Temporomandibular Arthritis in Association with Rheumatoid Arthritis -a Differential Diagnostic Approach to Temporomandibular Pain in Dental Practice

Reumatoidni je artritis sustavska kronična bolest koja često zahvaća i temporomandibularne zglobove. Ponekad je takav znak i prvi simptom početka bolesti. Stomatolog praktičar u svojemu radu može se susresti s takvom kazuistikom. Rad prikazuje pregled simptoma i kliničkih znakova koji se manifestiraju u bolesnika s reumatoidnim artritisom, osobito u području temporomandibularnoga zgloba. Navedeni su i drugi diferencijalnodijagnostički uzroci boli u području temporomandibularnoga zgloba.Rheumatoid arthritis is a chronic systemic disease, which often also affects temporomandibular joints. Occasionally such a sign may indicate the first symptom of the commencement of the disease. A dentist in practice can encounter such casuistics. The paper presents a review of symptoms and clinical signs manifesting in a patient with rheumatoid arthritis, particularly in the area of the temporomandibular joint. Other differential diagnostic causes of pain in the area of temporomandibular joint are also mentioned

Dental Treatment of the Patient with Porphyria

Porfirije su skupina nasljednih bolesti uzrokovanih defektnim enzimima na biosintetskom putu hema. Ovisno o defektu pojedinog enzima razlikujemo i razne vrste porfirija. Posljedica defekta enzima jest stvaranje abnormalnih količina prekursora hema (porfirina) koji se nakupljaju u tkivima i izlučuju mokraćom i stolicom. Klinički znaci gotovo potpuno proizlaze iz učinka tih spojeva na živčani sustav i kožu. Mnogi lijekovi, kao lokalni anestetici (lidokain), antibiotici (klindamicin, eritromicin, metronidazol) i dr. spadaju u precipitirajuće čimbenike i mogu uzrokovati akutne napade. Pacijentima s porfirijom sa sigurnošću se mogu dati bupivakain, amoksicilin, klavulanska kiselina, acetilsalicilna kiselina, paracetamol (1,2). Zato je stomatologu važno imati određene smjernice u slučaju liječenja pacijenta s nekim akutnim oblikom porfirije.Porphyria is a group of inherited diseases caused by defective enzymes on the biosynthetic pathway of heme. Depending on the specific enzyme defect different forms of porphyria can be differentiated. The consequence of the enzyme defect is the formation of abnormal amounts of porphyrins or precursors which accumulate in the tissues and are excreted in the urine and faeces. Almost all the clinical signs occur because of the effect of these compounds/products on the nervous system and skin. Numerous drugs, such as local anaesthetics (lidocaine), antibiotics (clindamycin, erythromycin, metronidazole) and others, can be precipitating factors and cause acute attacks. Patients with porphyria can safely be given bupivacaine, amoxycillin, clavulanic acid, acethylsalicilic acid and paracetamol (1, 2). Thus it is important for the dentist to have certain guidelines with regard to the treatment of patients with acute form of porphyria

The Advantages of Implant Therapy in Management of Edentulous jaws - Case Report

Potpuna proteza često nema zadovoljavajuću stabilnost u usnoj šupljini. Osobito nakon više godina nošenja proteze nastaju promjene u međučeljusnim odnosima te posljedično gubitak alveolarne kosti i poremećaj u stabilizaciji proteze. Postoji više načina implantološko-protetske rehabilitacije potpune bezubosti. U radu prikazujemo uporabu 2 usadka u bezuboj čeljusti te protetsku rehabilitaciju s tzv. kuglama. Prednosti ovakva načina implantološko-protetske rehabilitacije jesu u razmjerno lakom postavljanju usadka, postizanju zadovoljavajuće stabilnosti proteze te financijski razmjerno povoljnom rješavanju problema stabilnosti u odnosu prema drugim implantološkim metodama.Long term use of a conventional denture typically results in advanced alveolar bone loss, following a decrease of intermaxillary space and lack of stability. There a few ways in implant prosthodontics treatment of completely edentulous jaws. In this case report we show the use of two implants in completely endentulous patients and prosthetic rehabilitation with snap attachment. The advantages of implant prostodontics are relatively easily placement into the bone, stable implant assisted overlay denture, and relatively acceptable price

Implantoprosthetic Rehabilitation of Total Maxillary Edentulousness -Case Presentation

Implantoprotetička rehabilitacija gornje čeljusti može se učiniti na više načina. Plan i mogućnosti terapije ovisni su o općem pacijentovu zdravlju, lokalnom kliničkom i rtg nalazu i o pacijentovim financijskim mogućnostima. U našemu radu pokazat ćemo izradbu reducirane vironit proteze na prethodno postavljena 4 usatka u gornjoj čeljusti. Navedeni primjer pokazuje zadovoljavajuće rezultate što se tiče estetike i funkcije te se zato može preporučiti kao jedno od rješenja implantoprotetičke terapije potpune bezubosti gornje čeljusti.Implantoprosthetic rehabilitation of the upper jaw can be done in several ways. The plan and possible therapy depend on the general health of the patient, local clinical radiographic finding and financial possibilities of the patient. In this paper we show the construction of a reduced vironit prosthesis on 4 previously placed implants in the upper jaw. This example shows satisfactory results with regard to aesthetics and function and can therefore be recommended as a solution for implantoprosthetic therapy of total edentulousness of the upper jaw

Prevalence of Odontogenic Keratocysts Associated with Impacted Third Molars

In this study we analyzed the prevalence of the odontogenic keratocyst (OKC) associated with impacted third molars and evaluated OKC reactivity with the antibodies against cytokeratins (CK), particulary for CK10. Tissue samples were obtained from the proximity of the impacted molar. Differences between genders, age groups and localization of cysts were assessed using the x2-test and relative risk (RR), and associated confidence interval. Cysts were found in 75 cases, and the radicular ones prevailed (63%), followed by follicular and OKC (13% and 12% respectively). The RR for the upper jaw cysts was almost twice greater than for the mandible. For the OKC exclusively, the upper-lower jaw RR was 1:2. The RR for all cysts increases with age, while decreases for the OKCs. The risk for the OKC occurrence decreased with age, with no significant differences between age groups. Finally, based on the results from this study we cannot suggest that the CK10 staining should be considered an useful marker in differential diagnosis of the OKCs

Frenulectomy - When and Why?

Podatci iz literature često su dijametralno suprotni što se tiče potrebe da se izvede kirurški zahvat kod perzistentnoga frenuluma, bilo da se radilo o njegovoj izravnoj povezanosti s dijastemom medijanom ili ne. Različita su mišljenja o najpovoljnijem vremenu za zahvat ili na redoslijed intervencije kirurga, odnosno ortodonta. Većina se autora slaže u tome da je zahvat potreban, ali i da se s njim ne treba žuriti. Pojedini autori smatraju kako treba pričekati da iznikne trajni očnjak, a drugi upozoravaju i na mogućnost spontanoga zatvaranja dijasteme još i u vrijeme nicanja drugoga trajnog molara. Prema navodima u literaturi frekvencija tektolabijalnoga frenuluma djece je 7,3%, a odraslih samo l,3%, što upućuje na neopravdanost ranih kirurških tretmana. Naše istraživanje pokazuje sukladne podatke, jer je najveća zastupljenost frenulektomija (80%) u dobi do 20 godina. Od svih lokalizacija koje zahvaća hipertrofični frenulum njih 90% je u području gornje usne. Upravo ta povezanost između dobi i lokalizacije govori nam da se radilo o ortodontskoj indikaciji, zapravo o dijastemi medijani. Najveći broj dijastema zatvara se u vrijeme nicanja lateralnih sjekutića, pa ako dijastema i dalje perzistira, a popraćena je hipertrofičnim frenulumom, postoje male mogućnosti kasnijeg spontanog zatvaranja. Zato operativni zahvat izvodimo ne čekajući da niknu trajni očnjaci. Sve operativne intervencije za uklanjaje abnormalno razvijenog frenuluma svode se na inciziju, eksciziju ili transpoziciju tkiva u području frenuluma, odnosno kombinaciji svih triju postupaka. Operativne metode koje se najčešće preporučuju zbog zadovoljavajućeg postoperativnog rezultata, brzine samog zahvata i jednostavnosti tehnike jesu “V” ekscizija, te horizontalna incizija interdentalnoga tkiva i dijela papile incizive. Nakon toga kirurškoga tretmana moguće je učiniti i kortikotomiju na tome području ako je to potrebno. Svrha je ovoga istraživanja prikazati indikacije za frenulektomiju, s posebnim osvrtom na vrijeme kirurškoga zahvata.Data from the literature are often diametrically contradictory with regard to the need to carry out a surgical procedure in the case of a persistent frenulum, either when it is a case of its direct connection with the diastema median or not. Opinions vary on the most suitable time to perform the operation, or on the chronology of the intervention of the surgeon or orthodontist. The majority of authors agree that the operation is necessary but that there is no need for urgency. Some authors consider that one should wait until the eruption of the permanent molar, while others warn of the possibility of spontaneous closing of the diastema at the time of the eruption of the second permanent molar. According to reports in the literature the frequency of tectolabial frenulum in children is 7.3%, and in adults only 1.3%, which indicates that early surgical treatment is unjustified. Our investigation shows consistent data, because the greatest incidence of frenulectomia (80%) occurred up to the age of 20 years. Of all the sites affected by a hypertrophic frenulum, 90% were in the area of the upper lip. The connection between age and the localisation indicates orthodontic indication, of just the diastema median. Most diastema close during eruption of the lateral incisors, but if the diastema persists, and is accompanied by hypertrophic frenulum, the possibility of later spontaneous closing is slight. Thus the operative procedure can be carried out without waiting for the eruption of the canines. All operations for removal of abnormally developed frenulum comprise incision, excision or transposition of tissue in the region of the frenulum, i.e. a combination of all three procedures. The operative methods most frequently recommended because of the satisfactory postoperative result, speed of procedure and simple technique are “V” excision and horizontal incision of the interdental tissue and part of the papilla incisiva. After such surgical treatment it is possible to carry out corticotomy in the area if necessary. The aim of this study was to present indications for frenulectomy, with special reference to the time of the surgical procedure

Symptomatic capillary telangiectasia of the pons and intracerebral developmental venous anomaly – a rare association [Simptomatska kapilarna teleangiektazija ponsa i intracerebralna razvojna venska anomalija: prikaz slučaja]

Various combinations of vascular malformations of the brain in one lesion have been reported, while others seem to be very rare. In this report, the authors discuss the case of a coexistence of an capillary telangiectasia of the pons and intracerebral venous anomaly. To our knowledge, this is the first report of coexistence of a capillary telangiectasia of the pons and intracerebral venous anomaly apparted from each other. These discrete vascular malformations of the brain raise attention on possible interrelations in the pathogenesis of these entities. We report a case of pontine capillary telangiectasia and intracerebral venous anomaly in a 42-year-old woman with a right side facial palsy. Hight field magnetic resonance imaging suggested presence of a capillary telangiectasia of the pons. Another lesion in the left frontal gyrus was attributable to the venous anomaly. Along with neuroradiological findings, results of the somatosensor evoked potentials, brain stem auditory potentials, laboratory analysis including blood, cerebrospinal fluid and urine investigation are demonstrated. Awareness of the magnetic resonance imaging finding of the capillary telangiectasias and of the venous anomalies may help in defining clinical correlates of this vascular malformations, while the follow up of these malformations might help to asses risk of vascular rupture. We and others previously selects capillary telangiectasia and venous anomaly in two discrete entities. Coexistence of these malformations in the brain apparted from each other appear to be very rare and raise attention on possible interactions in their natural history and pathogenesis

The Tooth in the Maxillary Sinus as a Complication During Extraction of the Upper Wisdom Tooth

Svi udžbenici oralne kirurgije spominju među mogućim komplikacijama tijekom vađenja zuba i uguravanje korijena zuba ili cijeloga zuba u maksilarni sinus. Dok je prva komplikacija razmjerno česta, i s njom se oralni kirurzi susreću gotovo danomice, uguravanje cijeloga zuba u maksilarni sinus nije uobičajena komplikacija. Dva slučaja umnjaka u maksilarnome sinusu primljena su prošle godine na liječenje u Klinički zavod za oralnu kirurgiju KB “Dubrava”, Zagreb. U oba se slučaja radilo o komplikaciji nastaloj za vrijeme alveotomije gornjih retiniranih umnjaka. U oba slučaja zubi su skliznuli u sinus za vrijeme rada Beinovom polugom. Pacijenti su hospitalizirani i nakon potrebne obradbe u općoj su anesteziji provedene ekstirpacije zuba pristupom kroz facijalnu stjenku. Nakon što su odstranjeni zubi, izvršene su tamponade dna sinusa jodoformnom gazom koja je izvedena u usta u prednjem dijelu reza i odstranjena treći dan nakon zahvata. Pošto su odstranjeni šavovi, pacijenti su nadzirani do prestanka objektivnih i subjektivnih smetnji i time je liječenje bilo završeno. Primjeri se pokazuju kako bi se upozorilo da se komplikacija, za koju se obično misli da postoji samo u knjigama, može dogoditi svakome od nas. U tome smislu savjetujemo opreznu upotrebu klijeπta samo u slučajevima kada je zub moguće obuhvatiti preko ekvatora njegove krune, a s određenim ogradama umjesto Beinove poluge preporučujemo bilo koju od parnih poluga koje obično upotrebljavamo u donjoj čeljusti za vađenje korjenova donjih višekorijenskih zuba.All textbooks on oral surgery mention the pushing of the tooth root or the whole tooth into the maxillary sinus as one of the possible complications during tooth extraction. While the first complication is relatively frequent and oral surgeons come across it almost every day, pushing of the whole tooth into the maxillary sinus is an uncommon complication. Two cases of the wisdom tooth in the maxillary sinus were admitted last year for treatment in the Clinical Department of Oral Surgery. Both cases were complications which occurred during alveotomy of upper impacted wisdom teeth. In both cases the teeth had slid into the sinus during work with Bein\u27s elevator. The patients were hospitalised and after the necessary analyses extirpation of the teeth was performed under general anaesthesia by an approach through the facial wall. After removal of the teeth tamponade of the floor of the sinus was done with Jodoform gauze, which was carried out in the mouth in the frontal part of the cut and removed on the third day after the operation. After removal of the sutures the patients were monitored until objective and subjective problems ceased. The examples are presented in order to warn that complications which are commonly thought of as only occurring in books, can happen to each of us. With this in mind we recommend the careful use of forceps only in cases when it is possible to grasp the tooth through the equator of its crown, and with some reservation instead of Bein\u27s lever we recommend any of the elevators which are normally used in the mandible for extracting the roots of multi-rooted teeth

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

Sinus lifting in implantoprosthetic rehabilitation – Case report

Cilj: Gubitak svih zuba u gornjoj čeljusti ponekad dovodi do otežanog uzimanja hrane i otežanog govora. Odabir kvalitetne implantoprotetske terapije s predvidljivim rezultatima omogućuje bolesnicima bolju kvalitetu života. Prikaz slučaja: Bolesnica u dobi od 62 godine koristila je gornju totalnu protezu s kojom nije bila zadovoljna. Učinjen je sinus lifting obostrano i kirurško-protetska rehabilitacija te je bolesnica dobila fiksni protetski nadomjestak sidren na implantati ma. Rasprava i zaključak: Sinus lift ing, suvremena implantološka i protetska terapija nude nam različite mogućnosti u zbrinjavanju totalne bezubosti u maksili. Na taj način mogu se dobiti odlični estetski i funkcionalni rezultati.Aim: Loss of all maxillary teeth oft en leads to diffi culti es in patient’s feeding and speaking. A high quality selecti on of prosthetic implant rehabilitati on with foreseable results off ers a bett er quality of life to the pati ents. Case report: A 62-year-old pati ent was unhappy with her upper complete denture. A billateral sinus lift ing was performed followed by placement of 6 implants in the upper jaw and prostheti c rehabilitati on with a fixed denture anchored on the forementi oned implants. Discussion and conclusion: Sinus lift ing and contemporary prosthetic implant rehabilitati on off er various soluti ons in the treatment of edentulous maxilla with an excellent esthetic and functional outcome