Differential Diagnostics and Assessment of Cystic Translucencies of the Jaws

Cistične prozirnosti čeljusti više su ili manje jasno ograničena, ovalna ili okrugla, jedinstvena ili višestruka prosvjetljenja u kosti ravnih ili valovitih rubova, najčešće uzrokovana cistama pa je i dijagnostika takvih promjena najčešće jednostavna. Ponekad se iza takvih ili sličnih slika skrivaju patološke promjene koje stvaraju dijagnostičke poteškoće pa je za dijagnostiku potrebno odgovarajuće znanje i iskustvo, a i uz tu pretpostavku mogućnosti zabune katkada su moguće. Sve se konačno svodi na to da se ispravnom dijagnozom omogući ispravan izbor kirurškoga liječenja ili izbor neke druge metode liječenja, ovisno u naravi promjene. Patološke promjene koje u kosti stvaraju prosvjetljenja mogu biti: odontogene ili neodontogene ciste, pseudociste, odontogeni tumori bez kalcificiranoga tkiva, gigantocelularne promjene čeljusti, ektopičan položaj tkiva žlijezda slinovnica, benigni neodontogeni tumori poput dezmoplastičnog fibroma, hemangioma ili neurinoma, lokalizirani oblici histiocitoze X, koštane promjene u sklopu nekih sindroma, neke bolesti organskih sustava pa čak i primarni maligni tumori čeljusti ili metastaze drugih malignih tumora tijela. Ograničena prosvijetljenja u čeljusti mogu uzrokovati i zubni zametci prije njihove kalcifikacije, varijacije u trabekularnoj građi spongiozne kosti i žarišni osteoporotički koπtani defekti, poremećaji cijeljenja kosti nakon vađenja zuba, među koje spada i takozvani parafinom ili miosferuloza, zatim vezivno cijeljenje koštanih šupljina nakon kirurških zahvata i naposljetku prosvjetljenja koja su rezultat anatomske građe čeljusti. Svrha je predavanja prikazom primjera iz vlastite kazuistike prikazati tipične i atipične rendgenske slike, upozoriti na raznovrsnosti radioloških osobitosti, a osobito na specifičnosti radioloških nalaza koje nagovješćuju agresivan rast tvorbi ili veću potentnost njihova tkiva.Cystic translucencies of the jaws are more or less clearly circumscribed, oval or round, solitary or multiple translucencies in the bone with straight or wavy edges. As they are most frequently caused by cysts diagnosis of such lesions is usually simple. Occasionally pathological lesions are hidden behind such conditions, creating diagnostic difficulties, and consequently adequate knowledge and experience are required for diagnosis, and at the same time awareness that a mistake is occasionally possible. Namely, the correct diagnosis enables the correct choice of surgical treatment or choice of some other method of treatment, depending on the nature of the lesion. Pathological lesions which create translucency may be: odontogenic or nonodontogenic cysts, pseudocysts, odontogenic tumours without calcified tissue, gigantocellular jaw lesions, ectopic position of the salivary gland tissue, benign nonodontogenic tumours, such as desomoplastic fibroma, hemangioma or neurinoma, localised forms of histiocytosis X, osseous lesions in certain syndromes, some diseases of organic systems, and even primary malignant tumours of the jaws or metastases of other malignant tumours of the body. Restricted translucency in the jaws can be induced by dental germs prior to their calcification, variation in the trabecular structure of spongy bones and focally osteoporotic bone defects, impaired bone healing after tooth extraction, including so-called paraffinoma or myospherulosis, connective healing of the bone cavity after surgical procedures and finally translucencies which are the result of the anatomic structure of the jaws. The object of the lecture is to warn of the diversity of radiographic idiosyncrasies by showing examples of typical and atypical X-rays, particularly the specificity of radiographic findings which predict aggressive growth of formations or greater tissue potential

Application of Tricalcium Phosphate in the Treatment of Large Bone Cavities of Jaws

Trikalcijev fosfat -Ca3(PO4)2 -resorbilna je i biokompatibilna kalcijeva fosfatna keramika s omjerom atoma kalcija i fosfata vrlo sličnim prirodnom koštanom mineralu pa se u tkivu i ponaša poput vlastitoga koštanog transplantata. Na tržištu se pojavljuje u obliku zrnaca različite veličine. Postupno se resorbira tijekom pregradnje kosti i nadomješta novim koštanim tkivom, a u oralnoj se kirurgiji uglavnom upotrebljava kod većih defekata kosti koji nastaju nakon operacija cista i tumora te u dentalnoj implantologiji. Može poslužiti kao nosač osteoinduktivnih dodataka poput morfogenetskoga proteina te podržati njegovo djelovanje. Najpoznatiji su predstavnici te skupine Ceros 82, Calciresorb, Sinthograft, Augmen, Ilmaplant, a od novijih Cerasorb, Bio-Resorb i Biovision, pripravci na bazi beta-trikalcijeva fosfata. Svrha je rada prikazati dinamiku cijeljenja koštanih defekata čeljusti zaostalih nakon operacije cista, tumora ili drugih patoloških promjena koje su punjene granulatom Bio Resorba i usporediti ih s drugim poznatim metodama liječenja. Postupak je izveden na hospitaliziranim pacijentima s njihovim pristankom u Kliničkom zavodu za oralnu kirurgiju Kliničke bolnice Dubrava. Koštani su defekti punjeni potrebnom količinom granulata veličine zrnaca od 1000 - 2000 μm. Rezultati cijeljenja subjektivno su procijenjeni raščlambom kontrolnih snimaka nakon 2, 4 i 6 mjeseci i uspoređivani s cijeljenjem istovrsnih šupljina liječenih drugim postupcima. Od 37 pacijenata Bio Resorb je upotrijebljen u 10 slučajeva ( 3 radikularne ciste, 2 folikularne ciste, 2 odontogene keratociste i 3 traumatske koštane šupljine/ciste) koji su rezultirali koštanim šupljinama većim od 3 cm u promjeru. U jednome slučaju pacijentica je imala poteškoće s infekcijom pa su izbacivanje zrnaca i ponovne upalne smetnje trajali dva mjeseca poslije zahvata. U svih ostalih pacijenata nije bilo komplikacija, a obnova koštane strukture bila je završena u razdoblju od 4 do 6 mjeseci nakon zahvata. Prikazani primjeri i njihova usporedba s rezultatima dobivenim metodama ekskohleacije i dekortikacije čeljusti ili ekskohleacije i trajne poslijeoperacijske sukcije govore u prilog uporabe resorbilnoga trikalcijeva fosfata, osobito pri liječenju velikih traumatskih koštanih šupljina. Tom se metodom brže uspostavlja očekivana građa kosti nego drugim primijenjenim metodama.Tricalcium phosphate - Ca3(PO)2 is a resorptive and bio-compatible calcium phosphate ceramic with the ratio of calcium and phosphate atoms very similar to natural osseous mineral. Thus in the tissue it behaves like its own bone transplant. On the market it appears in the form of granules of different size. It gradually becomes entirely resorbed during the conversion of bone and substitution with new osseous tissue. In oral surgery it is mainly applied for major bone defects which occur after cysts and tumours operations, and in dental implantology. It can serve as a carrier of osteoinductive supplements, such as morphogenetic protein, and maintain its activity. The best known representatives of this group are Ceros 82, Calciresorb, Sinthograft, Augmen, Ilmaplant, while more recent are Cerasorb, Bio-Resorb and Biovision, preparations on the basis of beta-tricalcic phosphate. The purpose of the paper is to show the dynamism of healing bone defects of the jaw, remaining after operations for cysts, tumours, or other pathological lesions, which are filled with granulate Bio Resorba, and to compare them with other wellknown methods of treatment. The procedure was carried out in hospitalised patients with their consent in the Clinical Department of Oral Surgery, University Hospital “Dubrava.” The bone defects were filled with the appropriate amount of granulates, 1 000 -2 000 μm in size. Healing results were subjectively evaluated by analysis of radiographs after 2, 4, and 6 months and compared with the healing of the same kind of cavities treated by other procedures. Out of 37 cases Bio-Resorb was applied in 10 cases (3 radicular cysts, 2 follicular cysts, 2 odontogenic keratocysts and three traumatic bone cavities/cysts), which resulted in bone cavities larger than 3 cm in diameter. In one case a female patient developed infection and rejection of the granules, and repeated inflammatory problems lasted for two months after the intervention. No other patient showed complications, and the renewal of bone structure was completed in the period from 4 to 6 months after the intervention. The presented examples and their comparison with the results obtained by methods of excochleation and decortication of the jaw, or excochleation and permanent post operational suction, favour the application of resorptive tricalcic phosphate, particularly in the treatment of large traumatic bone cavities. This method ensures faster establishment of the expected bone structure than other applied methods

Prof. Branka Pilar-Svoboda (1920-2005) Farewell Speech at the Mirogoj Cemetery, 2nd March 2005

Rođena je u Slavonskome Brodu 30. studenoga 1920. Maturirala je u Slavonskoj Požegi 1939. godine. Diplomirala je na Medicinskom fakultetu u Zagrebu 1945., a zatim položila specijalistički ispit iz stomatologije 1951., pa iz maksilofacijalne kirurgije 1971. Disertaciju pod naslovom "Rast i razvoj čeljusti kod urođenih rascjepa usne i nepca" obranila je godine 1967., a habilitacijski rad pod naslovom "Hemihipertrofične i hemiartrofične unilateralne deformacije lica i ličnog skeleta" godine 1972. Na Stomatološkoj klinici na Šalati, iz koje je poslije nastao i Stomatološki fakultet u Zagrebu i Klinika za kirurgiju čeljusti lica i usta, volonterski je radila kao apsolventica medicine od godine 1944. Zadnjih godina Drugoga svjetskog rata pomagala je u liječenju mnogobrojnih ranjenika koji su tih godina zauzeli cijelu zgradu Klinike na Šalati. Bavila se maksilofacijalnom kirurgijom, stomatologijom i anesteziologijom, pa je tako bila anesteziologinja sve do dolaska na Kliniku prof. Vere Arko godine 1964. Kad je akademik Ivo Čupar pripremao svoje životno djelo "Kirurgija glave i vrata" u 3 dijela prof. Pilar-Svoboda uradila je zamašan dio posla i pomogla da se knjige objave. Nakon odlaska u mirovinu suočila se s bolešću koja joj je ograničavala komunikaciju s najbližima. Kao dinamičnoj osobi takav je život za nju bio osobito težak teret koji je ponekad jedva nosila. Sudbina joj nije dopustila da zajedno s Ivnom i Mirnom duže uživa u svojim unucima.She was born in Slavonski Brod on 30th November 1920. Matriculated in Slavonska Požega in 1939 and graduated at the School of Medicine in Zagreb in 1945. She later passed specialist examinations in Dental Medicine in 1951 and Maxillofacial Surgery in 1971. She defended her dissertation thesis entitled "Growth and Development of the Jaw in the Innate Cleft Lip and Palate", in 1967 and subsequent habilitation study entitled "Hemihypertrophic and Hemiatrophic Deformations of the Face and Facial Bones" in 1972. In 1944 she began work as a volunteer in the Clinic of Dental Medicine at Šalata, which later became the School of Dental Medicine in Zagreb and the Clinic of Maxillofacial and Oral Surgery. During the last few years of the Second World War she assisted in the treatment of numerous wounded people, who at that time occupied the whole of the Clinic at Šalata. She was engaged in maxillofacial surgery, dental medicine and anaesthesiology, and acted as an anaesthesiologist up until the arrival of Prof. Vera Arko to the Clinic in 1964. At the time when Ivo Čupar was preparing his life work "Surgery of the Head and Neck" in 3 volumes Prof. Pilar Svoboda helped with a large part of the work and publishing the books. After her retirement she was confronted with a disease which restricted her communication with people closest to her. As she was a dynamic person such a life was a particularly heavy burden, which at times was hard for her to bear. Fate prevented her enjoyment with Ivna and Mirna in the company of her grandchildren

Surgical Procedures in the Treatment of Large Osseous Cavities of the Jaws

Problem izbora kirurškoga postupka pri liječenju velikih koštanih šupljina koje nastaju pošto se odstrane benigne patološke promjene čeljusti sastoji se u tome kako kirurškim postupkom spriječiti moguće recidive lokalno invazivnih promjena te kako bez infekcije osigurati organizaciju krvnog ugruška i obnovu kosti. To je u povijesti bilo razlogom nastanka i razvoja nekoliko različitih kirurških postupaka. Prikazat će se rezultati liječenja velikih koštanih šupljina metodom Partsch II s intraoralnom poslijeoperativnom sukcijom, metodom Partsch II s dekortikacijom jedne strane čeljusti, rezultati nakon punjenja koštanih defekata s resorbilnim granulatom trikalcijeva fosfata (BioResorb tvrtke “Oraltronics”), te rezultati liječenja dvofaznim kirurškim postupkom. Iz rezultata provedenih kliničkih istraživanja može se zaključiti da svaka od spomenutih metoda daje dobre rezultate, ako se primijeni u ispravno izabranim indikacijama. Primjena intraoralne sukcije sigurna je i najjeftinija metoda za najveće koštane defekte, pogotovo ako se istodobno izvrši i dekortikacija jedne koštane stijenke. Primjena aloplastičnoga resorbilnog materijala sigurnija je od primjene neresorbilnih materijala i cijeljenje se završava bez komplikacije u razdoblju od šest mjeseci. Dvofazni kirurški postupak u liječenju odontoma čeljusti jedinstven je u literaturi. Napuštene metode marsupijalizacije ponovno oživljavaju nakon eksperimentalnih istraživanja kojima je dokazana promjena potentnosti epitela tako liječenih odontogenih keratocista za koje je iz literature i iz svakodnevne prakse poznato da su izrazito sklone recidivu, pa ih suvremena patologija danas svrstava među odontogene tumore.The problem of the choice of surgical procedure in the treatment of large osseous cavities which remain after the removal of benign pathological lesions of the jaws implies the need to prevent possible recurrences of local invasive lesions by the surgical procedure and to ensure organisation of the blood clot and restoration of the bone without infection. This was the reason for the appearance of several different surgical procedures that developed throughout history. The treatment of large osseous cavities by Partsch II method with intraoral postoperative suction and Partsch II method with decortication of one side of the jaw will be presented, and the results after filling the bone defect with resorbable granulate tricalcic phosphate (BioResorb, Oraltronics), and the results of treatment by biphase surgical procedure. From the results of clinical investigations it can be concluded that each of the above methods produces good results, when applied in correctly chosen indications. The application of intraoral suction is safe and the cheapest method for the largest osseous defects, particularly if at the same time decortication of one osseous wall is performed. The application of alloplastic resorbable material is safer than the application of nonresorbable materials, and healing is completed without complications within a period of six months. Biphase surgical procedure in the treatment of odontoma of the jaws is unique in the literature. The abandoned methods of marsupialisation are again being revived after experimental investigations showed changes in the virility of the epithelia of such treated odontogenic keratocysts, which from the literature and daily practice are known to be extremely prone to recurrence, and therefore in modern pathology today they are classified as odontogenic tumours

Central Hemangioma of the Mandible: Case Report

Autori opisuju centralni hemangiom donje čeljusti dijagnosticiran radiološki i patohistološki, a kirurški se postupak komplicirao zbog naknadnog krvarenja koje je zaustavljeno dodatnim kirurškim zahvatom. Kako je centralni hemangiom čeljusti dosta rijedak - što potvrđuje i navedena literatura – a moguće komplikacije kod te patološke promjene mogu biti izrazito opasne, svrha prikaza je istaknuti kliničke, radiološke i patohistološke karakteristike te tvorbe. Usporedba s drugim slučajem - koji je radiološki izgledao kao policističan tumor čeljusti, ali je tijekom zahvata počelo obilno krvarenje te je odgođen nastavak zahvata i indicirala se dodatna angiografska i radiološka obrada - pokazala je da nema karakteristične kliničke i radiološke slike koja bi mogla upozoravati na takve promjene. Raznolikost radioloških slika u svjetskoj literaturi upozorava da svaka transparencija u čeljusti među patološkim promjenama može biti i centralni hamangiom. Prikazani slučajevi potvrđuju takvo mišljenje.The authors present a case of central hemangioma of the mandible which was diagnosed radiographically and histopathologically. The surgical procedure was complicated by subsequent bleeding which was stopped by an additional surgical procedure. As central hemangioma of the jaws is a relatively rare findings, which can be observed from the relevant literature, and possible complications can be extremely dramatic, the aim of the presentation is to emphasise the clinical, radiographic and histopathological characteristics of this formation. Comparison with another case, which radiographically resembled a polycystic tumour of the jaw and which bled profusely during the operation, causing the postponement of the operation and indicating the need for additional angiographic and radiotherapy, demonstrated that there are no characteristic clinical and radiographic appearances which can indicate the possibility of such changes. The diversity of the radiographic appearances presented in the world literature shows that apart from other pathological changes any transparency in the jaws may also be a central hemangioma. The presented cases confirm this judgement

Surgical-Orthodontic Treatment of Developmental Odontogenic Cysts of the Jaws

Prikazani su rezultati kirurško-ortodontskoga liječenja odontogenih razvojnih cista sa svrhom da se upozori na važnost trajnoga timskog rada ortodonta i oralnoga kirurga u rješavanju svakoga pojedinog slučaja, ma kako se neki od njih činili jednostavnima. Takvom suradnjom moguće je sačuvati retinirane ili impaktirane zube i u slučajevima kad se čini da to neće biti moguće. Primjer liječenja velike folikularne ciste u osmogodišnje djevojčice dokaz je uspješnosti takve suradnje. Autori predstavljaju i suvremene spoznaje o liječenju odontogenih cista, upozoravaju na lokalnu invazivnost odontogene keratociste i najavljuju rezultate uporabe resorbilnoga granulata trikalcijeva fosfata.The results are shown of surgical-orthodontic treatment of developmental odontogenic cysts of the jaws with the purpose of demonstrating the importance of long-term teamwork of the orthodontist and oral surgeon in resolving each individual case, despite the fact that some cases may appear to be simple. Such cooperation enables the preservation of impacted teeth, even in cases when this appears almost impossible. The example presented of treatment of a large follicular cyst in an eight-year old girl is proof of the success of such cooperation. The authors also present contemporary knowledge on the treatment of odontogenic cysts, warn of the local invasive nature of odontogenic keratocysts and show the results of the application of resorptive granular tricalcium phosphate

The investigation of the manipulation with scores on amoral dimension of the HEDONICA inventory

Faking on Amoral dimension of the HEDONICA personality inventory was incited by the context simulation instructions: fake good (S2), fake bad (S3) and be honest (S1). Simultaneously, under instruction S1, the scores of respondents were measured on the Amoral facets of Self-concept scale (GSC), the Balanced social desirability scale (BIDR) and the cognitive tests of the fluid (IT2, ALF and RM) and the crystallized (AL4, vocabulary and GSN) intelligence, supposed (Morality), or known from the literature, as possible faking determinants. The score differences on Amoral dimension facets were calculated for S2 and for S3 situations using as a baseline the score in S1 situation. The score differences between S3 and S1 situations (abbreviated as FB) were found to be larger than the ones between S2 and S1 situations (abbreviated as FG). This result indicated that a) Amoral is susceptible to faking, and b) in S3, rather than in S2 situation, respondents displayed higher tendency of faking, or in other words, they incline to make worse rather than good presentation of themselves. The Projection facet of Amoral was most sensitive toward faking. These differences are found to be correlated with the Morality dimension of Self- concept scale and the fluid intelligence factor, but not with the dimensions of Social desirability scale in both situation for almost all faking scores on Amoral facets. Only Brutality was not related to the Morality, and Viciousness was not related to the Gf. This indicated that the dimension Morality of the Self-concept scale is far more correlated with the Amoral dimension of the HEDONICA personality scale than with the Social desirability scale

A Two-Stage Surgical Approach in the Treatment of a Large Complex Odontoma of the Mandible

Prikazan je neobično velik primjer jedinstveno složenog odontoma (complex) u angulusu donje čeljusti u 23-godišnjeg mladića. Zbog mogućeg prijeloma donje čeljusti, koji bi zbog veličine tvorbe mogao nastati za vrijeme kirurškoga zahvata u jednome aktu, proveden je dvofazan kirurški postupak koji se je pokazao uspješnim i za pacijenta prihvatljivim. Autori navode podatke iz literature i prikazuju druge kirurške mogućnosti za slične slučajeve. Raspravlja se o prednostima i nedostatcima spomenutih postupaka i ostavlja čitateljstvu da prosudi o njihovim vrijednostima.The paper describes an example of an unusually large, complex odontoma in the mandibular angle of a 23 year-old young man. Because of the possibility of fracture occurring in the mandible during the operation a two-stage surgical procedure was applied, which proved successful and was acceptable for the patient. The authors cite data from the literature, showing other possible surgical procedures in similar cases and discussing their advantages and disadvantages, leaving the reader to decide on the justification of all applied surgical procedures to date

Usporedba nastavnog plana na Stomatološkom fakultetu Sveučilišta u Zagrebu s odgovarajućim planovima u europskim zemljama

The staff of the Zagreb School of Dentistry firmly believes that dental medicine is a differentiated profession which have been crossed over the frames of mere dentistry long time age. The guidelines in education and practice should be based on the need of training a doctor of dental medicine to deal with the prevention, diagnosis, treatment and follow-up of the diseases of stomatognathic system and perioral regions. This statement is beyond any dispute and can be realised in future by enforcement of an independent school of dentistry within the frames of a university, with appropriate corrections of the curriculum and possibilities of introducing new subjects, according to the curricula of European Community countries and other developed countries of the globe, especially United States of America and United Kingdom.Na Stomatološkom fakultetu u Zagrebu postoji čvrsto uvjerenje svih nastavnika kako je stomatologija samostalna zdravstvena struka, koja je davno prešla okvire zubarstva te se u edukaciji treba rukovoditi pretpostavkama kako stvaramo liječnika - doktora stomatologije koji se bavi preventivom, dijagnostikom, liječenjem i praćenjem bolesti stomatognatoga sustava, oralne i perioralnih regija. Takvo stajalište može se u budućnosti osigurati samo jačanjem Stomatološkoga fakulteta kao samostalne sveučilišne ustanove u svim dijelovima njegove djelatnosti. Autori prikazuju povijesni razvoj i nastavni program Stomatološkoga fakulteta u Zagrebu, uspoređujući ga s programima fakulteta nekih europskih zemalja. Plan, program i trajanje studija stomatologije na Sveučilištu u Zagrebu vrlo su slični onima u drugim europskim zemljama. Autori vide budućnost Stomatološkoga fakulteta u sadašnjoj koncepciji i okvirima, uz odgovarajuće korekcije nastavnoga plana i programa, koje znače ravnomjerniji raspored nastave, otvaraju pitanje uvođenja nekih novih programskih sadržaja i pitanje trajanja studija, a sve u namjeri približavanja promjenama u okvirima Europske zajednice i drugim razvijenim zemljama svijeta, po sebice Sjedinjenih Američkih Država i Velike Britanije

Treatment of Large Odontoma of the Mandible by Two-Phase Surgical Procedure

Postoje dva moguća kirurška postupka u liječenju velikih jedinstveno složenih odontoma ili drugih odontogenih tumora donje čeljusti. Jedan je klasičan kirurški postupak, kao u slučajevima alveotomija retiniranih ili inpaktiranih zuba, i moguće ga je izvesti kad je riječ o manjim primjerima odontoma u kojima je okolna kost dovoljno sačuvana i ne postoji opasnost od patološkog ili jatrogenoga prijeloma donje čeljusti. Taj je zahvat također moguć i kod većih odontogenih tumora koji se lako ljušte iz njihova koštanoga ležišta. Drugi je postupak odstraniti tumor s pomoću takozvane sagitalne osteotomije donje čeljusti, kao što su to opisali Rittersma J. i van Gool AV. godine 1979. Autori prikazuju primjer neobično velikoga jedinstveno složenog odontoma u angulusu donje čeljusti u 23-godišnjeg muškarca. Zbog mogućega prijeloma čeljusti tijekom zahvata u jednom aktu, izvršen je dvofazni kirurški postupak koji se je pokazao uspješnim i prihvatljivim za pacijenta. Autori navode podatke iz literature, raspravljaju o prednostima i nedostatcima različitih kirurških postupaka ostavljajući slušateljstvu da ocijeni opravdanost pojedinih potupaka primjenjivanih do danas.Two methods are possible in the surgical treatment of large examples of complex odontomas or other odontogenic tumors of the mandible. One is classical intraoral approach, as in the case of alveotomy of retained or impacted teeth, wich im simple to perform in the case of small examples of odontomas, where the bone is still sufficiently preserved, and there is consequently no danger of pathological or iatrogenic fracture of the jaw. It is also possible in the case of large tumors that are easily denucleated from the bony site. Another method is to remove the tumor by means of so-called sagittal osteotomy of the mandible described by Ritersma J, and van Gool AV. 1979. The authors present an example of an unusually large, complex odontoma of the mandibular angle of a 23 yearold man. Because of the possibility of fracture during the operation in one step a two phase surgical procedure was applied, wich proved successful and was acceptable for the patient. The authors cite data from the literature, discussing advantages and disadvantages of different surgical procedures, leaving the audience to decide on justification of all applied surgical procedures to date