Uticaj balansne okluzije kod totalnih proteza na smanjenje redukcije bezubog grebena

Background/Aim. Balanced occlusal arrangement of artificial teeth and balanced occlusion is a specific type of occlusion that preserves the stability of complete dentures. Balanced occlusion comprises realization of tooth contacts at the working side as well as at the balancing side, at the same time. The aim of this study was to assess the influence of balanced occlusal arrangement of artificial teeth on the decrease in reduction of edentulous alveolar ridge. Methods. A longitudinal study on 91 fully edentulous patients was conducted using their panoramic radiographs and parameters of vertical dimension of edentulous ridges. All the patients were clinically examined by the same and a qualified dental practitioner. Numerical values of parameters of vertical dimensions of edentulous ridges and lines were statistically processed and compared using the Student's t-test. Results. Vertical dimensions and heights of edentulous ridges were different after comparison of parameters in complete denture wearers with balanced occlusion and complete denture wearers without bilaterally balanced occlusion, as well as between male and female edentulous patients. Statistically significant differences of heights were established in complete denture wearers' with a set of artificial teeth without balanced occlusion, at the baseline and 12 months after wearing of complete dentures. Conclusion. Balanced occlusion is a favored occlusal design in setting of artificial teeth in conventional complete dentures, which preserves edentulous ridge and influence the stability of dentures.Uvod/Cilj. Postava veštačkih zuba po balansnoj okluziji (BO) i balansno okluzalno uravnoteženje je posebna vrsta okluzije koja uslovljava i čuva stabilnost totalnih proteza. Balansna okluzija podrazumeva da kontakti veštačkih zuba postoje u isto vreme i na radnoj i na balansnoj strani. Cilj ove studije bio je da se ispita uticaj postave zuba po balansnoj okluziji na sniženje redukcije bezubog grebena. Metode. U okviru ove longitudinalne studije ispitan je 91 bezubi pacijent uz korišćenje ortopantomograma i parametara vertikalne dimenzije bezubog grebena. Svi pacijenti bili su i klinički ispitani od strane istog kvalifikovanog stomatologa, specijaliste stomatološke protetike. Numeričke vrednosti parametara vertikalne dimenzije bezubih grebenova bile su statistički obrađene i upoređene korišćenjem Studentovog t-testa. Rezultati. Vertikalna rastojanja i visine bezubih grebenova bile su različite pri upoređivanju parametara kod pacijenata koji su koristili totalne proteze sa BO i pacijenata koji su imali totalne proteze bez obostrane BO, a takođe i između pacijenata i pacijentkinja. Statistički značajne razlike utvrđene su kod pacijenata sa totalnim protezama u kojima zubi nisu bili postavljeni u skladu sa obostrano uravnoteženom BO, na početku merenja i posle 12 meseci terapije totalnim protezama. Zaključak. Balansna okluzija je zadovoljavajući i uspešan okluzalni odnos veštačkih zuba u totalnim zubnim protezama koji utiče na očuvanje bezubog grebena i uslovljava stabilnost totalnih proteza

Medication and positive remodeling of osteoporotic jaws

Osteoporosis causes micro-degradations and jaw-bone reduction. Initial positive turnover and bone recover should make hasten by local medication of osteoporotic jaws. The aim of this study was to present improvement of jaw pattern by local application of calcitonin and calcium throughout prosthetic treatment of selected osteoporotic patients. Patients undergoing study were osteoporotic and toothless (9 males and 27 females), with no malignancy. Non-osteoporotic complete denture wearers, 7 men and 7 women were controls. DPX-L (Lunar) was used in detection of skeletal degradations. Panoramic radiographs (Orthopantomograph 10, Siemens) and digital densitometer DT II 05 (England) were used in the analysis of bone density. T-results indicated systemic osteoporosis. After application of calcium and calcitonin in solutions, moderate increase of density (p lt 0.05) was verified, compensating up to 3% of total mandibular loss. The second section of results was restorative effect of prosthetic treatment of osteoporotic patients. In this study, osteoporosis affected women patients earlier than men. Regardless the necessity of careful selecting of patients for this kind of treatment, calcitonin and calcium in solutions should be considered as the priority of local therapy in osteoporotic toothless patients, providing positive bone remodeling, as well as success at the second level of therapy - positioning of dentures

Efekti primene kalcitonina i kalcijuma u lečenju bezubih pacijenata sa osteoporoznim mandibulama

Background/Aim. In addition to damage of the bones that support the remaining teeth, degradation of osteoporotic oral bones also lead to a consequent reduction of supporting tissues and the loss of dentures retention. The aim of this study was to assess the clinical and radiographic outcomes following injection of a calcitonin and calcium solution into the buccal aspects of edentulous mandibles. Methods. The experimental group of 67 edentulous patients diagnosed with osteoporosis, and the control group of 19 nonosteoporotic edentulous patients were treated with the calcitonin and calcium once solution per month. Mandibular bone density was measured from panoramic radiographs, supplemented by T scores of skeletal density in the experimental group. Results. After the therapy, measurements showed moderate increases in bone density, compensating for up to 4% of the total loss of minerals and solidity of denture-bearing areas of osteoporotic mandibles. Osteoporosis affected women earlier than men in this study. Conclusion. Application of a calcitonin and calcium solution is a suitable method of preprosthetic therapy for edentulous osteoporotic patients.Uvod/Cilj. Degradacija osteoporoznih viličnih kostiju vodi ka oštećenju kostiju koje podržavaju preostale zube, ali i posledičnoj redukciji potpornog tkiva i gubitku retencije proteze. Cilj rada bio je da se procene klinički i radiografski parametri posle tretmana bezubih mandibula rastvorom kalcitonina i kalcijuma ubrizganog u bukalne recesuse. Metode. Ispitnu grupu činilo je 67 bezubih pacijenata sa dijagnostikovanom osteoporozom, a kontrolnu grupu 19 bezubih pacijenata sa normalnom gustinom kosti (bez osteoporoze). Svi ispitanici dobijali su rastvor kalcitonina i kalcijuma jednom mesečno. Gustina kosti mandibule merena je na osnovu ortopantomograma svih ispitivanih pacijenata, uz komplementarni T-nalaz gustine skeleta na sistemskom nivou kod pacijenata iz ispitne grupe. Rezultati. Po završenoj terapiji utvrđen je umeren porast gustine kosti, čime je nadoknađeno oko 4% ukupnog gubitka mineralnih supstanci u regionima nosećeg tkiva osteoporoznih mandibula. Osteoporoza je zahvatala kosti žena ranije od kostiju muškaraca u ovoj studiji. Zaključak. Primena rastvora kalcitonina sa kalcijumom predstavlja kvalitetan metod medikacije i preprotetske pripreme bezubih pacijenata obolelih od osteoporoze

Oblici kalcijum-fosfata u kosti ljudskih vilica promenjene strukture usled osteoporoze

Introduction. Calcium phosphates are chemical compounds that can be found in various forms within nature, as well as in human jaws and bones. The aim of this study was to assess the structure of solid chemical compounds which form the structure of normal and osteoporotic jaw-bones. Materials and Methods. The jaw-bones taken from human cadavers were used in the study. Crystalographic forms of calcium phosphate, in the samples of human jaw-bone, were determined using X-ray diffraction technique. The experimental bone samples originated from osteoporotic jaw-bone of cadavers while control samples were taken from dentate jaw-bones of non-osteoporotic cadavers. Results. The results of this study showed that hydroxyapatite was the only phase determined in control non-osteoporotic bone samples. In experimental (osteoporotic) bone samples, the same phase was registered, as well as calcium monophosphate and hydrated calcium phosphate, registered as increments of values on α axis. Conclusion. Hydroxyapatite was the only compound detected in normal bone while osteoporotic bone contained others crystallographic forms of calcium phosphates.Uvod. Jedinjenja kalcijum-fosfata se u prirodi nalaze u različitim oblicima, a mogu se naći i u vilicama i kostima kod ljudi. Cilj ovog rada je bio da se proveri sastav čvrstih hemijskih jedinjenja koja čine strukturu normalne i kosti vilica zahvaćene osteoporozom. Materijal i metode rada. Kao materijal u istraživanju korišćene su vilice kadavera. Kristalografski oblici kalcijum-fosfata u kostima vilica određeni su metodom difrakcije rendgenskim zracima. Eksperimentalni uzorci kostiju su izdvojeni iz bezubih osteoporoznih vilica, a kontrolni uzorci iz ozubljenih vilica bez osteoporoze. Rezultati. Dobijeni rezultati su pokazali da je hidroksiapatit jedina kristalna faza u kontrolnim uzorcima vilica. U uzorcima vilica s osteoporozom, pored navedene faze, uočeni su i kalcijum-monofosfat i hidratisani kalcijum-fosfat kod povećanja vrednosti na alfa osi. Zaključak. Kod normalne kosti zastupljen je samo hidroksiapatit, dok se kod kosti zahvaćene osteoporozom javljaju i drugi kristalografski oblici kalcijum-fosfata

Changes in jaw dimensions and bone density in patients with osteoporosis

Introduction Osteopenia and osteoporosis reduce the density and mass of jaw bones. Aim The aim of this study was to present the methods of radiographic analysis in patients with osteoporosis prior to restorative treatment. Method 127 panoramic radiographs (Kodak, USA) and 39 retroalveolar radiographs (KD 58-R 30×40 mm, USA) were used for the analysis of density (DT II 05 densitometer, England) and dimensions of jaw bones with respect to segments corresponding to bone layers. Results The results of this study indicated statistically significant differences in bone density (p<0.05 and p<0.01) in patients with osteopenia. Bone density was significantly reduced (p<0.01 and p<0.001) in osteoporotic patients, when compared to controls. Significant reductions of edentulous ridges in osteoporotic patients women X=23.05 mm (kV=30.72%) and X=22.85 mm (kV=28.81%), and men X=28.83 (kV=8.55%) as well as X=25.36 (kV=11.43%), were observed. Conclusion Bone density of the upper and lower jaw is reduced in osteoporotic patients. At the very beginning of restorative prosthodontic therapy of osteoporotic patients, retroalveolar radiographs and panoramic radiographs should be obtained. Reference lines should be assigned, contours of the alveolar and edentulous ridges on radiographs should be analysed and bone density assessed

Design of complete denture reinforced with metal base

Introduction. Complete denture reinforced with metal bases is fabricated in cases of fracture risk as well as in selected patients with neuromuscular disorders. The aim of this report was to present different designs of metal framework for complete denture and their advantages in the treatment of edentulous patients. Material and Methods. The study included 116 edentulous patients who received complete dentures. The respondents were divided into two groups according to the type of denture used. Thirty one patients were rehabilitated with complete dentures reinforced with metal base, whereas 85 patients received conventional complete acrylic dentures. Metal bases were fabricated using Co-Cr-Mo alloy. Two designs different in regards to the vibrating line were fabricated: metal frame extended to the vibrating line and acrylic resin extended to the vibrating line. After investing and casting, metal bases were electropolished. Subsequent processes of arranging artificial teeth, waxing, flasking and finishing completed the fabrication process of dentures. Results. Denture base fractures were prevented in majority of patients. The design of upper denture where metal frame was extended to the vibrating line and metal base with elongation over the convex edentulous ridge in lower jaw were the most favored and successful in prosthetic rehabilitation of experimental group of edentulous patients. There was no need for rebasing of complete dentures reinforced with metal base. Conclusion. Complete denture reinforced with metal base presents a favorable design for rehabilitation of edentulous patients with well pronounced edentulous ridges and low tendency to resorption

Promene u mandibuli usled osteoporoze

Introduction: Osteoporosis may occur in bone tissue as a result of ageing. Aim: The aim of this study was to investigate remodeling of old human edentulous mandibular bone due to osteoporosis. Materials and Methods: Osseous surfaces of one edentulous and one dentate mandible were extracted from a cadaver. This study included 5 methods of analysis of bone structures in experimental and control bony samples of human mandibular bones. Absolute densities of samples were determined. SEM analysis and X-ray diffraction analysis of spectra were used to assess bony layers. Results: Minimum density 1.9658 g/cm3 of edentulous ridge site was detected. SEM micrographs indicated reductions of trabecular and lamellar width. Significant differences (p lt 0.01) in cancellous site width were recorded in experimental basal specimens. Noticeable increase of porosity was observed in 6.35% of edentulous ridge site and 14.06% of experimental basal site. There was a significant correlation between oxygen presence (p=0.046) eroded and defect bone surfaces (p lt 0.001). Complexes of hydroxyapatite, calcium-phosphate, tetracalcium-pyrophosphate and amorphous calcium-phosphate were inorganic constituents considerable mineral modifications of edentulous ridge site. Conclusion. Based on the results of the present study, various levels of degradation of cortical matrix and cancellous layers of edentulous mandible may be observed as a result of osteoporosis.Uvod. Osteoporoza može biti jedna od promena koje se javljaju u koštanom tkivu usled starenja. Cilj. Cilj ovog istraživanja je bio da se ispitaju promene u mandibuli nastale usled osteoporoze. Metod rada. Kao materijal korišćeni su uzorci kosti izdvojeni iz mandibula kadavera. Bezuba mandibula je bila eksperimentalna kost u istraživanju. U studiji je primenjeno 5 različitih metoda analizovanja strukture kosti iz uzoraka. Izmerene su apsolutne gustine uzoraka. SEM analiza i difrakcija X zracima su primenjene u cilju ispitivanja sastava slojeva kosti mandibula. Rezultati. Dobijeni rezultati su pokazali da je najmanja gustina od 1.9658 g/cm3 ustanovljena pri merenjima uzorka bezubog grebena eksperimentalne mandibule. Na osnovu SEM mikrografija utvrđene su redukcije trabekula i smanjenja širina lamela. Statistički značajne razlike (p lt 0.01) su zabeležene upoređivanjem numeričkih vrednosti širina mikroprostora u spongioznim površinama eksperimentalnih uzoraka. Progresivno povećanje poroznosti je utvrđeno u uzorku bezubog grebena kod 6,35% , i u uzorku bazalnog sloja kod 14,06% eksperimentalne mandibule. Upoređivanjem površina kosti sa različitim oblicima apatita usled izmena oblika kristala utvrđena je značajna povezanost prisustva kiseonika (P=0.046) na erodovanim i oštećenim površinama kosti (p lt 0.001). Hidroksiapatit, kalcijum-fosfat, tetrakalcijum-pirofosfat i amorfni kalcijum fosfat su sačinjavali neorganske faze u značajno izmenjenim mikrokristalima uzorka eksperimentnog bezubog grebena. Zaključak. Na osnovu rezultata istraživanja utvrđena je različita degradacija kortikalnog matriksa i spongioznih slojeva bezube mandibule nastalih usled osteoporoze

A preliminary study of local administration of dexamethasone after tooth extraction: Better preservation of residual alveolar ridge?

Background/Aim. It is important that the height of the edentulous alveolar ridge after tooth extraction remains at a reasonable acceptable level for as long as possible. The aim of this study was to report preliminary results of the clinical effect of local oral submucous administration of dexamethasone after tooth extractions in order to prepare alveolar supporting tissues for acceptance of removable dentures. Methods. In a total of 15 patients (11 partially and 4 completely edentulous) the quantity of 0.25 mL to 0.5 mL of dexamethasone was injected bucally and orally in the region of the tooth socket after complicated extractions. Results. Healing of extraction wounds was uneventful in all the patients, without pain or local inflammation. Conclusion. Dexamethasone can be locally applied to oral tissues to prevent post-extraction inflammation and extensive resorption of the residual alveolar ridge. The obtained results are promising for patients undergoing classic prosthodontic rehabilitation soon after tooth extraction, demonstrating that there are no adverse effects after local oral corticosteroids administration. [Projekat Ministarstva nauke Republike Srbije, br. 175021

Povezanost BMI, gustine skeleta i kosti mandibule u osteopeniji

Various indexes could be used in assessing of reduction of density of bones. However value of each index could indicate, or not to indicate exact changes of systemic skeletal density. Aim of this study was to assess accuracy of representing and correlation of body mass index, lumbar and skeletal density and mandibular density of individuals with minor or moderate reduction of bone densities. Materials and method. 9 men (mean age 62.4 yrs.) and 14 women (mean age 65.1 yrs.) were examined. Body mass index (BMI), density of skeleton (g/cm3) (Lunar DPX-L, USA),and density of mandible using panoramic radiograph (Orthopantomograph 10,Siemens,Germany) and digital densitometer (DT II 05, England) were calculated for every subject. Results. Mean values amounted BMI=17.1 kg/m2, skeletal density T=-1.8, and optical density of a bodies of mandibles ρo= 0.98 U/mm2, for men. Pearson's correlation coefficient was 0.324, and Spearman's coefficient was 0.219. Mean values amounted BMI=15.7 kg/m2, skeletal density T=-2.1, and density of mandibles ρo= 0.63 U/mm2, for women. Pearson's correlation coefficient was 0.201, and Spearman's coefficient was 0.167. Conclusion. BMI, T and ρo indicated small or moderate reduction of skeletal density- osteopenic changes in all subjects. Calculated values of statistical parameters indicated small significance in correlations of indexes of density and mass of bones.Uvod. U ispitivanju smanjivanja gustine kosti mogu se koristiti različiti indeksi, pri čemu vrednost svakog indeksa može, ali i ne mora, ukazati na značajne promene u kostima. Cilj rada jeste ispitivanje tačnosti u prikazivanju i korelacije indeksa telesne mase, gustine lumbalnih pršljenova i skeleta i gustine mandibule kod osoba sa malom ili umerenom redukcijom gustine kosti. Materijal i metod. Ispitano je 9 muškaraca (prosečna starost ispitanih 62,4 god.) i 14 žena (prosečna starost ispitanih 65,1 god.). Kod svakog ispitivanog su izmereni indeksi telesne mase (BMI), gustina skeleta (g/cm3) (Lunar DPX-L, USA) i gustina kosti donje vilice na osnovu ortopantomograma (Orthopantomograph 10, Siemens, Germany) i denzitometra (DT II 05, England). Rezultati. Kod muškaraca su prosečne vrednosti iznosile BMI=17,1 kg/m2, gustine skeleta T=-1.8, i gustine tela kostiju mandibula ρo= 0,98 U/mm2. Vrednost Pirsonovog koeficijenta korelacije je 0.324, a vrednost Spirmanovog koeficijenta je iznosila 0.219. Kod žena su prosečne vrednosti iznosile BMI=15,7 kg/m2, gustine skeleta T=-2.1, i gustine tela kostiju mandibula ρo= 0,63 U/mm2. Vrednost Pirsonovog koeficijenta korelacije je 0.201, a vrednost Spirmanovog koeficijenta je iznosila 0.167. Zaključak. Indeksi BMI, T i ρo su ukazali na umereno smanjenu gustinu kosti - ostepeniju kod svih ispitanih. Izračunate vrednosti parametara su ukazale na statistički malo značajne korelacije ispitivanih indeksa gustine i mase kosti

Terapijski pristup u rehabilitovanju jednostrano resorbovanog grebena gornje vilice i delimično resorbovanih grebenova donje vilice - prikaz slučaja

Introduction. The aim of this study was to fabricate a complete upper acrylic denture and a partial lower acrylic denture and provide occlusal rehabilitation with added benefit of correcting the position of altered condyle in a dysfunctional stomatognathic system. Case Report. Procedures for fabrication of acrylic dentures are thoroughly described. Specific scheme of occlusion was applied in the treatment of this patent. Occlusal contacts were established as tripod minor contacts on the side where the part of upper edentulous ridge was intensively reduced (on the right side) with divergent tracing of the condyle due to dysfunction. Tripod contacts were established on occlusal surfaces of opposing teeth as well. Contacts on the left side were formed as circumferential surfaces. Specially distributed occlusal contacts favorably influenced reduction of occlusal stresses on supporting tissues in the mouth of the patient. Tooth contacts arranged in such particular order were established to redistribute loading as well as to prevent excessive propulsion and latero-protrusive movements of the lower jaw. Conclusion. Occlusal pattern of tripod and single-point contacts was used to compensate differences in condylar movements of this patient with stomatognathic dysfunction, intending to diminish loads on reduced surfaces.Uvod. Cilj rada je bio da se prikaže postupak izrade gornje akrilatne totalne proteze i donje akrilatne parcijalne proteze, kojima je obezbeđena rehabilitacija okluzije kod pacijenta s korigovanjem položaja izmenjenog kondila usled disfunkcije njegovog stomatognatog sistema. Prikaz slučaja. U radu su detaljno prikazani postupci u iz radi akrilatnih proteza. U terapiji pacijenta je primenjena specifična shema okluzije, pri čemu su uspostavljeni tripodni okluzivni kontakti malih dimenzija na strani gde je greben intenzivno resorbovan i gde je postojalo deviranje kondila usled disfunkcije. Tripodni tačkasti kontakti su uspostavljeni i na okluzivnim površi nama zuba antagonista. Kontakti zuba na suprotnoj, levoj strani su uspostavljeni kao kružne linije po ograničenim malim površinama. Posebno raspoređeni kontakti zuba povoljno utiču na smanjenje pritiska na nosećim tkivima u ustima pacijenta. Kontakti zuba uspostavljeni na ovakav način rasterećuju i sprečavaju prekomernu propulziju i lateropropulzivne pokrete donje vi lice. Zaključak. Posebno ustanovljena i primenjena shema okluzije i tačkasti kontakti su u terapiji primenjeni da bi se kompenzovale razlike u pokretima kondila usled disfunkcije stomatognatog sistema i smanjilo opterećenje na redu kovani greben