Guided Bone Regeneration in Dental Implant Treatment - a Case Report

Gubitak prednjih zuba posljedica je patoloških procesa, retenecije zuba (najčešće gornjeg očnjaka), posljedica traume (avulzija ili fraktura korijena) ili nedostatka zubnoga zametka (najčešće gornjega drugog sjekutića). Takvi slučajevi mogu se riješavati ortodontski (zatvaranjem nastaloga prostora), protetski (različitim mostnim konstrukcijama) ili implantoprotetskom rehabilitacijom. Nedostatak ortodontske terapije dugotrajna je rehabilitacija i česti estetski nedostatci.Kod mostne konstrukcije moraju se odstraniti tvrda zubna tkiva susjednih zuba, a dijasteme su kontraindikacija za njihovu primjenu. Usadci omogućuju izradbu samostalnih žvačnih jedinica, ali je preduvjet dovoljno kosti za primarnu stabilizaciju i dugotrajnost usadka. Kada postoji manjak kosti, koristimo se vođenom koštanom regeneracijom (VKR). VKR dokazana je metoda koštane regeneracije, a uporaba kolagenih membrana znatno povećava učinkovitost opisanoga postupka. Dvadesetsedmogodišnjoj pacijentici operacijom je izvađen prvi gornji sjekutić zbog upalnoga procesa i resorptivnih promjena na kosti kao posljedice uzdužne frakture korijena. Neposredno nakon ekstrakcije kohleacijom je odstranjeno granulacijsko tkivo, koštani defekt ispunjen je Bio-Oss spongioznim granulama, a operacijsko polje pokriveno je Bio-Gide resorptivnom membranom. Godinu dana nakon operacije nastala je koštana regeneracija i ugrađen je ITI Straumannov implantat duljine 12 mm i promjera 3,3 mm. Zbog djelomične bukalne dehiscencije upotrijebljen je Fiziograft. Nakon 6 mjeseci izrađen je fiksnoprotetski nadomjestak.Loss of anterior teeth can be caused by pathological processes, tooth retention (mostly upper canine), result of trauma (avulsion or root fracture) or missing tooth germ. Such defects can be solved by orthodontic treatment (orthodontic space closure), prosthetic treatment (different bridge constructions) or with surgery treatment (dental implants). Inadequancy of orthodontic therapy is long lasting rehabilitation ond mostly esthetical imperfection. At the bridge constructions, hard tissues of adjacent teeth must be removed. Another contraindication is the presence of diastemas. Dental implants enable making selfsupporting mastication units, but require sufficient bone to adequately stabilise. When there are changes in alveolar bone height and width, we use guided bone regeneration (GBR). GBR has proved to be a suitable technique for promoting bone regeneration. GBR treatment with collagen membranes may significantly enhance bone regeneration. The left first incisor of a 27 years old patient was extracted because of resorptive processes on alveolar bone as a result of longitudinal fracture of the root. Immediately after extraction, the bone defect was filled with Bio-Oss spongiosa granules and covered with Bio-Gide resorbable bilayer mambrane. After one year the defect was restored to nearly original condition and ITI Straumann implant was placed. Because of labial dehiscence Fisiograft was used. The definitive restoration was placed after 6 months

Occurrence of Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation

Non-Hodgkinovi limfomi (NHL) su heterogena skupina limfoproliferativnih neoplazmi što ih obilježava pojava maligno promijenjenih limfocita u limfnome čvoru, a rjeđe primarno u drugim organima. Bolest se najčešće očituje bezbolnim povećanjem limfnih čvorova, koji pak u gastrointestinalnom i urinarnom traktu mogu praviti kompresiju. Infiltracija koπtane srži uzrokuje insuficijenciju mijelopoeze s posljedičnom anemijom, trombocitopeniju i neutropeniju. Klasifikacija bolesti temelji se na PHD nalazu i nalazu periferne krvi. Ekstranodularno bolest se najčešće javlja u gastrointestinalnom traktu, a često se javlja i u sinusima, tiroidnoj žlijezdi, salivarnim žlijezdama, dojci, bubrezima i plućima. Oko 25% ekstranodularnih limfoma javlja se na glavi i vratu i to u tzv. Waldejerovom prstenu, ali su primarni limfomi usne šupljine rijetkost. U radu prikazujemo slučaj šezdesettrogodišnjega muškarca s primarnom pojavom NHL-a na gingivi. Suspektna lezija u usnoj šupljini primijećena je tijekom vađenja upaljenoga korijena u gornjoj čeljusti. Promjena se nalazila u neposrednoj blizini odontogene upale, ali nije s njom bila povezana te se stoga uzme nalaz za biopsiju. Radiološki nalaz ne pokaže ništa specifično. PHD nalaz promjene pokaže nekrozu, krvarenje i polimorfnonuklearno upaljen infiltrat, te tumoroznu masu s atipičnim limfocitnim stanicama. Nakon dodatnoga pregleda hematopatologa utvrdi se NHL visoka stupnja malignosti B stanica. Po učinjenoj imunohistokemiji, utvrdi se NHL velikih stanica B-imunofenotipa, a pacijentovo se stanje definira kao NHL II E.Non-Hodgkin lymphomas (NHL) are a heterogenetic group of lymphoproliferative neoplasms, characterised by the occurrence of malignantly changed lymphocytes in a lymph node, and rarely primary in other organs. The disease most frequently manifests with painlessly enlarged lymph nodes, which in the gastrointestinal and urinary tract may cause compression. Infiltration of the bone marrow causes insufficiency of myelopoiesis, resulting in anaemia, trombocytopenia and neutropenia. Classification of the disease is based on PHD and peripheral blood findings. Extranodular disease occurs most frequently in the gastrointestinal tract, and also often occurs in the sinuses, thyroid gland, salivary glands, breasts, kidneys and lungs. Approximately 25% of extranodular lymphomas first occur on the head and neck in the so called Waldeyer\u27s ring, although primary lymphomas of the oral cavity are rare. We present the case of a 63-year-old man with primary occurrence of NHL on the gingiva. The suspect lesion in the oral cavity was noticed during extraction of an inflamed root in the upper jaw. The lesion was located in the immediate vicinity of odontogenic inflammation, although it was not connected with it, and thus a specimen was taken for biopsy. The radiographic finding did not show anything specific. PHD finding of the lesion showed necrosis, bleeding and polymorphonuclear inflamed infiltrate and a tumorous mass with atypical lymphocyte cells. After a further examination by a haematopathologist NHL was confirmed with a high degree of B-cell malignancy. Immunohistochemistry confirmed giant cell NHL, B immunophenotype, and the patient\u27s condition was defined as NHL II E

Prosthetic or Implantoprosthetic Treatment of Edentulous Areas

Gubitak zuba uzrokuje ne samo estetski već i funkcijski poremećaj stomatognatoga sustava. Rješavanje bezubosti još uvijek je velik izazov suvremenoj stomatologiji. Mogući su različiti pristupi, ovisno o vrsti i broju izgubljenih zuba te o stanju okolnoga tkiva. Bilo da se radi o gubitku samo jednoga zuba ili više njih, da bi se ispravno provela sanacija potrebno je poznavati funkciju žvačnoga organa i terapijske postupke. Nedostatak zuba može se rješavati ortodontski, protetski ili implantoprotetski. Koji od načina će se odabrati ovisi o samome slučaju, o izboru terapeuta, te o mogućnosti i suradnji pacijenta. U ovome radu prikazano je nekoliko slučajeva koji su se rješavali samo klasičnim protetskim nadomjestcima, a nasuprot tome i nekoliko sličnih slučajeva koji su riješeni intraosealnim usadcima i protetskim konstrukcijama na tim usadcima. Svrha ovog prikaza je prezentirati različite načine sanacije istih ili sličnih slučajeva, te dati smjernice kliničarima kada i u kojim slučajevima bi se trebalo opredijeliti za pojedinu vrstu terapije. Važno je napomenuti da obaviještenost i terapeuta i pacijenta čini ključnu ulogu u izboru što prikladnijega terapijskog postupka.Loss of teeth not only leads to aesthetic but also to functional impairment of the stomatognathic system. Solving edentulousness still presents a great challenge in contemporary dentistry. Various approaches are possible depending on the type and number of lost teeth, and also the condition of surrounding tissue. Regardless of whether it is a case of a single tooth or several, it is necessary to know the function of the masticatory organ and therapeutic procedures in order to correctly carry out treatment. Lack of teeth can be dealt with orthodontically, prosthetically or implanto prosthetically. Which method is chosen depends on the case itself, choice of therapist and on the practicability and cooperation of the patient. This study presents several cases which were treated by classical prosthetic restorations, as opposed to several similar cases which treated by intra-osseous implants and prosthetic constructions on the implants. The purpose of this presentation is to show different methods of treatment of the same or similar cases, and to give guidelines to clinicians, when and in which cases a particular treatment should be opted for. It is important to mention that the information acquired by the therapist, as well as the patient, represents the key role in the choice of the most suitable therapeutic procedure

The Influence of Bruxism on Mandibular Movement

Etiologija temporomandibularnih poremećaja (TMD) još je uvijek nerazješnjena. Mogući utjecaj bruksizma predmet je mnogih rasprava. Svrha ovog istraživanja bila je odrediti učinak bruksizma na funkciju stomatognatoga sustava. Ispitivana se skupina sastojala od 46 bruksista u dobi od 24-52 godine (x = 35,03 ± 6,92). Kontrolnu skupinu tvorilo je 50 nebruksista u dobi od 25-51 (x = 37,24 ± 6,37). Dijagnoza bruksizma postavljena je anamnestičkim upitnikom i kliničkim pregledom. Za mjerenje kretnje čeljusti uporabljena je precizna klizna mjerka. Mjereno je maksimalno otvaranje, desna i lijeva maksimalna laterotruzijska kretnja, te maksimalna protruzijska kretnja. U skupini bruksista srednja vrijednost maksimalnog otvaranja bila je 48,51 ± 5,01 mm, a u skupini nebruksista 49,76 ± 6,92 mm. Srednja vrijednost maksimalne desne laterotruzijske kretnje u skupini bruksista iznosila je 10,04 ± 2,51 mm, a kontrolna skupina imala je srednju vrijednost 10,31 ± 2,47 mm. Maksimalna lijeva aterotruzijska kretnja u bruksista iznosila je 9,74 ± 2,50 mm, a vrijednost kontrolne skupine bila je 10,33 ± 2,30 mm. Maksimalna protruzijska kretnja kod bruksista iznosila je 9,53 ± 1,97 mm, a u kontrolnoj skupini 10,81 ± 2,29 mm. Pearson ?2 test pokazao je statistički znatnu razliku između ispitivanih skupina (p < 0,05) jedino u varijabli maksimalne protruzijske kretnje (t = 2,93, p = 0,0004). Rezultati ovog istraživanja upućuju na zaključak da bruksizam može imati samo ograničeni utjecaj na pokretljivost čeljusti.The aetiology of temporomandibular disorders (TMD) remains controversial. The role of bruxism is still under discussion. The objective of this investigation was to determine the effect of bruxism on the function of the stomatognatic system. A group of 46 bruxers, aged from 24-52 years (x = 35.03 ± 6.92) was examined. The control group consisted of 50 nonbruxers aged from 25-51 years (x = 37.24 ± 6.37) bruxism was assessed by a questionaire and clinical examination. A precise calliper was used to measure jaw movement. Maximal opening, right and left aterotrusion, and maximal protrusion were measured. The mean value of maximal opening in the bruxers group was 48.51 ± 5.01 mm, and in the nonbruxers group 49.76 ± 6.92 mm. Ther mean value of maximal right laterotrusion in the bruxers group was 10.04 ± 2.51 mm, and of left laterotrusion 9.74 ± 2.50 mm compared to the nonbruxers group where the mean value of right laterotrusion was 10.31 ± 2.47 mm, and left laterotrusion 10.33 ± 2.30 mm. The mean value of maximal protrusion in the bruxers group was 9.53 ± 1.97 mm, while in the nonbruxers group it was 10.81 ± 2.29 mm. Pearson ?2 test analysis shows statisticaly significant difference (p < 0.05) between the groups only in relation to the maximal protrusion (t = 2.93, p = 0.0004). The results of this study suggest that bruxism may only have a limited influence on mandibular mobility

The Relationship Between Type of Occlusion and TMJ Sounds

Utjecaj okluzije na nastanak zvuka u temporomandibularnom zglobu nije potpuno potvrđen. Svrha je ovog istraživanja bila utvrditi utjecaj okluzijskih koncepcija na nastanak zvuka u temporomandibularnome zglobu. Ispitivana skupina sastojale se je od 96 ispitanika u dobi od 24 - 52 godine (x = 35,03 ± 6,92). Okluzijske koncepcije određene su kliničkim pregledom. U ovisnosti o kontaktima na laterotruzijskoj i meziotruzijskoj strani ispitanici su kategorizirani u tri skupine (okluzija vođena očnjakom, grupna funkcija, te bilateralno uravnotežena okluzija). Kliničkim pregledom te auskultacijom s pomoću stetoskopa registrirano je postojanje zvuka. 70,83 % ispitanika imalo je okluziju vođenu očnjakom, 16,66 % grupnu funkciju, a 12,5 % bilateralno uravnoteženu okluziju. Zvuk u temporomandibularnom zglobu postojao je u 41,6 % slučajeva. Rezultati statističke raščlambe (Pearson ?2) pokazuju da između skupina nema statistički znatne razlike (?2 = 2,09 p = 0,351). Rezultati ovog istraživanja upućuju na zaključak da okluzijske koncepcije nemaju utjecaja na nastanak zvuka u temporomandibularnom zglobu.The influence of occlusion on the occurrence of sound in the temporomandibular joint had not been complately proved. The objective of this investigation was to determine the effect of type of occlusion on the occurrence of sounds in the TMJ. A group of 96 subjects, aged from 24-52 years (x = 35.03 ± 6.92) was examined. The type of occlusion was dentermined by clinical examination. Depending on the contacts on the laterotrusal and mediotrusal side the subjects were categorized into three groups (canine guided occlusion, group function and balanced occlusion). The existence of sounds was registred by means of a clinical examination and auscultation by stethoscope. In the examined group 70.83% of examinees had canine guidance, 16.66 % group function and 12.5 % balanced occlusion. Temporomandibular joint sound was present in 41.6 % of subjects. The results of the statistical analysis (Pearson ?2) shows no statistically significant difference between these 3 groups (?2 = 2.09 p = 0.351). The results of this study suggest that the type of occlusion does not have an influence on the occurrence of sound in the TMJ

Use of digital photographs in prosthodontic reconstruction of vertical dimension

SAŽETAK. Cilj: Mnoge metode opisuju postupke za određivanje vertikalne dimenzije okluzije kod bezubih bolesnika, ali niti jedna od njih nije u potpunosti pouzdana. Cilj ovog rada je istražiti mogućnost rekonstrukcije vertikalne dimenzije okluzije pomoću digitalne fotografije. Metode: U istraživanju je sudjelovalo 55 ozubljenih ispitanika. Digitalni fotoaparat namješten je na udaljenosti od 1.5 m od ispitanika, u razini Frankfurtske horizontale. Slikane su dvije serije fotografija, s prednje strane i iz profila, pri čemu su zubi bili u položaju maksimalne interkuspidacije (ICP). Sn-Gn (subnasale-gnation) i N-Sn (nasion-subnasale) udaljenosti su izmjerene na ispitanicima i na fotografijama. Sn-Gn udaljenost za svakog ispitanika također je izračunata pomoću formule: N-Sn (ispitanik) x Sn-Gn (fotografija) / N-Sn (fotografija). Sn-Gn udaljenost je izračunata za frontalne i profilne fotografije. Za statističku obradu korišten je Kolmogorov-Smirnov test, deskriptivne metode te studentov t-test za zavisne uzorke (p<0.05). Rezultati: Nema značajnih razlika između Sn-Gn udaljenosti izmjerene na ispitanicima i one izračunate na digitalnim fotografijama (profilnim i frontalnim) (p>0.05). Zaključak: Vertikalna dimenzija okluzije može biti rekonstruirana s digitalne fotografije pomoću formule: NSn (ispitanik) x Sn-Gn (fotografija) / N-Sn (fotografija). Zbog toga bi bilo korisno da stomatolog praktičar fotografira bolesnike dok imaju zube i sačuva te fotografije u memoriji računala zajedno s ostalim stomatološkim podatcima.ABSTRACT. Aim: Many methods have been described to determine the occlusal vertical dimension in edentulous patients, but none of them is completely reliable. The aim of this study was to examine the possibility of reconstrucing the occlusal vertical dimension by using a digital photography. Methods: Digital photographs (obtained from a 1.5 m distance with a digital camera elevated to the height of the Frankfort plane) (frontal and profile) were obtained from 55 dentate subjects clenching in maximum intercuspidation (ICP). Sn-Gn (subnasale-gnation) and N-Sn (nasion-subnasale) distances were measured in the subjects and in their photographs. The Sn-Gn distance of each subject was also calculated by using the following formula: N-Sn (subject) x Sn-Gn (photograph) / N-Sn (photograph). Sn-Gn distance was calculated from both the frontal and profile photographs. A statistical analysis was performed (Kolmogorov-Smirnov test, descriptive statistical methods and Student t test for dependent samples) (p<0.05). Results: There were no significant differences between the Sn-Gn distance measured in a subject and the same distance calculated from a digital photograph (from both, the profile and frontal photographs) (p>0.05). Conclusions: The occlusal vertical dimension could be reconstructed from a digital photographs by using the formula: N-Sn (measured on a subject) x Sn-Gn (measured on the photograph) / N-Sn (measured on a photograph). Therefore, the general practitioner should obtain and keep stored such photographs in a computer together with other dental records of an individual

The Influence of Oral Hygienic Habits on Non-Carious Cervical Lesion Development

Svrha istraživanja bila je ispitati utjecaj određenih higijenskih navika (opće higijensko stanje usne šupljine, broj četkanja na dan, tvrdoća četkice) na javljanje nekarijesnih cervikalnih lezija. U istraživanje je uključeno 873 ispitanika u dobi iznad 10 godina. Rezultati pokazuju da postoji statistički vrlo velika razlika u higijeni između ispitanika s nekarijesnim cervikalnim lezijama i onih bez njih, da nema statistički znatne razlike u nastanku nekarijesnih cervikalnih lezija s obzirom na frekvenciju četkanja zuba i da nema statistički znatne razlike u pojavi nekarijesnih cervikalnih lezija s obzirom na tvrdoću četkice.The aim of this study was to assess the influence of certain oral hygienic habits (such as general hygiene of the mouth, frequency of toothbrushing, toothbrush hardness) on non-carious lesion development. The study was conducted on 873 subjects, aged 10 yrs or older. Results showed that there is a statistically significant difference regarding oral hygiene between subjects with cervical lesions and those without them. Furthermore, there is no statistically significant difference in non-carious cervical lesion development regarding frequency of toothbrushing and toothbrush hardness

Tumor Necrosis Factor-Alpha and Interleukin 6 in Human Periapical Lesions

Aim. The aim of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in human periapical lesions. Subjects and methods. Samples were obtained from three groups of teeth: symptomatic teeth, asymptomatic lesions, and uninflamed periradicular tissues as a control. Results. TNF-alpha levels were significantly increased in symptomatic lesions compared to control. Group with asymptomatic lesions had significantly higher concentrations compared to control. There were no significant differences in TNF-alpha levels between symptomatic and asymptomatic lesions. In group with symptomatic lesions, IL-6 levels were significantly higher than in group with asymptomatic lesions. The IL-6 levels in symptomatic group also showed significantly higher concentration in comparison with control group. In asymptomatic group, the IL-6 level had significantly higher concentrations compared to control. Conclusion. These results indicate that symptomatic lesions represent an immunologically active stage of disease, and asymptomatic lesions are the point from which the process advances toward healing