Mandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature

OBJECTIVE: Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw. ----- CASE REPORT: We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and bethamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and sutures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of microorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely. ----- CONCLUSION: This case highlights the fact that in some patients bone exposure might develop due to the pulpal-periodontal syndrome i.e. pulp necrosis

Effects of Tumor Necrosis Factor-a on Insulin Stimulated Amino Acid Transport in Cultured Rat Hepatocytes

It has been suggested that tumor necrosis factor alpha (TNF-a) plays a pivotal role in the pathogenesis of insulin resistance. It could act directly or indirectly in liver. The aim of this study was to determine direct short time (4 h) and long time (24 h) action of TNF-a on amino acid transport in cultured rat hepatocytes and possible role of protein kinase C (PKC) in insulin signal pathway and insulin resistance. Hepatocytes were isolated by a modified collagenase perfusion technique and cultured for 24 h in M 199 medium. In the presence of insulin basal alpha-amino isobutyric acid (AIB) uptake was increased 55%. TNF-a in short time action did not change basal AIB transport, but significantly (25%) increased insulin stimulated uptake. Short time action of TNF-_ was ameliorated by phorbol ester treatment. These results indicated that PKC activation is important in insulin signaling and TNF-a action. TNF-a acting directly did not cause insulin resistance in cultured hepatocytes

Microleakage along Glass-Fibre Posts Cemented with Three Different Materials after Cyclic Loading: A Pilot Study

The purpose of this in vitro study was to evaluate microleakage along glass-fibre posts cemented with three different cements after cyclic loading. After post-space preparation, fifty obturated root canals were randomly divided into three experimental groups and two control groups. In group 1, Glassix posts were cemented using Harvard cement, in group 2, Fuji PLUS cement was used and in group 3, Variolink II was used for post cementation. The specimens were artificially aged by loading in a special testing machine. Coronal leakage was evaluated using a fluid transport system. Posts cemented with Variolink II, showed significantly higher failure rate after loading, compared to group 1 and 2 (p=0.009). Comparing microleakage in samples that have not failed, specimens cemented with Variolink II showed significantly less fluid transport than specimens cemented with zinc phosphate and glass ionomer cements (p=0.04 and p=0.006, respectively). Variolink II cement exibited significantly less fluid movement compared with Harvard and Fuji PLUS cement

Cytotoxicity of Two Bioactive Root Canal Sealers

Uvod: Svrha istraživanja bila je ispitati citotoksičnost dvaju različitih bioaktivnih materijala za punjenje korijenskih kanala temeljenih na mineral-trioksidnom agregatu MTA Fillapex (Angelus, Solucoes Odontologicas, Londrina, PR, Brazil) i biokeramici, Endosequence BC Sealer (Brasseler, Savannah, Georgia, SAD) u kulturi mišjih fibroblasta L929. Materijali i postupci: Mišji fibroblasti L929, dobiveni iz potkožnog veziva miševa linije C3Hf, uzgojeni su u plastičnim posudama za staničnu kulturu površine 75 cm2 u inkubatoru na temperaturi od 37 ºC, uz 5-posto CO2 i 90 posto vlažnosti. Svježe zamiješani materijali – (0,1 g) Endosequence BC Sealer i MTA Fillapex – naneseni su na sterilne teflonske diskove promjera šest milimetara. Diskovi s materijalom i prazni teflonski diskovi koji su služili kao kontrola, stavljeni su u bunariće pločica za staničnu kulturu. Nakon inkubacije od jedan sat, šest, 20 i 24 sata, uklonjeni su teflonski diskovi i određen je broj živih stanica tripanskim modrilom u Neubaerovoj komorici. Rezultati: Promatranjem razlike između ispitivanih materijala i kontrolne skupine u pojedinim inkubacijskim razdobljima, dokazano je da punilo MTA u svim inkubacijskim razdobljima pokazuje statistički značajan pad broja živih stanica (p ≤ 0,05), a kod punila BC pojavljuje se statistički značajna razlika od šestog do dvadeset i četvrtog sata inkubacije (p ≤ 0,05). Punilo MTA u odnosu na punilo BC pokazalo je statistički značajan pad broja živih stanica samo nakon prvog i dvadesetog sata inkubacije (p ≤ 0,05), a u ostalim inkubacijskim razdobljima ta razlika nije bila statistički značajna (p ≥ 0,05). Zaključak: Punila MTA i Endosequence BC bila su citotoksična u kulturi mišjih fibroblasta.Objective: The aim of this study was to investigate the cytotoxicity of two different bioactive root canal sealers: one based on mineral trioxide aggregate, MTA Fillapex (Angelus, Solucoes Odontologicas, Londrina, PR, Brazil), and the other based on bioceramics, Endosequence BC Sealer (Brasseler, Savannah, Georgia, USA), in culture of mouse L929 fibroblasts. Materials and methods: Mouse fibroblasts (L929), obtained from subcutaneous connective tissue of mouse line C3Hf, were cultivated in plastic culture flasks in an incubator at 37ºC, with 5% CO2 and 90% humidity. Freshly mixed Endosequence BC Sealer and MTA Fillapex (0.1 g each) were placed on sterile teflon discs, 6 mm in diameter. Teflon discs with the materials as well as empty discs serving as control were placed in wells of 12-well plate. After incubation times of 1, 6, 20 and 24 hours, the teflon discs were removed from the wells and the number of viable cells was determined using trypan blue in Neubauer chamber. Results: In comparison to the control group, MTA Fillapex had significantly less viable cells for all incubation periods (p≤0.05), while Endosequence BC sealer had significantly less viable cells after 6, 20, and 24 hours of incubation (p≤0.05). MTA Fillapex exhibited ignificantly less viable cells in comparison to Endosequence BC sealer after the first hour and after 20 hours of incubation (p≤0.05), while for the other incubation periods there were no significant differences (p≥0.05). Conclusion: MTA Fillapex and Endosequence BC sealer were both cytotoxic in cultures of mouse L929 fibroblasts

Evaluacija inovativno digitalno kontroliranog Er:YAG lasera u liječenju leukoplakije - probno istraživanje

The use of lasers for treatment of oral leukoplakia has gained a lot of interest in the past years, however, data on the use of Er:YAG laser are scarce. The aim of this study was to compare the efficacy of Er:YAG laser and 1% topical isotretinoin in the treatment of 27 oral leukoplakia patients. Er:YAG laser (LightWalker AT, Fotona, Slovenia) was used in 27 patients with 27 leukoplakia lesions. Postoperative pain was assessed by use of visual analog scale (VAS), and the impact of laser treatment on the quality of life was assessed by the OHIP-14 questionnaire (Croatian version). Control group consisted of the same 27 patients previously treated with 1% topical isotretionin three times a day during the period of one year. No improvement in the size of leukoplakia lesions was observed after treatment with topical isotretinoin. There were significant differences between men and women according to leukoplakia localization, number of laser sessions and VAS (p<0.05). At follow-up after six months and one year, there was no recurrence of lesions. Er:YAG laser is a successful treatment for oral leukoplakia. Topical isotretionin treatment is unsuccessful in patients with oral leukoplakia.Posljednjih godina postoji veliko zanimanje za upotrebu lasera u liječenju oralne leukoplakije, ali su podatci o upotrebi Er:YAG lasera malobrojni. Cilj ovoga istraživanja bio je usporediti učinak Er:YAG lasera i 1%-tnog topikalnog izotretinoina u liječenju 27 bolesnika s oralnom leukoplakijom. Er:YAG laser (LightWalker AT, Fotona, Slovenia) je korišten u 27 bolesnika s 27 leukoplakičnih lezija. Poslijeoperacijska bol je određena uz pomoć vizualne analogne ljestvice (visual analog scale, VAS), a utjecaj na kvalitetu života mjeren je pomoću upitnika OHIP-14 (hrvatska verzija). Kontrolna skupina se sastojala od istih 27 bolesnika koji su prije toga liječeni 1%-tnim topikalnim izotretioninom tri puta na dan tijekom tri mjeseca. Nije bilo poboljšanja u veličini lezija leukoplakije nakon topikalno primijenjenog izotretinoina. Utvrđene su značajne razlike između muškaraca i žena s obzirom na lokalizaciju leukoplakije, broj laserskih zahvata i rezultata VAS (p<0,05). Šest mjeseci i godinu dana od laserskog zahvata nije bilo recidiva oralne leukoplakije. Er:YAG laser je uspješna terapija u liječenju oralne leukoplakije. Topikalna primjena izotretionina nije uspješna u liječenju oralne leukoplakije

Advanced Applications of the Er:YAG Laser in Oral and Maxillofacial Surgery

Lasers are becoming widely used in medicine and dentistry due to their beneficial effects such as: coagulation properties (less postoperative bleeding), less pain and edema. Lasers also allow good and rapid healing, a very low level of discomfort both during and after intervention and a rapid disappearance of symptoms.Laser technology has certain advantages such as accuracy of the incision, absence of vibration and manual pressure during use ; this is also true for Er: YAG laser application. Due to laser positive coagulation effects during surgical procedure, better sight of the work field is obtained.Lasers have played an integral part in the evolution of oral and maxillofacial surgery (OMS) ; and rapidly became the standard of care for many procedures performed by oral surgeons.The reason for this transition is simple: many procedures can be executed more efficiently and with less morbidity using lasers when compared with scalpel, electrocautery or high frequency devices.Laser surgery has emerged as an established method in advanced medicine. Laser- induced remote tissue treatment provides a number of advantages: controllable coagulation and cutting of surgical tissues with wavelength tissue-specific cutting efficiency