Analysis of Vestibuloplastics in a Thirty-Year Period (from 1975 to 2004)

Raščlambom povijesti bolesti i operativnoga protokola Klinike za kirurgiju lica, čeljusti i usta od godine 1975. do 2004. pokušavamo pratiti razvoj pretprotetske kirurgije kroz trideset godina. Pretpostavkom da su vestibuloplastike mjerilo razvijenosti oralnokirurške struke te educiranosti stomatologa i specijalista protetičara koji su u stanju postaviti pravu indikaciju za pretprotetski kirurški zahvat pokušavamo utvrditi kako se stanje u stomatologiji mjenjalo tijekom trideset godina. Za pretpostaviti je da se je posljednjih godina smanjila množina pacijenata upućenih na pretprotetski kirurški zahvat zbog povećanog broja ugrađenih usadaka i sve veće zastupljenosti raznih implantoloških sustava na našemu tržištu. S druge strane, povećani broj bolesnika operiranih od malignih bolesti usne šupljine i čeljusti trebaju neku vrstu pretprotetskoga kirurškog zahvata da bi ih se moglo uspješno protetski rehabilitirati. Sedamdesetih godina, kada je oralnom kirurgijom suvereno vladao pokojni profesor Ivo Miše, najveći dio bolesnika operiran je nekom njegovom operativnom metodom. Nakon njegove smrti njegovi najbliži suradnici, koji su obišli mnoge ugledne europske klinike i fakultete, uveli su nove operativne tehnike i metode i one sada čine najveći dio metoda liječenja. Dobiveni rezultati pokazuju osjetan pad broja operacija u posljednje dvije godine, no to ne mora značiti da se množina indikacija za pretprotetske kirurške zahvate smanjuje i da se takvi bolesnici rje-šavaju na neki drugi način, npr. ugradnjom usadaka, jer je u tridesetogodišnjem razdoblju bilo nekoliko godina s osjetnijim padom broja pretprotetskih kirurških zahvata za što ne postoji neko logično objašnjenje. U zaključku možemo reći da su vestibuloplastike i dalje ključni pokazatelj stanja u oralnoj kirurgiji i općenito u stomatologiji.By analysing case histories and operative protocol of the Department of Maxillofacial and Oral Surgery from 1975 to 2004 we have attempted to follow the progress of pre-prosthetic surgery over a thirty-year period. On the assumption that vestibuloplastics are the criteria for development of the oral surgical profession and education of the dentist and prosthetic specialists who are in a position to decide on the correct indication for pre-prosthetic surgical procedure, we have attempted to determine how the circumstances in dental medicine have changed over the thirty years. It may be presumed that the number of patients referred for pre prosthetic surgical procedure has decreased over the last few years because of the increased number of inserted implants and increasing number of available implantological systems on our market. On the other hand the increased number of patients operated on due to malignant diseases of the oral cavity and jaws need some kind of preprosthetic surgical procedure in order to successfully prosthetically be rehabilitated. During the 1970s when the late Professor Ivo Miπe dominated oral surgery, the majority of patients were operated on by his operative method. After his death his close co-workers, who had visited many important European clinics and schools introduced new operative techniques and methods which today comprise the largest number of treatment methods. The results obtained show a definite fall in the number of operations over the last two years, which need not necessarily mean that the number of indications for pre-prosthetic surgical procedure has decreased and that such patients are treated in another way, e.g. by the insertion of an implant, because there were several years in the thirty year period during which there was a distinct decrease in the number of pre-prosthetic surgical procedures, for which there is no logical explanation. Finally it can be said that vestibuloplastics are still the key indicator of the situation in oral surgery and in dental medicine in general

Surgical Treatment of Odontogenic Keratocysts by Intraoral Postoperative Suction

Prikazana su dva slučaja odontogenih keratocista od kojih se jedna pojavila na suprotnoj strani čeljusti nakon operacije folikularne ciste druge strane čeljusti, a druga je recidivirala u razmjerno kratku vremenu. Ni u jednome slučaju nije dokazana mogućnost postojanja Gorlin-Goltzova sindroma. Obje su odontogene keratociste kirurški liječene enukleacijom cistične čahure i poslijeoperacijskom intraoralnom sukcijom s time da je u drugome slučaju isti postupak ponovljen i prigodom pojave recidiva. Činjenica da trajna intraoralna poslijeoperacijska sukcija osigurava cijeljenje koštanoga tkiva donje čeljusti u razmjerno kratku vremenu, pri liječenju odontogene keratociste nije utjecala na mogućnost razvoja recidiva. Autori zato zaključuju da pri liječenju odontogenih keratocista nije važno koji ćemo kirurški postupak provesti, ako se služimo konzervativnim kirurškim postupkom. Metodu masupijalizacije u tim slučajevima treba potpuno napustiti. Druge konzervativne kirurške metode nose rizik recidiva i ako se recidivi više puta ponavljaju moguće je da keratocista prodre u meka tkiva gdje ju je teže kirurški pratiti. Autori smatraju da je raščlambom odgovarajućeg kliničkog uzorka potrebno procijeniti koliko se često javljaju ozbiljni recidivi odontogenih keratocista sa širenjem u meka tkiva ili druge perioralne strukture. O tim podatcima ovisi treba li pri liječenju recidiva odontogenih keratocista zauzeti stajališta kakva postoje pri liječenju svih lokalno invazivnih odontogenih tvorbi.Two cases of odontogenic keratocysts are presented of which the first occurred on the opposite side of the jaw after an operation for a follicular cyst, and the other recurred within a relatively short period. In neither case was the existence of Gorlin-Goltzov syndrome possible. Both odontogenic keratocysts were surgically treated by enucleation of the cystic capsule and postoperative intraoral suction. In the second case the procedure was repeated due to a recurrence. The fact that permanent intraoral postoperative suction ensures the healing of mandibular bone tissue in a relatively short time, it had no influence on the possibility of the development of a recurrence during the treatment of an odontogenic keratocyst. The authors therefore conclude that during the treatment of odontogenic keratocysts the surgical method used is not important if the surgical method used is conservative. In such cases the marsupialisation method should be completely abandoned. Other conservative surgical methods include the risk of recurrence, and should the recurrence occur repeatedly there is a possibility of the keratocyst penetrating into the soft tissue where it is more difficult to treat surgically. The authors consider that by analysing the relevant clinical sample it is necessary to calculate how often severe recurrences of odontogenic keratocysts occur with expansion into the soft tissue or other perioral structures. Thus these data could be used during the treatment of recurrences of odontogenic keratocysts, in view of the perspectives which exist in the treatment of all locally invasive odontogenic formations

Do We Know Everything about Radioosteonecrosis?

Maligne su bolesti, prema podatcima SZO, uz kardiovaskularne bolesti prevalentna bolest sadašnjice. Radijacijsko zračenje, kao jedan od oblika terapije malignoma, ima primarnu zadaću uništiti tumorske stanice, a što je moguće manje oštetiti okolno tkivo. Najveća i najopasnija komplikacija u radioterapiji glave i vrata svakako je osteoradionekroza (ORN). Ona se najčešće javlja kada je doza zračenja preko 60 Gy ili u pacijenata koji primaju kombinirano radio i kemoterapiju. U 5-22% takvih ozračenih pacijenata javlja se ORN. ORN se može javiti spontano, ali u 60% slučaja javlja se kao odgovor na ozljedu tkiva, najčešće nakon vađenja zuba, ali i drugih manipulacija u usnoj šupljini. Kost zbog radijacije postaje acelularna, avaskularna i hipoksična, a klinički se to očituje kao pojava ulceracija, nekroze sluznice i eksponiranje nekrotične kosti, uz pojavu bolnosti i eventualnih parestezija. Predilekcijsko mjesto su stražnji dijelovi donje čeljusti. U dijagnosticiranju ORN-a, osim kliničkoga pregleda, potrebno je uporabiti ortopantomogram, kompjutoriziranu tomografiju i magnetsku rezonanciju. U budućnosti će veliku važnost imati SPECT (single-photon emmision computed tomography). Kliničke smjernice u terapiji ORN-a su prije svega dobar preventivni program i periradijacijska skrb pacijenata koji idu na zračenje, a ako nastanu promjene, potrebna je kirurška terapija, terapija hidrobaričnim kisikom (HBO) te uporaba Marxova protokola. Prikaz niza primjera iz naše prakse prikazuje koliko su kliničke smjernice implementirane.According to data of the World Health Organisation, malignant diseases, apart from cardiovascular diseases, are the most prevalent diseases of today. As one form of therapy for malignancy radiation in 63% of patients has the primary task of destroying tumour cells, while minimally damaging the surrounding tissue. The greatest and most dangerous complication in radiotherapy of the head and neck is without doubt osteoradionecrosis (ORN). It occurs most frequently when the dose of radiation is more than 60 Gy or in the case of patients who receive combined radio and chemo-therapy. ORN occurs in 5-22% of such irradiated patients. ORN can occur spontaneously, although in 60% of cases it occurs as a response to tissue injury, usually after tooth extraction, but also after other manipulations in the oral cavity. Because of the radiation the bone becomes acellular, avascular and hypoxic, and clinically can be interpreted as the occurrence of ulceration, mucous membrane necrosis and exposure of necrotic bone, with pain and eventual paresthesia. Predilective sites are the posterior parts of the mandible. For diagnosis of ORN, apart from a medical examination, orthopantomogram, computerised tomography and magnetic resonance are needed. In the future SPECT (single-photon emission computed tomography) will have an important role. Clinical indicators in the therapy of ORN are first and foremost a good preventive programme and periradiational care of the patient undergoing radiation, and in the case that changes do occur surgical therapy is needed, therapy with hydrobaric oxygen (HBO), and the use of Marx\u27s protocol. Presentation of numerous examples from our practice shows how many clinical indicators are implemented

Surgical Treatment of Large Mandibular Cysts

Na temelju pregleda literature željelo se prikazati metode liječenja velikih cista donje čeljusti kako bi se utvrdilo jesu li pristupi u liječenju domaćih i svjetskih autora slični, a ako nisu, u čemu se razlikuju. Pregled literature je pokazao da se osnovna načela liječenja velikih cista donje čeljusti postupno mijenjanju i u svijetu i u nas. Metoda marsupijalizacije postupno se napušta i zamjenjuju je metode koje poput Partsch II metode primarno zatvaraju koštani defekt. Svim je tim postupcima jedinstveno to da nastoje smanjiti postoperacijski koštani defekt kako bi se mogućnosti infekcije krvnoga ugruška smanjile, a rana zacijelila primarno. Ti su postupci bitno skratili liječenje velikih koštanih cista donje čeljusti. Koju metodu izabrati ne treba predlagati. Kirurg će prema svojemu iskustvu i rezultatima postignutim odgovarajućim metodama izabrati onu od koje očekuje najmanje neugode za pacijenta i najkraći postupak liječenja.Based on a review of available literature sources on the treatment of large mandibular cysts, a comparison of various treatment approaches has been performed in order to identify similarities and differences between the treatment approaches used by domestic and foreign authors. The review shows that basic principles of the treatment of large mandibular cysts are changing in Croatia as well as abroad. Marsupialisation methods are being gradually replaced by different methods which all primarily close the bone defect, as in the Partsch II method. Methods differ only in the approach used to close it. The common goal of all these methods is to reduce the postoperative bone defect in order to reduce the possibility of coagulation, infections and to heal the wounds primarily. These methods lead to significantly reduced duration of the treatment of large mandibular cysts. The choice of the most suitable method is left to the surgeon, who, based on his experience and results obtained with a particular method in the past, has to choose the method which will pose the least possible stress on the patient and ensure the shortest treatment time

Orthognathic Surgery - Our Concept

Ortognatska kirurgija spada u skupinu estetsko-funkcionalnih operacija. Većina naših bolesnika dolazi na prvi pregled zahtijevajući promjenu izgleda. Prvi pregled je razgovor s bolesnikom i na njemu se uvijek nazočni ortodont i maksilofacijalni kirurg. Uzimaju se otisci fotografija an face i profila te telerendgen snimke. Na osnovi dobivenih podataka stvara se okvirni plan liječenja. Na drugome pregledu iznosi se plan liječenja i potanko se objašnjavaju postupci ortodontskog i kirurškog liječenja i moguće komplikacije. U razgovoru se rabi baza podataka ortognatskih zahvata i računalna simulacija. Bolesnici donose konačnu odluku te se na trećemu pregledu dogovara liječenje. Aktivno liječenje rijetko počinjemo prije sedamnaeste godine. Ovisno o planu, uključuje se oralni kirurg i počinje se s ortodontskim tretmanom. Kada je priprema za zahvat završena, ponavlja se razgovor s bolesnikom i dogovara se termin primitka. Bolesnik dolazi na bolničko liječenje pripremljen i s obavljenim anesteziološkim pregledom. Operacija je najčešće na dan primitka, a bolesnik u bolnici boravi 3 do 5 dana. Na primjerima vraćanja i izvlačenja donje i gornje čeljusti te bimaksilarnih zahvata prikazati ćemo naš pristup ortognatskoj kirurgiji.Orthognathic surgical treatment is both functional and esthetic. For most of our patients the reason for the first visit is esthetics. The first appointment is made in the combined maxillofacial and orthodontics clinic. During the first appointment we talk to the patient to get a general idea of his/her wishes and medical photographs, jaw models and X-rays are taken. After collecting all data a general plan for the treatment is made. During the second appointment we discuss our treatment plan together with details of both orthodontic and surgical therapy with the patient. In this discussion we use photographs from our data base and computer simulation. After the final patient’s decision is made, we start with the treatment. Depending on the treatment plan, it starts with either oral surgery or orthodontics. For most of the patients we do not start with treatment before seventeen years of age. After presurgical treatment is finished, we again discuss details of the operation with the patient and a hospital appointment is made. The operation is usually performed on the day of admission, and the hospital stay is 3 to 5 days. We discuss our treatment concept based on patients with the different types of skeletal deformities

Traumatic Bone Cysts

Traumatska koštana cista (TKC) patološka je tvorba složene etiologije. Prikladnu dijagnozu i liječenje dodatno komplicira i široka paleta drugih patoloških promjena u čeljusti koji diferencijalno dijagnostički dolaze u obzir. Karakteristično je da kod TKC-a nećemo naći tipičan nalaz za cistu, tj. u patohistološkoj raščlambi neće biti cističnog epitela u obliku cistične ovojnice. U anamnezi je moguće otkriti traumu u zahvaćenom području. TKC pokazuje karakteristično prosvjetljenje na rendgenogramu i najčešće ne daje simptome. U ovome radu prikazan je pregled literature i osnovne značajke TKC-a. Tipičan nalaz u tijeku operacije, rezultat patohistološke dijagnoze (PHD) i pravilno uzeta anamneza, uz dobro poznavanje diferencijalne dijagnostike, pomoći će nam uspješno liječiti pacijenta.A traumatic bone cyst is a pathological formation of complex aetiology. Adequate diagnosis and treatment are additionally complicated by the broad palette of other pathological processes in the area of the jaw, which can differentially diagnostically be considered. Characteristically, in the case of a TBC a typical finding for a cyst will not be found, i.e. in the histopathological analysis cystic epithelia in the form of a cystic sheath will not be present. In the case history it is possible to disclose trauma in the affected area. TBC shows characteristic radiolucent areas on the radiograph, and most frequently does not have symptoms. This study presents a review of literature and basic characteristics of TBC. A typical finding during the operation, the PHD result and correct recording of the case history, together with a good knowledge of differential diagnostics will enable realisation of successful treatment of the patient

Comparison of the Bond Strengths of Zinc Phosphate, Glass-Ionomer, and Compomere Cement for Dowel Cementation

Unatoč dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolčića. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolčića cementiranih s trima različitim vrstama cemenata: cink-fosfatnim, stakleno-ionomernim i kompomernim. Prikupljeno je 30 zuba i endodontski preparirano do dubine od 7 mm i ISO promjera 140. Podijeljeni su u 3 skupine od 10 uzoraka. S pomoću triju navedenih vrsta cemenata u njih su cementirani kolčići od čelične žice. Pošto se je cement stvrdnuo, izmjerena je vlačna sila potrebna za izvlačenje kolčića iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175±33,17 N, za stakleno-ionomerni 235,5±46,93 N, a za kompomerni 275,63±96,42 N. Kolčići cementirani kompomerom imaju znatno jaču retenciju od kolčića cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jače retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrješke u radu i razmjerna jeftinoća, te još uvijek u mnogim kliničkim okolnostima ostaje cement izbora.In spite of numerous previous studies, there is no final conclusion on which type of cement is the best for dowel cementation. The purpose of this study was to compare the retention of dowels cemented with three different cement types: zinc phosphate, glass-ionomer, and compomere. Thirty teeth were divided into 3 groups, root-canals were prepared to ISO 140, to 7 mm depth and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. For zinc phosphate it was 175±33.17 N, for glass-ionomer 235.5±46.93 N, and for compomere 275.63±96.42 N. The dowels cemented with compomere had significantly higher tensile strength than those cemented with zinc phosphate or glass-ionomer cement. Glass-ionomer cement had significantly higher tensile strength than zinc phosphate cement. The advantages of zinc-phosphate are its low price and simple usage. Thus, in many clinical situations it may be the cement of choice

Examination of the Retention of Sm-Co5 and Nd-Fe-B Magnets

U planiranju retencije jedna od najvažnijih zadaća jest konstrukcijom, veličinom i oblikom retencijskih elemenata omogućiti prijenos sila koje opterećena tkiva mogu prihvatiti bez oštećenja. Magneti izrađeni od biokompatibilnih materijala upotrebljavaju se sve češće kao suvremena sredstva retencije potpunih i djelomičnih protetskih nadomjestaka te resekcijskih proteza. Svrha je rada ispitati čimbenike o kojima ovisi jakost retencijske sile Sm-Co5 i Nd-Fe-B magneta. Uzorci su podijeljeni u dvije skupine: 28 parova Sm-Co5 magneta te 28 parova Nd-Fe-B magneta. Visine mjerenih magneta bile su 2; 2,5 i 3 mm. Svaki se je uzorak sastojao od skupine s lateralnom silom i skupine bez djelovanja lateralne sile. Vrijednosti sile izmjerene su s pomoću uređaja za mjerenje magnetne retencijske sile koji omogućuje mjeriti retencijske sile raznih kombinacija permanentnih magneta i feromagnetnih materijala. Rezultati su prikazani grafički i u tablicama. Temeljni čimbenici koji utječu na veličinu retencijske magnetne sile jesu: vrsta magneta, veličina, njihova međusobna udaljenost i postojanje lateralnih sila. Dobivene vrijednosti prikazuju koje se veličine i debljine magnetnih parova moraju upotrijebiti za željenu silu retencije.When planning retention one of the most important tasks is to ensure that the construction, size and form of the retentive elements enable the transfer of forces which the loaded tissues can accept without damage. The use of magnets fabricated from biocompatible materials is becoming increasingly used as a means of retention for total and partial prosthetic replacements and resectional prostheses. The purpose of this study was to examine factors on which the strength of retentive forces Sm-Co5 and Nd-Fe-B magnets depend. The samples were divided into two groups: 28 pairs of Sm-Co5 magnets and 28 pairs of Nd-Fe-B magnets. The heights of the measured magnets were 2, 2.5 and 3 mm. Each sample consisted of a group with lateral force and a group without lateral force. The force values were measured by means of a device for measuring magnetic retentive forces, which enables the measurement of retentive forces of different combinations of permanent magnets and ferromagnetic materials. The results are presented in figures and tables. The basic factors that influence the magnitude of the retentive magnetic force are the type of magnet, size, their mutual distance and the presence of lateral forces. The values obtained indicate which sizes and thickness of the magnetic pairs should be used for the desired force of retention

The Effect of Root Canal Preparation Depth on Retention of Endodontic Dowels

Ako nedostaje više od pola krune endodontski liječenoga zuba, potrebno ga je nadograditi lijevanom nadogradnjom ili konfekcijskim kolčićem. Retencija kolčića ovisi o njegovu promjeru, obliku, dubini ugradnje i upotrijebljenom cementu. Svrha rada bila je dobiti podatke o utjecaju dubine preparacije korijenskoga kanala na retenciju kolčića i usporediti postojeće preporuke. 30 je zuba podijeljeno u 3 skupine, korijenski su kanali preparirani do 5, 7 i 9 mm dubine i u njih su cementirani kolčići. Nakon 40 sati izmjerena je sila potrebna za čupanje kolčića iz korijenskoga kanala. Za kolčiće na dubini od 5 mm sila je iznosila 174,17 ± 29,45 N, na 7 mm 235,5 ± 46,93 N, a na 9 mm 255 ± 72,74 N. Produbljivanje preparacije s 1/3 na 1/2 dubine korijenskoga kanala (s 5 na 7 mm) znatno povećava retenciju. Produbljivanje s 1/2 na 2/3 dubine (s 7 na 9 mm) ne daje znatno povećanje retencije kolčića.When more than half of the crown of the endodontically treated tooth is missing, reinforcement with a cast post or a prefabricated dowel is needed. Four factors affect dowel retention: diameter, design, length, and employed cement. The purpose of this study was to measure the influence of root-canal preparation depth on retention force, and evaluate the commonly used principles. Thirty teeth were divided into 3 groups, root canals were prepared to 5.7 and 9 mm, and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. At 5 mm depth it was 174.17 ± 29.45 N, at 7 mm 235.5 ± 46.93 N, and at 9 mm 255 ± 72.74 N. There was significant difference between dowel retention at 1/3 and at 1/2 of the root depth (5 and 7 mm). Difference between retention at 1/2 and at 2/3 of the root depth (7 and 9 mm) was not significant