Thickness of Masticatory Mucosa in the Human Hard Palate and Tuberosity Dependent on Gender and Body Mass Index

The aim of this study was to clinically determine the thickness of masticatory mucosa in the hard palate and tuberosity as potential donor sites for subepitelial grafts for ridge augmentation procedures of small and moderate alveolar ridge defects to improve aesthetics of a pontic area of fixed partial dentures. In 102 periodontally healthy fully dentate subjects the thickness of mucosa was assessed by bone sounding with a periodontal probe. Twenty measurement points were defined, 18 on hard palate located on 3 lines running at different distances parallel to gingival margin and 2 on tuberosity. Data were analysed to determine differences between gender and different body mass index using t-test. The mucosa on the hard palate was significantly thicker than on the tuberosity. The thickest mucosa was registered on the second and the third line behind canines and on all 3 lines behind the first premolar. These areas are recommended as potential donor sites. Males had significantly thicker mucosa than females (p0.05) where the mucosa was the thinnest in the both gender, which was attributed to the protuberance of the palatal root of the first molar. The same was with the body mass index. Therefore canine-premolar palatal region is recommended for harvesting free subepitelial grafts for moderate augmentation of alveolar ridges for achieving optimal aesthetics of the pontic area

Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers

Resorpcija koštanoga tkiva može biti rezultat utjecaja raznih lokalnih i sustavskih čimbenika (pacijentova dob, traumatska oštećenja, razni oblici patoloških stanja, poremećaji u metabolizmu minerala, osteoporoza, hiperparatiroidizam i ostali hormonski poremećaji). Pojedini dijelovi koštanoga sustava različito reagiraju na navedene čimbenike te resorpcija ne mora uvijek biti podjednake jakosti u svim dijelovima kosti. Zabilježeni su različiti rezultati u povezanosti resorpcije kosti gornje i donje čeljusti s ostalim dijelovima koštanoga sustava. Resorpcija bezubih alveolarnih grebena također je povezana s nošenjem mobilno protetskih nadomjestaka. U nositelja potpunih te djelomičnih proteza s potpuno gingivnim ili gingivo-dentalnim opterećenjem veće je od resorpcije bezuboga grebena u nositelja djelomičnih proteza s dento-gingivnim opterećenjem. Jedna od najjednostavnijih metoda za rano otkrivanje promjena koštane strukture gornje i donje čeljusti jest metoda kliničke mikrodenzitometrije s upotrebom standardizirane intraoralne ili panoramske slike.Residual ridge resorption is a result of the influence of many different local and systemic factors (patient’s age, traumatic damage, different pathological conditions, mineral metabolism disorders, osteoporosis, hyperparathyroidism and hormone disbalance). Some parts of the skeleton react differently to the mentioned factors. The resorptive changes are not always the same intensity in all the parts of the skeleton. There are many different results in the investigation of the relationship between maxillary and mandibular resorption and the resorption of the rest of the skeleton. Alveolar ridge resorption is correlated with removable denture wearing. The resorption of the edentulous alveolar ridge is more extensive in full or partial denture wearers with mucosa- or mucosa-gingival support than in partial denture wearers with gingiva-mucosal support. One of the easiest methods for early diagnosis of bone structure changes in the upper and lower jaws is clinical microdensitometry, using a standardised intraoral or panoramic radiograph

Bone Densitometric Study of Mandibular Density Using Dental Panoramic Radiographs

Svrha rada bila je ocijeniti preciznost mikrodenzitometrijske metode na ortopantomogramima. U tu je svrhu upotrebljen bakreni kalibracijski klin (BKK) sastavljen od 5 slojeva, debeo od 0,1 do 0,5 mm. Ortopantomogrami su digitalizirani, a na digitaliziranim su snimkama izmjerene razine sivila na bakrenom kalibracijskom klinu te u području istraživanja. Izmjerene vrijednosti svih razina sivila, uz pomoć polinomne funkcije trećeg stupnja izražene su u ekvivalentima debljine bakrenog kalibracijskog klina. Uspoređujući vrijednosti ekvivalenata u području istraživanja na prvoj i drugoj digitaliziranoj snimci istog pacijenta vidljivo je da se razlike među njima kreću unutar 10%. Deset pacijenata dobrovoljaca slikano je dva puta, u vremenskom razmaku od 5 minuta. Rezultati su pokazali da je mikrodenzitometrijskom metodom moguće otkriti promjene u mineralnom sastavu koπtanoga tkiva kada one dosegnu 10%.The precision of the method of microdensitometry on panoramic radiographs (PR), using a five step copper stepwedge, was examined. Two PRs, one after the other, were made for each of the six examined patients. All the PRs were digitised. Gray levels were measured on the stepwedge and on the region of the interest. Measured gray level values were expressed in equivalents of the stepwedge thickness using 3rd degree polynomial. Comparing the values of the equivalents in the region of interest on the first and the second digitised image of the same patient, the differences were within 10%. The results revealed that the method detects mineral bone changes, which surpass more than 10% of the density on PR

Alveolar Bone Loss on Abutment and Non-Abutment Teeth in Relation to Removable Partial Denture Wearing. A Six Month Follow Up Study

Gubitak interdentalnog alveolarnoga koštanog septuma moguće je dijagnosticirati na radiološkoj slici u obliku omjera visine interdentalnog alveolarnoga septuma i visine korijenskoga dijela zuba mjerenog od cementno-caklinskoga spojišta do vrška korijena. Svrha ovog rada bila je izmjeriti visinu interdentalne alveolarne kosti na ortopantomogramima, na zubima nosačima i nenosačima u pacijenata nositelja djelomičnih proteza, prigodom predaje djelomične proteze i nakon 6 mjeseci. Dvadeset pacijenata (5 muškaraca, 15 žena), nositelja djelomičnih proteza, sudjelovalo je u istraživanju. Gubitak alveolarne kosti izmjeren je na ortopantomogramima, služeći se Shei indeksom, na mezijalnoj i distalnoj stijenci svakoga zuba nosača i nenosača u donjoj čeljusti, neposredno nakon predaje djelomične proteze te 6 mjeseci poslije. Također su zabilježene kliničke vrijednosti plak indeksa izmjerene na sredini bukalne i palatinalne stijenke te mezio- i disto-palatinalno na svakom zubu nosaču i nenosaču u donjoj čeljusti nakon predaje djelomičnih proteza te 6 mjeseci poslije. Rezultati istraživanja pokazali su da su se vrijednosti Shei indeksa znatno smanjile na distalnim stijenkama zuba nosačima te na mezijalnim i distalnim stijenkama zuba nenosača (p0,05). Gubitak koštane strukture oko zuba nosača i oko zuba nenosača vjerojatno je više povezan s visokim vrijednostima izmjerenoga plak indeksa te s niskom razinom oralne higijene nego s novonastalim opterećenjem od djelomičnih proteza.Loss of interdental alveolar bony septum can be determined directly from a radiograph as the relation between the length of the interdental bony crest of the alveolus to the tooth apex and the distance from the cemento-enamel junction of the tooth to the tooth apex. The aim of this study was to measure the height of the interdental alveolar bone around the abutment and non-abutment teeth in removable partial denture wearers (RPD) on dental panoramic radiographs (DPR) over a period of six months. Twenty RPD patients (5 male, 15 female) participated in the study. The alveolar bone loss measurement was performed on DPRs, using Schei index, on each mandibular abutment and nonabutment tooth on its mesial and distal side, after the RPD delivery and six months later. Recordings of plaque index (PlI) were made at the mid-buccal, mid-palatal, mesio- and disto-palatal surfaces of all abutment and non-abutment teeth in the mandible after the RPD delivery and six months later. The results revealed a decrease in Schei index values, on both abutment and non-abutment teeth, which reached a statistically significant level for distal Schei index values of the abutment teeth and mesial and distal Schei index values of the non abutment teeth (p0.05). We concluded that the decrease in bone support on both abutment and non-abutment teeth was attributed to the high levels of PlI and probable low level of oral hygiene than to the RPD loading

[Changes in M. temporalis activity in subjects with full dentures]

Kod 35 ispitanika sa prirodnim zubima ii 30 nosilaca totalnih proteza istražena je aktivnost m. temporalis anterior et posterior metodom površinske elektromiografije na aparatu sa ugrađenim digitalnim integrator i ma. Registracije su vršene u svim okluzijskim položajima (retruzija, incizalni položaj, dekstro i sinistrolateralna okluzija, maksimalna mterkuspidacija). Rezultati su prikazani u postocima maksimalne interkuspidaciije, a obrađeni su metodom analize varijance. Utvrđena je relativno veća aktivnost m. temporalis ant. kod nosilaca totalnih proteza u retruziji lateralnoj okluziji na radnoj strani [p < 0 ,0 1 ), što se pripisuje većem broju kontakta na lateralnim zubima kod proteza u ovim položajima. Također je utvrđena veća aktivnost m. temp. post. u (incizalnom položaju i lateralnoj okluziji na kontralateralnoj strani kod nosilaca totalnih proteza (p < 0,01 J. To se pripisuje manjem incizalnom kutu kod totalnih proteza, kao i rotaciji manđibule prema gore i naprijed uslijed resorpcije alveolnog grebena.The activity of anterior et posterior temporal muscle was studied in 35 subjects with natural teeth and 30 subjects with full dentures, employing the method of surface electromyography by means of a device supplied with built-in digital integrators. Records were taken in all occlusal positions (i.e. retrusiion, incisal position, d extra- and sinistro-lateral occlusion, maximal intercupation). The results obtained were processed by the method of variance analysis and are presented as percentage of maximal interciuspation. A relatively higher activity of m. temporalis anterior in retrusion and lateral occlusion on the working side was found in the subjects with full dentures (p < 0 ,0 1 ), which was attributed to more frequent contacts on the lateral teeth in dentures in theise positions. In these subjects, a higher activity of m. temporalis posterior was also found in the incisal position and lateral occlusion on the -contralateral side (p < 0 .0 1 ), which was ascribed to less steep incisad angle in full denture wearers, as well as an upward and forward rotation of the mandible due to resonption of residual ridges

Importance of Hamular Distance for Calculation of the Width of Maxillary Anterior Teeth

Nije jednostavno izabrati prikladne umjetne zube za protezu ako ne postoje predekstrakcijski modeli ili fotografije. Ovim istraživanjem željele su se utvrditi prosječne širine prednjih gornjih zuba i nepca. Svrha je također bila ustanoviti može li se temeljem mjerenja određenih dimenzija tvrdoga nepca rekonstruirati ispravne dimenzije gornjih prednjih zuba. U svrhu istraživanja izmjerene su dimenzije zuba i nepca na modelima gornje čeljusti 80 mlađih ispitanika (26 pacijenta i 54 pacijentica) s intaktnom denticijom i Angle klase I. Rezultati ovoga rada pokazali su da je najširi središnji gornji sjekutić, nešto je uži očnjak, a najuži je lateralni gornji sjekutić. Vrijednosti su dobivene za opseg zubnoga luka (52,05 mm), zatim za hamularnu udaljenost (47,1 mm), za stražnju gornju širinu (46,1 mm), za zbroj širina gornje fronte (46,04 mm), za prednju gornju širinu (35,8 mm) i za udaljenost između vrškova očnjaka (34,19 mm). Pri izboru širine gornje fronte može nam poslužiti hamularna udaljenost (udaljenost između hamularnih udubina na nepcu) i stražnja gornja širina (udaljenost središta fisura gornjih prvih kutnjaka) jer se statistički znatno ne razlikuju (p > 0,05). Nakon vađenja svih zuba nestaje stražnja gornja širina i nije ju moguće rekonstruirati zbog individualne resorpcije alveolarnoga grebena. No hamularna udaljenost se ne mijenja tijekom života i ne ovisi o zubima tako da je prikladna anatomska veličina za određivanje ukupne širine gornje fronte.Without pre-extraction photographs or casts it is not easy to select suitable artificial teeth. The aim of this study was to determine the relationship between the width of frontal maxillary teeth and the width of the hard palate. The aim was also to determine the possibility of reconstructing maxillary frontal teeth dimensions, based on hard palate dimensions. Teeth and hard palate dimensions were measured on maxillary casts of 80 fully dentate individuals (26 men and 56 women) of Angle class I occlusal relationship. The maxillary central incisor is the widest among the frontal maxillary teeth and canines are wider than second incisors. The width of the maxillary frontal teeth arch, measured with a flexible ruler is 52.05 mm, hamular distance 47.1 mm, distal maxillary width 46.1 mm, sum of the widths of all maxillary frontal teeth 46.04 mm, frontal maxillary width 35.8 mm, and finally the width between canine cusp tips is 34.19 mm. Based on the results of this study, the sum of all maxillary frontal teeth widths is equivalent to hamular distance dimension, as well as distal maxillary width, as there were no statistically significant differences between them. After extraction of all teeth, distal maxillary width is lost, which is not possible to reconstruct because of the individual rate of alveolar bone resorption. On the other hand, hamular distance remains the same dimension during the lifetime, because it is not determined by teeth position but by anatomical structures. Therefore, the hamular distance dimension is a suitable reference for determination of the dimension of the sum of all maxillary frontal teeth widths

The Influence of Gender and Age on the Values of Linear Radiomorphometric Indices Measured on the Lower Border of the Mandible

Osteopeniju ili gubitak kosti, kao prvi simptom osteoporoze, moguće je dijagnosticirati radiografski - na rendgenskoj slici vidljiva je smanjena gustoća kosti, a na ortopantomogramu moguće je izmjeriti debljinu kosti, stanjenost kortikalnoga dijela kosti, poroznost ili promjene u trabekulama spongioznoga dijela koštane strukture. Svrha ovog istraživanja bila je izmjeriti mentalni, antegonionalni i gonionalni radiomorfometrijski indeks čeljusti na 200 ortopantomograma, uzimajući u obzir dob i spol ispitanika. Tri indeksa: debljina kortikalnoga dijela kosti na gonionu (GI), antegonionu (AI) i u projekciji mentalnoga foramena (MI) mjerena su obostrano na donjemu rubu čeljusti na 200 ortopantomograma. Pouzdanost mjerenja dvaju ispitivača (p=0,89 za studenta stomatologije; p=0,93 za stomatologa) i podudarnost njihovih mjerenja (k=0,81) bila je zadovoljavajuća. Rezultati istraživanja pokazuju znatnu razliku između izmjerenih vrijednosti GI-a na lijevoj i na desnoj strani čeljusti (p<0,001). U muških pacijenata pronađene su statistički znatno više izmjerene vrijednosti MI-a u usporedbi sa ženama, a u žena starijih od 65 godina pronađena je znatno niža vrijednost AI-a u odnosu prema ženama mlađima od 65 godina. Na temelju dobivenih rezultata ovog istraživanja moguće je zaključiti da je ortopantomogram koristan kao vrlo jednostavna metoda procjene kakvoće čeljusne kosti u pacijenata u svrhu planiranja budućeg stomatološkog tretmana.Osteopenia (bone loss, first symptom of osteoporosis) can be identified radiographically - by a reduction in radiopacity of bone measuring the bone density or by observation of thinned cortices, porosity of the cortices, or changes in trabecular pattern on dental panoramic radiographs (DPRs). The objective of this study was to measure mental, antegonial and gonial radiomorphometric indices of the mandible on 200 DPRs taking into account age and gender of the participants. Three indices: cortical width at the gonion (GI), antegonion (AI) and below the mental foramen (MI) were measured at the lower border of the mandible, bilaterally on 200 DPRs. The reliability of the measurements (p= 0.89 for a dental student, p=0.93 for a dentist) and agreement between the observers (= 0.81) were satisfactory. The results of the study revealed significant difference between GI measured on the left and right side of the mandible (p<0.001). Male patients demonstrated significantly higher measured values for MI than female patients (p<0.001), and finally, female patients older than 65 years showed significantly lower measured AI values than those younger than 65 years. Based on the results of this study, we conclude that the DPR is useful as a simple method of screening patients for evaluation of mandibular bone quality prior to dental treatment

Resorpcija alveolarnoga grebena utvrđena na ortopantomogramima

This study was conducted to determine the relationship o f the center o f the mental foramen to the inferior (IM - CM) and superior borders (CM - SM) o f the mandible, as reference points on panoramic radiographs in different groups according to sex, age and loss of teeth, to elucidate some o f the factors contributing to alveolar ridge resorption. Measurements o f 564 images (left and right sides) on 282 panoramic radiographs revealed the mental foramen to be nearer to the lower border o f the mandible (p <0.05). There was no significant difference for IM - CM distances between the groups with different number o f teeth and o f different age in either men and women (p > 0.05), indicating this part o f the mandible to remain relatively constant in size, despite increasing age, loss of teeth and occurrence of postmenopausal osteoporosis in women. In women the mandible was found to be significantly smaller for both measured distances (IM - CM, and CM - SM) than in men (p 0,05) i kod muških i kod ženskih ispitanika. Za udaljenost od centra foramena mentale do donjeg ruba mandibula (IM - CM) nije bilo statistički značajne razlike (p > 0,05) između ispitanika različite dobi i različitog gubitka zubi, što ukazuje da se ovaj dio mandibule ne resorbira, bez obzira na dob, gubitak zuba ili nastanak postmenopauzalne osteoporoze u žena. Mandibula je kod žena bitno manja nego kod muškaraca za obje udaljenosti (IM - CM i CM - SM) (p < 0,01), što je i očekivani rezultat, jer žene imaju općenito slabije razvijen skelet. Za udaljenost od centra foramena mentale do gornjeg ruba mandibule (CM - SM) postojala je statistički značajna razlika između ozubljenih i potpuno bezubih ispitanika i kod ženskog i kod muškog spola (p < 0,05), što pokazuje da je potpuni gubitak zuba glavni etiološki faktor prilikom resorpcije alveolarnog nastavka i da je važno sačuvati zube prilikom izrade protetskih nadomjestaka

Epidemiological Study on Removable Denture Deliveries in Different Districts of Croatia, 1996–2001 and 2002

Aim of this study was to determine the prevalence of removable denture (complete and partial) deliveries through Croatian Public Health Service (covered by insurance) in different districts of Croatia and to compare the two periods: 1996 to 2001 and 2002. Number of dentures delivered was obtained from Croatian Institute for Health Insurance for the district of Zagreb, Rijeka, Split and Karlovac. Information of the population living in the same districts was obtained from the National Institute for Statistics. The percentage of fully edentulous inhabitants varied from more than 13% to more than 20%, dependent on the district, while the percentage of partial edentulism reconstructed with removable partial dentures varied from more than 13% to more than 30%. The highest percentage (average for living population) of complete and removable partial dentures was delivered in Zagreb in the both observed periods. In all districts, the number of complete denture wearers increased in 2002, except in Split. The percentage of removable partial denture deliveries increased significantly in all examined districts. Partial and complete denture deliveries increased in higher percentage in population younger than 70 years than in older population. The percentage of metal framework removable partial dentures increased significantly in all districts. The prevalence of removable denture deliveries increased, especially in patients younger than 70 years. This was attributed not only to the consequences of the 1991–1995 war, the migrations from rural to urban areas, decrease of economic status, but also to the new rules of the Croatian Insurance System

Factors Related to Oral Health Related Quality of Life in TMD Patients

The aims of the study were to determine the impact of temporomandibular disorders (TMD) on self-percieved oral health related quality of life (OHRQoL) and to compare OHRQoL of patients with TMD with a control group. A total of 81 TMD patients participated in a study group and 400 adults served as the control group. The mean OHIP summary scores were computed for all patients with the same diagnosis and the same subgroup of axis I according to the RDC/TMD exam form. The mean OHIP subscores for all seven domains of the OHIP questionnaire were compared between the study and the control group. The hierarchical linear regression model was used to assess the most important variables according to the RDC/TMD protocol that contribute to OHRQoL in TMD patients with the OHIP summary score as dependent variable. According to this study,TMD had a high association with reduced OHRQoL (p<0.001). More diagnoses of axis I according to the RDC/TMD protocol (p<0.001), higher age of TMD patients (p<0.001) and diagnoses associated with limited jaw movements contributed to more impaired OHRQoL (p=0.008 and p=0.030, respectively). Female TMD patients had no significantly different OHRQoL compared to male patients (p=0.436). According to regression analysis, higher age (p<0.001), more physical diagnoses (p=0.018) and diagnosis Ib (p=0.169) explained 39.1% of the variability (p<0.001) of the OHIP summary score in TMD patients