Early reconstruction of bone defect created after initial surgery of a large keratocystic odontogenic tumor: A case report

Introduction. Keratocystic odontogenic tumor (KCOT) is defined as a benign cystic neoplasm of the jaws of odontogenic origin with a high rate of recurrence. The most lesions occur in the posterior part of the mandible. Treatment of KCOT remains controversial, but the goals of treatment should involve eliminating the potential for recurrence while minimizing surgical morbidity. However, another significant therapeutic problem related to the management of KCOT is an adequate and early reconstruction of the existing jaw defect, as well as appropriate aesthetic and functional rehabilitation of a patient, especially in cases of a very large destruction of the jaws bone. Case report. We presented a 65-year-old female patient with very large KCOT of the mandible. Orthopantomographic radiography showed a very large elliptical multilocular radiolucency, located on the right side of the mandible body and the ascending ramus of the mandible, with radiographic evidence of cortical perforation at the anterior border of the mandibular ramus and the superior border of the alveolar part of the mandible. The surgical treatment included two phases. In the first phase, the tumor was removed by enucleation and additional use of Carnoy solution, performing peripheral ostectomy and excision of the affected overlying mucosa, while in the second phase, restorative surgery of the existing mandibular defect was performed 6 months later. Postoperatively, we did not register any of postoperative complications, nor recurrence within 2 years of the follow-up. Conclusion. Adequate and early reconstruction of the existing jaw defect and appropriate aesthetic and functional rehabilitation of the patient should be the primary goal in the treatment of KCOT, having in mind the need for a long-term post-surgical follow-up

Therapeutic efficacy of connective tissue autotransplants with periosteum and platelet rich plasma in the management of gingival recession

Background/Aim. Gingival recession progression in clinical practaice has influenced the development of various surgical procedures and techniques for solving esthetic imperfections and subjective difficulties coused by gingival recession. The aim of this study was to verify efficacy of surgical procedures and to compare both of surgical procedures through the keratinized tissue width. Methods. The study included 20 teeth with gingival recesion, Müller class I and II. Ten teeth with gingival recession were treated with connective tissue autotransplants with periosteum in combination with coronary guided surgical flap (CTG group). On the contralateral side 10 teeth with gingival recession were treated with the same surgical procedures but in combination with platelet-rich plasma (CTGPRP group). We measured the keratinized tissue width. For statistical significance we used the Student's t-test. Results. The study reveled a statistical significance in reducing vertical deepress of recession by both used treatments. Root deepness in CTG and CTG-PRP group was 90% and 93.5%, respectively. With both surgical techniques we achieved larger zone of keratinized gingiva but with a wide zone of keratinized tissue in CTG - the PRP group. Conclusion. The concept regeneration technique with PRP and with the stimulating influence of platele activated growth factors results in the regeneration of deep periodontal tissue as an important prerequisite for the successful treatment of gingival recession

Poređenje resorptivnih membrana u vođenoj koštanoj regeneraciji humanog i bovinog porekla

The properties of membranes for guided bone regeneration have been described by a number of authors. These involve biocompatibility, appropriate barrier features (mechanical prevention of soft tissue proliferation), tissue integration, immunologic neutrality, preservation of the space for new alveolar bone, and simplicity of application. Such membrane must hold out against the masticatory forces and tissue tension of the flap, and prevent the collapse of soft tissues and wound space reduction. The property of integration into the tissue guarantees wound stabilization and inhibits epithelial migration. The aim of this study was to compare and evaluate the influence of human resorbable demineralized membrane (RHDM) and bovine resorbable demineralized membrane (RBDM) on bone regeneration. The experiment, approved by the Ethical Committee, was performed on six dogs and conducted into three phases. Bone defects were created in all six dogs on the left side of the mandible, 8 weeks after extraction of the second, third and fourth premolar. One defect was covered with 200 μm thick RHDM, one with 200 μm thick RBDM, and the third defect was left empty (control defect). The pathohistological analysis was done two, four and six months after the surgery. In the third phase samples of bone tissue were taken and subjected to patohistological analysis. In all six dogs the defects treated with RHDM 200μm thick showed a higher level of bone regeneration in comparison with the defect treated with RBDM 200 μm thick and especially with the control defect. Our results demonstrated that the human membrane showed the least soft tissue ingrowth and promoted better bone formation at 6 months compared with a bovine one.Svojstva membrane za vođenu koštanu regeneraciju opisali su brojni autori. Ona uključuju biokompatibilnost, odgovarajuću barijernu moć (mehaničko sprečavanje proliferacije mekog tkiva), tkivnu integraciju, imunološku inertnost, očuvanje prostora za novu alveolarnu kost i jednostavnost primene. Membrana mora da izdrži sile žvakanja i tkivne tenzije režnja, da spreči kolaps mekih tkiva i smanjenje prostora rane. Svojstvo tkivne integracije omogućava stabilizaciju rane i inhibiciju epitelne migracije. Cilj studije je bio da ispita uticaj humane resorptivne demineralizovane membrane (RHDM) i bovine resorptivne demineralizovane membrane (RBDM) na koštanu regeneraciju i da ih međusobno uporedi. Eksperimentalna studija rađena na 6 pasa rase nemački ovčar, sprovedena je u tri faze. U prvoj fazi izvršena je ekstrakcija drugog, trećeg i četvrtog premolara sa leve strane. Osam nedelja nakon ekstrakcije, formirana su tri defekta na levoj strani mandibule i prekrivena humanom membranom debljine 200μm, bovinom membranom debljine 200 μm a treći defekt je ostavljen prazan (kontrolni defekt). Patohistološka analiza rađena je nakon dva, četiri i šest meseci posle hirurške intervencije. U trećoj fazi uzorci koštanog tkiva podvrgnuti su patohistološkoj analizi. Kod svih 6 pasa, defekti prekriveni humanom membranom debljine 200 μm, pokazali su patohistološkom analizom znatno veći stepen koštane regeneracije u poređenju sa defektima prekrivenim sa bovinom membranom i naročito sa kontrolnim defektom. Naši rezultati su pokazali da je humana membrana pokazala najmanje prorastanje mekim tkivom i bolju koštanu regeneraciju nakon 6 meseci u poređenju sa bovinom

Kefalometrijska analiza kranijalne baze i prednjeg dela lica kod osoba sa mandibularnim prognatizmom

Bacground/Aim. The literature suggests different views on the correlation between the cranial base morphology and size and saggital intermaxillary relationships. The aim of this study was to investigate the cranial base morphology, including the frontal facial part in patients with mandibular prognathism, to clarify a certain ambiguities, in opposing viewspoints in the literature. Methods. Cephalometric radiographies of 60 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, with no previous orthodontic treatment. On the basis of dental and sceletal relations of jaws and teeth, the patients were divided into two groups: the group P (patients with mandibular prognathism) and the group E (the control group or eugnathic patients). A total of 15 cephalometric parametres related to the cranial base, frontal part of the face and sagittal intermaxillary relationships were measured and analyzed. Results. The results show that cranial base dimensions and the angle do not play a significant role in the development of mandibular prognathism. Interrelationship analysis indicated a statistically significant negative correlation between the cranial base angle (NSAr) and the angles of maxillary (SNA) and mandibular (SNB) prognathism, as well as a positive correlation between the angle of inclination of the ramus to the cranial base (GoArNS) and the angle of sagittal intermaxillary relationships (ANB). Sella turcica dimensions, its width and depth, as well as the nasal bone length were significantly increased in the patients with mandibular prognathism, while the other analyzed frontal part dimensions of the face were not changed by the malocclusion in comparison with the eugnathic patients. Conclusion. This study shows that the impact of the cranial base and the frontal part of the face on the development of profile in patients with mandibular prognathism is much smaller, but certainly more complex, so that morphogenetic tests of the maxillomandibular complex should be included in further assessment of this impact.Uvod/Cilj. U literaturi postoje različiti stavovi o povezanosti morfologije i veličine kranijalne baze i sagitalnih međuviličnih odnosa. Cilj ovog rada bio je da se ispita morfologija kranijalne baze, uključujući i prednji deo lica, kod ispitanika sa mandibularnim prognatizmom da bi se razjasnile nedoumice donekle suprotnih stavova u literaturi. Metode. Analizirani su rendgenkefalometrijski snimci ukupno 60 bolesnika Klinike za stomatologiju VMA. Svi bolesnici bili su muškog pola, starosti od 18 do 35 godina koji ranije nisu bili ortodontski lečeni. Bolesnici su prema dentoskeletnim odnosima vilica i zuba bili svrstani u dve grupe: grupu P (bolesnici sa mandibularnim prognatizmom) i grupu E (kontrolna grupa ili grupa eugnatih bolesnika). Izmereno je i analizirano 15 kefalometrijskih parametara koji su se odnosili na kranijalnu bazu, frontalni deo lica kao i sagitalne međuvilične odnose. Rezultati. Dobijeni rezultati ukazuju da ni dimenzije kranijalne baze, ni njen ugao ne igraju značajnu ulogu u nastanku mandibularnog prognatizma. Analizom međuzavisnosti ustanovljeno je da postoji statistički značajna negativna korelacija između ugla kranijalne baze (NSAr) i uglova maksilarnog (SNA) i mandibularnog (SNB) prognatizma, kao i pozitivna korelacija između ugla nagiba ramusa prema kranijalnoj bazi (GoArNS) i ugla sagitalnih međuviličnih odnosa (ANB). Dimenzije sedlaste jamice (sella turcica), njena širina i dubina, kao i dužina nosne kosti statistički su značajno povećane kod bolesnika sa mandibularnim prognatizmom, dok ostale analizirane dimenzije prednjeg dela lica nisu bile izmenjene kod ove malokluzije u odnosu na eugnate bolesnike. Zaključak. Pokazalo se da je uticaj kranijalne baze i prednjeg dela lica na ispoljavanje profila kod bolesnika sa mandibularnim prognatizmom mnogo manji ali svakako složeniji, pa bi u dalja istraživanja trebalo uključiti morfogenetska ispitivanja maksilomandibularnog kompleksa kod ocenjivanja ovog uticaja

Poređenje resorptivnih membrana u vođenoj koštanoj regeneraciji humanog i bovinog porekla

The properties of membranes for guided bone regeneration have been described by a number of authors. These involve biocompatibility, appropriate barrier features (mechanical prevention of soft tissue proliferation), tissue integration, immunologic neutrality, preservation of the space for new alveolar bone, and simplicity of application. Such membrane must hold out against the masticatory forces and tissue tension of the fl ap, and prevent the collapse of soft tissues and wound space reduction. The property of integration into the tissue guarantees wound stabilization and inhibits epithelial migration. The aim of this study was to compare and evaluate the infl uence of human resorbable demineralized membrane (RHDM) and bovine resorbable demineralized membrane (RBDM) on bone regeneration. The experiment, approved by the Ethical Committee, was performed on six dogs and conducted into three phases. Bone defects were created in all six dogs on the left side of the mandible, 8 weeks after extraction of the second, third and fourth premolar. One defect was covered with 200 μm thick RHDM, one with 200 μm thick RBDM, and the third defect was left empty (control defect). The pathohistological analysis was done two, four and six months after the surgery. In the third phase samples of bone tissue were taken and subjected to patohistological analysis. In all six dogs the defects treated with RHDM 200μm thick showed a higher level of bone regeneration in comparison with the defect treated with RBDM 200 μm thick and especially with the control defect. Our results demonstrated that the human membrane showed the least soft tissue ingrowth and promoted better bone formation at 6 months compared with a bovine one.Svojstva membrane za vođenu koštanu regeneraciju opisali su brojni autori. Ona uključuju biokompatibilnost, odgovarajuću barijernu moć (mehaničko sprečavanje proliferacije mekog tkiva), tkivnu integraciju, imunološku inertnost, očuvanje prostora za novu alveolarnu kost i jednostavnost primene. Membrana mora da izdrži sile žvakanja i tkivne tenzije režnja, da spreči kolaps mekih tkiva i smanjenje prostora rane. Svojstvo tkivne integracije omogućava stabilizaciju rane i inhibiciju epitelne migracije. Cilj studije je bio da ispita uticaj humane resorptivne demineralizovane membrane (RHDM) i bovine resorptivne demineralizovane membrane (RBDM) na koštanu regeneraciju i da ih međusobno uporedi. Eksperimentalna studija rađena na 6 pasa rase nemački ovčar, sprovedena je u tri faze. U prvoj fazi izvršena je ekstrakcija drugog, trećeg i četvrtog premolara sa leve strane. Osam nedelja nakon ekstrakcije, formirana su tri defekta na levoj strani mandibule i prekrivena humanom membranom debljine 200μm, bovinom membranom debljine 200 μm a treći defekt je ostavljen prazan (kontrolni defekt). Patohistološka analiza rađena je nakon dva, četiri i šest meseci posle hirurške intervencije. U trećoj fazi uzorci koštanog tkiva podvrgnuti su patohistološkoj analizi. Kod svih 6 pasa, defekti prekriveni humanom membranom debljine 200 μm, pokazali su patohistološkom analizom znatno veći stepen koštane regeneracije u poređenju sa defektima prekrivenim sa bovinom membranom i naročito sa kontrolnim defektom. Naši rezultati su pokazali da je humana membrana pokazala najmanje prorastanje mekim tkivom i bolju koštanu regeneraciju nakon 6 meseci u poređenju sa bovinom

EO-based mouthwashes: Is there something that should be known?

The possibility to utilize the antibacterial and antibiofilm potential of essential oils (EOs) in dentistry is recognized and best seen in the design of EO-based mouthwashes. The up-to-date results, obtained with the most commonly used formulation being consisted of thymol, eucalyptol, menthol, and methyl salicylate (Listerine), proved its efficacy against plaque and gingival inflammation. However, novel alcohol-free products remain to be further investigated. Commercially available mouthwash containing curcumin, clove oil, mentha oil, eucalyptol, thymol and tea tree oil, and the mouthwash based on ginger EO (a-zingiberene, b-bisabolene, b-sesquiphellandrene, curcumene), reduced plaque index and improved periodontal status of the patients. The plaque index was also reduced and overall healing was improved after the surgical removal of the third molar by mouthwash containing John wort oil. In addition, Cinnamomum zeylanicum EO-based mouthwash and mouthwash containing peppermint oil were efficient against stomatitis and xerostomia, respectively. In addition to beneficial effects achieved in the mouth, i.e. at the appropriate site of application, novel investigations pointed-out that EO-based mouthwashes could be recognized as efficient in the reduction of bacterial and viral aerosols. This has been shown for Listerine, and for several mouthwashes containing following active substances of plants' EO origin: a-farnesene, b-farnesene, farnesol, nerolidol, a-bulnesene, eremanthin, b-sesquiphellandrene, spiroether, cinnamylacetate, cinnamaldehyde, eugenol, menthol, and carvacrol. This finding could be of special interest, in order to be included in further clinical studies related to COVID -19 pandemic

EO-based mouthwashes: Is there something that should be known?

The possibility to utilize the antibacterial and antibiofilm potential of essential oils (EOs) in dentistry is recognized and best seen in the design of EO-based mouthwashes. The up-to-date results, obtained with the most commonly used formulation being consisted of thymol, eucalyptol, menthol, and methyl salicylate (Listerine), proved its efficacy against plaque and gingival inflammation. However, novel alcohol-free products remain to be further investigated. Commercially available mouthwash containing curcumin, clove oil, mentha oil, eucalyptol, thymol and tea tree oil, and the mouthwash based on ginger EO (a-zingiberene, b-bisabolene, b-sesquiphellandrene, curcumene), reduced plaque index and improved periodontal status of the patients. The plaque index was also reduced and overall healing was improved after the surgical removal of the third molar by mouthwash containing John wort oil. In addition, Cinnamomum zeylanicum EO-based mouthwash and mouthwash containing peppermint oil were efficient against stomatitis and xerostomia, respectively. In addition to beneficial effects achieved in the mouth, i.e. at the appropriate site of application, novel investigations pointed-out that EO-based mouthwashes could be recognized as efficient in the reduction of bacterial and viral aerosols. This has been shown for Listerine, and for several mouthwashes containing following active substances of plants' EO origin: a-farnesene, b-farnesene, farnesol, nerolidol, a-bulnesene, eremanthin, b-sesquiphellandrene, spiroether, cinnamylacetate, cinnamaldehyde, eugenol, menthol, and carvacrol. This finding could be of special interest, in order to be included in further clinical studies related to COVID -19 pandemic

Clinical study of the lower third molars eruption level influence on incidence of acute infection

The aim of this paper was estimate if there was correlation between clinically and radiographically evaluated eruption level of the lower third molar and incidence and severity of the acute infection, respectively. Methods and material: The study was conducted in 100 male examinees, age range from 18 to 25 years old, with clinical and radiographic diagnosis of partially erupted or non erupted third molars. Results: Total number of examinees with clinically registered partially erupted lower third molars was 75, of which 62 (82.6%) manifested infection. Non erupted third molars were in 25 examinees of which 11 (44%) had signs of infection. Partial eruption stage of the third molar was the most common cause of the light infection form (68.8%). Infective complications in over 60% of examinees were related to higher levels of teeth eruption. Higher eruption positions of lower third molars were causing light infections in 56.1%, and in 31.5% - severe forms of infection. Most frequently, lower third molar was related to occurrence and severity of the infection when positioned in occlusal plane level. Conclusion: Partially erupted lower third molar, when positioned in occlusal plane level, is the high risk tooth for an infection to occur

Clinical efficacy of ampicillin in treatment of acute odontogenic abscess

Background/Aim. Antibiotics choice and the duration of their application in the therapy of acute odontogenic abscess is considered to be controversial. The aim of this study was to investigate the clinical efficacy of ampicillin in treatment of acute odontogenic abscess and to assess the antimicrobial susceptibility of the isolated bacteria in early phase of abscess development. Methods. This study included 60 patients with acute odontogenic abscess who were surgically treated (extraction of teeth and/or abscess incision) divided into two groups, ampicillin group and surgical group (without antibiotic treatment). Results. In the ampicillin group of patients treatment lasted on the average 4.67 days, while in the surgical group 6.17 days. A total of 78 bacterial strains were isolated from 60 patients. The most often bacteria were found to be Gram-positive facultative anaerobs (68/78). The most common bacteria isolated were Viridans streptococci (43/78). Susceptibility of isolated bacteria to ampicillin were 70.5%. Conclusion. Peroral use of ampicillin, after surgical treatment in an early phase of dentoalveolar abscess development, statistically significantly reduced the time of clinical symptoms of acute odontogenic abscess in comparison to surgical treatment only. The isolated bacterial strains in an early phase of dentoalveolar abscess development showed a high sensitivity to ampicillin