외상 받은 치아의 치수생활력 검사 : Laser Doppler flowmetry를 이용한 증례보고

김영진,송윤주,김현정,남순현 大韓小兒齒科學會 1999 大韓小兒齒科學會誌 Vol.26 No.2

외상받은 치아에서 치수강폐쇄, 치수괴사, 치근흡수, 인접치조골소실, 치근단염증성변화 및 치아상실 등의 부작용이 나타날 수 있으며, 이는 치근형성정도, 탈구의 종류, 고정의 기간에 따라 예후가 달라진다. 외상 후 부작용의 빈도를 줄이기 위해서는 조기에 치수생활력 유무를 판단하는 것이 중요하다. 그러나 미성숙치근을 가진 치아는 치수내 신경발달 분포가 불완전하고, 환자의 연령이 어려 술식에 대한 이해력이 부족하고 치과에 대한 공포감 때문에 전기치수검사등의 전통적인 치수생활력 방법의 신뢰도가 떨어진다. 반면 laser Doppler flowmetry는 치수 혈류량을 측정하여 치수생활력을 검사하는 방법으로서 보존적이며 객관적이고, 외상후 비교적 조기에 치수생활력을 측정할 수 있는 신뢰도가 높은 치수생활력 검사방법이다. 이에 저자는 외상받은 미성숙치아를 대상으로 냉검사, 전기치수검사, laser Doppler flowmetry를 이용하여 치수생활력을 검사하여 다음과 같은 결과를 얻었다. 1. 외상받은 치아의 치수생활력은 초기에는 음성으로 나타날 수 있으나 시간의 경과에 따라 양성으로 회복할 수 있어 장기간의 관찰이 필요하다. 2. 치수생활력은 냉검사, 전기치수검사 보다 laser Doppler flowmetry에서 더 빨리 나타났다. 3. 냉검사와 전기치수검사의 두가지 치수생활력 검사방법 중 전기치수검사 보다 냉검사가 신뢰도가 더 높았다. In the traumatized teeth, the major complications are pulp necrosis, and root resorption. The factors influencing to prognosis are the state of root development, type of injuries, quality of fixation. There are good prognosis in the case of immature teeth, minor luxation injuries. To minimize of occurrence of these complication, it is very important to determine the pulp vitality. This can help us decide whether or not to treat the teeth endodontically. But, it is difficult to determine of pulp vitality in immature teeth or traumatized teeth. In this case, pulp vitality test was done periodically on the traumatized upper central incisors, and the results were different among cold test, electric pulp test, and laser Doppler flowmetry. The conclusions were obtained from this case can be summarized as follows ; 1. Pulp vitality of traumatized teeth should be negative early, but with time going pulp vitality could be recovered. 2. The positive reaponse of pulp vitality test was detected earlier in laser Doppler flowmetry. 3. Between cold teat and electric pulp test, cold test was more reliable in determining pulp vitality.

미성숙 영구치의 치수치료

송제선,Song, Je Seon 대한치과의사협회 2019 대한치과의사협회지 Vol.57 No.8

For dental pulp treatment of immature permanent teeth, direct pulp capping or partial/cervical pulpotomy (apexogenesis) procedures can be used if the dental pulp is vital. MTA (Mineral Trioxide Aggregate) is regarded as the first choice dressing material for these procedures because its higher success rate. It can be also used successfully for devitalized dental pulp which has been treated by calcium hydroxide. This apexification procedure with MTA has a few advantage such as short treatment period and increase of resistance against root fracture. Recently, regenerative endodontic treatment was introduced for devitalized immature pulp. It can maintain pulp vitality and lead to continuing root development although the dental pulp was devitalized.

Long-term Prognosis of Pulpal Status of Traumatized Teeth Exhibiting Contradictory Results between Pulp Sensibility Test and Ultrasound Doppler Flowmetry: A Retrospective Study

Ahn, So-Yeon,Kim, Dohyun,Park, Sung-Ho Elsevier 2018 JOURNAL OF ENDODONTICS - Vol.44 No.3

<P><B>Abstract</B></P> <P><B>Introduction</B></P> <P>In this retrospective study, we investigated long-term (over 3 years) follow-up results of teeth that exhibited contradictory results between the pulp sensibility test (thermal or electric pulp test) and ultrasound Doppler flowmetry (UDF) until 1 year after trauma to inspect the prognosis of the pulp.</P> <P><B>Methods</B></P> <P>Data were collected from the records of trauma patients in our hospital between February 2012 and May 2015. The teeth that had continuously shown contrasting results on the pulp sensibility test and UDF until 1 year after trauma were chosen for the study. Cases with follow-up records of more than 3 years after trauma were finally included, and a retrospective chart review was performed.</P> <P><B>Results</B></P> <P>Data from 343 teeth in 147 patients who visited the hospital with traumatic dental injuries were examined. Among these, 13 teeth from 7 patients were included, and the record of each case was reviewed. All the subjects showed negative responses on the pulp sensibility test and positive responses on UDF until 1 year after trauma. Ultimately, 8 of the 13 teeth recovered pulp sensibility. Two teeth failed to recover pulp sensibility and became symptomatic; root canal treatment was performed on the teeth. The remaining 3 teeth belonged to patients suffering from nerve damage; therefore, the pulp sensibility test was not feasible.</P> <P><B>Conclusions</B></P> <P>Based on this study, UDF can be effectively used for the evaluation of pulpal status in traumatized teeth.</P>

치수생활력 검사를 위한 Laser Doppler flowmeter의 이용

김영진,남순현,김현정,서완종 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.3

저자는 본 병원에 내원한 환자중 미완성치구근단을 가지고 있으며 외상받은 치아 및 자가이식치아를 대상으로 기존의 치수생활력 검사방법과 더불어 LDF를 이용한 검사방법을 통해 다음과 같이 요약할 수 있다. 1. 치수 생활력 유무를 판단함에 있어 현재까지 널리 사용된 전기치수검사, 냉검사등의 방법은 치수 내 신경발달 정도 및 피검자의 주관에 의해 반응이 다르게 나타나는 경우가 많다. 2. 이에 반해 LDF를 이용한 치수생활력 검사방법은 위음성 및 위양성 반응의 빈도가 낮아 신뢰도가 높으며 비교적 조기에 치수생활력을 특정할 수 있는 우수한 방법이다. Various diagnostic methods, such as electric pulp test, cold test, cavity etc, have been used to determine the pulp vitality. At least two or more methods should be used with supplemental information to diagnose each case because using one method doesn't provide sufficient accuracy. These conventional methods have depended on nervous responses, but laser Doppler Flowmeter determines the pulp vitality by measuring pulpal blood flow. In this case, we tested the vitality of the traumatized teeth with incomplete root apices and autotransplanted teeth with conventional methods and Laser Doppler Flowmeter . Conventional methods. such as electric pulp test and cold test can produce various responses according to the development state of the pulpal nerve and the sensory threshold of the patient. but ,laser doppler Flowmeter has a lower false response rate than other pulp vitality test methods and it can determine the vitality somewhat earlier than the other method.

악교정 수술 후 치수 생활력에 관한 임상적 연구

배준수(Jun Soo Bae),류정호(Jong Ho Lyoo),유준영(Jun Young You),김용관(Yong Kwan Kim),신동용(Dong Yong Shin),이창선(Chang Sun Lee) 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

After orthognathic surgery, postoperative complications are studied by many clinician. The complications include sensory disturbance, jaw fracture, excessive bleeding, condylar positional changes and loss of pulp vitality. Few surgical procedures are as satisfying for the surgeon and patient as a well-done orthognathic surgery. On the other hand, the patient is more satisfied with the result than who are treated with only orthodontic treatment especially in severe deformity case. There are problems that patient overcome but it is not serious complications. One of these, the problem about loss of pulp vitality can't influence function but give a lot of discomfort to the patient. From September 1997 to January 1998, 7 patients who are treated for dentofacial deformity via Le Fort I osteotomy or anterior segmental osteotomy were examined pulp sensitivity using digital pulp tester. This preliminary study have a focus on the investigation of recovery of pulp vitality. The electric pulpal test were used at preoperative, postoperative, at intervals. And we report some results acquired from this study. Following result are obtained 1. In anterior segmental ostetomy case (1 case), total 12 teeth were examined. Postoperative 8 weeks, 1 tooth are positive reaction 2. In Le Fort I osteotomy case (6 case), total 71 teeth were examined. Postoperative 8 weeks, 5 teeth are positive reaction.

악교정 수술 후 치수 생활력에 관한 임상적 연구

양병은,송상훈,유준영,김용관,신동용,이창선,Yang, Byung-Eun,Song, Sang-Hun,You, Jun-Young,Kim, Yong-Kwan,Shin, Dong-Yong,Lee, Chang-Sun 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

After orthognathic surgery, postoperative complications are studied by many clinician. The complications include sensory disturbance, jaw fracture, excessive bleeding, condylar positional changes and loss of pulp vitality. Few surgical procedures are as satisfying for the surgeon and patient as a well-done orthognathic surgery. On the other hand, the patient is more satisfied with the result than who are treated with only orthodontic treatment especially in severe deformity case. There are problems that patient overcome but it is not serious complications. One of these, the problem about loss of pulp vitality can't influence function but give a lot of discomfort to the patient. From September 1997 to January 1998, 7 patients who are treated for dentofacial deformity via Le Fort I osteotomy or anterior segmental osteotomy were examined pulp sensitivity using digital pulp tester. This preliminary study have a focus on the investigation of recovery of pulp vitality. The electric pulpal test were used at preoperative, postoperative, at intervals. And we report some results acquired from this study. Follwing result are obtained 1. In anterior segmental ostetomy case (1 case), total 12 teeth were examined. Postoperative 8 weeks, 1 tooth are positive reaction 2. In Le Fort I osteotomy case (6 case), total 71 teeth were examined. Postoperative 8 weeks, 5 teeth are positive reaction

치수혈류 측정을 위한 광 프로브 개발

장경환(Kyung-Hwan Jang),최준열(Joon-Yul Choi),구정모(Jeong-Mo Koo),권민경(Min-Kyung Kwon),김덕원(Deok-Won Kim) 대한전기학회 2012 전기학회논문지 Vol.61 No.8

To diagnose dental pulp vitality, electric pulp tester has been widely used, which is a method to test condition of nerve. However, especially in the case of patients with trauma, nerve desensitization could temporarily occur even though nerve might be recovered by blood flow within the pulp later, which implies that blood flow in dental pulp is also an important factor for diagnosing vitality. This paper described the development of a probe that relatively measured blood flow in dental pulp using photoplethysmography (PPG). The probe emits four different wavelength light sources including three visible and an infrared light. We tested which light source detect sensitively the blood flow in dental pulp. As a result, green light had the largest peak to peak voltage and the power spectrum among different wavelengths.

정 전류원을 이용한 치수 검사기의 개발

김재성,남기창,김수찬,이승종,김덕원 대한전자공학회 2004 電子工學會論文誌-SC (System and control) Vol.41 No.2

전기를 이용한 치아의 자극은 치수의 생활력 평가의 한 방법이다. 전기 치수 검사의 기본원리는 치아 내의 치수에 전류 자극을 가하여 유발되는 통증 유무로 치수의 생활력을 평가한다. 그러나 치아의 에나멜질의 임피던스가 크고 개인에 따라 차이가 많기 때문에 치아의 상태에 영향을 받지 않으면서 자극을 제어하기가 불가능하다. 대부분의 치수검사기가 전압 자극 방법을 사용하고 있어 개인에 따라 자극 역치 값이 크게 변화한다 그러므로 치아 에나멜질의 두께 차에 의해 발생하는 영향을 최소화하기 위해 정 전류 치수 검사기가 필요하다. 그리고 치아 임피던스에 관계없이 넓은 전류 범위를 갖는 치수 검사기가 필요하다. 본 연구에서는 전류 안정 회로를 사용하여 최대 150 uA의 전류와 통증을 완화하는 버스트 파형을 발생시킬 수 있는 정 전류원 치수 검사기를 개발하고 그 성능을 확인하였다. Electric stimulation of teeth has been used for assessing pulp vitality. The principle is based upon the assumption that a subject feels the pain produced by electrical current stimulation of intradental nerve. Because of very high and wide range of impedance of the enamel, it is very difficult to determine stimulation levels regardless of teeth status. Most pulp testers adopt voltage stimulation method and thus, their stimulating threshold levels significantly depend on each individual. Therefore, a constant current stimulator is necessary to minimize the effect of wide variation due to different enamel thickness. And it is also necessary to test teeth vitality with a wide current range regardless of tooth impedance. In this study, we constructed a burst-wave type pulp tester to reduce the pain using a current stabilizing circuit with the maximum current of 150 uA.

Pulse Oximeter를 이용한 치수생활력측정

이제호,구본경,이종갑 大韓小兒齒科學會 2000 大韓小兒齒科學會誌 Vol.27 No.1

치수 생활력 검사시 전통적인 방법으로 전기치수검사나 온도변화검사 등이 있다. EPT와 ice test 즉, 전기치수검사와 온도변화검사는 치아의 신경학적 반응에 의해 치아의 실활여부를 판단하는 방법으로 환자가 아동일 때는 정확한 반응을 얻기가 어렵고, 환자의 주관적 반응을 판단해야 하므로 객관적이지 못하고, 소아환자에게 좋지 못한 자극을 주어 행동 조절의 문제를 일으키며, 거짓 양성반응과 거짓 음성반응이 나올 수 있다는 등의 한계가 있다. 최근에는 전통적인 방법의 한계를 극복하려는 시도에서 혈관의 보전성을 평가하는 방법인 laser doppler flowmetry와 pulse oximeter를 이용하는 방법이 소개되고 있다. Pulse oximeter의 원리는 두 가지 종류의 파장의 빛을 귀, 손가락 등 생체의 말단에 투과시켜 발산된 빛과 감지된 빛간의 두 파장의 흡수비로 산소포화 정도를 알아내는 것으로서 이에 착안하여 또 하나의 생체 말단인 치아에 이를 적용하여 치아의 실활 여부를 판단하는 것이다. 이 보고에서는 치수 생활력 검사시 pulse oximeter의 사용 가능성에 대해 검증하고 이의 임상적용에 대해 기초적 자료를 제공하고자 함을 목적으로 했는데 생활치에서는 평균 96.3%의 산소 포화도를 실활치에서는 평균 0.0%의 산소 포화도를 얻어냄으로서 pulse oximeter가 치아의 실활여부 판단에 있어 유용한 진단도구로서의 가치가 있다는 것이 밝혀졌다. Traditionally, EPT and thermal tests were used as diagnostic methods for pulp vitality test. The thermal and electrical stimulation tests are the methods to determine the vitality of a tooth based on its neuronal response. These have certain limitations, one of them is the difficulty of approaching the correct result in case of treatment of children. The reason is management problem caused by the unpleasant stimulation. Also, the response from patients are not objective, and false positive or false negative could be happened. Recently, laser doppler flowmetry and pulse oximeter which evaluate vascular integrity are introduced-in an effort of overcoming to limitation of traditional methods. The principle of pulse oximeter is to find out level of oxygen saturation by ratio of the two pulses between emitted light and detected light penetrating them to the termination of body, such as ears or fingers. From this point of view, it can be applied to a tooth to determine its vitality. The objective of this study lies mainly on varifying pulse oximeter as a method of determining tooth vitality and providing basic data of its clinical implementation. The result of the research showed that level of oxygen saturation in vital teeth was average of 96.3% and 0.0% in pulpless teeth. As a comprehensive result, pulse oximeter could be an useful diagnostic equipment in determining of tooth vitality.

A preliminary report on histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide

Ali Nosrat,Ali Peimani,Saeed Asgary 대한치과보존학회 2013 Restorative Dentistry & Endodontics Vol.38 No.4

Objectives: The purpose of the study was to evaluate human dental pulp response topulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calciumenriched mixture (CEM) cement. Materials and Methods: A total of nine erupted thirdmolars were randomly assigned to each pulpotomy group. The same clinician performedfull pulpotomies and coronal restorations. The patients were followed clinically forsix months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulpinflammation, and calcified bridge formation. Results: All patients were free of clinicalsigns/symptoms of pulpal/periradicular diseases during the follow up period. In CHgroup, one tooth had necrotic radicular pulp; other two teeth in this group had vitaluninflamed pulps with complete dentinal bridge formation. In CEM cement and MTAgroups all teeth had vital uninflamed radicular pulps. A complete dentinal bridgewas formed beneath CEM cement and MTA in all roots. Odontoblast-like cells werepresent beneath CEM cement and MTA in all samples. Conclusions: This study revealedthat CEM cement and MTA were reliable endodontic biomaterials in full pulpotomytreatment. In contrast, the human dental pulp response to CH might be unpredictable.