Application of subepithelial connective tissue grafts in pre-prosthetic surgery and graft harvesting techniques. A literature review

Introduction: Subepithelial connective tissue grafts (SCTGs) have been largely applied to cover exposed root surfaces resulting from gingival recessions. Besides treating gingival recessions, SCTGs are also employed in adjusting soft-tissue contours of restorations in edentulous areas, around dental implants, in ridge-preservation procedures with immediate implant placement as well as in papilla reconstruction. Despite the wide application of various xenogeneic grafts, which eliminate the formation of a second wound surface apart from the donor site, autogenous grafts remain the preferred material for soft-tissue contouring, especially in esthetically demanding regions and in restoration of the masticatory apparatus by fixed prosthetics.Aim: The aim of this study is to review the most commonly employed techniques for the procurement and application of subepithelial grafts for gingival augmentation in alveolar ridge contouring, as well as to identify their advantages and disadvantages.Materials and Methods: The present study relies on dental literature data available in PubMed and Google Scholar, from 1974 to 2019, published in the English language.Results: The literature review is based on publications whose aim to observe the data provided information on the main techniques for harvesting subepithelial grafts, as well as their application specifications for soft-tissue augmentation in pre-prosthetic surgery.Conclusion: The publications explored in the present study reveal that the presence of appropriate and affordable techniques for obtaining subepithelial grafts, both for contour correction and soft-tissue augmentation in localized areas around single teeth, particularly in areas of higher esthetic sensitivity. However, when larger transplants are needed, alternative methods are to be sought, particularly in cases where the palate has unfavorable anatomic characteristics or the palatal mucosal thickness is insufficient

A supernumerary maxillary premolar: a case report

Introduction: Supernumerary teeth are regarded as one of the most common dental anomalies. Occurrences may be single or multiple, unilateral or bilateral, and in one or both jaws. Incidences of supernumerary teeth are primarily found in permanent dentitions; however, they may rarely be encountered in primary dentitions as well. The presence of multiple supernumerary teeth is usually associated with certain conditions or syndromes such as cleft lip/palate, cleidocranial dysplasia (CD), Gardner's syndrome, Down syndrome, etc. Supernumerary teeth (hyperdontia) can be defined as any tooth or tooth structure that is in excess in the presence of 20 deciduous, or 32 permanent teeth in one individual. Aim: The aim of this article is to show clinical case with a supernumerary maxillary premolar, especially when there are other supernumerary teeth in one dentition without any records of present syndromes or genetic predispositionCase Presentation: The subject of this clinical study was an old patient, with complains of maxillary sinus pain. The intraoperative observations established that the supernumerary tooth was surrounded by bone tissue and no communication with the sinus cavity was observed.Results: Although no communication with the sinus cavity was observed, there were no complaints and complications after the extraction of the supernumerary tooth. The patient was called for a follow-up one week and six months after the extraction and had no complaints.Conclusion: Supernumerary teeth are not uncommon and their detection in most cases happens to be accidental, but the rare phenomenon of supernumerary premolars is of special research interest, especially when there are other supernumerary teeth in one dentition without any records of present syndromes or genetic predisposition

Preoperative management of patients with myasthenia gravis: a review article

Introduction: Myasthenia gravis (MG) is an autoimmune neurological disorder characterized by defective transmission at the neuromuscular junction. This neuromuscular disease marked by repetitive intermittent skeletal muscle weakness and fatigue Clinical symptoms are manifested in varying degrees depending on the age of diagnosis and antibodies to acetylcholine receptors. Facial and oropharyngeal muscles are among the most affected by this disease, thus presenting a lot of difficulties when dental treatment is performed. Since the disease is known to specifically affect the masticatory, facial and oropharyngeal muscles, dental treatment proves very challenging for dentists and patients alike. In order to choose the optimal and less invasive treatment approach and avoid inherent complications, dentists must be acquainted with the clinical features of MG as well as the medications administered in MG patients.Aim: The aim of the present study is to investigate and systematize the clinical presentations of MG in order to choose the most appropriate treatment approach and avoid complications. For this purpose, oral and maxillofacial clinicians must also be acquainted with the main groups of medications for this disease.Materials and Methods: This research relied on Google Scholar and PubMed publications, published in the period 2000–2022.Conclusion: Myasthenia gravis is a serious and rare chronic disease. In order to avoid complications, some of which life-threatening, it is of utmost importance to know its main symptoms as well as applicable medications in dental treatment

Analysis Of Vestibuloplasty Methods On Completely Edentulous Mandible - A Review

Цел: Да се направи анализ на различни методи на вестибулопластика, описани в наличната литература по отношение на тяхната ефектифност и приложимост в амбулаторни условия, както и да се оцени приложението на различни авто - и ксеногенни трансплантати в комбинация с тях. Материали и методи: Проведен е систематичен литературен обзор на статии и публикации, свързани подготовка на напълно обеззъбени челюсти за протезиране, в това число и вестибулопластика на долна челюст, с което се цели задълбочаване на вестибуларния сулкус и увеличаване на прикрепената лигавица, без да се извършва аугментация на долночелюстната кост. Да се проследят предимствата и недостатъците на някои от широко приложимите методи за вестибулопластика и да се проучат свойствата на различни видове трансплантати, приложени при извършване на вестибулопластика на долната челюст. Резултати: Използването на автогенни и ксеногенни дермални трансплантати за покриване на периоста води до по-малко свиване на опeративната рана по време на заздравителния период в сравнение с методите за вестибулопластика чрез вторична епителизация, намалява се възможността за образуване ръбци, съкращава се времето на заздравяване. Това дава възможност за ранно протетично възстановяване и предотвратява възникването на рецидиви. Прилагането на ксеногенни дермални трансплантати премахва образуването на втора ранева повърхност за придобиване на трансплантат и ограничението в количеството му, но увеличава стойността на хирургичната манипулация. Заключения: Спрямо направения анализ на различните методи на вестибулопластика и видовете трансплантати може да се направи извода че е необходимо да се извършат още проучвания по отношение на свойствата на трансплантатите и сроковете на протезиране.Purpose: to perform an analysis of various methods of vestibuloplasty described in the available reference materials in terms of their efficacy and applicability in outpatient care condition, as well as to assess the applicability of different autografts and xenogenic grafts in combination whit them. Materials and methods: A systematic reference literature overview has been performed of articles and publications related to the preparation of completely edentulous jaws prothetizations, including vestibuloplasty of the lower jaw, aimed at deepening the vestibular sulcus and increasing the attached mucosa without performing augmentation of the mandible bone. To follow up the advantages and disadvantages of some of the widely applicable vestibuloplasty methods and to study the propreties of varios types of grafts applied when performing vestibuloplasty of the lower jaw. Results: The use of autogenic and xenogenic dermal transplantats for covering the periosteum leads to less contraction of the surgery wound during the period of healing compared to the vestibuloplasty methods through secondary epithelization; the possibility of forming edges is reduced, the time to heal is shortened. This enables the early prosthetic recovery and prevents the formation of recidivisms. The application of xenogenic dermal transplants eliminates the formation of a second wound surface in order to acquire a transplant and the limitation in its quatity but increases the value of surgical manipulation. Conclusion: In relation to the analysis performed of the various methods of vestibuloplasty and the type of grafts a conclusion may be drawn that it is necessery to perform more studies regarding the graft properties and the period of prosthetization

Dental treatment of patients with cleidocranial dysplasia: two case reports

Introduction: Cleidocranial dysplasia (CCD) is an autosomal dominant disorder, also referred to ascleidocranial dysostosis. The diagnosis is made on the basis of clinical and radiological findings and is confirmed through a genetic analysis. Cleidocranial dysplasia manifestations in the skeletal system include aplasia or hypoplasia of the clavicles, leading to shoulder joint hypermobility, a cone-shaped chest with short ribs, a wide skull with prominent frontal bone, etc. The dental status of CCD patients is commonly marked by a persistent primary dentition, delayed eruption of permanent teeth, supernumerary teeth, an incorrect proportion between the two jaws, impaired masticatory function and aesthetics.Aim: The aim of the present study is to show the clinical and radiologic findings of two CCD patients and describe the multidisciplinary approach necessary for their treatment. Early diagnosis and awareness of the condition help to determine the optimal treatment and duration as well as to improve patients’ quality of life.Case Report: The subject of this clinical study are two closely related patients who sought professional dental help due to persistent primary teeth, delayed eruption of permanent dentition beyond the mean eruption age and resultant occlusal and aesthetics problems.Results: Correction of the dental status in CCD patients is a long process. Timely combination of orthodontic and surgical treatments is crucial for optimal and long-lasting results.Conclusion: Dental treatment of CCD patients is a complex endeavor. The type of approach in the orthodontic, surgical and prosthetic treatment is largely determined by the patients’ age, their general health as well as their intraoral status (present deciduous teeth, existing permanent teeth and occlusal contacts)

Application of allogeneic grafts for augmentation of the width of attached gingiva in pre-prosthetic surgery. A literature review

Introduction: Pre-prosthetic surgical procedures are intended to eliminate or improve any poor soft- and hard-tissue conditions in preparation of the prosthetic field. Vestibuloplasty continues to be regarded as a predictable and affordable procedure for increase of the prosthetic field, particularly in patients with removable dentures. With the introduction of dental implants, the need for pre-prosthetic surgical preparation of jaws has been considerably reduced, yet certain manipulations are still to be performed, such as increasing of the width of attached gingiva as well as correction of alveolar ridge defects using grafts.Aim: The aim of the present paper is to discuss some of the allogeneic grafts used in soft-tissue augmentation for the purposes of pre-prosthetic surgery, as well as their advantages and disadvantages.Materials and Methods: The present study relied on dental literature data, concerning the application of various allogeneic grafts for enlarging the width of attached gingiva in pre-prosthetic surgery, found in PubMed and Google Scholar, from 1910 to 2021, published in the English language.Results: The publications addressed in this review provide information on the clinical features of allogeneic grafts as a substitute for autogenous grafts, especially in cases where larger size grafts are required or where their harvesting may be limited by various factors.Conclusion: The application of autogenous grafts is supported by good clinical outcomes in the augmentation of the amount of attached keratinized gingiva. However, there are limitations associated with their harvesting. This necessitates the search for substitutes such as allogeneic or xenogeneic grafts, which could deliver similar clinical results.

A clinical case report of hypodontia and impacted supernumerary teeth in a patient diagnosed with Yunis-Varon syndrome

Introduction: Yunis-Varon syndrome (YVS) is an extremely rare autosomal recessive congenital disorder affecting many organs and systems (bones, ectodermal structures, the cardiorespiratory system, etc.). Abnormalities include aplasia or hypoplasia of the clavicles, facial dysmorphism, sparse hair, absence or hypoplasia of the thumbs, toes and distal phalanges, prominent auricles, shortened upper lip and other skeletal deformities, such as pelvic dysplasia, kyphosis, scoliosis, etc. Tooth structures and jaws are characterized by marked micrognathia, a narrow high-arched palate, hypodontia, impacted permanent teeth as well as supernumerary teeth.Aim. The present case report aims to describe the clinical and radiographic changes in the masticatory apparatus of a patient diagnosed with Yunis-Varon syndrome.Case Presentation: The subject of this study was а patient, suffering from pain in tooth #38. The clinical intraoral examination revealed hypodontia, but the radiographic image revealed many supernumerary teeth in the anterior and premolar region of both the maxilla and the mandible.Results: In addition to skeletal anomalies and impaired ectodermal structures, this rare syndrome can cause disturbances in the teeth and jaws. For this reason, dental specialists play an important role in the diagnosis and treatment of patients suffering from Yunis-Varon syndrome.Conclusion: Early intervention is important in Yunis-Varon syndrome. Future investigation will permit identification of thеsе skeletal and dental abnormalities

Monitoring bacterial growth in liquid cultures through the bulk optical parameters in the near-infrared region extracted using the radiative transfer theory

PhD ThesisNear infrared (NIR) spectroscopy offers promise as a monitoring tool for fermentation reactions by its potential to provide information about the physical and chemical state of given system. However, issues associated with confounding effects due to light scattering variations that occur during the fermentation process due to changes in the state of the microorganisms makes it difficult to obtain robust estimation of the analytes of interest. An approach for removing multiple scattering effects and separating absorption from scattering using the radiative transfer equation (RTE) is proposed in this work. In order to investigate its feasibility and to aid in the development of the technique, the method was applied to a simple system consisting of Bacillus subtilis growing in an aqueous solution. In this study optical properties (absorption coefficient μa, scattering coefficient μs, and anisotropy factor g) were estimated and their changes during growth, stationary, and decline phases of Bacillus subtilis culture were examined. It was found that the greatest changes were seen during the growth phase, predominantly manifested in the scattering spectra. Effect of sample thickness on the estimation of the optical properties throughout the cultivation was investigated. The extracted absorption and scattering spectra were found to be fairly consistent even though they were obtained from measurements from different sample thicknesses. The extracted optical properties were used to develop Partial Least Squares (PLS) models for prediction of biomass and glucose concentrations. The performance of these models was compared with those obtained using the raw measurements. As a result of the comparison it was revealed that scattering coefficient based models demonstrate good performance while predicting biomass. The accuracy of these models was equal or in some cases greater then the accuracy of the models built on transmittance and reflectance measurements. Glucose, the second analyte of interest in this work, was modeled with limited success and models were able to distinguish only between low and high level of glucose concentration. The effect of sample thickness on PLS models performance was also studied. Results have shown that sample thickness need to be chosen based on the specific analyte of interest in order to achieve good performance of the models

Monitoring bacterial growth in liquid cultures through the bulk optical parameters in the near-infrared region extracted using the radiative transfer theory

Near infrared (NIR) spectroscopy offers promise as a monitoring tool for fermentation reactions by its potential to provide information about the physical and chemical state of given system. However, issues associated with confounding effects due to light scattering variations that occur during the fermentation process due to changes in the state of the microorganisms makes it difficult to obtain robust estimation of the analytes of interest. An approach for removing multiple scattering effects and separating absorption from scattering using the radiative transfer equation (RTE) is proposed in this work. In order to investigate its feasibility and to aid in the development of the technique, the method was applied to a simple system consisting of Bacillus subtilis growing in an aqueous solution. In this study optical properties (absorption coefficient μa, scattering coefficient μs, and anisotropy factor g) were estimated and their changes during growth, stationary, and decline phases of Bacillus subtilis culture were examined. It was found that the greatest changes were seen during the growth phase, predominantly manifested in the scattering spectra. Effect of sample thickness on the estimation of the optical properties throughout the cultivation was investigated. The extracted absorption and scattering spectra were found to be fairly consistent even though they were obtained from measurements from different sample thicknesses. The extracted optical properties were used to develop Partial Least Squares (PLS) models for prediction of biomass and glucose concentrations. The performance of these models was compared with those obtained using the raw measurements. As a result of the comparison it was revealed that scattering coefficient based models demonstrate good performance while predicting biomass. The accuracy of these models was equal or in some cases greater then the accuracy of the models built on transmittance and reflectance measurements. Glucose, the second analyte of interest in this work, was modeled with limited success and models were able to distinguish only between low and high level of glucose concentration. The effect of sample thickness on PLS models performance was also studied. Results have shown that sample thickness need to be chosen based on the specific analyte of interest in order to achieve good performance of the models.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Relationship between root apices and the mandibular canal: cone-beam computed tomography analysis

Introduction: The anatomical relations between the roots of the distal teeth and the mandibular canal (MC) are clinically important, as well as the possible complications when they are not taken into account. The three-dimensional analysis of the lower jaw is a key aspect in ensuring safe intervention in its distal sections.Aim: The aim of this study is to investigate the relative location of the mandibular canal to the tooth apices, and the possible differences between males and females, different age groups, and between left and right half of the mandible.Material and Methods: Cone-beam computed tomography (CBCT) scans from 100 patients were used to evaluate measurements from 600 teeth and respective MC areas.Results: Direct contact between the root tips and the MC was found in 3.9% of the examined apices and penetration in the MC – in 0.8%. The average reported distance between the apices and the MC is shortest at the distal roots of the second molars. The values, registered for the female patients, were significantly lower than those for the male patients. No statistically significant difference was noted between the measurements in the left and the right half. Significant difference between the age groups was found only in single areas. Conclusion: Clinicians should be aware of the proximity of the root apices to the MC before attempting surgical and root canal procedures in the posterior mandible. Direct communication between the tips of the roots and the MC is not rare and may result in serious nerve injuries if underestimated