Clinico-statistical Analysis of Cooperation and Anesthetic Induction Method of Dental Patients with Special Needs

Background: This study aimed to evaluate the cooperative levels of dental patients requiring general anesthesia during dental treatments. Anesthetic induction methods for patients were also recorded and analyzed using descriptive statistics. Methods: Total 566 patients who visited Seoul National University Dental Hospital Clinic for Persons with Disabilities were reviewed on pre-anesthetic review and anesthesia records. The cooperative levels of patients were graded by 4 levels and induction methods used for the patients during general anesthesia application were analyzed. Results: More than half of patients(55.8%) were willing to receive the anesthetic induction(cooperative level 1), 18.6% were minimally cooperative(level 2), 20.8% needed physical restraint prior to induction(level 3), and 4.8% was poorly cooperative and induction procedure was performed under an unconscious condition after ketamine intramuscular injection(level 4). There was no gender difference in cooperative levels(P=0.11). Patients over 30 years revealed better cooperation levels compared to other age groups(P<0.05). For patients of level 1, 53.5% were anesthetized in a way of intravenous induction, while 77.1% out of patients of level 3 were anesthetically induced through inhalation method. Conclusion: Many dental patients with special needs were not cooperative to receive anesthetic induction. Additional behavioral support may be applied to poorly cooperative patients for the safe and successful clinical outcome

열순환 후 상아질 접착 계면의 수분 투과성 변화에 대한 정량적 분석

Thesis(doctors) --서울대학교 대학원 :치의학과(치과보존학전공),2008. 8.Docto

Comparison of the elastic modulus among three dentin adhesives before and after thermocycling

본 연구는 현재 시판되고 있는 여러 개의 상아질 접착제를 임상 술식에서와 같은 방법으로 사용한 후 열 시효처리를 통해 노화 과정을 재현한 다음 접착 계면의 탄성계수를 측정함으로써 가수분해에 따른 물성변화를 관찰 비교하고자 했다. 발거 한 지 2 주일 이내인 영구 대구치 21 개의 상아질 표면이 노출되도록 삭제하였다. 각각 7개의 치아에 시판되고 있는 3가지 상아질 접착제 (OptiBond FL, Clearfil SE, Xeno III)를 적용한 뒤 광중합 복합 레진(Premisa, Kerr, Orange, CA, USA) 를 1 mm 두께로 쌓아 올렸다. 각 치아를 이등분하여 절반 시편은 100,000회의 열 시효 처리를 가하도록 했다. Nanoindentation test를 통하여 각 시편의 adhesive layer와 hybrid layer의 탄성계수를 측정, 비교하였다. 열시효 처리 후 Xeno III군의 탄성계수가 통계학적으로 유의할 만한 감소를 보였다 (p < 0.05). Hydrophilic monomer를 많이 함유한 one-step self-etch adhesive system은 다른 제품에 비해 가수분해에 취약하여 이에 따른 물성 변화를 보이는 것으로 추정되며, 궁극적으로 수복물의 내구성에 영향을 미칠 것으로 여겨진다. The purpose of this study was to determine the effects on the elastic moduli of the adhesive and the hybrid layer from thermocycling. Twenty one human molars were used to create flat dentin surfaces. Each specimen was bonded with a light-cured composite using one of three commercial adhesives (OptiBond FL [OP], Clearfil SE Bond [CL], and Xeno III [XE]). These were sectioned into two halves and subsequently cut to yield 2-mm thickness specimens; one specimen for immediate bonding test without thermocycling and the other subjected to 10,000 times of thermocycling. Nanoindentation test was performed to measure the modulus of elasticity of the adhesive and the hybrid layer, respectively, using an atomic force microscope. After thermocycling, XE showed a significant decrease of the modulus in the adhesive layer (p < 0.05). Adhesives containing hydrophilic monomers are prone to hydrolytic degradation. It may result in the reduced modulus of elasticity, which leads to the mechanically weakened bonding interface

Pneumonia after Dental Treatment under Ambulatory General Anesthesia in Mentally Retard Patient -A Case Report-

A 15-years-old female patient with seizure disorder and pervasive developmental disorder was scheduled for dental treatment under ambulatory general anesthesia. She had past history of pneumonia and herpes encephalitis when she was 3 year old. Because of sever mental retardation and behavior disorder, routine laboratory test was substituted with physical exam and medical records of department of pediatrics. A few days before general anesthesia, she showed slight common cold, but pediatric consult had reported that there was minimal risk in general anesthesia. After 4-hour general anesthesia, she became critically sick with high fever, cough and malaise. After 10-day hospitalization with pneumonia and sepsis, she could go home

The nanoleakage patterns of experimental hydrophobic adhesives after load cycling

본 연구의 목적은 두 가지 실험용 소수성 상아질 접착제와 전통적인 3-step 상아질 접착제의 nanoleakage 양상을 load cycling 전, 후에 비교하여 상아질 접착제의 내구성을 예측해 보고자 하는 것이다. 두 가지 실험용 소수성 상아질 접착제 즉, 에탄을 포함 상아질 접착제, 메탄을 포함 상아질 접착제를 만들었다. 대구치 30개의 치관부 3분의 1을 절단하고 임의로 3군으로 나누어 각각 Scotchbond Multi-Purpose (3M ESPE, St. Paul, MN, USA), 에탄올 포함 상아질 접착제 및 메탄을 포함 상아질 접착제를 사용하여 상아질 접착 후, 복합레진으로 치관부를 수복하였다. 각각의 접착 시스템을 Load cycling 여부에 따라 두 군으로 나누고 각각의 치아를 접착 계면에 수직으로, 약 2.0 mm의 두께가 되도록 절단하여 치아마다 2개의 시편을 얻어 각 군 당10개의 시편을 얻었다. 시편을 50 % ammoniacal silver nitrate를 이용하여 염색한 후 주사전자현미경을 이용하여 혼성층의 nanoleakage를 관찰하였다. 은 침착의 분포는 image analysis software (Scion Image Beta 4.03, Scion Corp., Frederick, MD, USA)를 이용하여 gray value로 계산하였고 이 원분산 분석법으로 통계처리 하였다. 3종의 상아질 접착제에서 모두 nanoleakage가 관찰되었으나, 에탄올 포함 상아질 접착제와 메탄을 포함 상아질 접착제에서 Scotchbond Multi-Purpose 보다 적은 양의 nanoleakage 가 관찰되었다 (p < .0001). 각각의 상아질 접착제에서 load cycling에 따른 nanoleakage 양상의 변화는 관찰되지 않았다. 이상의 결과에서 친수성기를 줄이고 소수성기를 극대화 한 실험용 상아질 접착제가 접착 계면의 내구성 향상에 도움을 줄 수 있을 것으로 사료된다. The purpose of this study was: (1) to compare nanoleakage patterns of a conventional 3-step etch and rinse adhesive system and two experimental hydrophobic adhesive systems and (2) to investigate the change of the nanoleakage patterns after load cycling. Two kinds of hydrophobic experimental adhesives, ethanol containing adhesive (EA) and methanol containing adhesive (MA), were prepared. Thirty extracted human molars were embedded in resin blocks and occlusal thirds of the crowns were removed. The polished dentin surfaces were etched with a 35 % phosphoric acid etching gel and rinsed with water. Scotchbond Multi-Purpose (MP), EA and MA were used for bonding procedure. Z-250 composite resin was built-up on the adhesive-treated surfaces. Five teeth of each dentin adhesive group were subjected to mechanical load cycling. The teeth were sectioned into 2 mm thick slabs and then stained with 50 % ammoniacal silver nitrate. Ten specimens for each group were examined under scanning electron microscope in backscattering electron mode. All photographs were analyzed using image analysis software. Three regions of each specimen were used for evaluation of the silver uptake within the hybrid layer. The area of silver deposition was calculated and expressed in gray value. Data were statistically analyzed by two-way ANOVA and post-hoc testing of multiple comparisons was done with the Scheffe's test. Silver particles were observed in all the groups. However, silver particles were more sparsely distributed in the EA group and the MA group than in the MP group (p < .0001). There were no changes in nanoleakage patterns after load cycling

열순환 후 상아질 접착 계면의 수분 투과성 변화에 대한 정량적 분석

본 연구는 현재 시판 되고 있는 여러 개의 상아질 접착제를 임상 술식에서와 같은 방법으로 사용한 다음 열순환 후 접착계면의 변화를 관찰 비교하고자 했다. 발거 한지 한 달 이내인 대구치 28개의 교합면 상아질 표면에 4종의 상아질 접착제 (OptiBond FL [OP], AdheSE [AD], Clearfil SE Bond [CL], Xeno III [XE]) 중 하나를 적용한 뒤 복합 레진 (Premisa, Kerr) 을 1 mm 두께로 올린 후 광중합 하였다. 증류수에서 6일간 보관한 뒤, 치아의 정중선으로부터 수직으로 절단 하여 그 중 절반의 치아에서 2 mm 두께의 시편을 얻은 다음 남은 반쪽의 치아는 10,000회의 열순환을 가한 뒤 (, 침지 시간 25초, 대기 시간 5초) 같은 방법으로 2 mm 두께의 시편을 얻었다. 연마한 시편을 24시간 동안 50% ammoniacal silver nitrate solution에 담근 다음 photo-developing solution에서 8시간 동안 환원시켰다. 계면을 가로지르는 5개의 line상에서 wavelength dispersive spectrometry (WDS) detector를 이용하여 주사전상에 있는 원소들의 중량비를 계산하였다. 또한 열순환 전과 후의 시편에서 얻어진 5개의 silver 측정치를 서로 비교하였다. 열순환 전의 접착제층(adhesive layer)에서는 OP에서 가장 적은 silver의 투과가 관찰되었으며 (p < 0.0001), CL, AD, XE 순으로 투과 량이 증가함을 보였다. 혼성층 (Hybrid layer) 에서는 CL의 투과량이 가장 적었다 (p = 0.0039). 열순환 후에 접착제층과 혼성층에서 silver의 투과량은 증가하지는 않았다. Scanning electron microscopy (SEM) 사진을 통하여 각 시편의 접착 계면에서 접착제에 따른 특이적인 silver의 투과상을 관찰할 수 있었다. 전반적으로 OP 와 CL의 접착계면이 열순환 과정 중에도 온전히 유지됨을 볼 수 있었다. 접착 계면에서의 수분 투과 양상은 각 접착제에 따라 다른 형태를 보였으며 열 순환에 의해 유의할 만한 변화를 야기하지는 않았다. The purpose of this study was to perform quantitative comparisons of water permeable zones in both the adhesive and the hybrid layer before and after thermo cycling in order to assess the integrity of the bonding interface. Twenty eight flat dentin surfaces were bonded with a light-cured composite resin using one of four commercial adhesives [OptiBond FL (OP), AdheSE (AD), Clearfil SE Bond (CL). and Xeno III (XE)]. These were sectioned into halves and subsequently cut to yield 2-mm thick specimens; one specimen for control and the other subjected to thermocycling for 10,000 cycles. After specimens were immersed in ammoniacal silver nitrate for 24 h and exposed to a photo developing solution for 8 h, the bonded interface was analyzed by scanning electron microscopy (SEM) and wavelength dispersive spectrometry (WDS) at five locations per specimen. Immediately after bonding. the adhesive layer of OP showed the lowest silver uptake, followed by CL, AD. and XE in ascending order (p < 0.0001); the hybrid layer of CL had the lowest silver content among the groups (p = 0.0039). After thermocycling, none of the adhesives manifested a significant increase of silver in either the adhesive or the hybrid layer. SEM demonstrated the characteristic silver penetrated patterns within the interface. It was observed that integrity of bonding was well maintained in OP and CL throughout the thermocycling process. Adhesive-tooth interfaces are vulnerable to hydrolytic degradation and its permeability varies in different adhesive systems, which may be clinically related to the restoration longevity

DEVELOPMENT OF NANO-FLUID MOVEMENT MEASURING DEVICE AND ITS APPLICATION TO HYDRODYNAMIC ANALYSIS OF DENTINAL FLUID

This study was aimed to develop an instrument for real-time measurement of fluid conductance and to investigate the hydrodynamics of dentinal fluid. The instrument consisted of three parts; (1) a glass capillary and a photo sensor for detection of fluid movement, (2) a servo-motor, a lead screw and a ball nut for tracking of fluid movement, (3) a rotary encoder and software for data processing. To observe the blocking effect of dentinal fluid movement, oxalate gel and self-etch adhesive agent were used. BisBlock (Bisco) and Clearfil SE Bond (Kuraray) were applied to the occlusal dentin surface of extracted human teeth. Using this new device, the fluid movement was measured and compared between before and after each agent was applied. The instrument was able to measure dentinal fluid movement with a high resolution (0.196 nL) and the flow occurred with a rate of 0.84 to 15.2 nL/s before treatment. After BisBlock or Clearfil SE Bond was used, the fluid movement was decreased by 39.8 to 89.6%

DEVELOPMENT OF NANO-FLUID MOVEMENT MEASURING DEVICE AND ITS APPLICATION TO HYDRODYNAMIC ANALYSIS OF DENTINAL FLUID

본 연구의 목적은 나노리터 수준의 물 흐름을 계측할 수 있는 장치를 개발하고, 상아질의 물 투과성을 측정하여 치아과민증 치료제와 상아질 접착제의 상아세관 밀폐효과를 알아보고자 하였다. 본 연구에서 제작한 미세흐름 측정장치는 첫째, 물의 흐름을 감지하는 모세관과 광 센서부, 둘째 물의 흐름을 추적하는 서보모터와 구동부, 셋째, 모터의 회전을 측정하여 물의 이동량으로 변환하는 엔코더와 컴퓨터 기록장치 등 세 부분으로 구성되어 있다. 본 장비를 이용하여 교합 면이 절단되어 노출된 상아질의 물 투과도와 치아과민증 치료제인 BisBlock과 자가부식형 상아질접착제인 Clearfil SE bond의 상아질 밀폐효과를 측정하여 다음과 같은 결과를 얻었다. 1. 나노리터 수준의 물 흐름을 측정할 수 있는 장치를 제작하였고, 이를 이용하여 상아질의 물 투과도를 측정할 수 있었다. 2. 삭제 후 노출 연마된 상아질은 0.84 - 15.2 nL/s의 물 투과도를 보였고 Oxalate 제재인 BisBlock 이나 자가부식형 접착제 Cleafil SE bond 적용 시 투과도가 39.8 - 89.6% 감소하였다. This study was aimed to develop an instrument for real-time measurement of fluid conductance and to investigate the hydrodynamics of dentinal fluid. The instrument consisted of three parts; (1) a glass capillary and a photo sensor for detection of fluid movement, (2) a servo-motor, a lead screw and a ball nut for tracking of fluid movement, (3) a rotary encoder and software for data processing. To observe the blocking effect of dentinal fluid movement, oxalate gel and self-etch adhesive agent were used. BisBlock (Bisco) and Clearfil SE Bond (Kuraray) were applied to the occlusal dentin surface of extracted human teeth. Using this new device, the fluid movement was measured and compared between before and after each agent was applied. The instrument was able to measure dentinal fluid movement with a high resolution (0.196 nL) and the flow occurred with a rate of 0.84 to 15.2 nL/s before treatment. After BisBlock or Clearfil SE Bond was used, the fluid movement was decreased by 39.8 to 89.6%

Dental Treatment of a Patient with Cerebral Palsy under General Anesthesia

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was min and staying time at PACU was min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety