Craniofacial Morphology of Croatian Patients with Obstructive Sleep Apnea

Currently, there is no information available regarding craniofacial morphology of Croatian patients with obstructive sleep apnea (OSA). The aim of the study was to determine the craniofacial characteristics of patients with OSA and to assess the association of cephalometric and anthropometric variables related to craniofacial morphology with the apnea hypopnea index (AHI). Anthropometric measurements and upright lateral cephalometric radiographs were obtained from 20 male patients with OSA and 20 male controls. The 20 OSA patients were classified into two groups on the basis of body mass index (BMI) as obese and non-obese. Twenty three variables were identified and calculated for each cephalometric radiograph. OSA was defined as AHI ³ 5/hour. The OSA patients showed greater body mass index (BMI), neck circumference (NC) and cranial index (CI) and lower facial index (FI) compared to the controls (p<0.01). The patients with OSA showed significant cephalometric features as opposed to the controls: smaller linear distance between gonion and menton and anterior cranial base, greater linear distance from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate. Furthermore, they showed reduced upper airway width at two levels: the nasopharynx, and the region of posterior airway space, smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx and greater upper airway length. They also displayed significantly increased craniocervical angulation, larger angle between supramentale, menton and hyoid bone and larger angle between posterior nasal spine, supramentale and hyoid bone. The obese OSA patients showed greater neck circumference (NC) compared with the non-obese OSA. The obese OSA patients showed significant cephalometric features compared with the non-obese OSA patients: larger craniocervical angles larger angle between the third cervical vertebra, the centre of sella turcica and the posterior nasal spine, furthermore, greater linear distance between the hyoid bone and the third cervical vertebra and smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx. In our study, AHI was significantly correlated with cephalometric measurements S-Go, S-H, H-C3 and S-PNS-C3

Comparison of Amitriptyline with Stabilization Splint and Placebo in Chronic TMD Patients: a Pilot Study

Cilj rada: Autori su proveli kliničku studiju kako bi procijenili učinkovitost amitriptilina u liječenju pacijenata s kroničnim temporomandibularnim poremećajima (TMP) te usporedili rezultate liječenja amitriptilinom s onima postignutima stabilizacijskom udlagom. Materijali i postupci: U istraživanje je bio uključen dvadeset i jedan pacijent. Pacijenti su nasumično raspoređeni u tri skupine: pacijenti u skupini A primali su amitriptilin, oni u skupini B dobivali su placebo, a u skupini C liječeni su stabilizacijskom udlagom. Ishodi liječenja [bol procijenjena vizualnom analognom ljestvicom (VAS), maksimalno otvaranje usta bez boli, tj. maksimalno ugodno otvaranje (MCO) i kvaliteta života ovisna o oralnom zdravlju (OHIP-14)], zabilježeni su na početku (prije liječenja) te nakon prvog, šestog i dvanaestog tjedna tretmana. Rezultati: Nisu zabilježene statistički značajnije razlike među skupinama prije početka liječenja (p > 0,05). Rezultati procijenjeni VAS-om značajno su se poboljšali u skupini A (F = 11,326, p = 0,002, veličina učinka = 0,791) te u skupini C (F = 7,343, p = 0,005, veličina učinka = 0,647). Srednji rezultati za OHIP-14 značajno su smanjeni samo u skupini A (F = 4,417, p = 0,036, veličina učinka = 0,596). U skupini B rezultati prema vizualno analognoj ljestvici i prema OHIP-u 14 nisu se s vremenom značajnije promijenili. Pacijenti u skupini C imali su značajniju promjenu rezultata za maksimalno otvaranje usta bez boli u odnosu prema skupinama A i B. Zaključak: Prema rezultatima ove pilot-studije može se zaključiti da je primjena nižih doza amitriptilina tijekom 12 tjedana učinkovito smanjila bol i poboljšala kvalitetu života pacijentima s kroničnim TMP-om. Stabilizacijska udlaga pokazala se u istom razdoblju boljom u liječenju ograničenog otvaranja usta.Objective of work: The authors conducted a clinical study to evaluate the effectiveness of amitriptyline in treatment of chronic TMD patients and to compare treatment results with stabilization splint. Materials and Methods: Twenty-one patients with chronic TMD were included and randomly distributed into 3 groups: patients in Group A received amitriptyline, patients in Group B received placebo, and those in Group C were treated with stabilization splint. Treatment outcomes (pain assessed by a visual analogue scale (VAS), maximal comfortable mouth opening (MCO) and oral health related quality of life (OHIP-14)) were taken at baseline (before treatment), and at 1st, 6th and 12th week of treatment. Results: No statistically significant differences between the groups at baseline were found (p>0.05). VAS scores improved significantly in Group A (F=11.326, p=0.002, effect size =0.791) and in group C (F=7.343, p=0.005, effect size=0.647). Mean OHIP-14 scores decreased significantly only in Group A (F=4.417, p=0.036, effect size =0.596). In Group B, VAS and OHIP-14 scores did not change significantly over time. Subjects in Group C had a significant change in MCO relative to Group A and Group B. Conclusion: From this pilot study it can be concluded that the use of low doses of amitriptyline for a period of 12 weeks is effective for pain management and quality of life improvement in chronic TMD patients. Stabilization splint demonstrated superiority in the management of limited mouth opening during the same period

Aquacel® Ag and Ozone in Bisphosphonate Induced Osteonecrosis of the Jaws (BIONJ) Therapy: a Case Report

Svrha istraživanja: Bisfosfonatima inducirana osteonekroza čeljusti (BIONJ), nakon elektivnih dentalnih zahvata, sve je češća kod onkoloških bolesnika s koštanim metastazama koji se intravenski liječe bisfosfonatima. Klinički slučaj: Opisan je slučaj BIONJ-a u području drugoga desnog gornjeg premolara nakon vađenja zuba. Pacijentica je anamnestički bolovala od karcinoma dojke s koštanim metastazama, a kao terapija određeni su joj bili bisfosfonati intravenski i antimitotička kemoterapija. U prvom i drugom stadiju BIONJ-a liječena je konzervativno antiseptičkim otopinama za ispiranje usta, antibioticima i dodatno oblogama za rane Aquacell Ag te ozonskom terapijom. Nakon što šest mjeseci nije bila na bisfosfonatima, odlučili smo se za kirurški zahvat (resekcija bolesnog dijela kosti), a poslije je dobila djelomičnu gornju protezu. Zaključak: Konzervativna terapija, zajedno s Aquacellom Ag i heal ozonom reducirala je bol i gnojnu infekciju u razdoblju dok je pacijentica bila bez bisfosfonata, iako rana nije u cijelosti zacijeljela. Nakon šest mjeseci obavljen je uspješan kirurški zahvat. Prevencija je najbolji izbor u liječenju BIONJ-a.Objective: Bisphosphonate induced osteonecrosis of the jaw (BIONJ) is often seen in oncologic patients with bone metastasis, who are treated with intravenous bisphosphonates as a result of elective dental treatment. Clinical course: We present a case report of a 68-year-old patient with BIONJ in the right maxillary premolar region after a tooth extraction. The patient had breast cancer, bone metastasis, and received intravenous bisphosphonate therapy and anti-mitotic chemotherapy. Conservative therapy for stages 1 and 2 of BIONJ was indicated with mouth washes, antibiotics and, in addition, local Aquacel Ag wound dressing and HealOzone therapy. After 6 months of drug absence (bisphosphonates), the surgical procedure was performed and the patient obtained a removable prosthetic appliance. Discussion and conclusion: Conservative treatment in addition with Aquacel Ag and HealOzone reduced pain and infection in the waiting period, but the wound did not heal. The surgical procedure after the drug treatment was an efficient solution. Prevention is the best treatment of BIONJ

Usporedba protetičkih radova implantat - zub ili implantat - implantat

Objectives: The primary aim was to compare the amount of bone height change that occurs around the tooth and the implant when having tooth-implant-supported prosthetic restorations versus bone height change that appears around implants in only implant-supported prosthetic restorations. The secondary aim was to examine the influence of various factors such as the number of teeth involved in the construction, their endodontic treatment, number of implants, the type of implantology construction, the jaw in which the construction is located, the condition of the opposite jaw, gender, age, and working time, as well as to examine whether the initial bone level influenced the amount of change in bone height itself. Materials and methods: With a total of 50 respondents, 25 X-ray panoramic images were representing tooth-implant-supported prosthetic restorations, while the other 25 were representing implant-supported prosthetic restorations. Bone measures were taken (from enamel-cement junction/implant neck to the most apical bone point) from 2 panoramic radiographs. The first one is immediately after the implant placement and the second and the last one again in half a year up to seven years after, depending on the time when the photo was taken for each patient. The obtained difference represented the bone resorption, the bone formation, or a state without change. Influence of different factors, such as sex, age of the patient, working time, the number of teeth involved in the construction, endodontic treatment, number of implants, the type of implant construction, the jaw where the construction is located, the condition of the opposite jaw, as well as the initial bone condition, was examined. During the statistical analysis, frequency tables, basic statistical parameters, the Mann-Whitney U test, the Kruskal-Wallis Anova, Wilcoxon test, and regression analysis were used, and the results were presented in tabular form and the form of the Pareto diagram of t-values. Results: No statistically significant difference in bone change (whether we are talking about the place of the implant (-0.359±1.009 and median value 0.000), the place of a tooth (-0.428±0.746 and median value -0,150) in tooth-implant supported restorations, or the place of the implant in case of implant-supported structures (-0,059±0,200 and median value -0,120)) was proven. When talking about the influence of other factors, by regression analysis, the number of implants was shown to be the only factor with a statistically significant influence (β=0.54; P=0.019) in a change of bone level, but only when talking about implant-supported restorations. Conclusion: No significant difference was proven between bone height change, neither around the tooth nor the implant in tooth-implant-supported prosthetic restorations compared to the bone height changes around the implant in only implant-supported prosthetic restorations. Among all the examined factors, the number of implants has shown to have statistically significant contribution to the amount of bone height change in implant-supported prosthetic restorations.Ciljevi: Primarni cilj bio je usporediti promjenu visine kosti koja se pojavljuje na mjestu zuba i implantata kod protetičkih nadomjestaka postavljenih na zube i implantate u odnosu na promjenu visine kosti koja nastaje na mjestu implantata kod protetičkih nadomjestaka postavljenih isključivo na implantatima. Sekundarni cilj bio je ispitati utjecaj različitih čimbenika kao što su broj zuba nosača, endodontska obrada zuba, broj implantata, vrsta implantološkog rada, čeljusti u kojoj se rad nalazi, stanje nasuprotne čeljusti, zatim utjecaj spola, dobi i vremena nošenja, te ispitati je li početna razina kosti utjecala na daljnju promjenu same visine kosti. Materijali i metode: U istraživanju su korištene radiološke panoramske snimke ukupno 50 ispitanika, od čega su na 25 snimki bili protetički nadomjestci postavljeni na kombinaciju zuba i implantata, a na ostalih 25 protetički nadomjestci postavljeni isključivo na implantatima. Visine kosti, mjerene od caklinsko-cementnoga spoja/vrata implantata do najapikalnije točke kosti, uzete su s ukupno dvije radiološke panoramske snimke za svakog ispitanika. Prva je snimljena odmah poslije ugradnje implantata, a druga, ujedno i posljednja, pola godine do sedam godina nakon implantacije, ovisno o vremenu snimanja pacijenta. Dobivena razlika pokazivala je resorpciju kosti, formiranje kosti ili pak stanje bez promjene. Ispitan je i utjecaj različitih čimbenika kao što su spol, dob pacijenta, vrijeme nošenja, broj zuba nosača, endodontsko liječenje, broj implantata, vrsta implantološkog rada, čeljust u kojoj se rad nalazi, stanje nasuprotne čeljusti i početno stanje kosti. Tijekom statističke analize korištene su tablice frekvencija, osnovni statistički parametri, Mann-Whitneyjev U test, Kruskal-Wallisova ANOVA, Wilcoxonov test i regresijska analiza, a rezultati su prikazani tablično i u obliku Paretova dijagrama t-vrijednosti. Rezultati: Nema statistički značajne razlike u promjeni visine kosti, bilo da je riječ o mjestu implantata (-0,359±1,009 i medijan vrijednosti 0,000) i mjestu zuba (-0,428±0,746 i medijan vrijednosti -0,150) kod restauracija postavljenih na zub i implantat, odnosno na mjestu implantata u slučaju struktura postavljenih samo na implantatima (-0,059±0,200 i vrijednost medijana -0,120). Kada je riječ o utjecaju ostalih čimbenika, regresijskom analizom broj implantata pokazao se kao jedini čimbenik sa statistički značajnim utjecajem (β = 0,54; P = 0,019) na promjenu razine kosti, ali samo kada je riječ o protetičkim strukturama postavljenima isključivo na implantatima. Zaključak: Nije dokazana značajna razlika u promjeni visine kosti, ni na mjestu zuba, ni na mjestu implantata kod protetičkih nadomjestaka postavljenih na zubima i implantatima u usporedbi s promjenom visine kosti oko implantata kod protetičkih nadomjestaka postavljenih isključivo na implantatima. Među svim ispitanim čimbenicima broj implantata pokazao je statistički značajan doprinos u količini promjene visine kosti u protetičkim konstrukcijama postavljenim isključivo na implantatima

Analysis of Impacted and Retained Teeth Operated at Department of Oral Surgery, School of Dental Medicine, Zagreb

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8– (38.64%), –8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses –8 and 8– are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000

Analysis of Impacted and Retained Teeth Operated at Department of Oral Surgery, School of Dental Medicine, Zagreb

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8– (38.64%), –8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses –8 and 8– are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000

TRAIT ANXIETY MODERATES THE EFFECT OF DENTAL SURGERY PHASES ON VAGAL ACTIVATION

Decreases in parasympathetic (PNS) activation are a normative reaction to stressful situations. By the Porges&apos; Polyvagal theor

Comparison of Amitriptyline with Stabilization Splint and Placebo in Chronic TMD Patients: a Pilot Study

Objective of work: The authors conducted a clinical study to evaluate the effectiveness of amitriptyline in treatment of chronic TMD patients and to compare treatment results with stabilization splint. Materials and Methods: Twenty-one patients with chronic TMD were included and randomly distributed into 3 groups: patients in Group A received amitriptyline, patients in Group B received placebo, and those in Group C were treated with stabilization splint. Treatment outcomes (pain assessed by a visual analogue scale (VAS), maximal comfortable mouth opening (MCO) and oral health related quality of life (OHIP-14)) were taken at baseline (before treatment), and at 1st, 6th and 12th week of treatment. Results: No statistically significant differences between the groups at baseline were found (p>0.05). VAS scores improved significantly in Group A (F=11.326, p=0.002, effect size =0.791) and in group C (F=7.343, p=0.005, effect size=0.647). Mean OHIP-14 scores decreased significantly only in Group A (F=4.417, p=0.036, effect size =0.596). In Group B, VAS and OHIP-14 scores did not change significantly over time. Subjects in Group C had a significant change in MCO relative to Group A and Group B. Conclusion: From this pilot study it can be concluded that the use of low doses of amitriptyline for a period of 12 weeks is effective for pain management and quality of life improvement in chronic TMD patients. Stabilization splint demonstrated superiority in the management of limited mouth opening during the same period

Aquacel® Ag and Ozone in Bisphosphonate Induced Osteonecrosis of the Jaws (BIONJ) Therapy: a Case Report

Svrha istraživanja: Bisfosfonatima inducirana osteonekroza čeljusti (BIONJ), nakon elektivnih dentalnih zahvata, sve je češća kod onkoloških bolesnika s koštanim metastazama koji se intravenski liječe bisfosfonatima. Klinički slučaj: Opisan je slučaj BIONJ-a u području drugoga desnog gornjeg premolara nakon vađenja zuba. Pacijentica je anamnestički bolovala od karcinoma dojke s koštanim metastazama, a kao terapija određeni su joj bili bisfosfonati intravenski i antimitotička kemoterapija. U prvom i drugom stadiju BIONJ-a liječena je konzervativno antiseptičkim otopinama za ispiranje usta, antibioticima i dodatno oblogama za rane Aquacell Ag te ozonskom terapijom. Nakon što šest mjeseci nije bila na bisfosfonatima, odlučili smo se za kirurški zahvat (resekcija bolesnog dijela kosti), a poslije je dobila djelomičnu gornju protezu. Zaključak: Konzervativna terapija, zajedno s Aquacellom Ag i heal ozonom reducirala je bol i gnojnu infekciju u razdoblju dok je pacijentica bila bez bisfosfonata, iako rana nije u cijelosti zacijeljela. Nakon šest mjeseci obavljen je uspješan kirurški zahvat. Prevencija je najbolji izbor u liječenju BIONJ-a.Objective: Bisphosphonate induced osteonecrosis of the jaw (BIONJ) is often seen in oncologic patients with bone metastasis, who are treated with intravenous bisphosphonates as a result of elective dental treatment. Clinical course: We present a case report of a 68-year-old patient with BIONJ in the right maxillary premolar region after a tooth extraction. The patient had breast cancer, bone metastasis, and received intravenous bisphosphonate therapy and anti-mitotic chemotherapy. Conservative therapy for stages 1 and 2 of BIONJ was indicated with mouth washes, antibiotics and, in addition, local Aquacel Ag wound dressing and HealOzone therapy. After 6 months of drug absence (bisphosphonates), the surgical procedure was performed and the patient obtained a removable prosthetic appliance. Discussion and conclusion: Conservative treatment in addition with Aquacel Ag and HealOzone reduced pain and infection in the waiting period, but the wound did not heal. The surgical procedure after the drug treatment was an efficient solution. Prevention is the best treatment of BIONJ

Tooth-Implant-Supported Prosthetic Structures Versus Implant-Supported Restorations

Objectives: The primary aim was to compare the amount of bone height change that occurs around the tooth and the implant when having tooth-implant-supported prosthetic restorations versus bone height change that appears around implants in only implant-supported prosthetic restorations. The secondary aim was to examine the influence of various factors such as the number of teeth involved in the construction, their endodontic treatment, number of implants, the type of implantology construction, the jaw in which the construction is located, the condition of the opposite jaw, gender, age, and working time, as well as to examine whether the initial bone level influenced the amount of change in bone height itself. Materials and methods: With a total of 50 respondents, 25 X-ray panoramic images were representing tooth-implant-supported prosthetic restorations, while the other 25 were representing implant-supported prosthetic restorations. Bone measures were taken (from enamel-cement junction/implant neck to the most apical bone point) from 2 panoramic radiographs. The first one is immediately after the implant placement and the second and the last one again in half a year up to seven years after, depending on the time when the photo was taken for each patient. The obtained difference represented the bone resorption, the bone formation, or a state without change. Influence of different factors, such as sex, age of the patient, working time, the number of teeth involved in the construction, endodontic treatment, number of implants, the type of implant construction, the jaw where the construction is located, the condition of the opposite jaw, as well as the initial bone condition, was examined. During the statistical analysis, frequency tables, basic statistical parameters, the Mann-Whitney U test, the Kruskal-Wallis Anova, Wilcoxon test, and regression analysis were used, and the results were presented in tabular form and the form of the Pareto diagram of t-values. Results: No statistically significant difference in bone change (whether we are talking about the place of the implant (-0.359±1.009 and median value 0.000), the place of a tooth (-0.428±0.746 and median value -0,150) in tooth-implant supported restorations, or the place of the implant in case of implant-supported structures (-0,059±0,200 and median value -0,120)) was proven. When talking about the influence of other factors, by regression analysis, the number of implants was shown to be the only factor with a statistically significant influence (β=0.54; P=0.019) in a change of bone level, but only when talking about implant-supported restorations. Conclusion: No significant difference was proven between bone height change, neither around the tooth nor the implant in tooth-implant-supported prosthetic restorations compared to the bone height changes around the implant in only implant-supported prosthetic restorations. Among all the examined factors, the number of implants has shown to have statistically significant contribution to the amount of bone height change in implant-supported prosthetic restorations