Treatment by marsupialization of a dentigerous cyst invaginated in the right maxillary sinus

Rezumat. Chisturile dentigere sunt localizate la nivelul maxilarul superior în 30% din cazuri și sunt al doilea cele mai frecvente chisturi odontogene de dezvoltare. În continuare vom prezenta un caz clinic, tratat prin metoda marsupializării, la o pacientă de sex feminin cu vârsta de 50 de ani, ce acuza asimetrie facială. Marsupializarea are avantajul reducerii dimensiunilor cavităţii chistice progresiv. Având în vedere dimensiunea chistului (lungime mai mare de 30 mm, prezenţa dinţilor vitali asociaţi cavităţii chistice, riscul de perforaţie a sinusului maxilar și a planșeului fosei nazale pe dreaptă), a fost selectata o abordare minim invazivă.Summary. Dentigerous cysts are locate d in the upper jaw in 30% of cases, and is the second most frequent developmental odontogenic cyst. We will present a clinical case, resolved by marsupialization, in a 50-year-old female patient, with the only complaint/sign being facial asymmetry. The surgical techniques that may be used depend on various factors, and marsupialization has the advantage of reducing the dimensions of the cystic cavity. Considering the size of the cyst (greater than 30 mm in length, the presence of vital teeth associated to the cystic cavity, perforation risk of the maxillary sinus and of the nasal fossa floor on the right side), there has been chosen a minimally invasive approach

Effect of decompression using CAD/CAM technology vs. analogue methods for patients with various jaw cysts

Department of Oral and Maxillofacial Surgery and Oral Implantology Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Various odontogenic and nonodontogenic cysts can occur either in the upper or lower jaw, these entities are an important chapter of the oral and maxillo-facial pathology. Treatment methods for cystic lesions depends on the size, location, patient age, as well as proximity to vital structures such as teeth, inferior alveolar canal, and maxillary sinus. Radical treatment may be associated with numerous complications, such as facial deformity, missing teeth, infection of bone graft, and numbness if during surgery the nerve is harmed. Conservative treatment, such as decompression is recommended in case of large cysts or when it contains vital structures. Aim of the study. The aim of this study is to assess the effectiveness of decompression using the CAD/CAM technology in comparison to traditional analogue methods by measuring cystic lesion volume changes using computed tomography. Materials and methods. This study was axed on 4 patients, 2 of them had undergone traditional decompression for a cystic lesion of the jaw at the Department of Oral and Maxillofacial Surgery, and in 2 cases a CAD/CAM decompression device was fabricated at the SRL. „OMNI DENT”, study was conducted between 2015 and 2017. CT scans were taken in all patients before and after decompression at 3 and 6 months. Each scan was analyzed to evaluate the volume changes of cystic lesions to determine the time of enucleation, by using the threshold method, each cyst was virtually segmented. Results. In all 4 cases semi-automatic virtual segmentation of the cystic lesion, was performed. The duration of decompression ranged from 6 to 24 months. The reduction rates of cystic lesions in analogue group ranged from 39,64% to 87,23% with a mean of 63,43%, and in CAD/CAM group ranged from 60,47% to 98,32% with a mean of 79,39%. Conclusions. Even though traditional analogue methods have shown good results in reduction rates of cystic lesions, CAD/CAM is a subject of significant interest in the last years, which had shown promising results. The main advantages include the possibility to obtain a patient specific implant with increased precision which is less invasive with fewer surgical procedures, but further studies are necessary in order to confirm this statement

Assessment of the efficacy of the minimally treatment of patients with odontogenic maxillary cysts by method of decompression and marsupialization

Rezumat. Studiu a cuprins 51 de pacienţi diagnosticaţi cu chisturi odontogene ale maxilarului superior și inferior trataţi prin metodele chirurgicale miniminvazive de decompresie și marsupializare, supravegheaţi în dinamică pe parcusul a 6- 18 luni. Din acești pacienţi 16 au fost trataţi prin metoda de decompresie și 31 prin metoda de marsupializare. Evaluarea dinamicii a fost evaluată post-operator în raport cu dimensiunile iniţiale ale formaţiunilor chistice. Comparând dimensiunile iniţiale și cele evaluate în dinamică observăm o diferenţă statistică semnificativă (p<0,001) pentru fiecare criteriu, care vorbește despre rezultatele pozitive ale tratamentului în lotul general.Summary. The study comprised 51 patients diagnosed with odontogenic cysts of the upper and lower jaws treated by minimal invasive surgical methods of decompression and marsupialisation, folowed-up 6-18 months. Of these patients, 16 were treated by the decompression method and 31 by the marsupialization method. The assessment of folow-up was evaluated post-operatorly in relation to the initial dimensions of the cystic formations. Comparing the initial and the postoperative dimensions, we notice a significant statistical difference (p <0.001) for each criterion, which speaks of positive treatment results in the general group

Maxillary cysts. Statistical data

Rezumat În acest studiu au fost analizate 451 de cazuri de pacienți tratați în secția de chirurgie Oro-Maxilo-Facială în perioada aa. 2010—2014 , 262 pacienți diagnosticați cu chisturi la maxilarul superior și 189 pacienți cu chisturi la mandibulă. Datele acumulate au fost prelucrate cu ajutorul calculatorului individual. Analiza datelor a fost realizată utilizând programul IBM SPSS Statistics, şi componentei Excel a suitei Microsoft Office cu ajutorul funcţiilor şi modulelor acestor programe. În dependență de maxilarul afectat, s-au înregistrat 262 chisturi ale maxilarului superior (59,8%, Es= 2,31%) și 189 chisturi ale maxilarului inferior (40,2%, Es= 231%). Valoarea x²≤0,001 indică prevalența veridică a chisturilor maxilarului superior față de cel inferior.Summary In this study were included 451 of patients treated in Departament of Oro-Maxilo-Facial Surgery in period of 2010—2014 years, 262 of patients had cysts on the upper jaw and 189- on the lower jaw. Datas were analysed with personal computer using IBM SPSS Statistic soft and Microsoft Office Excel. We noticed 262 cases of upper jaw cysts (59,8%, Es= 2,31%) and 189 cases of lower jaw cysts (40,2%, Es= 231%). x²≤0,001 variable shows true prevalence of upper jaw cysts to those on the lower jaw

The particularities of implantprosthetic treatment in patients under anticoagulant therapy

Rezumat Scopul studiului a fost de a determina condiţiile optime de reabilitare implanto-protetică a pacienţilor aflaţi pe fondal de medicaţie anticoagulantă fără anularea acestor remedii. În studiu au fost incluşi 4 pacienţi aflaţi pe fondal de medicaţie anticoagulantă, cărora au fost efectuate următoarele intervenţii: instalarea a 21 implante dentare endoosoase de stadiul doi, sinus lift transcrestal, sinus lift lateral bilateral. Medicaţia anticoagulantă nu a fost suspendată, iar doza acestor remedii a fost modificată în dependenţă de valorile coeficientului internaţional de normalizare (INR). În timpul inervenţiilor chirurgicale semne de sângerare sporită nu au fost depistate. În perioada postoperatorie a fost înregistarat un caz de hemoragie tardivă (la a 7-ea zi după inserarea implantelor), cauzată de o supradozare cu anticoagulant (INR=6,2), care a fost de intensitate nesemnificativă şi uşor controlată prin aplicaţii locale de trombină umană şi acid aminocaproic de 5%. Prin studiul efectuat a fost demonstrat că instalarea implantelor dentare şi alte intervenţii de chirurgie orală (sinus lift transcrestal, sinus lift lateral) la pacienţii aflaţi sub medicaţie anticoagulantă este posibilă fără suspendarea acestor remedii, prioritate fiind acordată metodelor miniinvazive.Summary The aim of this study was to determine the optimal conditions for implant-prosthetic rehabilitation of patients under anticoagulation therapy without cancelling this medication. Four patients under anticoagulant medication were included in the study. The following procedures have been performed: placement of 21 two-stage dental implants, trans-crestal sinus floor elevation, the bilateral elevation of sinus floor membrane via lateral access. The anticoagulant therapy was not cancelled, but the dose of this drugs has been adjusted according to the International Normalized Ratio (INR) values. There were no signs of abundand bleeding during the surgery. One case of delayed bleeding (at the 7-th day) has been recorded postoperatively, due to hyper dosage of anticoagulant (INR=6,3). It’s intensity was not significant, ant it was easy controlled using local applications with human thrombin and 5% aminocaproic acid. It was demonstrated by this study that dental implant placement and other oral surgery procedures (trans-crestal sinus floor elevation, the elevation of sinus floor membrane via lateral access) in patients under anticoagulant medications is possible to perform without its cancellation. The priority was given to minimally invasive methods

The abscess of the mandibulo-lingual trench. therapeutic and surgical aspects

Catedra Chirurgie Oro-Maxilo-Facială “Arsenie Guțan”, USMF “ Nicolae Testemițanu”The abscess of the mandibulo-lingual trench is an often inflammatory pathology of the oro-maxillo-facial region. The odontogenic factor is the most commonly incriminated, where the 3rd molar diseases prevail. In this study were 207 patients. It was demonstrated the priority of the surgical method with endooral approach- being minimally invasive. The spreading inflammatory process in the border-lodges led us to carry out the tegument approach, which, although unsightly provide superior drainage of the first method. Both methods have therapeutic value, each can be applied depending on the clinical situation. Abcesul șanțului mandibulo-lingual este o patologie inflamatorie frecventă a regiunii oro-maxilo-faciale (OMF). Sursa de infecţie cea mai des implicată este odontogenă, prevalând afecțiunile molarului 3. În studiu au fost 207 pacienţi. A fost demonstrată prioritatea metodei chirurgicale de tratament prin acces endooral fiind una miniinvazivă. Răspîndirea complicațiilor inflamatorii în lojele învecinate ne-au determinat să utilizăm şi abordul exooral, care, cu toate că lasă cicatrici inestetice, asigură drenaj superior primei metode. Astfel, ambele metode au valoare terapeutică, fiecare dintre ele pot fi aplicate în dependență de situația clinică

The particularities of implantprosthetic treatment in patients under antigoagulant therapy

Catedra Chirurgie OMF şi Implantologie orală „Arsenie Guţan“ USMF „N. Testemiţanu“Rezumat Scopul studiului a fost de a determina condiţiile optime de reabilitare implanto-protetică a pacienţilor aflaţi pe fondal de medicaţie anticoagulantă fără anularea acestor remedii. În studiu au fost incluşi 4 pacienţi aflaţi pe fondal de medicaţie anticoagulantă, cărora au fost efectuate următoarele intervenţii: instalarea a 21 implante dentare endoosoase de stadiul doi, sinus lift transcrestal, sinus lift lateral bilateral. Medicaţia anticoagulantă nu a fost suspendată, iar doza acestor remedii a fost modificată în dependenţă de valorile coeficientului internaţional de normalizare (INR). În timpul inervenţiilor chirurgicale semne de sângerare sporită nu au fost depistate. În perioada postoperatorie a fost înregistarat un caz de hemoragie tardivă (la a 7-ea zi după inserarea implantelor), cauzată de o supradozare cu anticoagulant (INR=6,2), care a fost de intensitate nesemnificativă şi uşor controlată prin aplicaţii locale de trombină umană şi acid aminocaproic de 5%. Prin studiul efectuat a fost demonstrat că instalarea implantelor dentare şi alte intervenţii de chirurgie orală (sinus lift transcrestal, sinus lift lateral) la pacienţii aflaţi sub medicaţie anticoagulantă este posibilă fără suspendarea acestor remedii, prioritate fiind acordată metodelor miniinvazive. The aim of this study was to determine the optimal conditions for implant-prosthetic rehabilitation of patients under anticoagulation therapy without cancelling this medication. Four patients under anticoagulant medication were included in the study. The following procedures have been performed: placement of 21 two-stage dental implants, trans-crestal sinus floor elevation, the bilateral elevation of sinus floor membrane via lateral access. The anticoagulant therapy was not cancelled, but the dose of this drugs has been adjusted according to the International Normalized Ratio (INR) values. There were no signs of abundand bleeding during the surgery. O ne case of delayed bleeding (at the 7-th day) has been recorded postoperatively, due to hyper dosage of anticoagulant (INR=6,3). It’s intensity was not significant, ant it was easy controlled using local applications with human thrombin and 5% aminocaproic acid. It was demonstrated by this study that dental implant placement and other oral surgery procedures (trans-crestal sinus floor elevation, the elevation of sinus floor membrane via lateral access) in patients under anticoagulant medications is possible to perform without its cancellation. The priority was given to minimally invasive methods

The suppurations of the oromaxillofacial area. the evolution of microbial sensitivity to antibiotics

Catedra Chirurgie Oro-maxilo-facială și implantologie orală „Arsenie Guțan”, USMF „Nicolae Testemițanu”The augmented rate of resistance to antibiotics and the importance of empirical antibiotic therapy represent the premises for this study. 853 antibiograms, 30 microbial strains, 37 kinds of antibiotics were analyzed , with samples taken from various infections in the maxillofacial area. Analyzing the data we noted the increased resistance over the five years period of the Staphylococcus aureus to cephalexin and of the streptococcus pyogenes to benzylpenicillin. The alterating modifications of microbes result in antibiotic resistance. Therefore, these type of studies are necessary to be periodically examined in order to correctly direct the specialists when chosing the early antimicrobial treatment. Rata crescîndă a rezistenței la antibiotice precum și importanța antibioterapiei empirice constituie premisele efectuării studiului. Au fost analizate 853 antibiograme, 30 tulpini microbiene, 37 tipuri antibiotice, probele fiind prelevate de la nivelul diferitor infecții ale teritoriului oro-maxilo-facial. Analizînd aceste date am observat creșterea rezistenței pe parcursul a cinci ani a staphylococcului aureus la cefalexin și a streptococcului pyogenes la benzilpenicilină. Modificările microbiene de adaptare au ca consecinţă rezistenţa la antibiotice. Astfel asemenea studii sunt necesare de efectuat periodic pentru orientarea specialiştilor la alegerea tratamentului antimicrobian precoce