Dentists' clinical decision-making about teeth with apical periodontitis using a variable-controlled survey model in South Korea

BACKGROUND: This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making. METHODS: A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p < .05) were used to investigate factors related to the decision to extract the tooth. We divided factors into dentist-related factors (gender, years of experience, and professional registration) and tooth-related factors (tooth position, coronal status, root canal filling status, and size of the periapical radiolucency). Dentists were categorized into three groups, based on professional registration: general dental practitioners (GDPs), endodontists, and other specialists. Simple logistic regression analysis (p < .05) was used to evaluate the tooth-related factors influencing extraction, depending on the dentists' specialty. RESULTS: Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm. CONCLUSIONS: This study suggests that dentists' decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion. CLINICAL RELEVANCE: This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists' specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.ope

Topographic Analysis of the Isthmus in Mesiobuccal and Mesial Roots of First Molars in a South Korean Population

The purpose of this study was to evaluate the incidence and microscopic anatomy of the isthmus to provide more precise anatomical information about the mesiobuccal (MB) roots of the maxillary first molars and the mesial (M) roots of the mandibular first molars. Twenty-eight maxillary and 31 mandibular first molars were embedded, sectioned, stained, and observed at 30× magnification to evaluate the incidence and microscopic anatomy of the isthmus. The incidence of an isthmus 3 mm from the apex was 89.3% and 100% in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, respectively. The mean dentin thickness between the isthmus and the distal root surface was <1 mm at a distance of 3 mm from the apex in both types of roots. In this study, whenever two main canals were located in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, the likelihood of the presence of an isthmus increased. Therefore, clinicians should be aware of the thinnest dimensions in the distal surface of the MB roots of the maxillary first molars and the M roots of the mandibular first molars during nonsurgical and surgical root canal treatment.ope

국제형사재판소규정상 보충성원칙의 적용

학위논문(박사)--서울대학교 대학원 :법과대학 법학과,2019. 8. 정인섭.While we can acknowledges the exercise of the State's primary jurisdiction over crimes within the jurisdiction of the ICC through the principle of complementarity under the Rome Statute, we can not but admit that there is apparently certain limitations in that exercise. This double-sided nature of the principle of complementarity can lead to sharp tensions or confrontations between the State and the ICC with regard to investigations or prosecutions of crimes within the jurisdiction of the ICC. Furthermore, it is reasonable to say that there are still many controversial issues regarding the interpretation and application of the principle of complementarity reflected in the Rome Statute. More specifically there are issues regarding (i)the subject of evaluation of admissibility, (ii)the interpretation and application of the same person, the same conduct as a criterion for determining whether the concerned cases are the same case, (iii)the application of different criteria among the Pre-Trial Chamber, the Trial Chamber, and the Appeals Chamber in the so-called a two-steps test, (iv)the evaluation of admissibility concerning with violation against domestic due process principles and the problem of application of the concept of 'inability', (v)de jure and de facto meaning of 'self-referral', and (vi)controversy surrounding the amnesty and non-criminal accountability etc. These issues raise the question of how the principle of complementarity reflected in the Rome Statute should be interpreted and applied in the ICC procedures. In this dissertation, we examined the normative meaning of the principle of complementarity reflected in the Rome Statute, and then discussed the four major themes in order to clarify how it has been implemented in the ICC cases. First, this dissertation studied what the implications of the principle of complementarity at different procedural stages in the ICC, and consequently it was confirmed that the principle of complementarity in the procedural context gives priority to the exercise of the State's primary jurisdiction and checks the abuse of States jurisdiction simultaneously. Second, the principle of complementarity as a criterion for determining the admissibility of a case is important as a criterion for the ICC to exercise its jurisdiction complementarily, and the ICC has introduced various concepts and criteria such as 'potential case', 'the same person, the same conduct', and a two-steps test etc. However, when these concepts or criteria are applied to specific cases of the ICC, we can confirm that there are many problems and criticisms concerning with the application of the principle of complementarity. Therefore, taking it into consideration of the fact that it is necessary to establish the strict application of the principle of complementarity and the harmonization of the exercise of jurisdiction between the State and the ICC, this dissertation suggested several interpretative or alternative solutions for concerned issues. Third, the principle of complementarity as an exception for admissibility also requires rigorous interpretation and application in that it is considered that the State's jurisdiction has not be exercised if the principle meets the requirements of the concept of 'unwillingness and 'inability'. However, as a result of analyzing the ICC cases, it could be found that some Chambers overlooked that the three grounds of unwillingness are exhausted, and confirmed that the requirements of inability was not applied cumulatively by them. Nonetheless, it is remarkable that the Appeals Chamber had pointed out that the ICC can only intervene in an exceptional situation, such as the case that the State's violations of the due process principle are egregious and flagrant' and so on. Finally, this dissertation attempted to clarify the legal and factual meaning of the unanticipated "self-referral" in the Rome Conference. Moreover after this dissertation reviewed whether the amnesty and non-criminal accountability mechanism can be harmonized with the principle of complementarity, it suggested the principle or direction of interpretation for those issues. After all, the principle of complementarity reflected in the Rome Statute should not be deviated from the fundamental principle of Rome Statute, namely "ICC shall be complementary to national criminal jurisdiction" and should be interpreted and applied in harmony with the exercise of the State's primary jurisdiction. Throughout consistent interpretation and application of the principle of complementarity, it is possible to accomplish the harmonization between the exercise of national criminal jurisdiction and the realization of justice in an international level. In light of the above measures, we can put an end to impunity for the perpetrators of crimes within the jurisdiction of the ICC, and the international criminal justice will be ultimately realized.로마규정상 보충성원칙은 ICC 관할범죄에 대한 국가의 일차적 관할권 행사를 인정하면서도 일정한 경우 그 제약 가능성을 내포하고 있다. 보충성원칙의 이러한 양면적 성격은 ICC 관할범죄에 대한 수사나 기소를 두고 국가와 ICC 간 첨예한 긴장 내지 대립관계로 이어질 수 있다. 더욱이 로마규정에 반영되어 있는 보충성원칙은 그 해석과 적용을 두고 여전히 논쟁적인 쟁점들도 많이 가지고 있다. 즉 (i)재판적격성의 평가대상에 관한 문제, (ii)동일사건 여부의 판단기준인 동일인물, 동일행위의 해석 및 적용에 관한 문제, (iii)소위 2단계 평가에 있어서의 심급별 재판부간 상이한 기준 적용 문제, (iv)국내적 적법절차 위반 문제를 둘러싼 재판적격성 평가와 능력부재 개념의 적용상 문제, (v)자기회부(self-referral)의 법적․사실적 의미에 관한 문제, (vi)사면과 비형사적 책임추궁과 관련한 논쟁 등이 그러한 예이다. 이러한 쟁점들은 결국 로마규정에 반영되어 있는 보충성원칙이 ICC에서의 절차에서 어떻게 해석되고 적용되어야 하는가의 문제를 제기한다. 이러한 인식하에 이 논문에서는 로마규정에 반영된 보충성원칙의 규범적 의미를 검토한 후 이것이 ICC 사건에서 어떻게 구현되어 왔는지 규명하기 위해 크게 4가지 주제를 중심으로 논의를 전개하였다. 첫째, 보충성원칙이 ICC에서의 상이한 절차적 단계에서 갖는 함의가 무엇인지 검토하였고, 그 결과 절차적 맥락에서의 보충성원칙이 국가의 일차적 관할권 행사를 우선적으로 염두에 두면서도 동시에 국가의 절차적 남용을 견제하고 있음을 확인하였다. 둘째, 재판적격성 결정기준으로서의 보충성원칙은 ICC가 보충적으로 관할권을 행사하기 위한 판단기준으로서 중요한 의미를 지니며, ICC는 그 동안 판례를 통해 잠재적 사건 개념, 동일인물, 동일행위 기준, 2단계 평가 기준 등 이 원칙으로부터 파생된 여러 가지 개념이나 기준을 제시하고 있었다. 그렇지만 이러한 개념이나 기준이 ICC의 구체적 사건에 적용될 때 여러 가지 문제점이나 비판에 노정되어 있음을 확인할 수 있었고, 이에 보충성원칙의 엄격한 적용과 국가와 ICC 사이의 관할권 행사의 조화라는 관점에서 그 해석론이나 대안을 제시하였다. 셋째, 재판적격성 예외사유로서의 보충성원칙 역시 그 중심을 이루고 있는 의사부재와 능력부재 개념의 요건에 해당할 경우 국가의 관할권이 행사되지 않은 것으로 간주된다는 점에서 엄격한 해석과 적용을 요한다. 그러나 ICC 사건을 분석한 결과, 일부 재판부가 의사부재의 3가지 사유가 열거사항임을 간과하였고, 능력부재 개념의 누적적 적용을 이행하지 않은 사실도 확인할 수 있었다. 그럼에도 불구하고, 재판부가 국가의 적법절차 위반이 심각하고 노골적인 경우 등 예외적인 상황에서 ICC가 제한적으로 개입해야 한다는 취지의 입장을 밝힌 점은 주목할 만하다. 마지막으로 이 논문에서는 로마규정 성안 시 예상하지 못했던 자기회부의 법적․사실적 의미를 규명하고자 하였고, 로마규정에 반영되지 못한 사면과 비형사적 책임추궁제도가 보충성원칙과 조화될 수 있는지 여부를 검토한 후 이에 관한 해석원칙을 제시하였다. 로마규정에 반영되어 있는 보충성원칙은 ICC가 국가의 형사관할권을 보충한다는 로마규정의 기본원칙에서 벗어나지 않아야 하며, 국가의 일차적 관할권 행사와 조화되는 방향으로 해석되고 적용되어야 한다. 이러한 보충성원칙의 일관적인 해석 및 적용을 통해 국가의 형사관할권 행사와 국제적 수준의 정의실현이 조화를 이룸으로써 ICC 관할범죄에 대해 책임 있는 자들에 대한 불처벌 상태를 종식시키고, 국제형사사법정의가 궁극적으로 실현되도록 해야 할 것이다.제1장 서 론 1 제1절 문제의 제기 1 1. 연구의 배경 1 2. 선행연구 검토 6 제2절 연구의 목적과 범위 10 제2장 보충성원칙의 의의와 적용단계 14 제1절 보충성원칙의 의의 14 1. 국제사회의 상호공존의 핵심 기제로서의 보충성 14 2. 보충성원칙의 개념과 기능 17 3. 보충성원칙과 ICC의 재판적격성 간의 관계 22 4. 보충성의 유형 23 4-1. 소극적 보충성 24 4-2. 적극적 보충성 25 4-3. 상황적 보충성 28 제2절 보충성원칙이 적용되는 절차적 단계 31 1. 보충성원칙의 단계별 적용 31 2. 수사 개시 이전 단계 33 2-1. 자기규제적 절차로서의 성격 33 2-2. 안전보장이사회의 회부와 소추관 : 구속력 존부 여부 34 2-3. 전심재판부의 사법적 통제 37 3. 재판적격성에 대한 예비결정 단계 38 3-1. 수사개시와 국가통지 38 3-2. 국가의 수사보류 요청과 한계 42 3-3. 국가의 이의제기 및 그 제한 49 3-4. 절차적 남용 가능성 50 4. 사건의 재판적격성에 대한 이의제기 단계 51 4-1. ICC의 독자적인 재판적격성 결정의 의미와 요건 51 4-2. 이의제기의 조건과 한계 58 4-3. 수사의 일체성과 효율성 보호 63 4-4. 절차적 남용 가능성 66 제3장 재판적격성 결정기준으로서의 보충성원칙 68 제1절 재판적격성 평가대상으로서의 사건의 의미 71 1. 재판적격성 평가가 이루어지는 절차적 단계 71 2. 사태와 사건의 개념 72 3. 재판적격성의 평가 대상 75 3-1. 견해의 대립 75 3-2. ICC 재판부의 견해 77 3-2-1. 잠재적 사건 78 3-2-2. 동일인물, 동일행위 기준 83 제2절 재판적격성 결정기준으로서의 보충성원칙의 적용 89 1. 보충성원칙상 국가의 관할권 행사 : 수사 또는 기소 89 2. 2단계 평가에 의한 재판적격성 심사 92 2-1. 2단계 평가의 의미 92 2-2. 2단계 평가 기준의 적용방식 94 2-2-1. ICC 재판부의 견해 94 2-2-2. 검토 및 해석론 제시 100 3. 동일인물, 동일행위 기준의 적용 101 3-1. ICC 사건 분석 102 3-1-1. 동일인물, 동일행위 기준을 충족시키지 못한 사례 102 3-1-2. 동일인물, 동일행위 기준을 충족시킨 사례 117 3-2. 비판론 122 3-3. 평가 및 대안 124 제4장 재판적격성 예외사유로서의 보충성원칙 133 제1절 수사 또는 기소의 진정성 부재 133 제2절 의사부재 137 1. 의사부재의 사유 : 열거적인가 138 2. 의사부재의 3가지 사유 142 2-1. 보호할 목적 142 2-2. 부당한 지연 144 2-3. 독립성 또는 공정성의 결여 147 3. 국내적 적법절차의 결여와 의사부재의 관계 149 3-1. ICC 재판부의 입장 150 3-2. 견해의 대립 154 3-3. 평 가 161 제3절 능력부재 163 1. 능력부재 개념의 의미와 내용 163 2. 능력부재 개념의 적용 168 2-1. ICC 사건 분석 169 2-2. 평 가 174 제5장 보충성원칙의 적용상 補論 179 제1절 자기회부와 보충성원칙 적용의 포기 179 1. 검토의 배경 179 2. 견해의 대립 181 2-1. 긍정론 181 2-2. 부정론 183 3. 평 가 186 제2절 ICC 관할범죄에 대한 사면과 비형사적 책임추궁 191 1. 문제의 소재 191 2. ICC 관할범죄에 대한 사면 194 2-1. 재판 이전 단계에서 부여되는 사면 194 2-2. 재판 종결 이후에 부여되는 사면 196 3. ICC 관할범죄에 대한 비형사적 책임추궁 200 3-1. 견해의 대립 201 3-2. 평가 및 대안 206 제6장 결 론 211 참 고 문 헌 219 Abstract 248Docto

In Vitro Comparison of Biocompatibility of Calcium Silicate-Based Root Canal Sealers

The aim of this study was to assess the effect of three calcium silicate-based sealers (EndoSeal MTA, Nano-ceramic Sealer, and Wellroot ST) and two epoxy resin-based sealers (AH-Plus, AD Seal) on various aspects, such as cell viability, inflammatory response, and osteogenic potential, of human periodontal ligament stem cells (hPDLSCs). AH-Plus showed the lowest cell viability on hPDLSCs in all time periods in fresh media. In set media, hPDLSCs showed no significant differences in cell viability among all the tested materials. Wellroot ST showed the highest level of cell adhesion and the morphology of attached cells. AH-plus presented a significantly higher expression of IL-6 and IL-8 than the other sealers. AD Seal and three calcium silicate sealers showed high expression of the mesenchymal stem cell markers. ALP mRNA expression showed a significant increase in time-dependent manner on all of three calcium silicate-based sealers, which do not seem to interfere with the differentiation of hPDLSCs into osteoblasts. Based on the results from this study, calcium silicate-based sealers appear to be more biocompatible and less cytotoxic than epoxy resin-based sealers. Meanwhile, further and long-term clinical follow-up studies are required.ope

The application of "bone window technique" using piezoelectric saws and a CAD/CAM-guided surgical stent in endodontic microsurgery on a mandibular molar case

Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical 'bone-window technique' using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess. Periapical lesions were confirmed using cone-beam computed tomography (CBCT). Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.ope

Preserving the vitality of teeth adjacent to a large radicular cyst in periapical microsurgery: a case report with 4-year follow-up

Background: Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages. Case presentation: A patient presented with a large radicular cyst originating from a maxillary lateral incisor. The adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure. Results: The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices. Conclusion: Within the limitation of the present case report, we demonstrated that complete excision of large periapical cyst can be performed without sacrificing the vitality of the adjacent teeth, by preserving the integrity of their neurovascular supply through controlled microsurgical enucleation, and by a potential apical vascular repair ensuing unintended injury. Diagnosing the pulp vitality of non-offending teeth whose apices protrude into the cystic lumen is a complex process and can be misleading. Pressure from the growing cyst can inhibit vital teeth responses to neural-based sensibility tests leading to false negative results. Thus, in such cases, the use of blood perfusion-based vitality testing is recommended for correct initial diagnosis.ope

Volume Percentage of Filling Voids in Root Canals Prepared by a Novel Nickel-Titanium Rotary System (TruNatomy) Using Two Different Obturation Techniques

This study aimed to compare the volume percentage of filling voids in root canals prepared with a newly introduced rotary system, TruNatomy (Dentsply Maillefer), and obturated by the modified continuous wave (CW) or single cone (SC) filling technique. Plastic tooth models with four canals were enlarged by using TruNatomy files and randomly allocated into either the CW or SC group. The volume percentage of filling voids at 1-6 mm from the apex was analyzed by using microcomputed tomography; mean values were compared by using independent two-sample t-tests (p < 0.05). The mean volume percentages of the filling voids were 2.81 ± 1.11% and 1.77 ± 0.82% in the CW and SC groups, respectively. In the apical area (1-4 mm), volume percentages in the palatal were significantly different between the CW and SC groups; in the middle area (4-6 mm), volume percentages in the palatal and the second mesiobuccal canals were significantly different (p < 0.05). The SC group showed lower volume percentages of filling voids than the CW group. The canals prepared by the TruNatomy system can be obturated well by both the SC and CW techniques. The SC technique showed a lower number of voids, especially in the palatal canals.ope

Observation of an extracted premolar 2.5 years after mineral trioxide aggregate apexification using micro-computed tomography

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.ope

In Vivo Experiments with Dental Pulp Stem Cells for Pulp-Dentin Complex Regeneration

In recent years, many studies have examined the pulp-dentin complex regeneration with DPSCs. While it is important to perform research on cells, scaffolds, and growth factors, it is also critical to develop animal models for preclinical trials. The development of a reproducible animal model of transplantation is essential for obtaining precise and accurate data in vivo. The efficacy of pulp regeneration should be assessed qualitatively and quantitatively using animal models. This review article sought to introduce in vivo experiments that have evaluated the potential of dental pulp stem cells for pulp-dentin complex regeneration. According to a review of various researches about DPSCs, the majority of studies have used subcutaneous mouse and dog teeth for animal models. There is no way to know which animal model will reproduce the clinical environment. If an animal model is developed which is easier to use and is useful in more situations than the currently popular models, it will be a substantial aid to studies examining pulp-dentin complex regeneration.ope

Comparison of the Percentage of Voids in the Canal Filling of a Calcium Silicate-Based Sealer and Gutta Percha Cones Using Two Obturation Techniques

This study evaluated the root-filling quality of a calcium silicate-based sealer and gutta percha (GP) cones by measuring the percentage of voids. Twenty artificial molar teeth were divided into two groups: one obturated using the single-cone (SC) technique, and the other using the continuous wave (CW) technique. Obturation was performed with GP cones and Endoseal MTA (mineral trioxide aggregate, Maruchi, Wonju, Korea). Obturated teeth were scanned using microcomputed tomography, and the percentage of void volume was calculated in the apical and coronal areas. A linear mixed model was used to determine the differences between the two techniques (p 0.05), except for the CW group, which demonstrated a significantly higher void volume in the coronal area of the distal canal (p 0.05). The voids between the filling material and canal wall in the apical area were not significantly different between the two techniques.ope