Mineralni trioksidni agregat u terapiji eksterne resorpcije korena izbijenog zuba sa nezavršenim rastom korena - ishod posle deset godina

Introduction Root resorption may occur as a consequence of avulsion injury and may lead to the progressive loss of tooth structure. The aim was to report the outcome of root resorption treated with mineral trioxide aggregate in a replanted immature permanent incisor after 10 years of follow-up. Case outline This case presents external root resorption that was detected 18 months after the avulsion injury in a nine-year-old child. Apical portion of the canal was filled with mineral trioxide aggregate and the rest of the canal was filled with a canal sealer and gutta-percha. Control examinations were performed six months after the completion of the endodontic treatment and afterwards yearly. The tooth was asymptomatic clinically and radiographs did not show progression of root resorption up to four years of follow-up. Infraposition of the injured tooth was detected five years after the replantation, but without significant radiographic changes, until the eight-year follow-up, when root resorption was detected again. However, the tooth was still hard and symptomless at the 10-year follow-up. Conclusion Mineral trioxide aggregate may have an important role in the preservation of replanted immature teeth for a prolonged period.Uvod Resorpcija korena zuba se može javiti kao posledica povrede i može voditi progresivnom gubitku zubnih struktura. Cilj rada je bio da se prikaže klinički ishod replantacije izbijenog stalnog zuba sa nezavršenim rastom korena posle deset godina. Prikaz bolesnika Predstavljen je slučaj eksterne resorpcije korena zuba detektovane 18 meseci posle avulzione povrede kod devetogodišnjeg deteta. Apikalni deo kanala korena zuba je napunjen mineralnim trioksidnim agregatom, dok je ostatak kanala opturiran pastom i gutaperka poenima. Kontrolni pregledi su obavljani šest meseci posle završetka endodontskog lečenja i, posle toga, jednom godišnje. Do četvrte godine praćenja zub je bio bez kliničkih i radiografskih znakova progresije resorpcije korena. Infrapozicija povređenog zuba uočena je pet godina posle replantacije, ali bez značajnih radiografskih promena sve do osme godine praćenja, kada je uočeno napredovanje resorpcije korena. Ipak, posle deset godina zub je i dalje bio klinički bez simptoma. Zaključak Mineralni trioksidni agregat može imati značajnu ulogu u dugotrajnom očuvanju replantiranih zuba sa nezavršenim rastom korena

How to maintain oral health in children with respiratory diseases: Literature review

The most frequent chronic respiratory problems in childhood are asthma and cystic fibrosis (CF). The purpose of this paper is to review basic knowledge and recent advances in oral health and associated dental morbidities in children with asthma and CF. This review considered clinical trials and systematic reviews related to oral health in children with CRD. An online base Medline was searched to determine relevant papers, using the combination of the following terms: 'asthma', 'cystic fibrosis', 'caries', 'dental erosion', and 'oral health'. Oral health problems in children with chronic respiratory diseases (CRD) may be influenced by natural course of the disease, pharmacotherapy (inhalation therapy with bronchodilators and inhaled corticosteroids in asthmatic patients, systemic antibiotics and pancreatic enzyme replacement therapy in CF patients), medication administration technique and nutritional habits. Children with CRD may have higher prevalence of oral diseases. Patients and their parents, but also general paediatricians and pulmonologists, should be aware of importance of good oral health. Dental practitioners should be more informed about risk factors and specificities of oral health in these patients. Preventive measures, early diagnosis and effective treatment strategies in children with CRD can reduce occurrence of oral diseases and improve patient's quality of life

Prophylactic properties of fluoride-releasing dental materials

The process of dental caries is determined by a delicate balance between pathological factors (bacteria and carbohydrates) that lead do demineralization and protective factors (saliva, calcium, phosphate and fluoride) that lead to remineralization. Contemporary approach to the treatment of dental caries includes preventive and prophylactic measures based on the notion of "demineralization and remineralization" in a micro phase in order to retain healthy teeth. Development of dental materials which release fluoride, calcium and phosphate throughout a considerable period of time certainly contributed to that. The purpose of this article was to review prophylactic and therapeutic properties of fluoride releasing dental materials, and discuss the current status concerning the prevention or inhibition of caries development and progression. .Etiopatogeneza karijesa određena je ravnotežom između patoloških faktora (bakterije i ugljeni hidrati) koji vode demineralizaciji i protektivnih faktora (pljuvačka, fluoride, joni kalcijuma i fosfata) koji dovode do remineralizacije zubnih tkiva. Savremeni pristup u terapiji karijesa podrazumeva preventivne i profilaktičke mere koje su bazirane na dobrom poznavanju demineralizacionih i remineralizacionih procesa u gleđno-plakovnoj interfazi, sa ciljem očuvanja zdravih zubnih tkiva. Tome svakako doprinosi i razvoj savremenih stomatoloških materijala koji oslobađaju fluoride, kalcijum i fosfate u dužem vremenskom periodu. Cilj rada je bio da se predstave profilaktički i terapijski efekti stomatoloških materijala koji oslobađaju fluoride, kao i trenutne mogućnosti u prevenciji i zaustavljanju progresije karijesa.

Challenges in experimental evaluation of morphological, chemo-mechanical and adhesive properties of glass-ionomer based dental materials

Changes in composition and new material characteristics require verification in clinical and experimental studies. Investigating glass-ionomer cements under laboratory conditions encounters problems in interpreting the results and in comparing them with other types of materials tested in the same way. As the connection between the glass-ionomer cements and the dental tissues is delicate, it is often the case that the impact of fractures and other artifacts is either underestimated or over-dimensioned when interpreting the results. A critical review was performed, with defining the main problems regarding the usage of SEM, EDX and nanoindentation techniques in glass-ionomer based materials evaluation

Microleakage, adaptation ability and clinical efficacy of two fluoride releasing fissure sealants

Background/Aim. Retention of fissure sealants and good adaptation to enamel are essential for their success. Fluoride releasing resin-based materials are widely accepted for pit and fissure sealing, but newly designed glass ionomers can serve as a good alternative. The aim of this study was to evaluate microleakage and sealing ability in vitro, and to clinically assess two fluoride releasing fissure sealants. Methods. The sample for experimental study consisted of 20 freshly extracted intact human third molars, divided in two experimental groups according to the sealing material: fluoride releasing resin-based (Heliosel F) and glass ionomer (Fuji Triage) material. Digital images and scanning electron microscope were used to assess microleakage and adaptation ability. Sample for clinical study consisted of 60 children, aged 6-8 years, with high caries risk, divided in two groups according to the sealant material. Fissure sealant was applied to all erupted, caries-free first permanent molars. Sealants were evaluated after 3, 6 and 12 months using modified Ryge criteria for retention, marginal adaptation, colour match, surface smoothness and caries. Results. Microleakage was detected in more than half of the specimen, without significant differences between the two groups (p > 0.05). Both materials exhibited acceptable sealing ability. Complete retention at the end of the observation period was 81.8% for resin-based, and 21.1% for glass-ionomer fissure sealant (p < 0.001). The presence of caries in sealed molars has been detected in one patient in both groups. During the 12-month observation period, Helioseal F demonstrated better retention, marginal adaptation and surface smoothness (p < 0.001). There were no differences between the two materials regarding caries and color match (p > 0.05). Conclusion. Both tested materials demonstrate satisfactory clinical and caries prophylactic characteristics that justify their use in contemporary preventive dentistry

Hemijsko-mehaničko uklanjanje karijesa

The purpose of this paper was to introduce Carisolv™ system for chemo-mechanical caries removal and its main characteristics, mechanism of action, clinical procedure and the efficacy of this alternative method. New materials and technical and technological development contributed to more precise and efficient work in dentistry. However, problems of rotary instruments for caries removal have remained. Chemomechanical method for caries removal was introduced thirty years ago as an alternative to the conventional mechanical instruments. The technique involved applying a solution onto the carious tissue, allowing it to soften and to remove it without use of drill. Its advantages were: selective removal of carious tissue, absence of pain, reduced need for local anesthesia and reduced potential negative effects to the dental pulp.Cilj ovog rada je bio da se predstavi Carisolv sistem za hemijsko-mehaničko uklanjanje karijesa i ukaže na njegove osnovne karakteristike, mehanizam delovanja, odnosno kliničku proceduru i efikasnost ove alternativne metode uklanjanja karijesa. Zahvaljujući tehničko-tehnološkom napretku i usavršavanju stomatoloških materijala, tokom poslednjih decenija nastupili su veliki pomaci u stomatologiji. Ipak, problem rotirajućih instrumenata za uklanjanje karijesa još uvek nije rešen na zadovoljavajući način, tako da veliki broj pacijenata i dalje ima odbojnost prema stomatološkim intervencijama. Hemijsko-mehanička metoda uklanjanja karijesa je pre tri decenije ponuđena kao alternativa konvencionalnoj metodi. Suština ove ideje je bila da se na karijesno tkivo zuba aplikuje rastvor koji će ga razmekšati i omogućiti da se izmenjeno tkivo jednostavno ukloni bez upotrebe mašinskih instrumenata. Prednosti ovakvog terapijskog postupka bile su: selektivno uklanjanje karijesnog tkiva, izostanak bolnih senzacija smanjena upotreba lokalnih anestetika, odnosno smanjena mogućnost oštećenja pulpe. Cilj ovog rada je bio da se predstavi Carisolv sistem za hemijsko-mehaničko uklanjanje karijesa i ukaže na njegove osnovne karakteristike, mehanizam delovanja, odnosno kliničku proceduru i efikasnost ove alternativne metode uklanjanja karijesa

Zastupljenost razvojnih anomalija zuba kod ortodontskih pacijenata u Srbiji

Introduction/Objective the aim of this study was to evaluate the prevalence of developmental dental anomalies (DDA) in Serbian orthodontic patients. Methods the sample was composed of 1,001 panoramic radiographs of orthodontic patients, older than seven years, taken as a part of the initial diagnostic procedure at the Clinic of Orthodontics, School of Dental medicine in Belgrade. The DDA that could be diagnosed accurately on panoramic X-rays were documented. Descriptive analysis was used to determine prevalence and sex distribution of DDA. The Pearson ch2 test and Fisher's exact test were used to compare number of affected teeth in males and females (level of significance was 95%). Results the prevalence of DDA in Serbian orthodontic patients was 34.8% (15.5% males and 19.3% females). Impactions were present in 16.5%, hypodontia in 12.9%, hyperdontia in 4.4%, microdontia in 2.9%, macrodontia in 1.8% and transposition in 0.8% of patients. Maxillary canines were the most frequently impacted teeth. Maxillary second molars were more prone to impaction in females (p lt 0.05). Impacted incisors were more prevalent in maxilla, premolars, and second molars in mandible. The most commonly missing teeth were upper left second premolars. Mesiodens was the most frequently found supernumerary tooth. Conclusion We reported a high a rate of DDA in Serbian orthodontic patients, more in females than males. The most frequently observed DDA were impaction, tooth agenesis, hyperdontia, microdontia, macrodontia, and transposition. All investigated DDA were more frequently present in females, except hyperdontia. Current findings could offer a foundation for epidemiological studies on DDA prevalence.Uvod/Cilj Cilj ovog istraživanja je bio da se ispita zastupljenost razvojnih anomalija zuba kod ortodontskih pacijenata u Srbiji. Metode Uzorak je činio 1001 ortopantomografski snimak ortodontskih pacijenata starijih od sedam godina sa Klinike za ortopediju vilica Stomatološkog fakulteta u Beogradu. Beleženo je prisustvo razvojnih anomalija za čiju dijagnostiku je potreban samo ortopantomografski snimak. Za ispitivanje zastupljenosti razvojnih anomalija zuba korišćena je deskriptivna statistička analiza. ch2 test je korišćen radi poređenja broja zuba sa anomalijom između polova (stepen značajnosti 95%). Rezultati Razvojne anomalije zuba su bile zastupljene kod 34,8% ortodontskih pacijenata (15,5% muškaraca i 19,3% žena). Impakcije zuba su bile prisutne kod 16,5% pacijenata, hipodoncija kod 12,9%, prekobrojni zubi kod 4,4%, mikrodoncija kod 2,9%, makrodoncija kod 1,8% i transpozicija kod 0,8% pacijenata. Očnjaci u gornjoj vilici su bili najčešće impaktirani zubi. Gornji drugi kutnjaci su bili skloniji impakciji kod žena (p lt 0,05). Dokumentovano je više impaktiranih sekutića u gornjoj vilici, a pretkutnjaka i drugih kutnjaka u donjoj vilici. Najčešće su nedostajali gornji levi pretkutnjaci. Od svih prekobrojnih zuba najčešće je bio uočavan meziodens. Zaključak Prikazali smo postojanje visoke učestalosti razvojnih anomalija zuba kod ortodontskih pacijenata u Srbiji sa većom izraženošću kod osoba ženskog pola. Najčešće anomalije bile su impakcija, hipodoncija, hiperdoncija, mikrodoncija, makrodoncija i transpozicija. Sve anomalije su bile učestalije kod žena, osim u slučaju prekobrojnih zuba. Rezultati sadašnje studije mogu biti polazna tačka za epidemiološke studije o učestalosti razvojnih anomalija zuba

Karijes zuba i mogućnosti njegovog lečenja

Contemporary tendencies in dentistry are based on the concept of maximal protection of healthy tooth tissues. Caries removal has been done traditionally with mechanical rotary instruments that are fast and precise. However, conventional cavity preparation has potential adverse effects to the pulp due to heat, pressure and vibrations. Moreover, drilling often causes pain and requires local anaesthesia, and these procedures are frequently perceived as unpleasant. Etiology, development and prevention of dental caries are better understood today and new restorative materials that bond micromechanically and/or chemically to dental tissues have been introduced. Thus, development of a new, less destructive caries removal technique is allowed. In the last decades, many alternative methods have been introduced in an attempt to replace rotary instruments. These are claimed to be efficient and selective for diseased tissues and to offer comfortable treatment to the patients. New methods include air abrasion, air polishing, ultrasonic, polymer burs, enzymes, systems for chemo-mechanical caries removal, and lasers. The aim of this paper was to discuss various caries removal techniques and possibilities of their use in clinical practice. Based on the literature review it can be concluded that none of the new caries removal methods can completely replace conventional rotary instruments.Današnja stanovišta u stomatologiji podrazumevaju što manju traumu uz što veće očuvanje zdravih tkiva, kako u dijagnostikovanju, tako i u lečenju obolelih zuba. Zahvaljujući boljem razumevanju etiologije i mogućnosti prevencije karijesa, kao i razvoju savremenih stomatoloških materijala koji uspostavljaju adhezivnu, mikromehaničku, odnosno hemijsku vezu sa zubnim tkivima, stvara se mogućnost uštede zdrave zubne supstance. Obrada karijesne lezije se duže od jednog veka obavlja pomoću mašinskih rotirajućih instrumenata, koji obezbeđuju brz i precizan tretman. Međutim, tokom uklanjanja karijesa ovim instrumentima razvijaju se visoka temperatura, visok pritisak i vibracije, što predstavlja potencijalnu opasnost od oštećenja pulpe. Pored toga, uklanjanje karijesa ovim metodom dovodi do bolnih reakcija i zahteva primenu lokalnih anestetika, što je često osnovni razlog zbog kojeg veliki broj pacijenata ima odbojnost prema stomatološkim intervencijama. U lečenje karijesa su poslednjih decenija uvedeni razni terapijski postupci, čiji je cilj da se postigne efikasno i selektivno uklanjanje karijesnog tkiva, a da pri tom primenjeni metod bude prijatniji za pacijente. Nove mogućnosti obuhvataju primenu vazdušne abrazije i vazdušnog poliranja, ultrazvuka, polimernih borera, enzima, sistema za hemijsko-mehaničko uklanjanje karijesa i lasera. U radu su prikazane specifičnosti različitih metoda uklanjanja karijesa i mogućnosti njihove primene u stomatološkoj praksi. Na osnovu pregleda aktuelnih istraživanja zaključuje se da zasad nijedna tehnika ne može u potpunosti zameniti konvencionalne mašinske instrumente, ali i da je razvoj stomatološke nauke sigurno usmeren ka tom cilju

Mikrobiološka analiza efikasnosti hemijsko-mehaničke metode uklanjanja karijesa dentina

The aim of the study was to assess the efficacy of the chemo-mechani- cal method for caries removal based on microbiological analyses of dentine samples. Sixty freshly extracted teeth with coronaly caries were analysed. In the experimental group (30 teeth) chemo-mechanical caries removal was performed, and in the control group (30 teeth) rotary instruments were used. Before the caries treatment and at the completion of cavity preparation dentine samples were taken by sterile round ISO 012 bur for microbiological analyses. Results of the study showed significant differences between initial and final dentine samples, while differences between the experimental and control group were not significant. The microbiological analyses in the present study imply that the chemo-mechanical method for caries removal is as efficient as the conventional technique.Cilj rada je bio da se mikrobiološkom analizom uzoraka dentina sa dna preparisanog kaviteta proceni kvalitet i efikasnost hemijsko-mehaničke metode u uklanjanju karijesa. Istraživanje je obavljeno na 60 sveže ekstrahovanih zuba na kojima je dijagnostikovan koronarni karijes. Nakon ekstrakcije, zubi su podeljeni u dve grupe: u eksperimentalnoj grupi (30 zuba) primenjena je hemijsko-mehanička metoda uklanjanja karijesa, dok je u kontrolnoj grupi (30 zuba) karijes uklanjan mašinskim rotirajućim instrumentima. Neposredno pre i nakon terapijske procedure, sterilnim okruglim ISO 012 borerom uzimani su uzorci dentinskog detritusa za mikrobiološku analizu. Dobijeni rezultati ukazuju na značajnu razliku u broju bakterija između početnih i finalnih uzoraka dentina, ali bez značajnih razlika u eksperimentalnoj i kontrolnoj grupi. Rezultati istraživanja ukazuju na efikasnost hemijsko-mehaničke metode u uklanjanju karijesom oštećenih zubnih tkiva

Dojenje iz ugla dečjeg stomatologa

Current recommendations by the European Academy of Paediatric Dentistry, American Academy of Paediatric Dentistry, and International Association of Paediatric Dentistry advocate weaning from breast milk and avoiding unrestricted breastfeeding after the eruption of primary teeth in order to lower the risk of early childhood caries (ECC). However, World Health Organization, American Academy of Paediatrics and nutritional recommendations support exclusive breastfeeding up to six months of age, following continued breastfeeding along with appropriate complementary foods, favouring unrestricted and prolonged breastfeeding even beyond the age of two. The purpose of this review is to discuss current data in the literature regarding the association between breastfeeding and ECC in order to address this problem and to provide consistent recommendations. PubMed search revealed possible link between breastfeeding and ECC, however without evidence strong enough to establish the appropriate oral health preventive recommendation. Having in mind known benefits of breastfeeding, it is advisable to adhere to current paediatric guidelines which promote unrestricted breastfeeding as long as it is mutually desired by mother and child. This recommendation doesn't exclude but complements the prevention and timely treatment of ECC. Furthermore, there is a need to highlight the importance of education of parents and health care providers about the ECC risk factors, identification of initial lesions and consequences. Further research regarding this issue is needed.Savremene preporuke Evropske i Američke akademije dečjih stomatologa i Međunarodnog udruženja dečjih stomatologa savetuju postepeni prekid dojenja nakon nicanja mlečnih zuba kako bi se smanjio rizik od nastanka karijesa ranog detinjstva (KRD). Sa druge strane, preporuke Svetske zdravstvene organizacije, preporuke Američke akademije pedijatara i stručnjaka iz oblasti ishrane prepoznaju brojne kratkoročne i dugoročne pozitivne efekte dojenja i podržavaju isključivo dojenje do uzrasta od šest meseci, a zatim postepeno uvođenje čvrste hrane sa nastavkom dojenja uz neograničeno i dojenje na zahtev do druge godine deteta i duže. Cilj ovog preglednog rada je bio da se analiziraju savremeni podaci u literaturi o uticaju dojenja na nastanak KRD, kako bi se doprinelo formiranju jedinstvenog stava i pružila jasna informacija majkama kako prevenirati KRD. Na osnovu pretraživanja Pub Med baze podataka, uočava se da postoji povezanost između dojenja i KRD, ali nije dovoljno argumentovano koje su najbolje mere u prevenciji karijesa. Imajući u vidu poznate pozitivne efekte dojenja, smatra se da je preporučljivo pratiti savremene pedijatrijske preporuke koje savetuju neograničeno dojenje koliko God to uzajamno prija majci i detetu. Ipak, potrebno je imati u vidu neophodnost ranih preventivnih poseta dečjem stomatologu i edukacije zdravstvenih radnika radi adekvatnih i blagovremenih saveta o higijeni usne u duplje i ishrani kako bi se izbegao nastanak karijesa ranog detinjstva i omogućilo blagovremeno dijagnostikovnje inicijalnih lezija. Neophodna su dalja istraživanja u ovoj oblasti