Primjena denosumaba na bol tijekom terapije difuznoga sklerozirajućeg osteomijelitisa mandibule: prikaz slučaja

This is the first case report where two patients were under uniform denosumab administration protocol in diffuse sclerosing osteomyelitis (DSO) treatment and were closely monitored for 18 months. Objectives: This study aimed to describe the beneficial effects of denosumab in DSO treatment as well as pain relief and the significant lack of long-term use due to poorer outcomes after repeated use. DSO of the jaw is a poorly understood rare chronic disease the treatment of which is still very challenging despite a rapid development of medicine. Different medical treatments have been pro-posed without any significant long-lasting success. Bisphosphonates have offered substantial clinical benefit in DSO therapy, but due to harmful pharmacodynamic properties, denosumab therapy has been used to replace bisphosphonate therapy. Patients had a reduction in pain intensity with each subsequent application of denosumab but with less success than the first administration of de-nosumab. This case report has shown that denosumab could be a promising conservative treatment option for pain treatment in patients suffering from DSO.Opisane su dvije pacijentice s difuznim sklerozirajućim osteomijelitisom (DSO) mandibule koje su liječene denosumabom prema jednakom protokolu i praćene su 18 mjeseci. Cilj je bio opisati korisne učinke denosumaba u liječenju DSO-a, ali i slabije djelovanje na ublažavanje boli poslije dugotrajne primjene. DSO čeljusti nedovoljno je istražena rijetka kronična bolest čije je liječenje, unatoč razvoju medicine, još uvijek vrlo izazovno. Predloženim metodama ne postiže se značajan i dugotrajan uspjeh. Bisfosfonati su se pokazali korisnima u liječenju DSO-a, no zbog štetnih farmakodinamičkih svojstava potrebna je alternativna terapija. Ovaj prikaz slučaja pokazuje da se dvjema pacijenticama bol smanjila poslije aplikacije denosumaba čiji je najjači učinak uočen poslije prve primjene. Denosumab bi mogao biti opcija konzervativnog liječenja boli koja obećava kad je riječ o pacijentima s DSO-om

Indistinctly Synchronous Lung and Base of the Tongue Adenocarcinoma: Case Report and Discussion of Possi- ble Patterns of Disease Development

Adenokarcinom pluća čini oko 40% svih karcinoma pluća i karakteriziraju ga različite stanične i molekularne značajke. Česte su udaljene metastaze iz primarnog karcinoma pluća, međutim metastaze u jeziku prilično su rijetke i neočekivane. Ako postoje dokazi o metastazama u jeziku, primarni tumor je najvjerojatnije širen, a prognoza loša. Takvi pacijenti zahtijevaju cjelovitu obradu kako bi se procijenio opseg bolesti, jer stadij tumora igra glavnu ulogu u određivanju izbora liječenja. U ovom slučaju želimo predstaviti neobičan slučaj istodobnog adenokarcinoma pluća i baze jezika i razgovarati o mogućim obrascima razvoja bolesti.Lung adenocarcinoma accounts for about 40% of all lung cancers and is characterized by distinct cellular and molecular features. Distant metastases from primary lung cancer are frequent, howev- er metastasis of the tongue is quite rare and unexpected. If there is existing evidence of metastasis in tongue, primary tumor is most probably generally disseminated and prognosis is poor. Such patients require a complete staging workup to evaluate the extent of disease, because tumor stage plays a major role in determining the choice of treatment. In this case report we want to present an unusual case of simultaneous lung and base of the tongue adenocarcinoma and discuss the possible patterns of disease development

Knowledge and Attitudes about Dental Trauma Among the Students of the University of Split

Svrha rada: Traume zuba kod djece čest su problem i svatko tko s njima radi trebao bi imati dovoljno znanja i vještina da u slučaju traume može osigurati odgovarajuću pomoć na mjestu nezgode. Cilj rada bio je procijeniti znanje studenata o hitnim terapijskim postupcima u slučaju dentalnih trauma kako bi u svojoj budućoj karijeri znali zbrinuti takve ozljede. Materijal i metode: Presječno istraživanje o hitnim terapijskim postupcima u slučaju dentalnih trauma provedeno je na temelju upitnika koji je ispunilo 679 studenata s pet različitih studija. Dobiveni podatci analizirani su Studentovim t-testom ili jednosmjernom analizom varijance (ANOVA), Tukeyijevim post-hoc testom te višestrukom linearnom regresijskom analizom (p < 0,05). Rezultati: Ukupna srednja vrijednost znanja studenata o hitnom liječenju dentalnih trauma bila je 4,32 ± 2,25 (maksimalno 10). Uočena je pozitivna povezanost znanja s dobi studenta (β = 0,722, P ≤ 0,001), ovisno o tome jesu li tijekom akademskog obrazovanja dobili neki oblik edukacije o zbrinjavanju dentalnih trauma (β = 2,365, P ≤ 0,001) te o njihovoj osobnoj procjeni o važnosti znanja kad je riječ o hitnim terapijskim postupcima (β = 0,433, P ≤ 0,001). Zaključak: Može se zaključiti da ispitani studenti posjeduju ograničeno znanje o traumama zuba te o postupcima njihova zbrinjavanja. Dobiveni rezultati pokazuju koliko je važna dodatna izobrazba svih koji bi se mogli susretati s traumama zuba tijekom svojega rada kako bi se postigli što bolji rezultati u liječenju dentalnih trauma.Objectives: Dental trauma among children is a common problem, and everyone who works with them needs to possess appropriate knowledge and skills to provide proper care at the site of the accident. The aim was to evaluate the knowledge of emergency management of dental trauma among students who should be capable of managing such injuries in their future career. Material and Methods: A cross-sectional survey regarding dental trauma emergency management was conducted on 679 stu-dents from five different studies using a questionnaire. The obtained data were analyzed by the Student t-test or one - way ANOVA using the Tukey’s post-hoctest and multiple linear regression analysis (p<0.05). Results: The total knowledge score regarding the emergency management of dental trauma among examined student was 4.32±2.25 (max 10). The positive association of the knowledge score was observed with the age of student (β=0.722, p≤0.001). A similar relation was observed depending on whether they received dental injuries training during their academic education (β=2.365, p≤0.001), as well as students’ assessment of the importance of knowledge regarding dental trauma emergency management (β=0.433, p≤0.001). Conclusions: It can be concluded that the surveyed students have limited knowledge regarding dental injuries and their emergency management procedures. The obtained data emphasized the importance of additional education of all professions that may encounter dental trauma injuries to improve the outcomes of dental trauma treatment

Procjena genotoksičnosti i citotoksičnosti dentalnih implantata na gingivnim epitelnim stanicama

Objectives: Although titanium-based implants are considered bioinert, it has been found that they are subject to corrosion and wear. This study aimed to evaluate the cytotoxic and genotoxic potential of two implant systems in gingival epithelial cells. Material and methods: Gingival swabs were taken three times from 91 subjects. The first swab was taken before dental implant placement, the second swab 90 days after dental implant placement and the third swab 21 days following the healing abutment placement. DNA damage was analyzed using the micronucleus test. Tested dental implants with corresponding healing abutments were Ankylos and Dentium SuperLine. Results: Of all scored forms of cytogenetic damage in gingival cells of individuals after implementation of tested dental implant systems, only an increase in the number of binucleated cells (P ≤ 0.001) was significant in contrast to control values for both tested implant systems, 90 days after dental implant placement and 21 days following the healing abutment placement. Conclusion: It may be concluded that there are no titanium-based implant dependent cytogenetic damage in gingival epithelial cells. A slight increase in cytogenetic damage has been observed but it is of no biological relevance and might be associated with healing abutment induced effect.Cilj istraživanja: Iako se titanijevi dentalni implantati smatraju bioinertnima, potvrđeno je da su podložni koroziji i trošenju. Cilj ovog istraživanja jest procjena citotoksičnoga i genotoksičnoga potencijala dviju vrsta implantoloških sustava na gingivnim epitelnim stanicama. Materijal i metode: Uzorci oljuštenih gingivnih stanica uzeti su od 91 ispitanika u trima razdobljima. Prvi bris uzet je prije postavljanja implantata, drugi 90 dana poslije njegove ugradnje, a treći 21 dan poslije postavljanja nadogradnje za oblikovanje gingive, tj. gingivnoga formera. Oštećenje DNK procijenjeno o je mikronukleusnim testom. Ispitivani dentalni implantati s gingivnim formerima bili su Ankylos i Dentium SuperLine. Rezultati: Dobiveni rezultati pokazuju da se poslije postavljanja obiju vrsta ispitivanih dentalnih implantata (Ankylos i Dentium) znatno povećava broj binuklearnih stanica (P ≤ 0,001) u odnosu prema početnim vrijednostima i to 90 dana poslije postavljanja implantata i 21 dan poslije postavljanja gingivnoga formera. Zaključak: Na temelju dobivenih rezultata može se zaključiti da titanijevi dentalni implantati nakon postavljanja ne izazivaju citotoksične i genotoksične učinke na gingivnim stanicama. Uočeni blagi učinci ne mogu se smatrati biološki relevantnima

Effects of orally administered magnesium on anesthesia and postoperative analgesia after surgical removal of the lower third molars

Postoperativna kontrola boli predstavlja jedan od glavnih zdravstvenih imperativa svake kirurške struke pa tako i oralne kirurgije. Kirurško uklanjanje donjih trećih molara uz provodnu anesteziju donjega alveolarnoga živca, spada u najčešće operativne zahvate u oralnoj kirurgiji, zbog čega su kontrola boli, ali i drugih očekivanih postoperativnih komplikacija u vidu trizmusa i otekline od izuzetne važnosti. U ovoj prospektivno, randomiziranoj, dvostruko slijepoj, placebo kontroliranoj studiji o utjecaju peroralnoga magnezija na anesteziju, postoperativnu analgeziju te druge očekivane komplikacije nakon operativnoga uklanjanja donjega trećeg molara sudjelovalo je 80 punoljetnih zdravih osoba s oba impaktirana donja umnjaka. Ispitanici su ovisno o obliku konzumacije lijeka (u obliku tableta ili pastila) bili podijeljeni u dvije skupine po 40 osoba. S obzirom na to da su svi ispitanici imali oba impaktirana donja umnjaka, svaki je ispitanik jednom nakon operacije konzumirao magnezij, a jednom placebo u obliku tablete ili pastile ovisno kojoj je skupini pripadao. Vrijeme potrebno za nastup bloka i trajanje anestezije mjereno je u minutama, dok je postoperativna bol mjerena uz pomoć VAS-a u vremenskim intervalima 2, 4, 6, 12, 24 i 72 sata nakon operacije. Također je mjereno vrijeme uzimanja prvoga analgetika, ukupna količina uzetih analgetika te stupanj otekline i ograničenoga otvaranja usta (trizmus) u prva tri postoperativna dana. Dobiveni podatci su analizirani Spearmanovom korelacijskom analizom, Wilcoxon signed-rank testom, MannWhitney U testom te višestrukom regresijskom analizom. Uočena je statistički značajno manja postoperativna bol za sva ispitivana vremena nakon operacije u skupini magnezij tableta u odnosu na placebo tablete (P < 0,001, za sva ispitana vremena), osim za 4 sata (P = 0,017), dok je u skupini koja je konzumirala pastile uočeno značajno smanjenje boli 12, 24, 48 i 72 sata nakon operacije (P = 0,029; P = 0,003; P = 0,006; P = 0,002, slijedom). Količina uzetih analgetika bila je značajno manja na dan operativnog zahvata (P ˂ 0,001), prvi postoperativni dan (P ˂ 0,001) i treći postoperativni dan (P = 0,044) uz konzumaciju magnezij tableta, u usporedbi kad su pacijenti konzumirali placebo tableta. Nije bilo razlike za početak djelovanja, a ni za trajanje anestezije unutar skupine koja je konzumirala placebo i magnezij bilo u obliku tableta ili pastila, ali ni između skupine ispitanika koji su konzumirali magnezij u obliku tableta i pastila, P=0,950 za početak djelovanja anestezije, P=0,054 za vrijeme trajanja anestezije. Korištenje magnezija imalo je statistički značajan pozitivan učinak na mogućnost otvaranja usta u skupini ispitanika koji su koristili magnezij bilo u obliku tableta ili pastila u svim ispitivanim vremenima (P˂0,001). Nakon konzumacija magnezija u obliku tableta oteklina je bila manja prvoga (P = 0,050) i trećega dana (P = 0,006) nakon operacije. Rezultati istraživanja su dokazali pozitivan učinak magnezija na smanjenje postoperativne boli, trizmusa i otekline nakon operativnoga uklanjanja donjih trećih molara.In oral surgery, like in other surgical professions, management of postoperative complications are one of the provider’s main health concerns. The most common surgical procedure in oral surgery is the removal of the lower third molar, along with block anesthesia of the inferior alveolar nerve. This procedure involves mucoperiosteal flap elevation, tooth separation, bone removal, and flap suturing that can lead to the most commonly expected postoperative complications in the form of pain, trismus and swelling, which are are most commonly expressed up to three days postoperatively, with regression of symptoms from the first to the third postoperative day. Managing of those complications in the postoperative period is an extremely important factor in facilitating a patient’s recovery in terms of life and oral functions. This study evaluated the effect of oral magnesium, which is one of the main multifunctional intracellular cation that participates as a cofactor in more than 300 enzymatic processes, on anesthesia, postoperative analgesia, and other concomitant postoperative complications such as trismus and swelling after surgical removal of the lower third molar. This analgesic effect, and effect of magnesium on anesthesia could be explained by two main mechanisms. The first is by antagonizing peripheral and central N-methyl-D aspartate (NMDA) receptors, while the second mechanism involves the reduction of catecholamine release. The NMDA receptor is an amino acid receptor which result in opening of a cation-free ion channel. This couse the entry of Na + ions and a smaller amount of Ca2 + into the cell, while at the same time the potassium ions leave the cell. Magnesium blocks the entry of calcium ions into the cell and incompetently antagonizes NMDA receptor channels what plays a significant role in the prevention and treatment of severe postoperative pain. The effect of magnesium on trismus and muscle could be explained by reducing the presynaptic release of acetylcholine, and by reducing the effects of acetylcholine on postsynaptic receptors by which magnesium increases the excitatory threshold of axons, resulting in a potential effect on muscle relaxation, or a decrease in muscle contraction. Besides that, magnesium has also an antiinflamatory effect. To the best of our knowledge, this is the first study to assess the effects of magnesium on the postoperative incidence of the above complication

Effects of orally administered magnesium on anesthesia and postoperative analgesia after surgical removal of the lower third molars

Postoperativna kontrola boli predstavlja jedan od glavnih zdravstvenih imperativa svake kirurške struke pa tako i oralne kirurgije. Kirurško uklanjanje donjih trećih molara uz provodnu anesteziju donjega alveolarnoga živca, spada u najčešće operativne zahvate u oralnoj kirurgiji, zbog čega su kontrola boli, ali i drugih očekivanih postoperativnih komplikacija u vidu trizmusa i otekline od izuzetne važnosti. U ovoj prospektivno, randomiziranoj, dvostruko slijepoj, placebo kontroliranoj studiji o utjecaju peroralnoga magnezija na anesteziju, postoperativnu analgeziju te druge očekivane komplikacije nakon operativnoga uklanjanja donjega trećeg molara sudjelovalo je 80 punoljetnih zdravih osoba s oba impaktirana donja umnjaka. Ispitanici su ovisno o obliku konzumacije lijeka (u obliku tableta ili pastila) bili podijeljeni u dvije skupine po 40 osoba. S obzirom na to da su svi ispitanici imali oba impaktirana donja umnjaka, svaki je ispitanik jednom nakon operacije konzumirao magnezij, a jednom placebo u obliku tablete ili pastile ovisno kojoj je skupini pripadao. Vrijeme potrebno za nastup bloka i trajanje anestezije mjereno je u minutama, dok je postoperativna bol mjerena uz pomoć VAS-a u vremenskim intervalima 2, 4, 6, 12, 24 i 72 sata nakon operacije. Također je mjereno vrijeme uzimanja prvoga analgetika, ukupna količina uzetih analgetika te stupanj otekline i ograničenoga otvaranja usta (trizmus) u prva tri postoperativna dana. Dobiveni podatci su analizirani Spearmanovom korelacijskom analizom, Wilcoxon signed-rank testom, MannWhitney U testom te višestrukom regresijskom analizom. Uočena je statistički značajno manja postoperativna bol za sva ispitivana vremena nakon operacije u skupini magnezij tableta u odnosu na placebo tablete (P < 0,001, za sva ispitana vremena), osim za 4 sata (P = 0,017), dok je u skupini koja je konzumirala pastile uočeno značajno smanjenje boli 12, 24, 48 i 72 sata nakon operacije (P = 0,029; P = 0,003; P = 0,006; P = 0,002, slijedom). Količina uzetih analgetika bila je značajno manja na dan operativnog zahvata (P ˂ 0,001), prvi postoperativni dan (P ˂ 0,001) i treći postoperativni dan (P = 0,044) uz konzumaciju magnezij tableta, u usporedbi kad su pacijenti konzumirali placebo tableta. Nije bilo razlike za početak djelovanja, a ni za trajanje anestezije unutar skupine koja je konzumirala placebo i magnezij bilo u obliku tableta ili pastila, ali ni između skupine ispitanika koji su konzumirali magnezij u obliku tableta i pastila, P=0,950 za početak djelovanja anestezije, P=0,054 za vrijeme trajanja anestezije. Korištenje magnezija imalo je statistički značajan pozitivan učinak na mogućnost otvaranja usta u skupini ispitanika koji su koristili magnezij bilo u obliku tableta ili pastila u svim ispitivanim vremenima (P˂0,001). Nakon konzumacija magnezija u obliku tableta oteklina je bila manja prvoga (P = 0,050) i trećega dana (P = 0,006) nakon operacije. Rezultati istraživanja su dokazali pozitivan učinak magnezija na smanjenje postoperativne boli, trizmusa i otekline nakon operativnoga uklanjanja donjih trećih molara.In oral surgery, like in other surgical professions, management of postoperative complications are one of the provider’s main health concerns. The most common surgical procedure in oral surgery is the removal of the lower third molar, along with block anesthesia of the inferior alveolar nerve. This procedure involves mucoperiosteal flap elevation, tooth separation, bone removal, and flap suturing that can lead to the most commonly expected postoperative complications in the form of pain, trismus and swelling, which are are most commonly expressed up to three days postoperatively, with regression of symptoms from the first to the third postoperative day. Managing of those complications in the postoperative period is an extremely important factor in facilitating a patient’s recovery in terms of life and oral functions. This study evaluated the effect of oral magnesium, which is one of the main multifunctional intracellular cation that participates as a cofactor in more than 300 enzymatic processes, on anesthesia, postoperative analgesia, and other concomitant postoperative complications such as trismus and swelling after surgical removal of the lower third molar. This analgesic effect, and effect of magnesium on anesthesia could be explained by two main mechanisms. The first is by antagonizing peripheral and central N-methyl-D aspartate (NMDA) receptors, while the second mechanism involves the reduction of catecholamine release. The NMDA receptor is an amino acid receptor which result in opening of a cation-free ion channel. This couse the entry of Na + ions and a smaller amount of Ca2 + into the cell, while at the same time the potassium ions leave the cell. Magnesium blocks the entry of calcium ions into the cell and incompetently antagonizes NMDA receptor channels what plays a significant role in the prevention and treatment of severe postoperative pain. The effect of magnesium on trismus and muscle could be explained by reducing the presynaptic release of acetylcholine, and by reducing the effects of acetylcholine on postsynaptic receptors by which magnesium increases the excitatory threshold of axons, resulting in a potential effect on muscle relaxation, or a decrease in muscle contraction. Besides that, magnesium has also an antiinflamatory effect. To the best of our knowledge, this is the first study to assess the effects of magnesium on the postoperative incidence of the above complication

Effect of Denosumab Therapy on Pain Level in Diffuse Sclerosing Osteomyelitis of the Mandible: a Case Report

This is the first case report where two patients were under uniform denosumab administration protocol in diffuse sclerosing osteomyelitis (DSO) treatment and were closely monitored for 18 months. Objectives: This study aimed to describe the beneficial effects of denosumab in DSO treatment as well as pain relief and the significant lack of long-term use due to poorer outcomes after repeated use. DSO of the jaw is a poorly understood rare chronic disease the treatment of which is still very challenging despite a rapid development of medicine. Different medical treatments have been pro-posed without any significant long-lasting success. Bisphosphonates have offered substantial clinical benefit in DSO therapy, but due to harmful pharmacodynamic properties, denosumab therapy has been used to replace bisphosphonate therapy. Patients had a reduction in pain intensity with each subsequent application of denosumab but with less success than the first administration of de-nosumab. This case report has shown that denosumab could be a promising conservative treatment option for pain treatment in patients suffering from DSO

Povezanost indeksa tjelesne mase i pojave komplikacija poslije operacijskog uklanjanja donjega trećeg kutnjaka

Objectives: Swelling, pain and trismus after the surgical removal of the mandibular third molars are the most common and expected postoperative complications. The aim of this cross-sectional study was to assess the association of those postoperative complications and BMI after surgical removal of the mandibular third molars. Material and methods: 84 patients who required the surgical removal of their lower third molar were enrolled in this study and were divided into 4 groups dependent on their BMI. Data were tested by one-way analysis of variance (Welch’s ANOVA). The differences were tested by the intragroup using the Games-Howell test. Results: The effect of BMI on pain had a statistically significant difference within the first 24 postoperative hours: 4 hours (p=0.014), 6 hours (p=0.034, p=0.049), 12 hours (p= 0.00.P=0.023), and 24 hours (p=0.010). For swelling and trismus in the exception on first postoperative day between underweight and normal weight groups (p=0.026), and underweight and overweight groups (p=0.014) no statistically significant correlation was found Conclusion: BMI has an impact on a patient’s early postoperative recovery.Cilj: Oteklina, bol i trizmus najčešće su, ali i očekivane, komplikacije nakon operacijskoga uklanjanja donjega trećeg kutnjaka. Cilj ovog istraživanja bio je procijeniti povezanost spomenutih postoperativnih komplikacija i BMI nakon kirurškoga uklanjanja donjih trećih kutnjaka. Materijali i metode: U ovo su istraživanje bila uključena 84 ispitanika kojima je bilo potrebno kirurški ukloniti donje treće kutnjake. Bili su podijeljeni u četiri skupine, ovisno o izračunatom BMI-ju. Za ispitivanje dobivenih rezultata korištena je jednosmjerna analiza varijance (Welchova ANOVA), a razlike između grupa testirane su Games-Howellovim testom.Rezultati: Učinak BMI-ja na bol dokazan je statistički značajnom razlikom unutar prva 24 postoperativna sata: 4 sata (p = 0,014), 6 sati (p = 0,034, p = 0,049), 12 sati (p = 0,00, p = 0,023) i 24 sata (p = 0,010). S druge strane, nije pronađena statistički značajna povezanost za oteklinu i trizmus, s iznimkom otežanoga otvaranja usta prvoga postoperativnoga dana kod skupine pothranjenih u usporedbi s ispitanicima s normalnom tjelesnom masom (p = 0,026) i prekomjernom tjelesnom masom (p = 0,014). Zaključak: BMI utječe na pacijentov rani postoperativni oporavak

The Attitude of the General Dentist in the Republic of Croatia toward Treating Children

The aim of this study was to determine the attitude of general dentists in the Republic of Croatia toward working with children. The questionnaire survey involved 361 general dentists. The questionnaire was divided into three parts and contained 34 questions. The first part of the questionnaire survey contained demographic data questions. In the second part, dentists answered questions about the characteristics of the dental offices where they work, the materials that they mostly use, and how they work with children. The third part of the questionnaire referred to attitudes about working and treating young children and consisted of 12 statements, to which the answers were offered on a Likert scale from one to five. This study showed that only 12.46% of dentists have a positive attitude toward treating children and 30.19% of dentists have a negative attitude toward treating children. In addition, the attitude toward working with children correlates with both the knowledge they acquired during dental studies (R = 0.355; p &le; 0.001) and gender (R = &minus;0.103; p = 0.035). This study confirmed that women have a more often positive attitude toward treating young children. There was a major correlation between the level of education and positive attitudes toward treating children. The child&rsquo;s non-cooperative behavior was the main reason why general dentists refuse to work with children