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

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

Marsupialisation of Keratocystic Odontogenic Tumour of the Mandible: Current Dilemma

Autori predstavljaju rezultate liječenja keratocističnog odontogenog tumora (KCOT-a) čeljusti kirurškim postupkom marsupijalizacije u kontekstu suvremenih dilema koje se o tom problemu mogu naći u literaturi. Na temeljno pitanje, može li marsupijalizacija biti konačan postupak u liječenju KCOT-a, još se ne može sa sigurnošću odgovoriti ni na osnovi podataka iz literature ni pozitivnih podataka predstavljenih u radu. Prikaz nešto promijenjenih rezultata liječenja uzorka iz ranije publiciranog rada i dvaju slučajeva nakon toga izvješća, autorima daju za pravo tvrditi da je marsupijalizacija metoda izbora, s vjerojatnošću da bude i konačan postupak u liječenju KCOT-a. Prema suvremenim podatcima iz literature traži se i nadalje višegodišnje postoperativno praćenje pacijenata i primjena dodatnih sredstava liječenja kako bi se spriječili recidivi.The authors present the results of treating mandibular keratocystic odontogenic tumour (KCOT) by the surgical method of marsupialisation in the context of current dilemma in the literature regarding this problem. The basic question of whether marsupialisation can be the definitive method in treatment of KCOT still cannot be answered with certainty, neither on the basis of data from the literature nor on the basis of positive data presented in the study. Presentation of slightly modified results of the treatment of a sample from an earlier published study, and two cases treated subsequently give the authors the prerogative to claim that marsupialisation of KCOT is the method of choice, which will probably be the definitive method of treatment. Current data from the literature still require several years of postoperative monitoring of patients and application of additional means of treatment in order to prevent relapse

New Illustrations of st. Apollonia in the Churches of st. Catherine in Zagreb and Vodnjan

Svrha rada bila je opisati kapelu svete Apolonije u Akademskoj crkvi svete Katarine u Zagrebu zbog činjenice da se u njoj, osim dosad opisivane oltarne pale koja prikazuje sveticu, nalazi i reljef od štuka s prikazom mučeništva svete Apolonije, no do danas nije predstavljen u stomatološkoj literaturi. Opisuju se svi likovni, kiparski i reljefni elementi kapele te procjene likovnih stručnjaka o njihovoj atribuciji i vrijednosti. Potpuno je drugačiji slučaj s ikonografskim prikazom svete Apolonije u romaničkoj crkvi svete Katarine, djevice i mučenice iz Vodnjana. Riječ je, naime, o nedavnom otkriću fresaka u toj crkvi koja potječe iz 16. stoljeća. Tijekom restauratorskih radova započetih 2012. godine konzervatori i restauratori Odjela za zidno slikarstvo i mozaik Hrvatskoga restauratorskog zavoda otkrili su freske nepoznatog autora ispod cementnog sloja žbuke, a na njima i lik svete Apolonije. Prvi je primjer u Akademskoj crkvi svete Katarine jasno vidljiv, ali ostao je neprimijećen autorima koji su u stomatološkoj literaturi opisivali oltarnu palu koja prikazuje sveticu, a drugi u crkvi svete Katarine u Vodnjanu bio je nevidljiv i slučajno je otkriven pri restauraciji fresaka do tada prekrivenih žbukom. Oba se opisuju s namjerom da bi se u stomatološkoj periodici, osim struke, našlo što više prikaza svete Apolonije te dobilo stvarno stanje o ikonografskim prikazima te svetice u Hrvatskoj, a sadržaji likovne umjetnosti u bliskoj vezi s dentalnom medicinom postali dostupni čitateljstvu.The aim of the article is to describe the chapel of St. Apollonia in the Academic Church of St. Catherine in Zagreb because, apart from the previously described altarpiece which shows the saint, there is also a stucco relief in the church which shows the martyrdom of St. Apollonia, which has not previously been described in the dental literature. All artistic, sculptural and relief elements of the chapel are described and evaluations of their value are provided by art experts. The case of the iconographic illustration of St. Apollonia in the Romanesque Church of St. Catherine, Virgin and Martyr in Vodnjan is quite different. Namely, the frescos were recently discovered in the church which dates from the 14th century. During restoration work, which was commenced in 2012 by the Conservatory and Restoration Department for Mural and Mosaic of the Croatian Restoration Institute, frescos by an unknown author were revealed under a layer of mortar showing the figure of St. Apollonia. The first example in the Academic Church of St. Catherine is clearly visible, but was not described by authors in dental literature, and the second example in the Church of St. Catherine, Virgin and Martyr in Vodnjan was not visible and was later revealed by chance during restoration of frescos which had been covered with mortar. Both examples are described to increase the number of illustrations of St. Apollonia in the journal, and to present the situation today with regard to iconographic illustrations of the saint in Croatia, so that the content of visual arts closely connected with dental medicine is accessible to readers

THE EFFECT OF SINGLE PREOPERATIVE APPLICATION OF AN ANTIBIOTIC ON THE CCURRENCE OF COMPLICATIONS AFTER ALVEOLECTOMY OF THE LOWER WISDOM TOOTH

Svrha istraživanja bila je na kliničkom uzorku istražiti opravdanost profilaktičke primjene antibiotika amoksicilina u sprječavanju komplikacija nakon alveotomije donjeg umnjaka. Uzorak se sastojao od dvije skupine nasumce izabranih ispitanika. Prvu su skupinu činile dvije podskupine pacijenata koji prije zahvata nisu imali znakova upale u predjelu umnjaka. U prvoj podskupini bilo je 100 ispitanika koji su 1 sat prije zahvata peroralno dobili 2 g amoksicilina ( Belupo- farmaceutska kompanija, Koprivnica, Hrvatska), a u kontrolnoj podskupini 100 pacijenata koji dobili placebo – kapsule maltodekstrina u blister pakovanju (Magdis – farmaceutska proizvodnja, Sveta Nedjelja, Hrvatska). Drugu skupinu činile su dvije podskupine od po 100 ispitanika, koji su prethodno imali znakove perikoronarne ili druge upale uz zub koji se odstranjivao i koji su prije zahvata primili amoksicilin ili placebo kao i u prethodne dvije podskupine. Rezultati prve ispitne skupine u podskupini s placebom pokazali su: statistički značajno više oteklina 1. stupnja unutar 24 sata (P = 0,048), veći broj ispitanika s povišenom temperaturom nakon zahvata (P=0,042), intenzitet boli nakon 24 sata statistički izraženiji u ispitanika s oteklinom 2. stupnja (P=0,015) i s poslijeoperativnim krvarenjem (P=0,002) te više ispitanika s povišenom temperaturom nakon 7 dana (P=0,012). U podskupini s antibiotikom pokazalo se: oteklinu 1. stupnja nakon 7 dana imalo je statistički značajno više ispitanika (P=0,001) i bilo je manje, ali ne statistički značajno, ispitanika bez otekline, negoli u skupini s placebom. Nisu nađene razlike između ispitanika dviju podskupina u stupnju trizmusa, kao niti u intenzitetu boli praćenom kroz vrijeme od 24 sata i nakon 7 dana.Rezultati druge ispitne skupine u podskupini s placebom pokazali su: intenzitet boli nakon 7 dana bio je značajno izraženiji (P=0,001), a prosječno trajanje boli bilo je značajno duže, veći je broj ispitanika imao krvarenje unutar 24 sata (P=0,001), veća bol zabilježena je u ispitanika koji su imali otekline 2. i 3. stupnja (P=0,013), (P=0,049) te u ispitanika s krvarenjem unutar 24 sata (P=0,003), nakon 7 dana ispitanici su iskazali značajno veću bol uz oteklinu 1. stupnja (P=0,003) u odnosu na podskupinu s antibiotikom. U zaključku se profilaktička primjena antibiotika preporučuje kao rutinski postupak u slučajevima kontaminiranih rana, kakve su one koje nastaju nakon alveotomije donjih umnjaka koji su prethodno uzrokovali upalu u svojoj okolini. I u skupini ispitanika bez prethodne upale profilaktička primjena antibiotika pokazala je pozitivne rezultate, ali se ne preporučuje kao rutinski postupak.The object of the study was to examine in a clinical sample the justification of prophylactic application of the antibiotic amoxicillin to avoid complications after alveolectomy of the lower wisdom tooth. The sample consisted of two groups of randomly selected patients. The first group comprised two sub-groups of patients who had not had previous signs of inflammation in the region of the wisdom tooth. In the first subgroup there were 100 patients who had received 2 g. of amoxicillin (Belupo – pharmaceutical company, Koprivnica, Croatia ) one hour before the operation and a control group of 100 patients who had received a placebo – capsule in a bubble- pack filled with maltodextrin (Magdis – pharmaceutical production, Sveta Nedjelja, Croatia). The second group comprised two sub-groups of 100 subjects each, who had previously had signs of pericoronary or other types of inflammation of the tooth which was extracted and who had received amoxicillin or a placebo, as in the previous two sub-groups. The results of the first examined group in the sub-group with a placebo were: statistically significantly more 1st degree swelling within 24 hours (P = 0.048), a greater number of subjects with raised temperature after the operation (P=0.042), pain intensity after 24 hours was statistically more marked in subjects with 2nd degree swelling (P=0.015) and with post-operative bleeding (P=0.002) and more subjects with raised temperature after 7 days (P=0.012). The following was found in the sub-group with antibiotic: 1st degree swelling after 7 days was statistically significant in more subjects (P=0.001), and there were fewer subjects with swelling than in the group with a placebo. No differences were found between the subjects in the two sub-groups in the trismus grade, nor in pain intensity, monitored during a period of 24 hours and after 7 days. The results of the second examined group in the sub-group with a placebo were: pain intensity after 7 days was significantly more intense (P=0.001), and the average duration of pain was significantly longer, a greater number of subjects had bleeding within 24 hours (P=0.001), greater pain was registered in subjects who had 2nd and 3rd degree swelling (P=0.013), (P=0.049) and in subjects with bleeding within 24 hours (P=0.003), and after 7 days subjects had significantly greater pain with 1st degree swelling (P=0.003) compared to the sub-group with antibiotic. In conclusion obtained prophylactic application of an antibiotic is recommended as a routine method in cases with contaminated wounds. In the group of subjects with no previous inflammation prophylactic application of an antibiotic is not recommended as a routine method

THE EFFECT OF SINGLE PREOPERATIVE APPLICATION OF AN ANTIBIOTIC ON THE CCURRENCE OF COMPLICATIONS AFTER ALVEOLECTOMY OF THE LOWER WISDOM TOOTH

Svrha istraživanja bila je na kliničkom uzorku istražiti opravdanost profilaktičke primjene antibiotika amoksicilina u sprječavanju komplikacija nakon alveotomije donjeg umnjaka. Uzorak se sastojao od dvije skupine nasumce izabranih ispitanika. Prvu su skupinu činile dvije podskupine pacijenata koji prije zahvata nisu imali znakova upale u predjelu umnjaka. U prvoj podskupini bilo je 100 ispitanika koji su 1 sat prije zahvata peroralno dobili 2 g amoksicilina ( Belupo- farmaceutska kompanija, Koprivnica, Hrvatska), a u kontrolnoj podskupini 100 pacijenata koji dobili placebo – kapsule maltodekstrina u blister pakovanju (Magdis – farmaceutska proizvodnja, Sveta Nedjelja, Hrvatska). Drugu skupinu činile su dvije podskupine od po 100 ispitanika, koji su prethodno imali znakove perikoronarne ili druge upale uz zub koji se odstranjivao i koji su prije zahvata primili amoksicilin ili placebo kao i u prethodne dvije podskupine. Rezultati prve ispitne skupine u podskupini s placebom pokazali su: statistički značajno više oteklina 1. stupnja unutar 24 sata (P = 0,048), veći broj ispitanika s povišenom temperaturom nakon zahvata (P=0,042), intenzitet boli nakon 24 sata statistički izraženiji u ispitanika s oteklinom 2. stupnja (P=0,015) i s poslijeoperativnim krvarenjem (P=0,002) te više ispitanika s povišenom temperaturom nakon 7 dana (P=0,012). U podskupini s antibiotikom pokazalo se: oteklinu 1. stupnja nakon 7 dana imalo je statistički značajno više ispitanika (P=0,001) i bilo je manje, ali ne statistički značajno, ispitanika bez otekline, negoli u skupini s placebom. Nisu nađene razlike između ispitanika dviju podskupina u stupnju trizmusa, kao niti u intenzitetu boli praćenom kroz vrijeme od 24 sata i nakon 7 dana.Rezultati druge ispitne skupine u podskupini s placebom pokazali su: intenzitet boli nakon 7 dana bio je značajno izraženiji (P=0,001), a prosječno trajanje boli bilo je značajno duže, veći je broj ispitanika imao krvarenje unutar 24 sata (P=0,001), veća bol zabilježena je u ispitanika koji su imali otekline 2. i 3. stupnja (P=0,013), (P=0,049) te u ispitanika s krvarenjem unutar 24 sata (P=0,003), nakon 7 dana ispitanici su iskazali značajno veću bol uz oteklinu 1. stupnja (P=0,003) u odnosu na podskupinu s antibiotikom. U zaključku se profilaktička primjena antibiotika preporučuje kao rutinski postupak u slučajevima kontaminiranih rana, kakve su one koje nastaju nakon alveotomije donjih umnjaka koji su prethodno uzrokovali upalu u svojoj okolini. I u skupini ispitanika bez prethodne upale profilaktička primjena antibiotika pokazala je pozitivne rezultate, ali se ne preporučuje kao rutinski postupak.The object of the study was to examine in a clinical sample the justification of prophylactic application of the antibiotic amoxicillin to avoid complications after alveolectomy of the lower wisdom tooth. The sample consisted of two groups of randomly selected patients. The first group comprised two sub-groups of patients who had not had previous signs of inflammation in the region of the wisdom tooth. In the first subgroup there were 100 patients who had received 2 g. of amoxicillin (Belupo – pharmaceutical company, Koprivnica, Croatia ) one hour before the operation and a control group of 100 patients who had received a placebo – capsule in a bubble- pack filled with maltodextrin (Magdis – pharmaceutical production, Sveta Nedjelja, Croatia). The second group comprised two sub-groups of 100 subjects each, who had previously had signs of pericoronary or other types of inflammation of the tooth which was extracted and who had received amoxicillin or a placebo, as in the previous two sub-groups. The results of the first examined group in the sub-group with a placebo were: statistically significantly more 1st degree swelling within 24 hours (P = 0.048), a greater number of subjects with raised temperature after the operation (P=0.042), pain intensity after 24 hours was statistically more marked in subjects with 2nd degree swelling (P=0.015) and with post-operative bleeding (P=0.002) and more subjects with raised temperature after 7 days (P=0.012). The following was found in the sub-group with antibiotic: 1st degree swelling after 7 days was statistically significant in more subjects (P=0.001), and there were fewer subjects with swelling than in the group with a placebo. No differences were found between the subjects in the two sub-groups in the trismus grade, nor in pain intensity, monitored during a period of 24 hours and after 7 days. The results of the second examined group in the sub-group with a placebo were: pain intensity after 7 days was significantly more intense (P=0.001), and the average duration of pain was significantly longer, a greater number of subjects had bleeding within 24 hours (P=0.001), greater pain was registered in subjects who had 2nd and 3rd degree swelling (P=0.013), (P=0.049) and in subjects with bleeding within 24 hours (P=0.003), and after 7 days subjects had significantly greater pain with 1st degree swelling (P=0.003) compared to the sub-group with antibiotic. In conclusion obtained prophylactic application of an antibiotic is recommended as a routine method in cases with contaminated wounds. In the group of subjects with no previous inflammation prophylactic application of an antibiotic is not recommended as a routine method

Angiomyoma – Angioleiomyoma of the Cheek

The authors present the case of an angiomyoma – angioleiomyoma of the cheek in a 58-year-old man. The tumour was palpable, although clinically not visible, and the only case of a tumour of smooth muscle treated in the Clinical Department of Oral Surgery over the last 40 years. The operation was performed in the Outpatient Department by intraoral procedure. The postoperative course passed without complications. Current literature on leiomyomas is cited in the Introduction, followed by presentation of the case and histological characteristics of the tumour. The example is presented as a rarity and one of the differential diagnostic possibilities in the diagnostics of soft tissue tumours in the oral cavity

Marsupialization in the Treatment of Jaw Cysts

U radu je postavljeno pitanje vrijednosti marsupijalizacije kao metode liječenja čeljusnih cista i cističnih odontogenih tumora. Postupak je obavljen retrospektivnom raščlambom uzoraka od 71 pacijenta obrađenog u dvanestogodišnjemu razoblju u Kliničkom zavodu za oralnu kirurgiju i u Klinici za kirurgiju čeljusti i lica Kliničke bolnice Dubrava u Zagrebu. Među uzorcima je bila 61 odontogena cista (85,92 %) – od kojih 14 (19,72 %) odontogenih keratocista i sedam (9,86 %) njihovih recidiva. Radikularnih i folikularnih odontogenih cista bilo je ukupno 39 (54,93 %), zatim slijedi šest traumatskih koštanih šupljina -”cista” (8,45 %), jedan odontogeni tumor (1,41 %), jedan gigantocelularni centralni granulom (1,41 %), jedan recidiv gigantocelularnog granuloma (1,41 %) i jedan centralni kavernozni hemangiom (1,41 %). Tvorbe su bile liječene svim poznatim kirurškim postupcima, a marsupijalizaciji je bilo podvrgnuto deset pacijenata - tri (9,68 %) s cistama promjera od 3 do 6 centimetara te šest ( 22,22 %) s cistama većima od šest centimetara. Riječ je bila o odontogenim keratocistama ili njihovim recidivima te o po jednom slučaju radikularne i folikularne ciste čeljusti. Rezultati su pokazali da se marsupijalizacijom vidljivo smanjuje koštana šupljina u svim tako liječenim slučajevima te da ju je moguće primijeniti kao konačan kirurški postupak kojim se mogu potpuno izliječiti odontogene keratociste ili druge odontogene ciste čeljusti. No, kako su rezultati preliminarni, postupak ipak treba primjenjivati racionalno.The investigation raises the question of the value of marsupialization as a method for treatment of jaw cysts and cystic odontogenic tumours. The study comprises a retrospective analysis of a sample of 71 patients treated during a twelve-year period in the Clinical Department of Oral Surgery and the Clinic of Maxillofacial Surgery of the University Hospital Dubrava. The sample consisted of 61 odontogenic cysts (85.92%), among which 14 (19.72%) were odontogenic keratocysts and 7 (9.86%) recurrences of odontogenic keratocysts. There were 39 (54.93%) radicular and follicular odontogenic cysts, 6 traumatic bone cavities “cysts” (8.45%), one odontogenic tumour (1.4%), one giant-cell central granuloma (1.41%), one recurrence of a giant-cell granuloma (1.41%) and one central cavernous hemangioma (1.41%). The formations were treated by all known surgical procedures, and marsupialization was undertaken in 9 patients of which 3 (9.68%) with cysts 3-6 cm in diameter and 6 (22.22%) with cysts larger than 6 cm. They were odontogenic keratocysts or their recurrences and one case each of a radicular and follicular jaw cyst. The results showed that marsupialization visibly reduced the bone cavity in all cases treated by this method and indicated that it could be applied as the final surgical procedure in which a complete cure is possible of odontogenic keratocysts or other odontogenic cysts of the jaws. However as the results are preliminary the procedure should be applied rationally