19 research outputs found
Analysis of Vestibuloplastics in a Thirty-Year Period (from 1975 to 2004)
RaÅ”Älambom povijesti bolesti i operativnoga protokola Klinike za kirurgiju lica, Äeljusti i usta od godine 1975. do 2004. pokuÅ”avamo pratiti razvoj pretprotetske kirurgije kroz trideset godina.
Pretpostavkom da su vestibuloplastike mjerilo razvijenosti oralnokirurÅ”ke struke te educiranosti stomatologa i specijalista protetiÄara koji su u stanju postaviti pravu indikaciju za pretprotetski kirurÅ”ki zahvat pokuÅ”avamo utvrditi kako se stanje u stomatologiji mjenjalo tijekom trideset godina.
Za pretpostaviti je da se je posljednjih godina smanjila množina pacijenata upuÄenih na pretprotetski kirurÅ”ki zahvat zbog poveÄanog broja ugraÄenih usadaka i sve veÄe zastupljenosti raznih implantoloÅ”kih sustava na naÅ”emu tržiÅ”tu. S druge strane, poveÄani broj bolesnika operiranih od malignih bolesti usne Å”upljine i Äeljusti trebaju neku vrstu pretprotetskoga kirurÅ”kog zahvata da bi ih se moglo uspjeÅ”no protetski rehabilitirati.
Sedamdesetih godina, kada je oralnom kirurgijom suvereno vladao pokojni profesor Ivo MiÅ”e, najveÄi dio bolesnika operiran je nekom njegovom operativnom metodom.
Nakon njegove smrti njegovi najbliži suradnici, koji su obiÅ”li mnoge ugledne europske klinike i fakultete, uveli su nove operativne tehnike i metode i one sada Äine najveÄi dio metoda lijeÄenja.
Dobiveni rezultati pokazuju osjetan pad broja operacija u posljednje dvije godine, no to ne mora znaÄiti da se množina indikacija za pretprotetske kirurÅ”ke zahvate smanjuje i da se takvi bolesnici rje-Å”avaju na neki drugi naÄin, npr. ugradnjom usadaka, jer je u tridesetogodiÅ”njem razdoblju bilo nekoliko godina s osjetnijim padom broja pretprotetskih kirurÅ”kih zahvata za Å”to ne postoji neko logiÄno objaÅ”njenje.
U zakljuÄku možemo reÄi da su vestibuloplastike i dalje kljuÄni pokazatelj stanja u oralnoj kirurgiji i opÄenito 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 MiĻe 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 sluÄaja odontogenih keratocista od kojih se jedna pojavila na suprotnoj strani Äeljusti nakon operacije folikularne ciste druge strane Äeljusti, a druga je recidivirala u razmjerno kratku vremenu. Ni u jednome sluÄaju nije dokazana moguÄnost postojanja Gorlin-Goltzova sindroma. Obje su odontogene keratociste kirurÅ”ki lijeÄene enukleacijom cistiÄne Äahure i poslijeoperacijskom intraoralnom sukcijom s time da je u drugome sluÄaju isti postupak ponovljen i prigodom pojave recidiva.
Äinjenica da trajna intraoralna poslijeoperacijska sukcija osigurava cijeljenje koÅ”tanoga tkiva donje Äeljusti u razmjerno kratku vremenu, pri lijeÄenju odontogene keratociste nije utjecala na moguÄnost razvoja recidiva. Autori zato zakljuÄuju da pri lijeÄenju odontogenih keratocista nije važno koji Äemo kirurÅ”ki postupak provesti, ako se služimo konzervativnim kirurÅ”kim postupkom. Metodu masupijalizacije u tim sluÄajevima treba potpuno napustiti. Druge konzervativne kirurÅ”ke metode nose rizik recidiva i ako se recidivi viÅ”e puta ponavljaju moguÄe je da keratocista prodre u meka tkiva gdje ju je teže kirurÅ”ki pratiti. Autori smatraju da je raÅ”Älambom odgovarajuÄeg kliniÄkog uzorka potrebno procijeniti koliko se Äesto javljaju ozbiljni recidivi odontogenih keratocista sa Å”irenjem u meka tkiva ili druge perioralne strukture. O tim podatcima ovisi treba li pri lijeÄenju recidiva odontogenih keratocista zauzeti stajaliÅ”ta kakva postoje pri lijeÄenju 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 sadaŔnjice.
Radijacijsko zraÄenje, kao jedan od oblika terapije malignoma, ima primarnu zadaÄu uniÅ”titi tumorske stanice, a Å”to je moguÄe manje oÅ”tetiti okolno tkivo.
NajveÄa i najopasnija komplikacija u radioterapiji glave i vrata svakako je osteoradionekroza (ORN). Ona se najÄeÅ”Äe javlja kada je doza zraÄenja preko 60 Gy ili u pacijenata koji primaju kombinirano radio i kemoterapiju. U 5-22% takvih ozraÄenih pacijenata javlja se ORN. ORN se može javiti spontano, ali u 60% sluÄaja javlja se kao odgovor na ozljedu tkiva, najÄeÅ”Äe nakon vaÄenja zuba, ali i drugih manipulacija u usnoj Å”upljini. Kost zbog radijacije postaje acelularna, avaskularna i hipoksiÄna, a kliniÄki se to oÄituje kao pojava ulceracija, nekroze sluznice i eksponiranje nekrotiÄne kosti, uz pojavu bolnosti i eventualnih parestezija. Predilekcijsko mjesto su stražnji dijelovi donje Äeljusti. U dijagnosticiranju ORN-a, osim kliniÄkoga pregleda, potrebno je uporabiti ortopantomogram, kompjutoriziranu tomografiju i magnetsku rezonanciju. U buduÄnosti Äe veliku važnost imati SPECT (single-photon emmision computed tomography).
KliniÄke smjernice u terapiji ORN-a su prije svega dobar preventivni program i periradijacijska skrb pacijenata koji idu na zraÄenje, a ako nastanu promjene, potrebna je kirurÅ”ka terapija, terapija hidrobariÄnim kisikom (HBO) te uporaba Marxova protokola. Prikaz niza primjera iz naÅ”e prakse prikazuje koliko su kliniÄke 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 lijeÄenja velikih cista donje Äeljusti kako bi se utvrdilo jesu li pristupi u lijeÄenju domaÄih i svjetskih autora sliÄni, a ako nisu, u Äemu se razlikuju.
Pregled literature je pokazao da se osnovna naÄela lijeÄenja velikih cista donje Äeljusti postupno mijenjanju i u svijetu i u nas.
Metoda marsupijalizacije postupno se napuÅ”ta i zamjenjuju je metode koje poput Partsch II metode primarno zatvaraju koÅ”tani defekt. Svim je tim postupcima jedinstveno to da nastoje smanjiti postoperacijski koÅ”tani defekt kako bi se moguÄnosti infekcije krvnoga ugruÅ”ka smanjile, a rana zacijelila primarno.
Ti su postupci bitno skratili lijeÄenje velikih koÅ”tanih cista donje Äeljusti.
Koju metodu izabrati ne treba predlagati. Kirurg Äe prema svojemu iskustvu i rezultatima postignutim odgovarajuÄim metodama izabrati onu od koje oÄekuje najmanje neugode za pacijenta i najkraÄi postupak lijeÄenja.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. VeÄina naÅ”ih bolesnika dolazi na prvi pregled zahtijevajuÄi promjenu izgleda. Prvi pregled je razgovor s bolesnikom i na njemu se uvijek nazoÄni ortodont i maksilofacijalni kirurg. Uzimaju se otisci fotografija an face i profila te telerendgen snimke. Na osnovi dobivenih podataka stvara se okvirni plan lijeÄenja. Na drugome
pregledu iznosi se plan lijeÄenja i potanko se objaÅ”njavaju postupci ortodontskog i kirurÅ”kog lijeÄenja i moguÄe komplikacije. U razgovoru se rabi baza podataka ortognatskih zahvata i raÄunalna simulacija. Bolesnici donose konaÄnu odluku te se na treÄemu pregledu dogovara lijeÄenje. Aktivno lijeÄenje rijetko poÄinjemo prije sedamnaeste godine. Ovisno o planu, ukljuÄuje se oralni kirurg
i poÄinje se s ortodontskim tretmanom. Kada je priprema za zahvat zavrÅ”ena, ponavlja se razgovor s bolesnikom i dogovara se termin primitka. Bolesnik dolazi na bolniÄko lijeÄenje pripremljen i s obavljenim anestezioloÅ”kim pregledom. Operacija je najÄeÅ”Äe na dan primitka, a bolesnik u bolnici boravi 3 do 5 dana. Na primjerima vraÄanja i izvlaÄenja donje i gornje Äeljusti te bimaksilarnih zahvata
prikazati Äemo naÅ” 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 patientās 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 koÅ”tana cista (TKC) patoloÅ”ka je tvorba složene etiologije. Prikladnu dijagnozu i lijeÄenje dodatno komplicira i Å”iroka paleta drugih patoloÅ”kih promjena u Äeljusti koji diferencijalno dijagnostiÄki dolaze u obzir. KarakteristiÄno je da kod TKC-a neÄemo naÄi tipiÄan nalaz za cistu, tj. u patohistoloÅ”koj raÅ”Älambi neÄe biti cistiÄnog epitela u obliku cistiÄne ovojnice. U anamnezi je moguÄe otkriti traumu u zahvaÄenom podruÄju. TKC pokazuje karakteristiÄno prosvjetljenje na rendgenogramu i najÄeÅ”Äe ne daje simptome. U ovome radu prikazan je pregled literature i osnovne znaÄajke TKC-a. TipiÄan nalaz u tijeku operacije, rezultat patohistoloÅ”ke dijagnoze (PHD) i pravilno uzeta anamneza, uz dobro poznavanje diferencijalne dijagnostike, pomoÄi Äe nam uspjeÅ”no lijeÄiti 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
UnatoÄ dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolÄiÄa. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolÄiÄa cementiranih s trima razliÄitim 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 pomoÄu triju navedenih vrsta cemenata u njih su cementirani kolÄiÄi od ÄeliÄne žice. PoÅ”to se je cement stvrdnuo, izmjerena je vlaÄna sila potrebna za izvlaÄenje kolÄiÄa iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175Ā±33,17 N, za stakleno-ionomerni 235,5Ā±46,93 N, a za kompomerni 275,63Ā±96,42 N.
KolÄiÄi cementirani kompomerom imaju znatno jaÄu retenciju od
kolÄiÄa cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jaÄe retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrjeÅ”ke u radu i razmjerna jeftinoÄa, te joÅ” uvijek u mnogim kliniÄkim 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 175Ā±33.17 N, for glass-ionomer 235.5Ā±46.93 N, and for compomere 275.63Ā±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 zadaÄa jest konstrukcijom, veliÄinom i oblikom retencijskih elemenata omoguÄiti prijenos sila koje optereÄena tkiva mogu prihvatiti bez oÅ”teÄenja. Magneti izraÄeni od biokompatibilnih materijala upotrebljavaju se sve ÄeÅ”Äe kao suvremena sredstva retencije potpunih i djelomiÄnih protetskih nadomjestaka te resekcijskih proteza. Svrha je rada ispitati Äimbenike 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 pomoÄu ureÄaja za mjerenje magnetne retencijske sile koji omoguÄuje mjeriti retencijske sile raznih kombinacija permanentnih magneta i feromagnetnih materijala. Rezultati su prikazani grafiÄki i u tablicama. Temeljni Äimbenici koji utjeÄu na veliÄinu retencijske magnetne sile jesu: vrsta magneta, veliÄina, njihova meÄusobna udaljenost i postojanje lateralnih sila. Dobivene vrijednosti prikazuju koje se veliÄine 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 viÅ”e od pola krune endodontski lijeÄenoga zuba, potrebno ga je nadograditi lijevanom nadogradnjom ili konfekcijskim kolÄiÄem. Retencija kolÄiÄa ovisi o njegovu promjeru, obliku, dubini ugradnje i upotrijebljenom cementu. Svrha rada bila je dobiti podatke o utjecaju dubine preparacije korijenskoga kanala na retenciju kolÄiÄa i usporediti postojeÄe preporuke. 30 je zuba podijeljeno u 3 skupine, korijenski su kanali preparirani do 5, 7 i 9 mm dubine i u njih su cementirani kolÄiÄi. Nakon 40 sati izmjerena je sila potrebna za Äupanje kolÄiÄa iz korijenskoga kanala. Za kolÄiÄe na dubini od 5 mm sila je iznosila 174,17 Ā± 29,45 N, na 7 mm 235,5 Ā± 46,93 N, a na 9 mm 255 Ā± 72,74 N. Produbljivanje preparacije s 1/3 na 1/2 dubine korijenskoga kanala (s 5 na 7 mm) znatno poveÄava retenciju. Produbljivanje s 1/2 na 2/3 dubine (s 7 na 9 mm) ne daje znatno poveÄanje retencije kolÄiÄa.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 Ā± 29.45 N, at 7 mm 235.5 Ā± 46.93 N, and at 9 mm 255 Ā± 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