Evaluation of the efficiency of sinus lifting techniques

Right after teeth extraction in posterior regions, there is a following process that consists of physiological resorption and nonfunctional atrophy of the remained alveolar bone ridge. That also impacts the quality on the quality and quantity of the remained bone tissue, what later makes the implant incorporation and the prosthetic restoration much harder and complicated than usual it is. In the posterior region of the upper jaw additional complication of the prosthetic restoration process causes the existing of paranasal sinus that is located right in the body of the upper jaw maxilla. It’s post extraction pneumatization reduces the height of bone tissue what causes difficulties in dental implants placement. The aim of this survey is to evaluate the clinical outcome and the efficiency of the most often used sinus lifting techniques. Were analyzed totally 78 published studies that were done in the last 12 years. The study is made on narrative review of published articles that were investigating the related subject. Research was done by using the most common data bases: NCBI (US National Library of Medicine), Emedicine, PubMEd, Webmd. By using the open method for sinus lifting there needs to be formed lateral window in the bone tissue first by elevating the mucoperiosteal flap on the vestibular surface of the maxillary alveolar ridge and after that creating iatrogenic fenestration on the cortical lamina without perforating the sinus membrane. After the sinus membrane is being separated, the following step is augmentation. For this step are used four different types of bone substituent: autogenous, allogeneic, xenogeneic bone graft and synthetic alloplastic materials. The closed method for sinus lifting is performed after previous created place for the future implant in the residual alveolar bone ridge in the maxilla, after that with special instruments a perforation is being made in the bone floor of the maxillary sinus and carefully elevating the sinus membrane up for a few millimeters. In the created space a bone graft material is being placed and at the same time a dental implant is being applied. From the gathered results, both of the techniques are considered to be effective, in all of the followed cases the implant placements were successful with high rate of postoperative osseointegration, the healing period was without complications and also successful. There was no prosthetic failure in any case. From this survey the final conclusion is that both of the techniques are successful when it comes to sinus lifting. Very important is to have a qualitative imaging like computed tomography or roentgen before placing the implants to be able to estimate the bone volume and height. If the residual bone height is less than 5 mm the survival rate of the future implants is not guaranteed. Keywords: Sinus lift techniques, implant placement, bone augmentation, alveolar bone resorption

Menaging the most common complications of radiation therapy in patients with head and neck cancer

Radiation therapy is widely used approach in treatment of head and neck cancer, unfortunately it leaves consequences that are influencing the patients’ life in a negative way. During and after the treatment with ionizing irradiation it affects not only the malignant area that is being treated, but also the surrounding tissues and organs that are located near the region that is targeted (oral mucosa, jaw bones, teeth, salivary glands, surrounding muscles and the temporomandibular joints),leaving changes in their structure and functions. Many of the patients that are treated, have not been prepared optimally for the radiation treatment, what also affects the post operative condition of their tissues and organs that are located nearby to the radiation treated area. The aim of this study was to define the most common postradiation complications in patients with head and neck cancer and to evaluate the efficiency of the solutions that are used to manage them. For this study were analyzed in details 37 published articles on the studied topic, the research was done online using the data bases NCBI, Cochrane Library, Medline, PubMed and Webmd. The inclusion criteria were: studies made in vivo; studies written in English; case reports on head and neck cancer patients; surveys on patients after radiation therapy; studies on patients with intraoral complications from after radiation therapy. Results showed that radiation induced complications in the head and neck cancer patients can be classified in three groups as early, intermediate and late changes. The most common changes were found in the tissues (mucosa, skin, subcutaneous connective tissues, salivary glands, the bone tissues and the teeth), resulting with: hyposalivation (xerostomia), mucositis, opportunistic infections, radiation caries, dysphagia, altered taste and difficulties with the chewing and swallowing. Many studies have shown that the percent of damage on the oral mucosa is strongly related to the radiation dose and the type of ionizing irradiation that patients are being treated with. Treatment consists of application of lubricants; usage of substitutes for saliva; and stimulants for the saliva production, with preparations like pilocarpine and cevimeline, and electro stimulation. The loss of the taste after the treatment can be partial or total. Mostly affected are the sour and bitter tastes, rarely the sweet and the salty taste, and very rare is total loss on all of the flavors. Fortunately in most of the studied cases has been show that the changes in the taste were reversible after a period of time, in some cases a few months and in others it can happen even up to a few years until it reaches total recovery. It is crucial to implement more solutions and to find new ways to manage the complications that follow after the irradiation, so the quality of the life in these patients can be spared in any possible way. Using the new approaches such as IMRT and VMAT on these patients, could also improve their condition after the treatment, and reduced dosage of the irradiation also could be tested and implemented if it is possible

Клинички аспекти и третман на постирадијациона ксеростомија

Правилната и непречена функција на саливарните жлезди овозможува продукцијата на салива да биде во потребната количина, што претставува еден од основните фактори кои се потребни за правилно извршување на функциите на стоматогнатниот систем.Во одредени случаи и состојби саливарните жлезди се афектирани од различни влијанија и последователно на тоа може да биде алтерирана нивната функција. Кај пациентите со малигни неоплазми на глава и врат кои се изложени на терапија со радијацијаи покрај тоа што аплицирањето на зраците е врз туморското ткиво, несомнено се афектира и околното здраво ткиво. Така што, во голема мера се афектирани и саливарните жлезди и во најголем број од случаите пациентите се соочуваат со тешки последици како што е енормно намалување на функцијата на жлездите, последователно на тоа и изразен степен на ксеростомија. Со оглед на тоа, ксеростомијата најчесто е и главен предизвикувач на појавите: орален мукозитис, промени во оралната микрофлора, дисфагија, воспаленија на грлото, промена и губење на вкусот, кариес, промени во квалитетот на гласот, халитоза, дискомфорт, отежнато џвакање и голтање кои потоа доведуваат до нутритивни компликации и губење на телесната тежина. Ксеростомијата е најчесто застапената последица од терапијата со зрачење кај пациенти со малигни неоплазми на глава и врат, а воедно оваа појава е и главниот фактор кој го нарушуваат говорот и голтањето и го намалуваат квалитетот на животот на пациентот по терапијата. Поради ова од круциелно значење е правилно менаџирање на оваа состојба, одредување на точниот степен на хипофункција и примена на адекватен третман

Application of combined fixed - mobile prosthetic allowances

Aim: The aim of this study was to demonstrate the use of a fixed and mobile prosthetic supplement combined, to compensate for retention elements, improve the stability of the prosthesis, better aesthetic appearance, better hygiene, periodontal protection and better caries protection. Material and method: For this purpose, three fixed prosthetic benefits were set up in several different patients and were monitored for a certain period and compared with other patients who only had a fixed or only mobile prosthetic allowance. Conclusion: The conclusion is that capacities with combined fixed-line prosthetic benefits have a lower strain on natural teeth. Common accessories connect the bridge and the partial (wironti) cell. This link is invisible that provides a good aesthetic result. The mobile phone can be removed and maintained. Prosthetics, fixed and mobile are used when we can replace lost teeth with fixed prosthetic replacement (can not be removed), mobile replacement (can be removed) or a combination. Key words: fixed, stability, connection, esthetic, benefits, protection

Treating of fully edentulous mandible using four compressive implants immediately loaded with overdenture: case report

Introduction: The treatment of fully edentulous lower jaw is truly challenging among the dentists. Using contemporary acrylic denture is conventional method in those situations. However, this solution has several disadvantages: insufficient retention, stabilization, lack of comfort, difficulties for patients in mastication, speech and swallowing. Aim: The main goal is to hightlight the benefits of usage compressive implants immediately loaded with overdenture. Case description: We are presenting a female patient at the age of 62 without any medical issues. Intraorally, we diagnosed fully edentulous mandible, treated with conventional acrylic denture. All clinical and paraclinical examinations such as 3D CBCT and anatomical studio models were made. After discussion about the available treatment options, we decided to insert four compressive implants with multi-unit platform in the anterior part of the mandible between the mental foramens. Inserted implants are immediately loaded with overdenture. Implants were inserted using full thickness flap with mid-crestal incision. During the implantation, we achieved implant torque between 35N/cm and 45N/cm. The final impression was taken after 72 hours, with the close-tray method by using specially designed transfers for compressive MS implants. On the final cast with implant analogs, dental technician used burnout abutments for producing milled bar. The bar and the implant platform are connected by the screw-retention method. The milled bar is used for enhancing the retention and stability of the acrylic denture. After 48 hours throughout the principle of occlusal rims, vertical dimension was registered. In the next phase the wax try-in of the denture was performed and when the denture was finished, it was delivered to the patient. Conclusion: With this treatment option, we are preventing bone resorption in the anterior part of the mandible. Denture achieves better retention and stability. Patients are getting better oral health related quality of life as a result of improvements in mastication, speech and swallowing. The dental hygiene is easily maintained due to the screw-retention. Key words: anodontia, overdenture, compressive implant, immediate loa

Sophisticated graft materials and barrier membranes for oral surgery and dental implantology applications

The main aim of this review article is to evaluate the data bases presenting the different kinds of graft materials and barrier membranes applications which are dating in this new era and of it result and benefits from their usage. Regarding to the need of graft materials and barrier membranes applications, it is known that bone loss and jawbone defects from different etiology are common, so their usage and features are increasingly being examined and analyzed. Significant is the fact that bone graft materials are used as a scaffolds to replace the missing bone and for new bone growth. These materials can be derived from a patient’s own body like natural substitutes or can be of a synthetic origin. On the other hand, the different barrier membranes have a role to protect and stabilize graft material and to enable better regeneration. The materials which are acceptable for grafting procedures depend from clinical case and from specific features. Advances in technology and sophisticated materials for bone grafting offer numerous solutions and different treatment options for patients with bone deficiency. The new way of solving large bone defects proved as successful in cases treated with a bone graft combined with a barrier membrane

Periapical lesions: current modalities

In cases with periapical lesions, there are two types of treatment modalities: noninvasive and invasive. The first one noninvasive is also known as nonsurgical or endodontic treatment. The second one – invasive method is surgical approach. In some cases, there is a need for combination of both approaches. In everydays clinical treatment, the first choices is less invasive method and has better outcomes. Treatment of some periapical lesions (like cysts) are a theme of discussion and we do not have best option to treat them. The patient should make the definitive decision about the treatment. The doctor should inform him about the advantages and disadvantages of endodontic-noninvasive and surgical-invasive procedure. The therapeutic modalities for these pathologies are a wide range of treatment from endodontic treatment to different surgical options. We like to find out and present the best way about healing the periapical lesion. We wanted to know whenever surgical or non-surgical approach is better, and if using them might improve healing of those pathologies. The aim was clear and to reach it, we make an electronic search of medical and dental literature. We searched the following electronic databases: PubMed and Embase Ovid. Inclusion and exclusion criteria were used to reach the aim of this review study. We place restriction about language (only those articles that are written on English) and publication date (articles that are not older than 2010 year). We excluded duplicate article. We searched the references of the studies that we included for those review. We searched by hand the reference list of the studies and journals in the fields of endodontics and oral surgery. Every periapical lesion should firstly begin with good performed endodontic treatment. In some cases, there is a need for surgical approach of periapical pathologies because the endodontic treatment is not successful. Some cases might fail because of multipurpose factors such as: foreign body reaction, the size of the periapical lesion, biofilm, oral health and oral hygiene. A surgical approach is an option in cases when periapical lesion is large. Marsupialization might be the adequate option of treatment for those lesions in some cases. In cases with postoperative periapical lesion there is a need for surgical retrograde treatment. The procedure can be performed with hand endodontic instruments to make mechanical treatment of the root canal especially the part that is untreated. The advantages, disadvantages and modalities of treatment of periapical lesions are discussed in this review. According to these review there is no evidence that the first approach leads to better results compared to the second approach. This conclusion is based on electronic research of the literature database and clinical trials. There are several options for treatment to eliminate the clinical problems of periapical lesions but furder research is necessary. This review article is about the benefits of both approaches, and to determinate the best treatment modalities of cases with periapical pathologies, healing and postoperative quality of dental life. Keywords: periapical lesions, endodontic treatment, surgical treatment

The benefits of using the socket shield technique in partial extraction therapy: an article review

The technique with socket shield is used like not total extraction therapy which is based on preserving segment from one of the sides on the root from the tooth that is going to be extracted. The main use of this technique is in cases for implant placement that is combined with grafting bone. The goal of this technique is to preserve as much as possible tissue from the periodontal ligament and also to spare the gingival tissue from unnecessary damaging during the therapy. Indications for this technique are : 1. To support and to preserve buccofacial bone part of extraction socket in cases that require immediate implants.2. Socket shield technique is indicated in cases with vertical fractures of teeth that are without any pathology of the pulpal tissue, where the bone tissue sparing and also attractive look are a main goal.3. To preserve the papilla between the placed dental implants. In spite of that to have a full success of this therapy is required to have enough bone tissue that will allow stability of the future implant and also absence of any kind of infection. The advantages from application of this technique are many, such as prevention from resorption of the lamellar bone, high aesthetics results, improved primary stability of the future implant, minimal invasiveness during the procedure, prevention from forming a connective tissue with the implant, low cost compared with other procedures etc. There are also disadvantages such as possibility of displacement of the buccal lamellar bone. The purpose of this study is to analyze the efficiency of this socket shield approach in immediate implant treatment. This study was based on Narrative review on published surveys, using PubMed, Medscape, Webmd, Mdconsult, Emedicine data bases. The preservation of the whole attachment apparatus of the tooth to maintain complete preservation of the alveolar bone tissue, makes the socket shield approach a very good technique that results with high level efficiency. The clinical outcomes from different studies is believed for this technique to be the best approach for alveolar ridge sparing in the future and also to use as less material as possible. Keywords: Socket-shield technique, bone grafting, immediate implant, partial extraction, bone preservation

Buccal fat pad flap for closure of oroantral communication

Oroantral communication is created as a consequence of some dental procedures, extractions, expanded cyst, iatrogenic trauma or progressive infection. There are many traditional techniques that are used for this intervention, such as nasolabial flap, palatal transposition flaps, standard buccal flap, and latest technique pedicled buccal fat pad flap (BFP). For this technique is characteristic that the size of the buccal fat pad remains the same, no matter the body weight of the person and its fat distribution in the body. It is also easy to prepare and this tissue has a good blood supply. For this study were analyzed totally 43 articles, while 31 of them were with the inclusion criteria. It was based on narrative review on published articles in English language that reported results about the studied topic. The research was done with the use of data bases PubMed, Medscape, NCBI, and Cochrane Library. From the gathered results, it has been shown that patients treated with the BFP technique have had 81,75% successful outcome, and 18,25% resulted with failure. Pain was registered more intense, than the pain in the control group, same with postoperative edema, however there was not statistical significant difference in the maximum mouth opening in both techniques. From this study was concluded that the usage of BFP technique results with more intense post-operative consequences, however the high blood supply makes it good choice for closing OAC

Ефикасност при употребата на хербални препарати во третман на воспаленија на оралната лигавица

Оралните воспаленија (ОВ) можат да бидат предизвикани од најразлични општи или локални етиолошки фактори. Стоматитите, како чести и болни инфламаторни заболувања на оралната лигавица, се карактеризираат со: везикули, афти, ерозии и улцерации. Хербалните препарати (ХП), кои се користат за елиминирање на причината, имаат значајна улога во третманот на ОВ. Овие препарати поседуваат антиинфламаторни, антибактериски, антифунгални и аналгетски ефекти. Цел: Да се евалуираат клинички истражувања кои ја потврдуваат ефикасноста на ХП кај ОВ. Материјали и методи: Беше извршена евалуација на неколку хумани клинички студии, публикувани во последните пет години, во базата на податоци PubMed®. Резултати: Орални мукоадхезивни гелови и водички за испирање на уста, на база на: Aloe vera, Propolis, Matricaria chamomilla, Commiphora myrrha, Zataria multiflora, Curcuma longa се користат при третман кај ОВ. Во една студија, кај 65% од пациентите третирани со Propolis-водичка за испирање на уста, била целосно подобрена клиничката слика кај ОВ, во седумдневен третман. Друга студија покажала дека кај 76,6% од пациентите третирани со Aloe vera гел дошло до целосно исчезнување на улцерациите на мукозната лигавица, а кај 76,7% од пациентите третирани со гел од Commiphora myrrha, целосно исчезнала болката, после шестиот ден од третманот. Куркумата, користена како течност за испирање на уста, во едно истражување кај 80% од пациентите имало комплетно повлекување на промените после две-неделен третман. Употребата на водичка за испирање на уста со екстракт од Zataria multiflora (ZME), двојно ја намалила инциденцата на оралниот мукозитис, во однос на плацебо–групата. Интензитетот на болката и појавата на орален мукозитис биле 3,152 пати поретки кај групата која користела ZME. Заклучок: Хербалните препарати брзо и ефикасно можат да доведат до елиминација на симптомите и ублажување на болката. Затоа, нивната употреба кај вакви заболувања рапидно расте. Клучни зборови: мукозитис, стоматитис, третман, хербална медицина