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Abstract Background A recent database study and meta-analysis reported that adjunctive glucocorticoid therapy reduces mortality in patients with non-human immunodeficiency virus-associated (non-HIV) Pneumocystis jirovecii pneumonia (PCP), having hypoxemia. However, the optimal glucocorticoid dose remains unclear. Our study aimed to evaluate the effectiveness of pulse methylprednisolone compared with mild-to-moderate steroid doses in patients with non-HIV PCP. Methods This multicentre retrospective cohort study included adults with non-HIV PCP receiving adjunctive steroids at three Japanese tertiary care hospitals from June 2006 to March 2021. Patients were categorised into pulse methylprednisolone and mild-to-moderate dose groups. Pulse methylprednisolone involved an initial intravenous infusion of 500–1000 mg methylprednisolone daily, while the mild-to-moderate dose was lower. Primary and secondary outcomes were 30-day and 180-day mortality from treatment initiation. Patient characteristics were adjusted using propensity score analysis with overlap weighting. Subgroup analysis focused on patients with respiratory failure. Results The study included 139 patients with non-HIV PCP: 55 in the pulse methylprednisolone group and 84 in the mild-to-moderate dose group. After adjusting for patient background, 30-day mortality (14.2% vs. 15.5%, P = 0.850) and 180-day mortality (33.5% vs. 27.3%, P = 0.516) did not differ significantly between groups. Subgroup analysis revealed no significant associations among patients with respiratory failure. Conclusions After adjusting for patient characteristics, no difference in prognosis was observed between pulse methylprednisolone and mild-to-moderate dose groups in patients with non-HIV PCP. A mild-to-moderate dose of adjunctive corticosteroid may suffice for treating non-HIV PCP.

This report describes the case of a 59-year-old man with poorly differentiated lung adenocarcinoma and cachexia who completed chemoradiation therapy for stage III lung cancer following the administration of anamorelin. Anamorelin, a ghrelin receptor agonist, effectively improved his appetite and performance status, thereby enabling the continuation of treatment. The role of anamorelin in enhancing appetite during acute-phase treatment is promising; however, further studies must be conducted to elucidate its interaction with chemoradiation therapy. This case report highlights the potential of anamorelin as a therapeutic option for the management of cancer-related cachexia during curative treatment for lung cancer.

Background/purpose: There are reports on the relationship between periodontal treatment and the whole body. The purpose of the present study was to investigate the effect of periodontal initial treatment on brain function activity by improving periodontal tissue and the occlusal status of subjects with periodontitis. Materials and methods: The subjects were 13 patients with periodontitis. Following the patient's informed written consent, the periodontal initial treatment provided to the patient included tooth brushing instruction, scaling and root planning, however, occlusal adjustment was not performed at this stage. Periodontal examination, occlusal force examination and fMRI results were also evaluated at the initial and the reevaluation examinations. Results: After the periodontal initial treatment had been performed, periodontal tissue had significantly improved. In addition, cerebral blood flow in the insula and primary motor cortex was also improved, as confirmed by fMRI. Conclusion: This result suggests that the periodontal ligament has recovered and the periodontal ligament neuron have been further subjected to clenching in the insula.

Background: Since there are many differential diagnoses for cemento-osseous dysplasia (COD), it is very difficult for dentists to avoid misdiagnosis. In particular, if COD is related to an embedded tooth, differential diagnosis is difficult. However, there have been no reports on the characteristics of the imaging findings of COD associated with embedded teeth. The aim of the present study was to investigate the occurrence and imaging characteristics of cemento-osseous dysplasia (COD) associated with embedded teeth, in order to appropriately diagnose COD with embedded teeth. Methods: The radiographs with or without histological findings of 225 patients with COD were retrospectively analyzed. A retrospective search through the picture archiving and communication system (PACS) of the Division of Oral and Maxillofacial Radiology of Kyushu Dental University Hospital was performed to identify patients with COD between 2011 and 2022. Results: Fifteen COD-associated embedded mandibular third molars were identified in 13 patients. All 13 patients were asymptomatic. On imaging, COD associated with embedded mandibular third molars appeared as masses that included calcifications around the apex of the tooth. On panoramic tomography, COD showed inconspicuous internal calcification similar to that of odontogenic cysts or simple bone cysts, especially in patients with COD only around the mandibular third molar region. Those with prominent calcification resembled cemento-ossifying fibroma, calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, adenomatoid odontogenic tumor, and so on, as categories of masses that include calcifications on panoramic tomography and computed tomography. Conclusions: The current investigation is the first to report and analyze the imaging characteristics of COD associated with embedded teeth. It is important to consider the differences between COD and other cystic lesions on panoramic tomography, and the differences between COD and masses that include calcifications on CT.

Abstract Background Very recently, a significant relationship between tonsilloliths and dental plaque-related pathologies was reported using digital panoramic radiographs. Their dynamics over time suggest that tonsilloliths may be in a permanently active phase that functions to remove foreign matter. The aim of the study was to evaluate the relationship between the occurrence of tonsilloliths and the extent of periodontitis. Methods A total of 608 patients who underwent both CT and panoramic radiographs were included in the study. Both of two imaging were retrospectively and independently assessed with respect to the presence of tonsilloliths detected on CT and panoramic radiographs, and bone defects caused by periodontitis detected on panoramic radiographs. The type of retrospective study is case-control. Then, the differences between age groups were evaluated with respect to the degree of bone resorption and its correlation with the presence of tonsilloliths. The relationships between categorical variables were assessed using Pearson’s correlation coefficient or Spearman’s correlation coefficient. Results There was a significant relationship between tonsilloliths on CT and the extent of the bone defect on panoramic radiographs (Spearman’s correlation coefficient, r = 0.648, p = 0.043). In addition, there was a significant difference in the extent of the bone defect caused by periodontitis between subjects with and without tonsilloliths in the 60 to 69-year-old group (Mann-Whitney U test, p = 0.025), 70 to 79-year-old group (Mann-Whitney U test, p = 0.002), and 80 to 89-year-old group (Mann-Whitney U test, p = 0.022), but not in other age groups (Mann-Whitney U test: under 9-year-old group, p = 1.000; 10 to 19-year-old group, p = 1.000; 20 to 29-year-old group, p = 0.854; 30 to 39-year-old group, p = 0.191, 40 to 49-year-old group, p = 0.749; 50 to 59-year-old group, p = 0.627; ≥90-year-old group, p = 1.000). Conclusions The presence of tonsilloliths was related to the extent of periodontitis because the structures were responding dynamically.

Abstract Objectives The shapes of gubernaculum tracts (GTs) in molars as accessional teeth remain unidentified. To elucidate imaging peculiarities of GTs in molars with aging on multidetector‐row computed tomography (MDCT). Material and methods This retrospective study was conducted using CT images, including maxillary and mandibular molars, with no abnormal findings from 239 patients. Shapes of alveolar bone, GTs, and dental sacs of the maxillary and mandibular molars were analyzed multi‐sectionally. Correlations between 2‐ and 3‐dimensional imaging figures of GTs in molars and chronological age or stage of molar formation were analyzed. Results Some forms of GTs in maxillary and mandibular third molars were observed. In the early stage, GTs were visualized as bone defect lines on the dentition and grooves on the mesial alveolar crest continuous with the dental sac to mesial tooth bud. GTs of the third molar formed a J‐shape in maxillary teeth and Y‐shape in mandibular teeth in the middle stage, as alveolar bone around the GT developed. In the mature stage, the course of the GT changed to straight and perpendicular. Some GT forms were also identified in first and second molars. Significant correlations were found between GT alterations and chronological age or stage of molar formation. Moreover, tracts continuing from the distal side of mandibular third molars were detected. Conclusions This paper describes the peculiarities and process of progression for GTs in molars, and the existence of tracts continuing from the distal side of mandibular third molars, unlikely dentition with deciduous predecessors. These preliminary data should prove beneficial for studies focusing on GTs in molars.

Abstract Purpose Ultrasound-guided supra-inguinal fascia iliaca block (SFIB) is widely used as regional anesthesia of the hip and thigh. It is difficult to judge the blocking effect and the spreading local anesthesia. We hypothesize that the effect and spread of the block could be proven objectively by a rise in the temperature. In this prospective observational study, the broad regional rise in skin temperature of twenty patients who were scheduled for hip surgery was measured using an infrared thermographic camera at multiple intervals following ultrasound-guided SFIB. Methods Infrared thermographic imaging of skin temperature at the femoral, obturator, and lateral femoral cutaneous nerve sites was performed before and at 5-min intervals after ultrasound-guided SFIB for up to 15-min post-injection. The primary outcomes are skin surface temperature. Sensory block was assessed immediately after the final infrared thermographic image acquisition using the cold test. Results Compared to pre-injection baseline, temperature increased by 1.2 °C [95% confidence interval (CI) 0.4–2.0 °C] after 5 min, 1.2 °C (95% CI 0.4–2.0 °C) after 10 min, and 0.9 °C (95% CI 0.4–2.1°C) after 15 min. The cold test response was reduced in all cases at the femoral and lateral femoral cutaneous nerve sites and in 13 cases at the obturator nerve site. The sensitivity and specificity of the temperature increase to cold loss were 96% and 63%, respectively when we defined >0°C as the clinical threshold. Conclusions Successful SFIB significantly enhanced skin temperature at the hip and thigh in all cases, suggesting that infrared surface thermography can be used as an objective assessment tool for adequate analgesia. Trial registration University Hospital Medical Information Network Clinical Trials Registry ( UMIN 000037866 ). Registered 31 August 2019.

Abstract Background Tonsilloliths are related clinically to halitosis and tonsillar abscess. However, the dynamics of tonsilloliths over time are unknown. The aim of the study was to evaluate change in the characteristics of tonsilloliths in a time-dependent fashion by follow-up computed tomography (CT). Methods Tonsilloliths were analyzed in 326 CT scan pair sets of initial and at least two follow-up CT examinations of patients with whole palatine tonsils and various diseases of the oral and maxillofacial regions. Results Over the follow-up period, 12.1% of tonsilloliths disappeared. Approximately 26.1% of tonsilloliths changed in size during follow-up, mostly increasing in size. In tonsilloliths that showed enlargement, the mean (± standard deviation) growth rate was 0.61 ± 0.41 mm per year. Approximately 37.3% of tonsilloliths changed position during the follow-up period; of these, movement was toward the respiratory tract in 92% at a mean rate of − 1.38 ± 1.59 mm per year. The calcification levels of almost all tonsilloliths showed dynamic change: HU number increased in 84.3% and decreased in 12.7% of tonsilloliths over the follow-up period. The mean rate of HU increase was 63.8 ± 96.3 HU/year, and the mean rate of HU decrease was − 38.4 ± 66.8 HU/year. Conclusions The calcification levels of all tonsilloliths showed dynamic fluctuation, and a tendency for excretion of tonsilloliths from the body. Their dynamics over time suggest that tonsilloliths may be in a permanently active phase which functions to remove foreign matter.

Abstract Background Patients with myotonic dystrophy may have increased sensitivity to drugs used for anesthesia. We successfully managed general anesthesia in a patient with myotonic dystrophy using a novel intravenous anesthetic, remimazolam. Case presentation The patient was a 46-year-old man, 169 cm in height, and weighing 60 kg. He was diagnosed with myotonic dystrophy 5 years previously. Phacoemulsification for both eyes was scheduled under general anesthesia. Anesthesia was induced with remimazolam 6 mg/kg/h for 1 min and maintained by continuous infusion at 0.25 mg/kg/h during surgery, a 1/4 dose of the standard infusion rate, as indexed by a bispectral index (BIS). Six minutes after remimazolam discontinuation, the patient opened his eyes on verbal command with sufficient spontaneous respiration. Flumazenil (0.2 mg) was administered to boost the patient’s recovery. Conclusion In addition to the short-acting anesthetic remimazolam, the presence of the antagonist flumazenil enabled complete recovery from anesthesia, without postoperative complications.

Purpose Hypotension is a risk factor for adverse perioperative outcomes. Preoperative transthoracic echocardiography has been extended for preoperative risk assessment before noncardiac surgery. This study aimed to develop a machine learning model to predict postinduction hypotension risk using preoperative echocardiographic data and compared it with conventional statistic models. We also aimed to identify preoperative echocardiographic factors that cause postinduction hypotension. Methods In this retrospective observational study, we extracted data from electronic health records of patients aged >18 years who underwent general anesthesia at a single tertiary care center between April 2014 and September 2019. Multiple supervised machine learning classification techniques were used, with postinduction hypotension (mean arterial pressure Results Of 1,956 patients, 670 (34%) had postinduction hypotension. The area under the receiver operating characteristic curve using the deep neural network was 0.72 (95% confidence interval (CI) = 0.67–0.76), gradient boosting machine was 0.54 (95% CI = 0.51–0.59), linear discriminant analysis was 0.56 (95% CI = 0.51–0.61), and logistic regression was 0.56 (95% CI = 0.51–0.61). Variables of high importance included the ascending aorta diameter, transmitral flow A wave, heart rate, pulmonary venous flow S wave, tricuspid regurgitation pressure gradient, inferior vena cava expiratory diameter, fractional shortening, left ventricular mass index, and end-systolic volume. Conclusion We have created developing models that can predict postinduction hypotension using preoperative echocardiographic data, thereby demonstrating the feasibility of using machine learning models of preoperative echocardiographic data for produce higher accuracy than the conventional model.

Objective. In this study, we have introduced a case in which the effective blood oxygenation level-dependent signal on functional magnetic resonance imaging (fMRI) was altered by the improvement of periodontal tissue and occlusal function in a patient with periodontitis Stage II Grade B. Material and Methods. A 61-year-old female patient requiring periodontal treatment was diagnosed as having periodontitis Stage II Grade B via clinical and radiographic examinations. Her past medical history included type 2 diabetes, hypertension, and hyperlipidemia. Following the patient’s informed written consent, the periodontal initial treatment provided to the patient included tooth brushing instruction and scaling and root planing; however, occlusal adjustment was not performed at this stage. Occlusal force and fMRI results were also evaluated at the initial and reevaluation examinations. Results. After the periodontal initial treatment had been performed, it was noted that the patient’s periodontal tissue and occlusal force had improved. It was also evident from fMRI that cerebral blood flow had been activated in the insula, primary motor cortex, and premotor cortex. Conclusion. This result suggested that the periodontal ligament had recovered and the periodontal ligament neuron had been further subjected to clenching in the insula so that the muscle spindle sensation impacted the motor cortex.

This study aimed to compare the effects of abiraterone acetate plus prednisone (AAP) with androgen deprivation therapy (ADT) with those of combined androgen blockade (CAB) therapy in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). This study retrospectively identified 163 patients with high-risk mHSPC at Kindai University and affiliated hospitals between January 2014 and December 2020. Kaplan-Meier analysis was used to summarize progression-free survival (PFS) and overall survival (OS). Multivariate Cox proportional hazard modeling was used to identify the prognostic factors in the overall cohort. Propensity score matching was used to adjust the clinical characteristics, and log-rank test was applied to these propensity score–matched cohorts. Seventy-four patients who received AAP with ADT and 89 patients who received CAB were included in this study. The median follow-up duration was 27 months (range, 2–89 months). The median PFS and OS were not reached by the AAP+ADT group and 15 and 79 months, respectively, in the CAB group. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) score and AAP+ADT were significant prognostic factors for PFS, whereas ECOG PS score, visceral metastasis, and AAP+ADT were significant prognostic factors for OS. The 2-year PFS was 76.1% in the AAP+ADT group and 38.6% in the CAB group (P < 0.0001), and the 2-year OS was 90.2% in the AAP+ADT group and 84.8% in the CAB group (P = 0.015). In conclusion, AAP+ADT had better PFS and OS than CAB in patients with high-risk mHSPC.

Psychological pressure during sports competition disturbs the ideal physical movement and causes injury. Baseball batting frequently causes trunk injuries. This study aimed to examine the influence of psychological pressure on the lumbar kinematics and trunk muscle activity during the baseball batting. Fourteen collegiate baseball players participated in this study. The participants performed bat swings under three different psychological conditions (non-pressure, pressure, and emphasized pressure). The lumbar kinematics and trunk muscle activity were measured during each bat swing. One- and two-way analyses of variance were performed to compare the lumbar kinematics and trunk muscle activity among different psychological pressure conditions. The lumbar flexion angle throughout the bat swing in the swing phase, from the moment of ground contact of the lead foot to the moment of ball contact, was significantly larger under the pressure and emphasized pressure conditions than under the non-pressure condition (P

Abstract Background The purpose of the present study was to describe the CT imaging findings of normal incisive canals and incisive canal cysts and propose cut-off values to differentiate between them. Methods A total of 220 normal subjects and 40 patients with incisive canal cysts on multi-detector row computed tomography (MDCT) were retrospectively analyzed. The shapes, sizes, anatomic variations, Hounsfield scale values, and so on of maxillary incisive canals and the sizes and Hounsfield scale values of maxillary incisive canal cysts were analyzed. Results A significant difference in sizes of maxillary incisive canals in normal subjects was found between males and females. The sizes of maxillary incisive canals were significantly wider during aging, but shapes, anatomic variations, and Hounsfield scale values in the maxillary incisive canals were not significantly different with aging. A significant difference in sizes but not Hounsfield scale values was found between normal maxillary incisive canals and maxillary incisive canal cysts. Based on a cut-off of over 6 mm in the width of incisive canals, maxillary incisive canal cysts could not be appropriately diagnosed for subjects over 60 years of age. Over 60 years of age, maxillary incisive canal cysts could be appropriately diagnosed based on a cut-off of over 7.1 mm in width of incisive canals. When maxillary incisive canals of the hourglass types were seen on sagittal sections, significantly more patients had maxillary incisive canal cysts than other types. Conclusion In coincidentally diagnosing asymptomatic incisive canal cysts on imaging, we should apply different cut-offs for the size of the maxillary incisive canal for patients over and under 60 years of age. Specifically, the cut-offs for the long axis of maxillary incisive canal cysts were 7.1 mm for patients over 60 years of age and 6.0 mm for those under 60 years of age. In addition, we should pay attention to wider canals with hourglass shapes as indicative of cystic change of maxillary incisive canals.

Introduction. The SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test is useful for diagnosing COVID-19, and the RT-PCR positive rate is an important indicator for estimating the incidence rate and number of infections. COVID-19 pneumonia is also associated with characteristic findings on chest CT, which can aid in diagnosis. Methods. We retrospectively evaluated patient background characteristics, the number of cases, the positivity rate, and chest CT findings for positive and negative cases in 672 patients who underwent RT-PCR for suspected COVID-19 at our hospital between April 3 and August 28, 2020. In addition, we compared trends in the positive rates at approximately weekly intervals with trends in the number of new infections in Machida City, Tokyo. Results. The study included 323 men and 349 women, with a median age of 46 years (range: 1 month–100 years). RT-PCR findings were positive in 37 cases, and the positive rate was 5.51%. Trends in the positive rate at our hospital and the number of new COVID-19 cases in the city were similar during the study period. Among patients with positive results, 15 (40.5%) had chest CT findings, and 14 had bilateral homogeneous GGOs. Among patients with negative results, 190 had chest CT findings at the time of examination, and 150 were diagnosed with bacterial pneumonia or bronchitis, with main findings consisting of consolidations and centrilobular opacities. Only 11 of these patients exhibited bilateral homogeneous GGOs. Conclusion. Bilateral homogeneous GGOs are characteristic of COVID-19 pneumonia and may aid in the diagnosis of COVID-19.

Respiratory failure is a common complication in patients with myotonic dystrophy (MD) and might be a presenting symptom in the perioperative setting. We report the case of a 59-year-old woman with MD who underwent open cholecystectomy and developed postoperative respiratory failure. Without reintubation, the patient was successfully managed with bilevel positive airway pressure (BiPAP) and was discharged uneventfully. BiPAP may be considered as an alternative for postoperative respiratory failure in patients with MD. Careful observation of patients' postoperative condition and an earlier application of BiPAP are instrumental in avoiding retracheal intubation, which may cause further serious problems in patients with MD.

Objective: To clarify what future problems must be resolved and how clinical findings of SARS-CoV-2 infection differ from those of cHCoV infection. Methods: Patients and Methods Clinical characteristics of 14 patients with laboratory-confirmed Coronavirus disease 2019 (COVID-19) and 5 patients with cHCoV pneumonia admitted to our institution and treated up to March 8, 2020, were retrospectively analyzed. Results: On admission, 10 patients had pneumonia, 5 of whom had pulmonary shadows detectable only via computed tomography (CT). During hospitalization, another patient with no pulmonary shadows on admission developed pneumonia. In total, 11 (78.6%) of the 14 patients developed pneumonia, indicating its high prevalence in COVID-19. During hospitalization, the patients' symptoms spontaneously relapsed and resolved, and gastrointestinal symptoms were frequently found. C-reactive protein values showed correlation with the patients’ clinical courses. Ritonavir/lopinavir were administered to 5 patients whose respiratory conditions worsened during admission, all of whom improved. However, the pneumonia in the 6 other patients improved without antivirals. None of the 14 patients died, whereas 5 other patients with cHCoV pneumonia were in respiratory failure on admission, and one patient (20%) died. Conclusion: Both SARS-CoV-2 and cHCoV can cause severe pneumonia. Problems for future resolution include whether antiviral agents administered in cases of mild or moderate severity can reduce the number of severe cases, and whether antivirals administered in severe cases can reduce mortality.

Structural and electrical properties of Al-doped Mg _x Zn _1−x O films were improved by post-annealing with supplying Zn vapor. The Al-doped Mg _x Zn _1−x O films were deposited on glass substrates by a sol-gel method. The substrates were dip-coated with a precursor solution and were dried on a hotplate at 270 °C for 10 min. This dip-coating and drying process was repeated 10 times, and the Al-doped Mg _x Zn _1−x O films were obtained after calcination in air at 500 °C for 1 h. The as-grown films were post-annealed in H _2 at 400 °C for 20 min. To supply zinc vapor, a glass slide with a thermally evaporated Zn layer (Zn cap) was put on the sample surface during the post-annealing. The as-grown films had the wurtzite structure with the c -axis perpendicular to the substrate surface, but the intensity of the (002) diffraction peak decreased with increasing Mg content (x). The crystallinity of the films was improved after the post-annealing with a Zn cap, which was observed when x was below 0.1. The resistivity and carrier concentration of the film (x = 0.1) after the post-annealing with a Zn cap was 6.0 × 10 ^−3 Ωcm and 5.7 × 10 ^19 cm ^−3 , respectively. On the other hand, the resistivity of the film (x = 0.1) after the post-annealing without a Zn cap was 6.6 × 10 ^2 Ωcm. Transmittance spectra in the visible range were not affected by the post-annealing. The optical bandgap of the film (x = 0.1) after the post-annealing with a Zn cap was 3.41 eV.

We aimed to determine the significance and usefulness of imaging characteristics of gubernaculum tracts (GT) for the diagnosis of odontogenic tumors or cysts. This was a retrospective analysis of relationships between odontogenic or non-odontogenic tumors or cysts and the GT that were visualized using multi-detector computed tomography (MDCT). The relationship between the size of a mass and expansion of the GT in all odontogenic tumors or cysts to which GTs were contiguous on MDCT, was statistically analyzed. Intact or expanded GTs were detected in MDCT images on the top of almost all odontogenic tumors or cysts, but not on non-odontogenic tumors or cysts. Characteristic image findings regarding the relationship between the GT and the odontogenic mass were detected for the respective odontogenic tumors or cysts in which the GTs were contiguous to the mass on MDCT. In ameloblastomas, expansion of the GTs significantly and very strongly correlated with tumor size (r = 0.741, p = 0.0001), but this correlation was very weak in dentigerous cysts (r = 0.167, p = 0.028) and there was no correlation between these parameters in odontogenic keratocysts (r = -0.089, p = 0.557). The imaging characteristics of GTs at the top of masses should be very useful for both the differential diagnosis of the pathological diagnosis of odontogenic masses and for differentiation between odontogenic and non-odontogenic masses.

We report a rare case of multiple complex odontomas and the subsequent occurrence of an ossifying fibroma at the same site as one of the removed odontomas. A 3-year-old Japanese boy presented three complex odontomas at the unerupted deciduous first and second molars and permanent first molar on the left side of the mandible. The two odontomas at the deciduous teeth were immediately extirpated, and, after 2 years of follow-up, the odontoma at the unerupted permanent first molar was removed. At the age of 7 years, a small odontoma surrounding the deciduous second molar emerged as a recurrence. When the patient was 9 years old, an ossifying fibroma occurred near the apex of the first premolar, i.e., the site where one of the original odontomas existed. Furthermore, a small radiopaque mass over the crown of the unerupted permanent second molar was observed at the age of 10 years; this mass was probably an additional fourth complex odontoma. This is not only a rare case report of ossifying fibroma associated with multiple complex odontomas but also a valuable time course observation of the development of such odontogenic tumors.

Mineral trioxide aggregate (MTA) is a material that has been used worldwide in several clinical applications, such as apical barriers in teeth with immature apices, repair of root perforations, root-end filling, pulp capping, and pulpotomy. The purpose of this case report was to describe successful revascularization treatment of an immature mandibular right second premolar with apical periodontitis in a 9-year-old female patient. After preparing an access cavity without anesthesia, the tooth was isolated using a rubber dam and accessed. The canal was gently debrided using 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide irrigant. And then MTA was packed into the canal. X-ray photographic examination showed the dentin bridge 5 months after the revascularization procedure. Thickening of the canal wall and complete apical closure were confirmed 10 months after the treatment. In this case, MTA showed clinical and radiographic success at revascularization treatment in immature permanent tooth. The successful outcome of this case suggests that MTA is reliable and effective for endodontic treatment in the pediatric dentistry.