Primena lasera u stomatologiji

Lasers and laser technology is now used in many medical and dental indications. The aim of this study was to demonstrate many excellent points that should be considered by the dentist who is contemplating the use of lasers in dental practice. The interaction of laser radiation on soft tissue enables dry and bloodless surgery, minimal postoperative swelling and scarring, and minimal postoperative pain. Lasers for hard tisues encourage efficient diagnosis of caries and improve the resistence of dental enamel to caries, laser etching of enamel, cavity preparations, photopolymerization of composite resin and sterilization of the root canal system. All staff who are involved in using lasers must be trained with regard to treatment protocols and safety measures. All personnel and the patient must wear safety-approved glasses.Laseri i laserska tehnologija se danas koriste u brojnim medicinskim i stomatološkim indikacijama. Cilj ovog rada je bio da predstavi osnovne karakteristike lasera i mogućnosti njihove primene u stomatološkoj praksi. Efekat lasera na meka tkiva obezbeđuje manje invazivnu, hirurgiju bez krvi, minimum postoperativnih komplikacija i intervenciju bez bola. Laseri za tvrda tkiva omogućavaju efikasnu dijagnostiku karijesa, povećavaju otpornost gleđi prema karijesu, omogućuju efikasno kondicioniranje gleđi, kvalitetnu preparaciju kaviteta i polimerizaciju materijala, odnosno efikasnu sterilizaciju očišćenog i obrađenog kanala korena zuba. Za sigurnu primenu lasera neophodna je edukacija osoblja o laser aparatima i preduzimanje sigurnosnih i zaštitnih mera za pacijente i osoblje

Razmazni sloj na dentinu u restaurativnoj stomatologiji

Adhesion to enamel has become a routine technique in restorative dentistry. Adhesion to dentin, however, is still under investigation. Except structural elements of the dentin, smear layer has been one of the reasons that the interaction between the adhesive system and this tissue is difficult. The smear layer tissue created by cutting a tooth. It varies in thickness, roughness, density and degree of attachment andoccludes tubules and reduces the dental permeabilita. Dentin adhesivesystems can react with intertubular and peritubular dentin only when this smear layer is removed or when the adhesive system is capable of diffusion through layer of debris. As part of restorative procedures required by adhesive dentistry, the smear layer must be removed, modified or impregnated by the resin to allow for bonding between the tooth and the restorative material. For remove and dissolve of smear layer acid conditioners on total etch and self-etching primers were used. Self-etching primer systems are undergoing rapid evolution; their results are not yet sufficiently predictable overall, but some systems have achieved positive results in both enamel and dentin bonding. Further studies are necessary to confirm the long-term efficiency of these self-etching primers.Adhezija za gleđ predstavlja rutinsku tehniku u restaurativnoj proceduri, dok je adhezija za dentin još uvek problem brojnih istraživanja. Osim strukturalnih karakteristika dentina i prisustvo razmaznog sloja je jedan od osnovnih razloga otežane interakcije između adhezivnih materijala i ovog tkiva. Razmazni sloj je u stvari površinski sloj na dentinu koji nastaje sečenjem dentina rotirajućim intstrumentima. Ovaj sloj ima različitu debljinu, hrapavost i gustinu, zatvara dentinske kanaliće i smanjuje propustljivost dentina. Dentin adhezivna sredstava mogu reagovati sa intertubularnim i peritubularnim dentinom, jedino ako je razmazni sloj uklonjen ili ako adhezivni sistem može da difunduje kroz ovaj sloj. Kao deo restaurativne procedure koju zahteva adhezivna stomatologija razmazni sloj mora biti uklonjen, modifikovan ili impregniran vezivnom smolom kako bi se ostvarila kvalitetna adhezivna veza između zubnih struktura i restaurativnih materijala. Za uklanjanje ili modifikovanje razmaznog sloja na dentinu koriste se kiselinski kondicioneri u tehnici totalnog nagrizanja gleđi i dentina odnosno u tehnici sa samonagrizajućim prajmerima. Samonagrizajući prajmeri se brzo razvijaju, njihovi rezultati nisu predvidljivi u potpunosti, ali ovi adhezivni sistemi ostvaruju kvalitetnu vezu i sa gleđi i sa dentinom. Da bi se potvrdila njihova dugoročna efikasnost neophodna su dalja klinička ispitivanja

Smear layer on dentin in restorative dentistry

Adhesion to enamel has become a routine technique in restorative dentistry. Adhesion to dentin, however, is still under investigation. Except structural elements of the dentin, smear layer has been one of the reasons that the interaction between the adhesive system and this tissue is difficult. The smear layer tissue created by cutting a tooth. It varies in thickness, roughness, density and degree of attachment andoccludes tubules and reduces the dental permeabilita. Dentin adhesivesystems can react with intertubular and peritubular dentin only when this smear layer is removed or when the adhesive system is capable of diffusion through layer of debris. As part of restorative procedures required by adhesive dentistry, the smear layer must be removed, modified or impregnated by the resin to allow for bonding between the tooth and the restorative material. For remove and dissolve of smear layer acid conditioners on total etch and self-etching primers were used. Self-etching primer systems are undergoing rapid evolution; their results are not yet sufficiently predictable overall, but some systems have achieved positive results in both enamel and dentin bonding. Further studies are necessary to confirm the long-term efficiency of these self-etching primers

Surgical vs. nonsurgical management of post-traumatic intercostal lung herniation in children

Background: Intercostal lung herniation (ILH) is an exceptionally rare condition in pediatric patients, characterized by disruption of fascial planes and intercostal musculature allowing for protrusion of a portion of the lung parenchyma into this space. In most cases it is a consequence of blunt chest trauma. Due to the rarity of the condition, diagnostic and management approaches are based on the experience in adults, where CT is the most often used diagnostic tool, and surgery is the primary management approach. Recent published experience in adult and pediatric patients supports the use of less invasive imaging and management strategies, particularly in otherwise asymptomatic patients, giving us the opportunity to reconsider our clinical approaches in the diagnosis and management of these patients. Methods: We present a recent case of posttraumatic ILH. In addition, we conducted a systematic review of the literature. A search of the PubMed, Embase, Ovid, Scopus and Cochrane databases was conducted using a combination of the following search terms: intercostal lung hernia in children, lung herniation in children, traumatic intercostal lung hernia in children. Two authors independently extracted data, reviewed the abstracts, and assessed them for inclusion in the review. Results: All reported cases were single case reports, with total of 16 including our patient. All ILH were unilateral. The most common etiology was bicycle handle bar injury 10 (63%). Herniation was found on the anterior chest wall in 13 (81%) patients, and in 3 (19%) was on the anterolateral chest wall. To confirm the diagnosis chest x-ray was used in 14 (88%) patients, CT chest in 7 (44)%, fluoroscopy in 1 (6%), chest ultrasound in 3 (19%), and in 1 patient there was no imaging documented. Management was surgical in 10 patients (63%) including thoracotomy with primary closure in 8 patients and thoracoscopic repair in 2 patients. Six patients (37%) had nonsurgical management by chest strapping, with complete resolution of herniation within 2â6 weeks. There was no reported complications or recurrence following either type of management. Conclusions: Postraumatic intercostal lung herniation in children is a rare condition. Including our case reported here, there are only 16 reported cases. In children ILH is mostly seen after blunt chest trauma caused by bicycle handle bar injury. Given the rarity of the condition, the pediatric literature on this subject is scarce, with no published guidelines or evidence based recommendations for imaging and management approaches (surgical vs. nonsurgical). Although rare, the pediatric surgeon should be familiar with this condition in order to avoid potentially harmful, invasive or unnecessary diagnostic and therapeutic approaches that are extrapolated from experience in adult patients. Noninvasive imaging modalities including chest radiographs and ultrasound, and nonsurgical management of posttraumatic intercostal lung herniation should be considered as an initial treatment option in the management of asymptomatic patients

Free intestinal perforation in children with Crohn's disease

Background: Free intestinal perforation in children with Crohn's disease (CD) is a rare, but serious complication that requires urgent surgical management. The incidence, contributing risk factors, diagnostic workup, and management strategies for these complex pediatric patients are not well established. Methods: We present a recent case of free intestinal perforation in a patient with CD. In addition, a systematic review of the literature was conducted by searching the PubMed, Embase, Ovid, Scopus and Cochrane databases. Two authors independently extracted data, reviewed the abstracts, and assessed them for inclusion in the review. Results: The literature review identified 21 pediatric patients documented in 14 publications; including our case, there are a total of 22 pediatric patients reported. The majority of patients presented with features of peritonitis. Perforation occurred early in the disease course (median 6.5 months), and was most commonly a single perforation in the ileum with active Crohn's disease (82%). Colonic perforation occurred in 18% of patients. All patients underwent urgent surgical management. Surgical approaches included resection of the diseased bowel segment with proximal diversion in eleven patients (50%), resection with primary anastomosis in 9 (41%) or direct suture repair in two (9%). Both patients who underwent simple primary repair developed post-operative complications. Conclusions: Free intestinal perforation may occur at any age and stage of Crohn's disease. Three-dimensional imaging may be required to confirm the diagnosis. The management of free intestinal perforation in CD is surgical. This should involve resection of the involved segment with proximal diversion or resection with primary anastomosis in selected cases. Primary suture closure of the perforation is discouraged. Keywords: Free intraperitoneal perforation, Pediatric Crohn's diseas