% with K-file for the hand. In the cutting quantity of the root canal wall, 2.7 mm³ with ERT file, 2.5 mm³ with K-file for the hand, 2.3 mm³ with RECIPROC, and 1.6 mm³ with WaveOne. In the case where an Ni-Ti instrument was used, the instrument could closely fit the complicated root canal morphology, and a non-cutoff site was not found at the end of the root canal or on the concave surface of the root canal wall. In all cases, when all of the instruments were used, there were the where sites no cut off was enough. In the cases where Ni-Ti instruments were used, remainders were seen, which seemed to be the degenerated dental pulp. For all of the instruments, a smear layer was found on the root canal wall surface after the cutting.
 Conclusion: In the cases where Ni-Ti WaveOne and RECIPROC were used, root canal preparation could be achieved within a short time. Also, a higher cutting ratio was attained in the case where the instrument for a dental engine was used when compared with the case where hand instruments were used, showing the results of efficient cutting. However, in the cases where WaveOne and RECIPROC were used, by which the cutting could be completed within a shorter time, due to the solving and the removal caused by the use of hypochlorite sodium solution, solving and removal had to be carried out for removing the organic substance layer on the wall surface, which were not resected.

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 Purpose: To evaluate the influence of irrigants on torque generated during rotary preparation of plastic root canal models using stainless steel engine-driven rotary files.
 Methods: The stainless steel files of .06 taper size No. 40 (ERT file, Mani) and the standardized straight canal models were used. A computer-controlled torque testing-device was specially designed for this investigation. A root canal orifice was enlarged in advance by using an instrument with a taper of .12 taper ERT file. The following substances were used as irrigants: paste-type NaOCl (Canal Cleaner, Bee Brand Medico Dental), paste-type EDTA (Glyde File Prep, Dentsply Maillefer, Switzerland), distilled water, and dry canal (control). Each irrigant was injected in adequate quantity into the root canal every 30 seconds from the starting of the preparation. And rotary files of .06 taper were inserted to a depth of 8 mm into the root canal. The torque generated under each experimental condition was recorded. Five root canal models were used for each condition. The cutting efficacy is analyzed according to the torque-insertion distance and to the calculation of the variation in torque (ΔT).
 Results: The cutting torque used at the time of canal preparation was increased as the file was inserted in the direction of the root apex under each of the experimental conditions. The value of ΔT was significantly influenced by the difference of the irrigants, and the value decreased in the order of: control>EDTA paste>NaOCl paste>distilled water (p<0.05).
 Conclusion: The paste-type NaOCl and distilled water indicated a good lubricity during the ERT instrumentation.

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 Purpose: TLR3 expressing in immune cells senses double-strand RNA derived from virus, induces type Ⅰ interferon production and contributes to anti-viral immune responses. Although TLR3 is also reported to be expressed in gingival epithelial cells, little is known about its characteristics compared with TLR2 and TLR4, which are recognized as the ligand of LPS of perio-pathogenic bacteria. This study investigated the effects of stimulation of TLR3 in gingival epithelial cells in the presence of nicotine.
 Methods: TLR3 expression in a human gingival epithelial cell line, epi4 cells, established at our laboratory, was examined using RT-PCR and flow cytometry. The change of expression of TLR3 in the presence of nicotine was examined using real-time PCR. The levels of IFN-β in gingival epithelial cells stimulated with TLR3 agonist Poly (I: C) in the presence or absence of nicotine were measured using ELISA. The phosphorylation of IRF3 was examined using Western blotting.
 Results: Gingival epithelial cells expressed TLR3 and the expression was upregulated in the presence of nicotine. TLR3-inducible IFN-β production and phosphorylation of IRF3 in epi4 cells were increased in the presence of nicotine.
 Conclusion: IFN-β production was induced via TLR3 expressing in gingival epithelial cells. Upregulation of IFN-β production in the presence of nicotine was possibly involved in increasing the phosphorylation of IRF3 by nicotine.

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 Objective: The purpose of the present study is to explore an effective method for shaping the root canal with the Self-adjusting File (SAF) system, which moves in an oscillating up-and-down motion to simultaneously shape and irrigate the root canal, using a less tissue-irritating weak alkaline ethylenediaminetetraacetic acid (EDTA) solution as irrigation fluid.
 Methods: Thirty freshly extracted human premolars without caries were divided into 6 groups (n=5 for each group). After the crowns were resected, patency was established with K-file #15. After working lengths for the subject teeth were determined, glide paths were confirmed using K-file #20. Then canal roots were shaped with the SAF system set at 3,000 vibrations/min or 5,000 vibrations/min using 3% sodium hypochlorite solution or weak alkaline 3% EDTA solution as irrigation fluid and distilled water as control. Status of decalcified dentin was then examined by nano indentation testing and the effect on the removal of dentin smear layer in the apical portion of the root canal was assessed with a scanning electron microscope.
 Results: No statistically significant difference was found in each item of indentation hardness (HIT), Martens hardness (HM), and indentation modulus (EIT) of the decalcified dentin between respective groups. Additionally, the SAF system showed significantly higher effect on the removal of dentin smear layer in the root canal at both 3,000 vibrations/min and 5,000 vibrations/min in EDTA group compared with sodium hypochlorite solution and control groups.
 Conclusion: The combined use of the SAF system and EDTA solution demonstrated no significant difference in the effect on the decalcification of dentin smear layer in the root canal compared with control groups. In addition, it was demonstrated that the SAF system exerts effect on the removal of dentin smear layer in the apical portion of the root canal, for which root canal irrigation is challenging, at both 3,000 vibrations/min and 5,000 vibrations/min.

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 Purpose: The files are manufactured using M-wire and G-wire technology, improving strength and resistance to cyclic fatigue in comparison with other rotary Ni-Ti files. The enhancement of flexibility made with WaveOne Gold (Dentsply Maillefer, Switzerland) by G-wire makes quality endodontics available in curved root canals. The purpose of this study was to analyze the shaping ability and working time in root canal shaping by the WaveOne Gold and WaveOne (Dentsply Maillefer) after glide path.
 Methods: Seventy Endo-Training block canals (Dentsply Maillefer) were used, divided according to WaveOne Gold (Small, Primary, Medium & Large) and WaveOne (Small, Primary, Large) Ni-Ti rotary system used in canal shaping into 3 groups. Canal transportations were assessed by comparing the pre-instrumentation and post-instrumentation images under an Olympus SZX16 with digital Camera DP71, and the superimposed images were analyzed by the WinRoof, and the working times for root canal shaping were measured. Data were statistically analyzed, and the significance level was set at p<0.05.
 Results: WaveOne Gold and WaveOne exhibited a lower mean of canal transportation, and there was no significant difference between WaveOne Gold and WaveOne after glide path confirmation in canal transportation (p>0.05).
 Conclusions: This study confirmed the ability of WaveOne Gold to better perform with fewer aberrations and shorter working period when compared with WaveOne.

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 Purpose: This study aimed to evaluate the cytotoxicity for cementoblasts by the root canal sealer; the biocompatibility was measured from the cell proliferation rate, and morphological changes.
 Methods: The human cementoblasts (HCEM) were seeded in 6 well culture plates 1×10⁵ cell/well, Canals N, Canal sealer N (CS-N), and Surface Pre Reacted Glass-ionomer (SPRG) in 5% CO₂ conditions. The cultured cells were collected 24, 48 and 72 hours after incubation to measure the number of cells. Cementoblasts after culture were observed using a phase contrast microscope and compared with morphological changes.
 Result: The cytotoxic ratio stimulated by root canal sealer was compared to non-stimulated HCEM. The cytotoxic ratio showed there was not a significant difference between control and root canal sealers (Canals N 84.2±10.0%, CS-N 83.4±11.7%, SPRG 77.0±9.6%) after 24 hours. The cell growth ratios by root canal sealers were not different significantly between control and root canal sealers from 24 hours to 72 hours. The cell morphology was not changed by all root canal sealers from 24 hours to 72 hours.
 Conclusion: For the cytotoxicity of the root canal sealer for human cementoblasts by a viable cell count measurement and morphological changes, the result of the analysis showed that there was no cytotoxicity.

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 Purpose: Endodontic-periodontal problems with bifurcation involvement are often observed in clinical situations. It has been reported that this disease is caused by not only a variety of factors including endodontic, periodontal problems, but also complicated etiology. To obtain a good prognosis, it is important to make a correct diagnosis of the bottom cause. Here, we report a case of endodontic-periodontal disease with a bifurcation involvement in which successful results were obtained using the infected root canal treatment with a bacteriological examination.
 Case: A 37-year-old woman visited our hospital with the chief complaint of gingival swelling. She had a history of depression. She had been experiencing gingival swelling for about 4 months. Her gingival conditions worsened and she had severe pain in the vicinity of mandibular right second molar. Then, she visited a general practitioner and received a proposal of root separation or tooth extraction, but had no treatment because of her fears and anxieties. She was referred to our college hospital for specialized care on February 9, 2009, manifesting spontaneous pain (−), percussion pain (+), buccal gingival swelling (+), sinus tract (−), and apical pressure pain (+) in 47. A probing periodontal pocket depth (PPD) of 6 mm with bleeding on probing, and buccal Class I bifurcation involvement was found at the buccal center of 47. A radiographic examination revealed the wide radiolucency in the bifurcation and periapical region of 47. The infected root canal treatment was implemented based on a clinical diagnosis of Class I endodontic-periodontal disease. Subsequently, the anaerobic culture test was performed and we confirmed the absence of intra-root canal bacteria. At 3 months after starting the treatment, bone regeneration was observed at the bifurcation region of 47 with the reduction of PPD, clinical symptoms and her insecurity, the root canal filling was carried out. The post-treatment follow-up with up to an 8-month recall showed favorable results with the disappearance of radiolucent periapical lesion and bifurcation involvement and no recurrence of the gingival swelling was observed. Then, functional rehabilitation was implemented with a whole cast crown. During the 6 years 5 months follow-up period, both periapical and periodontal tissue condition has remained stable and the clinical symptoms have not been observed.
 Conclusion: The results provide the importance of accurate examination and diagnosis in the treatment of endodontic-periodontal problems, leading to the improvement of QOL in patients with an unstable mental condition.

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