Neue Arbeitsgewohnheiten in der zahnärztlicnen Praxis

U stomatologiji se oduvijek težilo za racionalizacijom i uštedom radnog vremena. Zubnomedicinska oprema se postepeno usavršavala, međutim, o zdravlju, tj. o uloženom naporu terapeuta za vrijeme rada nije se vodilo dovoljno računa. Statistički podaci o profesionalnim oboljenjima stomatologa ukazuju na opterećenje i nefiziološki način rada. Kontroliranjem rada stomatologa uz zubarsku stolicu sni, manjem usporenom filmskom tehnikom, pronađen je optimalni položaj i način rada, koji minimalno opterećuje organizam. Amerikanac Thompson, 1955. godine, uvodi zasade ergonomije u stomatologiju, tj. ne vodi računa samo o racionalizaciji rada, nego prvenstveno o zdravlju terapeuta te tako nastaje novi stil rada. Novi stil rada, po principu ergonomije, omogućuje veću efikasnost, kraće zadržavanje pacijenta u ordinaciji, čuva zdravlje terapeuta i podiže razinu usluga. Autori naglašuju, da je prijelaz na novi stil rada u nas još nemoguć, zbog pomanjkanja sredstava, ali svakako treba tomu težiti.Tendencies aiming at rationalism and saving of time have always been apparent in stomatology. The quality of the dental medical equipment and instruments has gradually undergone improvement but little thought was given to the health problems, i. e. the exertions of the therapeutists at work. Statistical data on professional diseases of dentists indicate that they work under excessive strain and adopt non-physiological methods of work. The most favourable position and the best method of work presenting the least strain on the dentist\u27s organism was selected on the basis of observations of the work of dentists at to the dental chair by means of a slow motion replay film. The American Thompson introduced into dentistry in 1955 the principles of ergonomy, taking into account not only rationalism of work but primarily the health of the dentist and thus a new style of work was established. This new style of work according to the principles of ergonomy enables greater efficiency, a shorter period of time which the patient has to spend in the consulting room, preserves the health of the dentist and raises the level of the dental services. The authors emphasize that at present in our country it is not possible to introduce a new style of work in our dental practices because of lack of funds, but tendencies should be directed towards these new working habits.Rationelle Arbeitsmethoden und Zeitersparnis sind seit jeher Bestrebungen in der Stomatologie. Die zahnärztichen Einrichtungen wurden vervollkommnet, doch der Gesundheit, bzw. dem Arbeitsaufwand des Zahnarztes wurde nicht genügend Aufmerksamkeit gewidmet. Statistische Angaben überprofessionelle Erkrankungen des Zahnarztes verweisen auf Überlastung in der unphysiologischen Arbeitsteilung. Durch Kontrolle der Arbeitsgewohnheiten am Operationstuhl mit verlangsamter Filmtechnik, wurde die optimale Stellung und Arbeitsweise, welche den Organismus am wenigsten belastet, ermittelt. Der Amerikaner Thompson hat 1955 Errungenschaften der Ergonomie in die Stomatologie eingeführt, welche vor allem den Gesundheitszustand des Zahnarztes berücksichtigt, womit ein neuer Arbeitsstil entstand. Dieser nach den Prinzipien der Ergonomie angewandte Arbeitsstil ermöglicht eine grössere Arbeitsleistung, verkürzt den Aufenthalt des Patienten in der Ordination, schont die Gesundheit des Zahnarztes, und hebt das Niveau der zahnärztlichen Darbietungen. Die Autoren heben hervor, dass der Übergang zum neuen Arbeitsstil,, wegen des grossem Kostenaufwandes, bei uns noch auf Schwierigkeiten stösst, doch sollte man sich bemühen dies zu erreichen

Die Experimentalle bewertung des Diakets und Zinkoxyphosphatzements als mittel fur die Wurzelkanalfullung

Autori su u eksperimentu na zubima psa histološki ispitivali efikasnost diaketa i cink oksifosfatnog cementa, kao sredstava za punjenje korijenskih kanala. Ustanovili su reaktivnu upalu u području periapeksa, kao posljedicu iritacije stranog tijela. Istovremeno su ustanovili degenerativne promjene upalnih stanica i proliferacija veziva. Polazeći sa stajališta da nema idealnog sredstva za punjenje korijenskih kanala, može se do daljnjega dopustiti upotreba diaketa i cink oksifosfatnog cementa za punjenje korijenskih kanala.The authors investigated the efficacy of Diaket and zinc oxyphosphate cement as suitable agents for the filling of root canals in experiments on the teeth of dogs. They found a reactive inflammation periapically as the result of irritation caused by the foreign body. Simultaneously degenerative changes of the inflammatory cells was established and proliferation of the connective tissue. Starting from the assumption that no ideal agent for the filling of root canals has so far been found, Diaket and zinc oxyphosphate cement may be used for the time being for the filling of root canals.Die Autoren haben an Hundezähnen die Wirkung des Diakets und Zinkoxyphosphatzements als M ittel für die Wurzelkanalfüllung histologisch untersucht. Es konnte eine reaktive Entzündung im Gebiet des Periapex als Folge des Fremdkörperreizes festgestellt werden. Gleichzeitig wurden degenerative Veränderungen an Zellen und Wucherungen des Bindegewebes festgestellt. Da es kein ideales Mittel für die Wurzelkanalfüllung gibt, kann die Anwendung des Diakets und Zinkoxyphosphatzements für die Wurzelkanalfüllung befürwortet werden

Beobachtungen über akrilat-keramische Füllungsmateriale

Autori u uvodu govore o potrebi zamjene silikatnih cemenata, koji imaju privremeni karakter, novim boljim materijalima. Ističu da ni autoakrilati, u koje se polagala velika nada, nisu u potpunosti zadovoljili. Složeni materijali za punjenje kaviteta, koji se sastoje iz organske baze i anorganskog dijela, imaju veliku budućnost. Autori su ispitivali i uspoređivali novi akrilatno-keramički materijal TD 71, sa silikatnim cementom Achatit biochromatic. Na materijalu od 366 ispuna aproksimalnog i cervikalnog kaviteta bila je ispitivana stabilnost boje, rubna i duboka diskoloracija, površinska kontura te marginalna adaptacija i adhezija. Kontrola je bila izvršena nakon 6 i 10 mjeseci. Autori na temelju svojih promatranja zaključuju, da TD 71, kao složeno sredstvo za punjenje prednjih zubi, zahtijeva osobitu pažnju, jer predstavlja dobru alternativu za silikatni cement, osobito u kiselom miljeu usne šupljine. To sredstvo zadovoljava u potpunosti kozmetske zahtjeve, stabilno je u boji i vrlo dobro pri leži uz rubove kaviteta. Uz dobro izvedenu podlogu od cink oksifosfatnog cementa ne oštećuje pulpu.Introducing their paper the authors express the need of replacing silicate fillings with new filling materials as silicate has a rather temporary character. Out of the new compound materials the authors aim was to compare and evaluate TD 71 with silicate cement Achatit biochromatic.On various 366 fillings in 180 patients with approximal and cervical cavities, the colour stability, discoloration, surface contour and marginal adaptation was checked. Controls of the filings had been undertaken after 6 and 10 months. Based on their observations the authors conclude that TD 71, the new compound material for filling front teeth deserves special attention as it represents a good alternative for silicate cements, especially in the sour environments of the oral cavity. TD 71 satisfies the cosmetic appearence, has colour stability with good adherance to the cavity walls and with a phosphate cement lining does not endanger the pulp.Einleitend betonen die Verfasser die Notwendigkeit Silikatzemente mit anderen Füllungsmaterialien auszutauschen, da Silikatfüllungen eigentlich als provisorischer Material anzusehen ist. Von den neuen komplexen Füllungsmaterialien, die eine organische und anorganische Komponente haben, denen eine grosse Zukunft bevorsteht, wurde TD 71 untersucht und mit Achatit biochromatic verglichen. Auf 366 Füllungen von aproximalen und cervikalen Kavitäten an 180 Patienten wurde die Farbstabilität, die Rand und Tiefverfärbung, die Oberfläche, marginale Adaptation und Adhaesion untersucht. Kontrollen waren nach 6 und 10 Monaten durchgeführt. Auf Grund Ihrer Erfahrungen schliessen die Verfasser dass TD 71, das neue akrilat-keramische Füllungsmaterial als Material für vordere Zähne besondere Aufmerksamheit verdient, weil es eine gute Alternative für Silikate vorstellt, besonders im saueren Milieu der Mundhöhle. TD 71 entspricht den kosmetischen Forderungen, zeigt eine Farbstabilität und gutes Adhesion vermögen an den Wanden der Kavität und mit einer Zementunterlage ist keine Auswirkung auf das Pulpagewebe zu erwarten

Gold foil in restorative dentistry

Autori prikazuju vrste zlata koje se mogu upotrijebiti za izradu direktnih ispuna od zlatne folije. Prikazane su varijacije mogućih klasa kaviteta. Iznesene su prednosti i moguće poteškoće prilikom izrade ispuna od zlatne folije. Smatra se da su ispuni od zlatne folije idealno sredstvo za izradu ispuna u terapeutskoj stomatologiji. Naglašava se potreba izrade takvih ispuna u toku edukacije studenata radi stjecanja potrebne vještine i strpljivosti u radu. Ograničenje upotrebe zlatne folije je velika skupoća materijala i znatan utrošak vremena.The authors bring forth various forms of gold which can be used in the direct gold foil restorative procedure. All possible variations of cavity preparations are shown for the techique mentioned. Advantages and possible difficulties during operative procedures are brought forth. It is believed that gold foil restorations prove to be the most ideal material in operative dentistry. Special emphasis is placed on the importance of practicing this technique during the pre-graduate study which results in better skill deveopment and precision for the future dentist. The hain setbacks with this technique are the high costs involved and the prolonged operative time period

Erfahrungen mit kortikosteroid-antibiotischen Präparaten in der Endodontie

U višegodišnjem radu u Zavodu za dentalnu patologiju Stomatološkog fakulteta u Zagrebu, autori su ispitivali mogućnosti koritosteroid-antibiotskog preparata u suvremenom endodontskom tretmanu oboljele pulpe. Budući da ovi preparati imaju dva svojstva: antiflogističko i antibakterijsko, postoji osnova za njihovu primjenu u različitim oboljenjima zubne pulpe. Tim preparatima kod hiperemije i pulpitisa, naročito u bitnim intervencijama pacijenta brzo i efikasno rješavamo boli. U slijedećem posjetu kod pulpitisa je neophodno izvršiti biopulpektomiju totalis. U toku tretmana gangrene pulpe sa periapeksnim promjenama ili bez njih, kortikosteroid-antibiotski preparat je također pokazao dobra svojstva. Zaključno autori smatraju da taj preparat mogu preporučiti u suvremenim endodontskim tretmanima, ali uz strogu indikaciju i točnu dijagnozu.The authors have investigated the possibilities of applying corticosteroid-antibiotics in the course of modern endodontic treatment for a diseased dental pulp, doing research work over a number of years at the Institute for Dental Pathology of the Faculty of Dentistry in Zagreb. Since these drugs have two properties, i. e. the antiphlogistic and the antibacterial effect, possibilities exist for their application in different diseases of the dental pulp. Particularly in urgent interventions have these drugs proved effective in killing pain quickly and efficaciously in patients suffering from hyperemia and pulpitis. Biopulpectomy totalis must inevitably be carried out at the next visit to the dentist. In the course of the treatment of gangrene of the pulp with or without periapical changes, corticosteroid-antibiotics have also shown good results. Concluding, the authors consider that corticosteroid-antibiotics therapy may be recommended in modern endodontic treatment but with strict indications and only in cases where a precise diagnosis has previously been made.In mehrjähriger Arbeit haben die Autoren die Möglichkeit der Behandlung der erkrankten Pulpa mit kortikosteroid-antibiotischen Präparaten gerprüft. Die antiphlogistischen und antibakteriellen Eigenschaften dieser Präparate ergeben die Grundlagen für ihre Anwendung bei verschiedenen Pulpaerkramkungen. Bei Hyperämie und Pulpitis wirken sie rasch und sicher schmerzstillend, insbesondere bei akuten Interventionen. Bei Pulpitis muss unbedingt in der folgenden Visite die totale Biopulpektomie ausgeführt werden. Bei der Behandlung der gangränösen Pulpa, mit oder ohne periapikalen Veränderungen, sind diese Präparate auch von guter Wirkung. Zusammenfassend sind die Autoren der Meinung, dass diese Präparate für die zeitgemässe endodontische Behandlung, unter strenger Indikation und genauer Diagnose, empfohlen werden können

Endokarditis dentogen Verursacht

Autori iznose da se dijagnoza bakterijskog endokarditisa dentogenog porijekla postavlja na osnovu nalaza kardiologa, bakteriologa i stomatologa. Poznato je, da je oko 30% slučajeva bakteriijskog endokarditisa dentogenog porijekla, te da postoji predispozicija za ovo oboljenje kod 1% čitavog pučanstva.Prognoza oboljenja ovisi o brzini dijagnoze i terapije. Hemokultura je najvažniji dijagnostički elemenat. Do pojave bakterijskog endokarditisa dolazi često nakon nekog zahvata u usnoj šupljini, a najčešći uzročnik je streptokok. Uloga stomatologa se sastoji u otkrivanju i otklanjanju žarišta. Svaki zubno-medicinski zahvat u usnoj šupljini mora se izvršiti pod zaštitom antibiotika kod pacijenata koji boluju ili su preboljeli bakterijski endokarditis, ili pak postoji predispozija za bakterijski endokarditis. Iz svega prethodno iznesenog, jasno je da se svaki tretman kao i dijagnoza mora postaviti u uskoj suradnji kardiologa, bakteriologa i stomatologa.The authors state that the diagnosis of bacterial endocarditis of dentogenous origin is based on the findings of the heart specialist, bacteriologist and dental surgeon. It is known that about 30% of all cases of bacterial endocarditis are of dentogenous origin and that a predisposition for this affliction is present in 1 % of the entire population. The prognosis depends on the rapidity of the diagnosis and on the treatment. Hemoculture is the most important diagnostical aid element. Batcterial endocarditis often develops after an intervention in the oral cavity and the most frequent causative agent is the streptococcus. The task of the dental surgeon is to detect and to remove the focus. Every dental-medical intervention in the oral cavity must be undertaken under the protection of antibiotics in all patients who suffer from or who have just recovered from bacterial endocarditis or in cases where there exists a predisposition for bacterial endocarditis. All the aforesaid shows that the diagnosis and treatment must be undertaken in close cooperation of the heart specialist bacterilogist and dental surgeon.Die Autoren heben hervor, dass die Diagnose des bakteriellen Endocarditis dentogenen Ursprungs aufgrund der Befunde des Kardiologen, Bakteriologen und Stomatologen gestellt wird. Ungefähr 30% der Fälle von bakteriellen Endocarditiden sind dentogenen Ursprings, bei 1% der Bevölkerung besteht eine Prädisposition zu dieser Erkrankung. Die Prognose der Erkrankung hängt von der frühzeitigen Diagnose und Therapie ab. Die Erscheinung des bakteriellen Endocarditis ist häufig in Zusammenhang mit einem Eingriff in der Mundhöhle. Die häufigsten Erreger sind Streptococcen. Die Aufgabe des Stomatologen besteht in der Entdeckung und Beseitigung des Herdes. Jeder zahnärtztliche Eingriff in der Mundhöhle muss bei Patienten, welche an bakterieller Endocarditis erkranken, oder dazu prädistiniert sind, unter dem Schutz von Antibiotika erfolgen. Aus dem Dargestellten ist ersichtlich, dass jede Behandlung und Diagnose in enger Zusammenarbeit von Kardiologen, Bakteriologen und Stomatologe zu geschehen hat

[The influence of chelating effect on human dentin]

Uvodno se govori o helacijskom fenomenu i njegovoj primjeni u endodontskoj terapiji. Autori su htjeli ustanoviti, služeći se elektronskom mikroskopijom, strukturne promjene u području cirkumpulpnog dentina i na mikrofotografijama potvrditi razlike u reljefu površine dentina \u27kad je bilo provedeno ručno, mehaničko kemijsko i dodatno ispiranje korijenskog kanala. Detaljno je bilo promatrano 32 uzorka i ustanovljeno je da helator izaziva velike promjene u izgledu cirkumpulpnog dentina. Širenje korijenskog kanala samo ručnim instrumentima ne zadovoljava postulat temeljitog čišćenja endodontskog prostora, dok mehaničko ikemijska obrada (raširivač + helator), te naizmjenično ispiranje s 3% otopinom vodi kova su peroksid a i destiliranom vodom daje bolje rezultate. Budući da je na taj način odstranjen omekšani cirkumpulpni dentina povećana je mogućnost permeaibiinosti dentina za farmaka, a korijenski kanal je bolje pripremljen za apturaciju.A short presentation is made, by way of introduction, of the chelating phenomenon and its application in endodontic therapy. The objective of the study was to detect, using scanning electron microscopy, structural changes in the circumpulpar dentin and to ascertain the differences in the reliefs of dentin surfaces in microphotographs following manual tretment and following mechanico-chemical treatment and additional rinsing of the root canal. A detailed examination of 32 sam.ples revealed that the chelating agent had elicited marked changes in the appearance of circumpulpar dentin. Enlargement of the root canal by manual instruments alone does not afford a through cleaning oif the endodontic space, while mechanico-chemical treatment (reamer plus chelating agent) and alternating rinsing with a 3% solution of hydrogen peroxide and distilled water gives good results. Since in this way the softened circumpulpar dentin is removed, dentin becomes more permeable to drugs and the root canal is better prepared for obturation

Zeitgemässe Grundprinzipien bei der Präparation der Kavität

Osnovni cilj terapijske stomatologije je odstranjivanje kariozno promijenjenog tkiva i očuvanje zdrave zubne pulpe. Vodeći računa o prevenciji oboljenja tvrdih zubnih tkiva i zubne pulpe te pridržavajući se principa ergonomije u svakodnevnom ambulantnom radu i vodeći računa o pacijentovu vremenu, autori preporučuju određeni redoslijed prilikom preparacije kaviteta. Važan je svakako i pravilan izbor svrdla, odnosno dlijeta, za obradu kaviteta. Autori smatraju da je preparacija kaviteta odgovorna dužnost svakog stomatologa, a kako se vide dosta česte greške, kad je u pitanju oblik kaviteta, preventivna ekstenzija, osiguranje retencije i rezistencije ispuna te definitvno finiranje i poliranje rubova kaviteta, pokušali su upozoriti na odgovarajući potrebni redoslijed u obradi kaviteta i na pravilan izbor dijamantnih svrdla.The basic aim of therapeutic dentistry is to remove the tissue altered by caries and to preserve the dealthy dental pulp. Taking into account the need for the prevention of disease of the hard dental tissues and of the dental pulp and following the principle of ergonomy in our daily work with out-patients, placing particular emphasis on the time the patient has to spend in the doctor\u27s consultation room, the authors recommend a certain chronological order to be followed in the preparation of cavities. Certainly the right choice of a drill and chisel is of the utmost importance in preparing cavities. The authors consider that the preparation of cavities presents a responsible duty to every dentist and since mistakes frequently occur in shaping the cavity, in preventive extension, in securing retention and resistance of the filling and adding the final touch and polishing of the edges of a cavity, we have tried to draw attention to the chronological order which is necessary to follow in the preparation of cavities and we have emphasized the proper choice of diamond drills.Der Grundgedank bei der therapeutischen Stomatologie ist die Beseitigung des Kariös veränderten Gewebes und die Erhaltung der gesunden Zahnpulpe. Der Prävenz der Erkrankung der harten Gewebe und der Zahnpulpe Rechnung tragend und der Prinzipien der Ergonomie Rechnung tragend wie auch der Zeit des Pazienten empfehlen die Autoren in der alltägigen Ambulanzarbeit eine bestimmte Reihenfolge bei der Präparation der Kavität. Allerdingst auch die rechte Wahl des Bohrers und Meissels ist bei der Bearbeitung der Kavität von Wichtigkeit. Die Autoren sind der Meinung, dass die Präparation der Kavität verantwortliche Pflicht jedes Stomatologen ist und da Ziehmlich häufige Fehler zu Sehen sind, wenn in Frage stehen die Form der Kavität, die präventiv Extension, Sicherung der Retenz und die Resistenz der Füllung wie auch das definitive Finieren und Polieren der Ränder der Kavität, so haben sie versucht auf die entsprechende nötige Reihenfolge bei der Bearbeitung der Kavität aufmerksam zu machen, nicht weniger auch auf die rechte Wahl der Diamantbohrer