Импакција на повеќе заби без присуство на синдром - приказ на случај

Tooth eruption is а continuous process by which developing teeth move through the soft tissue, oral epithelium, jaw bones and overlying mucosa, to emerge in the oral cavity, contact the teeth of the opposing dental arch, and enable teeth functional position in mastication. Abnormal tissue interactions during tooth development may be potentially revealed as ectopic tooth development, ectopic eruption or tooth impaction. In human dentition, permanent tooth impaction is relatively common. Impaction of the first permanent molar is an uncommon condition and few cases are reported in the literature. It is essential to diagnose and treat the impacted permanent molars as early as possible because treatment at a later stage is usually more complicated due to the tendency of malocclusion to increase with time. We report a case with impaction of the maxillary first permanent molar and impaction of all, maxillary and mandibular permanent second molars. This condition compromise masticatory function. Unilateral mastication also compromises the function of temporomandibular joint. The aim of this case-report was to present orthodontic treatment with Schwartz removable appliance in a patient with maxillary left-side impaction of the second premolar, first molar and second molar. The goal of the first phase was positioning the maxillary first molar into the dental arch with good bone and periodontal support. The surgical intervention, operculectomy, was done and the orthodontic treatment started by traction of the first molar with elastic ligature attached from the bonded bracket to the mobile appliance. One month later the tooth movement was obvious.Ерупцијата на забите е континуиран процес со кој забите во развој се движат низ мекото ткиво, оралниот епител, коските на вилиците и слузницата што ги покрива, за да излезат во усната шуплина, да дојдат во контакт со забите од спротивниот забен лак и да ја овозможат функционалната положба на забите при џвакање. Абнормалните ткивни интеракции за време на развојот на забите потенцијално може да се откријат како ектопичен развој на забите, ектопична ерупција или импакција на забите. Кај човечкото забало, импакција на траен заб е релативно честа појава. Импакција на првиот траен молар е невообичаена појава и само неколку случаи се пријавени во литературата. Импактирани трајни катници неопходно е да се дијагностицираат во рана фаза и да се третираат што е можно порано, бидејќи третманот во подоцнежната фаза е обично покомплициран поради тенденцијата да се зголеми можноста за развој на дентална малоклузија со текот на времето. Во овој приказ на случај станува збор за импакција на првиот максиларен траен молар и импакција на сите, максиларните и мандибуларните трајни втори молари. Оваа состојба ја оневозможува џвакалната функција на пациентот. Едностраната мастикација исто така влијае негативно и на темпоромандибуларниот зглоб. Целта на овој приказ на случај беше да се претстави ортодонски третман со мобилен апарат според Шварц кај пациент со еднострана максиларна импакција на лев втор премолар, првиот молар и вториот молар. Целта на првата фаза беше позиционирање на максиларниот прв молар во забниот лак со добра коскена и пародонтална подршка. Беше направена хируршка интервенција, оперкулектомија, и ортодонскиот третман започна со влечење на првиот молар на кој беше поставен стандарден брекет со еластична лигатура прикачена на мобилниот апарат. Еден месец подоцна движењето на забот беше очигледно.&nbsp

Full-arch fixed overdenture in lower jaw - immediate solution for efficient mastication

Complete anodontia and alveolar ridge resorption are responsible for lack of retention and stabilization of conventional acrylic lower denture. Hybrid prostheses on 4 implants placed immediately in the first 7 days is therapeutic solution which allows patients better chewing and increased effective masticatory force. Aim: The study aims to assess the functional and subjective treatment outcomes of full-arch fixed overdenture hybrid rehabilitation. Material and Methods: 60 patients with hybrid prostheses over 4 implants were included in the study. The measurement of the masticatory force was done in the chewing center in the projection of the distally placed implant. Electro-gnathic-dynamometer measured the force of the muscle elevator and depressor of the mandible. Sensor was placed in plastic bite templates and the force value was registered three times. Results: The mean masticatory forces measured in the chewing center before implants and overdenture were 95.7 N. One month later with the prosthesis the value was increased to 185.6 N and after 18 months 186.2 N. Conclusion: There is significant increase in masticatory force in area of ​​the distal implant. This is indicating increased resistance to load and higher efficiency of the chewing process after the treatment. Keywords: overdenture, full-arch, hybrid prosthesi

SARS-CoV-2 Infection: General Characteristics and Specific in Dental Practice

The transmission of the coronavirus and possible routes of infection are still unclear. The most common routes of infection in humans are direct transmission through respiratory droplets and salivа when coughing or sneezing and indirect transmission through contaminated surfaces. Most of the infected people after the incubation period have clinical manifestations with mild or moderate respiratory tract infections (RTIs). Physician of dental medicine performs aerosol procedures which transmit the virus directly from healthy people. Oral fluids, blood, conjunctiva, nasal, and oral mucosa are also a source of infection, so they are highly exposed to the virus, much more than other medical staff and therefore it is crucial to establish appropriate protocols and prevention strategies. Under conditions of a declared global pandemic, dentists are advised to stop their work of all cases that are not urgent. If the dental office is one of those that provide the necessary and urgent medical attention, it is necessary to strictly implement control measures to prevent infection. The basic protocols for the operation of the dental offices have been published by the Dental Chamber of Macedonia and they are recommendations regarding the procedures for the maintenance of the hygiene of the medical staff and the working space. Recent experience has shown that dental health-care services are often neglected and inadequately treated in epidemics. Dental workers are particularly exposed to RTIs due to their specific field and mode of operation, so the current experience will prepare them for future challenges. &nbsp

Implant-prosthetic therapy failure in smoker and nonsmoker patients

Introduction: Implant-prosthetic therapy has predictable success, and the complications are associated with a lot of factors. Smoking cigarettes is reason for different oral diseases, bone loss, loss of soft tissue and teeth, appearance of periimplantitis and implant loss. The corellation of smoking and implant-prosthetic therapy failure was examined in the clinical study. Materials and method: Fifty patients with FDP on 61 implants in frontal and molar region were investigated. They were divided in two groups: smokers and nonsmokers. Thirty four patients were smokers, and sixteen didn’t smoke cigarettes in the last two years. Criteria data for the success of the therapy were mobility of the implant, pain, peri-implant bone loss higher than 1.5 mm, absence of technical complications and function and aesthetics appeal. Control checkups were made after six months, one and two years. Patients had questionnaires, clinical examination and X-ray. Results: There is a statistically significant difference between smokers and nonsmokers in the failure rates of dental implants. During first year 0,5 mm of bone was lost around eleven implants, and 0,05 mm next years.Total seven implants failed, five in smoker group at the beginning of the first year, and 2 in nonsmoker group during second year. Conclusion: Results showed that smoking habit can increase the risk of early implants loss two times more often in smokers. For some complications like periimplantitis, local factors have greater influence. Smoking does not increase the risk of late implant loss, but the implants at patients with smoking habit, in correlation with several different local risk factors, is contraindicated. Early complications are results of smoking, while quality and quantity of surrounding bone are responsible for late complications.The results from the investigation, also give informations for proper treatment planning, and patient education for quiting their harmfull habit. Keywords Implants, therapy failure, smoking, periimplantitis

Prosthodontics Status and Treatment Needs among the Elderly in the Republic of Macedonia

BACKGROUND: Oral health care management among the elderly differs from the rest of the population, due to some specific physiological changes and general health status related to age. We know very little about the oral health in elderly in the Republic of Macedonia, because there are only a few articles published about dental health status and edentulism of this population.AIM: The study aimed to evaluate the prosthodontic status of older adults over 65 years in the Republic of Macedonia, about their socio-economic status and individual factors.MATERIAL AND METHODS: A cross-sectional study was conducted in 8 regions, in rural and urban areas of Macedonia and a representative sample of 432 people (age > 65 years) was examined. Statistical analyses of the data were made by chi-square tests and the corresponding C-coefficient.RESULTS: Only 6% of all participants had not any prosthetic appliance, 9.5% had more than one bridge, 28.7% of examinees had partial dentures, both bridge(s) and partial denture(s) had 10.7% participants, and 45.1% of examinees were toothless. There was a significant difference between patients who visited the dentist more than once a year and those who did not (c2 = 14.2; df = 4, p < 0.01). From all of the participants, 40.3% used public dental care organisations.CONCLUSIONS: We found a high prevalence of edentulousness among older adults over 65 years in Macedonia. The study confirmed the necessity for establishing healthcare educational programs for the dental treatment of elderly in Macedonia

Treatment planning for effective and efficient correction of Class II malocclusion

Objective: The approach of treatment of Class II malocclusion correction depends on several factors such as: the status and pattern of growth, severity of the malocclusion and patient's cooperation. Because of the wide variation found in Class II malocclusions, many different diagnostic decisions weather to extract or not to extract, must be made and treatment mechanics must, of necessity, differ as well. This case reports describe the common diagnostic decisions and the different biomechanics regarding the teeth extractions in patients with Class II malocclusion as well as regarding the dimensions of denture: the anterior limit, the lateral and the vertical limit in patients with different skeletal pattern. Case: The treatment of a Class II malocclusion in case 1 hyperdivergent patient, required extraction of maxillary first premolars to correct the increased overjet, proclined upper incisors, convex profile and skeletal Class II. Case 2 patient with hypodivergent skeletal pattern was treated with camouphlage treatment with maxillary premolar extraction for correction of the jaw relation, retracting the teeth in the extraction space and maintaining the lower incisors position, achieving Angle Class I in the canine region and Angle Class II in the molar region. Case 3 with normal pattern of growth was treated with second maxillary premolars extraction. Due to the fact that the patients were adults, treatment plan could not have included headgears and functional appliances for Class II correction. In all three cases we did not flare the mandibular incisors in order to level the Curve of Spee or to eliminate crowding, due to the fact that their position is very critical. Conclusion: The results included harmonic occlusal relationships with adequate positioning of the teeth in their bony bases and correction of skeletal disharmonies. We can conclude that accurate diagnosis and treatment planning following orthodontic extraction guidelines lead to a long-term stability. Any decision regarding the need for extraction of teeth during orthodontic therapy is not only dependent on the presence or absence of space in the dental arches. Other issues should be evaluated in order to achieve proper malocclusion correction, maintenance or improvement of facial aesthetics and result stability. It is necessary to develop individualized treatment plan with complete evaluation of patient’s dental, facial and skeletal patterns to offer a correct diagnosis and proper treatment plan. We should respect the basic orthodontic principles of treatment planning and do not exceed the biological limitations according to the natural equilibrium. Keywords: Class II malocclusion, Treatment planning, Treatment mechanics, Extraction

Оклузални сплинтови при ортодонтски третман кај пациенти со дисфункција на темпоромандибуларен зглоб

Вовед: Дисфункцијата на темпоромандибуларниот зглоб(ТМЗ) има мултифакторијална етиологија и вообичаено е придружена со низа на симптоми како што се: постоење на звучни манифестации(крепитации), миофункционална болка, хипермобилност на зглобот, рестриктивно отворање на устата и т.н. Постојат различни тераписки постапки за менаџирање на овие пациенти. Оклузалните сплинтови претставуваат прва линија во стратегијата на ортодонтскиот третман на пациентите со дисфункција на ТМЗ. Цел: Целта на овој труд е да ја прикажеме ефикасноста од употребата на оклузални сплинтови во менаџирање на пациенти со дисфункција на ТМЗ, преку репозиционирање на мандибулата во централна релација, пред започнување на ортодонтската терапија со фиксни ортодонтски апарати.  Материјал и метод: Кај адултен пациент со длабок загриз, дистооклузија, оклузален кант и латерогнатија, со присуство на крепитации и сублуксација на ТМЗ, со главна поплака за историја на главоболки, болка во регијата на ТМЗ која ирадира во пределот на вратот и хипертрофија на левиот масетеричен мускул екстраорално, извршивме комплетен клинички преглед, анализа на рентген ортопантомографска снимка, антеро-постериорна цефалометриска анализа и анализа на студио модели и изработивме репозиционирачки сплинт од тврд акрилат и по 8 месеци од неговата употреба, започнавме со фиксна ортодонтска терапија.   Резултати: Употребата на сплинт како меѓуфазен третман, пред започнување на фиксната ортодонтска терапија, успешно помогна во редуцирање на симптомите на дисфункција на ТМЗ кај пациентот.  Заклучок: Пациентите со дисфункција на ТМЗ имаат потреба од внимателен, сеопфатен пристап со комбинација од третмански постапки, започнувајќи од репозиционирање на мандибулата и кондилот во централна релација во зглобната јама, релаксирање на орофацијалната мускулатура со помош на оклузален сплинт и понатаму аплицирање на фиксна ортодонтска терапија со цел да се доведат забите во идеална оклузија според сите гнатолошки принципи. Клучни зборови: Дисфункција на темпоромандибуларниот зглоб, оклузален сплинт, фиксен ортодонтски третман

Проценка на оралното здравје кај геријатриски пациенти

The geriatric population in R. Macedonia presents a specific group that needs continuous evaluation of their oral health. According to WHO data in 2010, 12 % of the population was aged 65+ years in Macedonia. Aging is the process with different specific changes in all systems and organs, including the orofacial system. The most common conditions associated with age in the geriatric population are teeth loss, parodontopathy, precancerous lesions and oral carcinomas, xerostomia, resorption of the residual alveolar ridge, and overall dysfunction of the orofacial system. There is a great influence of the performed prosthodontic therapy in geriatric patients on the overall and general health. The aim of this study was to evaluate the condition of the soft tissues in geriatric patients, especially in patients with prosthodontic treatments, their oral health, and the influence of oral health on life quality. Мaterial and methods: Оbservational cross-sectional study was conducted in geriatric patients and Geriatric Oral Health Assessment Index (GOHAI) was used for self-assessment of their oral health and the impact of oral conditions and performed dental treatment on quality of life. Results: Participants witha mean age of 72.88 years reported several general and systemic diseases, and the main risk factors for their oral mucosal changes were smoking and drinking alcohol. Total anodontiа was observed in 37.5% of respondents and partial anodontia in 62.5%. The average period of wearing dentures was 7.8 years. The total scoreof the quality of life and oral health of the respondents varied in the interval 1.93 ± 0.65, and the average value in the subjects with prosthetic constructions for p> 0.05 (p = 0.19) was slightly higher in relation to the subjects without any prosthodontic device. Conclusion: GOHAI-12 score in the study had a low value, less than 50 indicated that the respondents were in poor oral health. According to the results of the self-assessment, there was a weak to moderate perception of oral health. An integrated approach is needed to achieve a critical positive level of general and oral health in geriatric patients    Геријатриската популација во  Македонија претставува специфична група која има потреба од континуирана евалуација на нивното орално здравје. Според податоците на СЗО во 2010 година, 12 % од населението во Македонија било на возраст 65+ години. Стареењето е процес со различни специфични промени во сите системи и органи, вклучувајќи го и орофацијалниот систем. Најчестите состојби поврзани со возраста кај геријатриската популација се губење на забите, пародонтопатија, преканцерозни лезии и орални карциноми, ксеростомија, ресорпција на резидуалниот алвеоларен гребен и целокупна дисфункција на орофацијалниот систем. Големо е влијанието на извршената протетичка терапија кај геријатриските пациенти врз нивното целокупно и општо здравје. Целта на оваа студија беше да се процени состојбата на меките ткива кај геријатриските пациенти, особено кај пациентите со протетички третмани, нивното орално здравје и влијанието на оралното здравје врз квалитетот на животот. Материјал и методи: Спроведовме опсервациона студија на пресек кај геријатриските пациенти, а геријатрискиот индекс за проценка на оралното здравје (GOHAI) беше употребен за да се изврши евалуација  на нивното орално здравје и влијанието на оралните состојби и извршениот дентален третман врз квалитетот на животот. Резултати: Испитаниците со просечна возраст од 72,88 години пријавиле повеќе општи и системски заболувања, а главните фактори на ризик за промените на оралната мукоза биле пушењето и пиењето алкохол. Вкупна анодонција е забележана кај 37,5% од испитаниците и делумна анодонција кај 62,5%. Просечниот период на носење протези изнесуваше 7,8 години. Вкупната оценка за квалитетот на животот и оралното здравје на испитаниците варираше во интервалот 1,93 ± 0,65, а просечната вредност кај субјектите со протетички конструкции за p> 0,05 (p = 0,19) беше нешто повисока во однос на субјектите без било каква протетичка изработка. Заклучок: Резултатот на GOHAI-12 во студијата имаше ниска вредност, помалку од 50 што покажа дека испитаниците беа со слабо орално здравје. Според резултатите од самооценувањето, имаше слаба до умерена перцепција за нивното оралното здравје. Потребен е интегриран пристап за да се постигне критично позитивно ниво на општото и оралното здравје кај геријатриските пациенти

Oral Hygiene Index in Early Childhood Caries, Before and After Topical Fluoride Treatment

BACKGROUND: Circular caries occurs in the earliest age of the children (1 - 1.5 year), immediately after the eruption of the deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces.OBJECTIVE: The main objective of this clinical trial was to determine the correlation between oral hygiene shown with Oral Hygiene index, and the initial stages of circular caries (initial lesion and superficial form), before and after topical fluoride treatment.MATERIAL AND METHODS: For determination of the OHI - index we used the method of Green - Vermillion. It was determined two times in 117 patients, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years old and diagnosed with initial stages of circular caries. Amino fluoride solution was applied once a week, during six months.RESULTS: We obtained statistically significant improvement of OHI - index at the end of the test, among treated subjects from both major groups.CONCLUSION: It can be concluded that the level of oral hygiene is correlated with the progression of changes in enamel. Topical fluoride treatment has a positive impact on reducing ECC

Advantages of CAD/CAM versus Conventional Complete Dentures - A Review

BACKGROUND: The introduction and evolution of CAD/CAM technology into complete dentures fabrication brought high expectations in improving disadvantages associated with conventional methods.AIM: The purpose of this review was to analyse the existing literature on computer-engineered complete dentures and to determine their advantages over the conventional dentures.MATERIAL AND METHODS: An electronic search of the English literature from January 1994 to March 2018 was performed in PubMed/MEDLINE, using the following keywords: CAD/CAM complete dentures, computer-engineered complete dentures, complete digital dentures, complete milled dentures, and rapid prototyping dentures.RESULTS: A total of 179 English language titles were obtained from the database, and 14 were relevant to fulfil the purpose of this review. A review of 7 articles is summarized in 2 tables for presenting a comparison between CAD/CAM and conventional dentures in clinical and laboratory studies.CONCLUSION: Following the review of articles that discussed the comparison between CAD/CAM and conventional complete dentures in clinical studies, it can be concluded that the main advantages of CAD/CAM dentures are the reduced clinical chair time and the number of visits, digital archiving, significantly higher retention, and more favorable clinical and patient-centered outcomes. As a result of the review of laboratory studies, superior mechanical and physical properties in CAD/CAM dentures were revealed, concerning enhanced accuracy of fit of milled denture bases, less denture tooth movement and increased toughness, ultimate flexural strength, and higher elastic modulus