INJECTION-MOLDING APPROACH IN THE RESTORATION OF LATERAL TEETH INTERDENTAL ANATOMY

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Directiva stomatologiei operative contemporane este realizarea restaurărilor estetice într-un mod simplificat, dar cu prezervarea aspectelor structurale și funcționale. Tehnica injection-molding permite refacerea elementelor de anatomie interdentară, respectând conceptul biomimetic. Scopul lucrării. Relevarea avatajelor restabilirii anatomiei interdentare la dinții laterali în baza abordului injection-molding. Material și Metode. Au fost supuși examenului clinic și paraclinic pacienți care au prezentat cavități carioase aproximale localizate la nivelul dinților laterali. Restabilirea morfo-funcțională a fost realizată prin tehnica injection-molding, cu utilizarea sistemului de matrici și pene interdentare Bioclear. Rezultate. Tratamentul restaurator prin aplicarea tehnicii injection-molding și sistemului Bioclear a permis restabilirea eficientă a suprafeței de contact, atunci când distanța dintre marginea cervicală a cavității carioase și dintele adiacent a fost mai mare de 0.7 mm. Folosirea matricilor anatomice și compozitului preîncălzit a determinat o bună adaptare marginală a materialului, cu refacerea ambrazurilor ocluzale, cervicale, vestibulare și orale. Concluzii. Redesign-ul de preparare a cavităților carioase aproximale la dinții laterali, sistemul translucent de matrici, combinația compozitului flowabil cu cel de tip pastă favorizează restabilirea anatomică a morfologiei proximale, cu evitarea marginilor debordante.Background. The directive of contemporary operative dentistry is to carry out aesthetic restorations in a simplified way, but with the preservation of structural and functional aspects. The injection-molding technique allows the rehabilitation of interdental anatomy elements, respecting the biomimetic concept. Objective of the study. Revealing the benefits of restoring lateral teeth interdental anatomy based on the injection-molding approach. Material and Methods. Patients with proximal carious cavities located in the lateral teeth were subjected to clinical and paraclinical examination. The morpho-functional restoration was performed by the injection-molding technique, using the matrices and wedges of Bioclear system. Results. Restorative treatment by injection-molding technique and Bioclear system allowed the effective restoration of the contact area, when the distance between the cervical edge of the carious cavity and the adjacent tooth was more than 0.7 mm. The use of anatomical matrices and preheated composite determined a good marginal adaptation of the material, with the rehabilitation of occlusal, cervical, vestibular, and oral embrasures. Conclusion. The redesigned preparation of proximal carious cavities in lateral teeth, the translucent matrix system, the combination of flowable composite with paste composite favor the anatomical restoration of the proximal morphology, avoiding the overhanging margins

Joining functionality and esthethics in the treatment of reduced unidental edentation by means of adhesive bridges

Therapeutic Stomatology, Department FCEMPh, Orthopedic Stomatology Department, State Medical and Pharmaceutical University „Nicolae Testemitanu”, Chisinau, Republic of Moldova.Introduction: Partial unidental edentations of dental arcades in the front side, including the absence of the premolars lead to disorder from aesthetic perspective and of the occlusal function. In line with the biological principle, the modern concept of stomatological treatment provides for mini-invasive interventions on the dental tissues. On the background of this concept, fixed prosthetic restoration supported on implantation blunts continue to be elected therapeutic solutions of treating unidental edentations. In clinical situations with relative or absolute contraindications to implantation therapy, the adhesive bridges, achieved by direct restoration technique, ensure a longlasting in-between solution in the dentist treatment schemes. Using the wax-up technique under this treatment is efficient because of visualizing the form and design of the future construction, but also as a reference for the individual rehabilitation of the overjet and overbite, occlusal parameters that characterize the anterior guidance. Materials and methods: There were examined and assessed 5 patients with partial unidental edentations in the front side of the dental arcades, including the lack of premolars. Along with the clinical examination, there were performed orthopantomographies; if needed-dental-periodontal xrays; as well as instrumental functional diagnosis. Based on the diagnosis models, there were assessed the parameters of the potential prosthetic space. The data of the aesthetic evaluation were input in a special fiche developed by us. Results: Data of the clinical-instrumental examination provided us information about the condition of the teeth, condition of the mucous membrane, form and profile of deprived teeth ridges. Assessment of parameters of potential prosthetic area in the selected clinical cases proved insufficient space to plan an implant-prosthetic treatment. Wax-up has been performed on diagnosis models mounted in the adjustable articulator, taking into account the condition of the overjet and overbite, which feature the anterior guidance. The data from the aesthetic evaluation fiche provided useful information in the treatment consisting of direct restoration with adhesive dental bridges. ConcIusions:The results of the aesthetic evaluation, as well as the data of the examination of unidental edentation patients governed the choice of a treatment with adhesive bridges, accomplished by means of direct method

Abordarea tehnicii injection-molding în restabilirea anatomiei interdentare a dinților laterali

Background. The directive of contemporary operative dentistry is to carry out aesthetic restorations in a simplified way, but with the preservation of structural and functional aspects. The injection-molding technique allows the rehabilitation of interdental anatomy elements, respecting the biomimetic concept. Objective of the study. Revealing the benefits of restoring lateral teeth interdental anatomy based on the injection-molding approach. Material and Methods. Patients with proximal carious cavities located in the lateral teeth were subjected to clinical and paraclinical examination. The morpho-functional restoration was performed by the injection-molding technique, using the matrices and wedges of Bioclear system. Results. Restorative treatment by injection-molding technique and Bioclear system allowed the effective restoration of the contact area, when the distance between the cervical edge of the carious cavity and the adjacent tooth was more than 0.7 mm. The use of anatomical matrices and preheated composite determined a good marginal adaptation of the material, with the rehabilitation of occlusal, cervical, vestibular, and oral embrasures. Conclusion. The redesigned preparation of proximal carious cavities in lateral teeth, the translucent matrix system, the combination of flowable composite with paste composite favor the anatomical restoration of the proximal morphology, avoiding the overhanging margins.Introducere. Directiva stomatologiei operative contemporane este realizarea restaurărilor estetice într-un mod simplificat, dar cu prezervarea aspectelor structurale și funcționale. Tehnica injection-molding permite refacerea elementelor de anatomie interdentară, respectând conceptul biomimetic. Scopul lucrării. Relevarea avatajelor restabilirii anatomiei interdentare la dinții laterali în baza abordului injection-molding. Material și Metode. Au fost supuși examenului clinic și paraclinic pacienți care au prezentat cavități carioase aproximale localizate la nivelul dinților laterali. Restabilirea morfo-funcțională a fost realizată prin tehnica injection-molding, cu utilizarea sistemului de matrici și pene interdentare Bioclear. Rezultate. Tratamentul restaurator prin aplicarea tehnicii injection-molding și sistemului Bioclear a permis restabilirea eficientă a suprafeței de contact, atunci când distanța dintre marginea cervicală a cavității carioase și dintele adiacent a fost mai mare de 0.7 mm. Folosirea matricilor anatomice și compozitului preîncălzit a determinat o bună adaptare marginală a materialului, cu refacerea ambrazurilor ocluzale, cervicale, vestibulare și orale. Concluzii. Redesign-ul de preparare a cavităților carioase aproximale la dinții laterali, sistemul translucent de matrici, combinația compozitului flowabil cu cel de tip pastă favorizează restabilirea anatomică a morfologiei proximale, cu evitarea marginilor debordante

Theoretical considerations in the selection of dowel core devices under the prosthetic treatment by means of substitution method

Coordonator ştiinţific Gribenco Vitalie – asist.univ. Catedra Stomatologie Ortopedică „I.Postolachi”The substitution method of treating coronary odontal lesions that are widespread in terms of surface and depth is based on the substitution of the natural tooth crown with a fixed prosthetic restauration mounted on a dowel core device. The assessment of the odontal and parodontal status, clinical conditioning in line with the requirements, physical properties of the substances the dowel core devices are made of, esthetical exigencies,the absence or presence of muscular parafunctions underlie the selection of the appropriate dowel core devices and techniques, which, in the end, would ensure the efficiency of the treatment method and a favorable forecast. Metoda substituirii de tratament a leziunilor odontale coronare(LOC) întinse în suprafaţă şi profunzime are la bază înlocuirea coroanei naturale a dintelui cu o restaurare protetică fixă agregrată pe un dispozitiv corono-radicular(DCR). Evaluarea statusul odontal şi parodontal, condiţionarea clinică conform cerinţelor, proprietăţile fizice ale materialelor din care sunt confecţionate DCR, exigenţele estetice, lipsa sau prezenţa parafuncţiilor musculare stau la baza selectării DCR –urilor şi tehnicilor respective, care în final vor asigura eficienţa metodei de tratament şi un prognostic favorabil

Abordarea clinico-morfologică a leziunilor albe ale mucoasei orale

Background. The white lesions of the oral mucosa have a wide range of clinical manifestations with different etiology and varied prognosis, from benign conditions to dysplastic or carcinomatous lesions. Their study is a primary direction in the management of white lesions. Objective of the study. Presentation of known aspects, but also the continuous development of terms and systems with a clinical value of white lesions, as well as information on how these terms should be used in an international consensus. Material and Methods. 14 patients, 8 women and 6 men, aged 20-65, were questioned and examined. During the inspection and palpation of oral cavity mucosa, the presence of white lesions was outlined. To establish a differential diagnosis, histopathological examination of the bioptates was performed. Results: Of the total number of patients included in the study, 4 patients (28.6%) were diagnosed with oral leukoplakia (2 patients - verrucous form, 1 - flat form, 1 - erosive form), 5 (35.7%) – oral lichen planus, 3 (21.4%) - oral candidiasis, 2 (14.3%) - chemical lesion of the oral mucosa. The histopathological examination was performed for 7 patients, 4 patients have presented oral leukoplakia and 3 - oral lichen planus. Conclusion. The characteristic aspects of white lesions are based on a various pathogenetic mechanism and are conditioned by keratinization disorders (leukoplakia, oral lichen planus), the development of surface fungal colonies (oral candidiasis), the presence of epithelial necrosis (chemical lesions). Introducere. Leziunile albe ale mucoasei cavității orale prezintă un spectru larg de manifestări clinice cu diferită etiologie și variat pronostic, de la formațiuni benigne până la leziuni displazice sau carcinomatoase. Studierea acestora reprezintă o direcție primordială în managementul leziunilor albe. Scopul lucrării. Prezentarea aspectelor cunoscute, dar și continua dezvoltare a termenilor și a sistemelor cu o valoare clinică a leziunilor albe, precum și informarea asupra modului în care acești termeni ar trebui utilizați în cadrul unui consens internațional. Material și Metode. Au fost supuși chestionării și examinării 14 pacienți, 8 femei și 6 bărbați, cu vârsta cuprinsă între 20-65 de ani. La inspecția și palparea mucoasei cavității orale a fost conturată prezența leziunilor albe. Pentru stabilirea unui diagnostic diferențial a fost realizat examenul histopatologic al țesuturilor bioptate. Rezultate. Din totalul pacienților incluși în studiu, 4 pacienți (28,6 %) au fost diagnosticați cu leucoplazia mucoasei cavității orale (2 pacienți – forma verucoasă, 1 – forma plată, 1 – forma erozivă), 5 (35,7 %) – lichen plan bucal, 3 (21,4 %) – candidoza bucală, 2 (14,3 %) – leziune chimică a mucoasei cavității orale. Examenului histopatologic au fost supuși 7 pacienți, dintre care 4 au prezentat leucoplazia mucoasei cavității orale și 3 – lichen plan bucal. Concluzii. Aspectele caracteristice leziunilor albe au la bază un mecanism patogenetic divers și sunt condiționate de tulburările de keratinizare (leucoplazia, lichenul plan bucal), dezvoltarea coloniilor fungice de suprafață (candidoza bucală), prezența necrozei epiteliale (leziunile chimice)

Caracteristicile morfopatologice ale leucoplaziei mucoasei cavității orale

Catedra de odontologie, parodontologie și patologie orală, USMF „Nicolae Testemiţanu”Background. Morphopathological examination is an important step in diagnosis establishment of oral leukoplakia. Morphopathological changes, correlated with clinical manifestations, direct the management of oral leukoplakia. Objective of the study. Establishment of morphopathological changes characteristic for oral leukoplakia. Material and Methods. We questioned and examined 6 patients, 4 women and 2 men, who had oral leukoplakia. A partial excisional biopsy of the affected mucosa was applied, with the transfer and histopathological analysis of the bioptate in the morphopathology department. Results. 6 cases were marked by the presence of the phenomenon of hyperkeratosis, represented by the increased thickness of the keratinized layer. In 2 of the cases, parakeratosis was highlighted, characterized by incomplete keratinization of epithelial cells, with the disappearance of the granular layer and the persistence of pycnoctic nucleus cells in the stratum corneum, and 1 case revealed glycogenic acanthosis. The lack of cellular atypism, irregular stratification of the epithelium, increased mitotic activity determined the presence of non-dysplastic morphopathological changes. Conclusion. In the absence of cellular atypism, the morphopathological picture characterized by hyperkeratosis, parakeratosis and glycogenic acanthosis determines a low potential for malignant transformation of leukoplastic changes.Introducere Examenul morfopatologic reprezintă o etapă importantă în stabilirea diagnosticului de leucoplazie a cavității orale. Modificările morfopatologice, corelate cu manifestările clinice, dirijează managementul afecțiunilor leucoplazice. Scopul lucrării. Stabilirea schimbărilor morfopatologice, caracteristice leucoplaziei mucoasei cavității orale. Material și Metode. Au fost supuși chestionării și examinării 6 pacienți, 4 femei și 2 bărbați, ce prezentau leucoplazia mucoasei cavității orale. A fost aplicată biopsia excizională parțială a mucoasei afectate, cu transferarea și analiza histopatologică a bioptatului, în secția de morfopatologie. Rezultate. Cele 6 cazuri au fost marcate de prezența fenomenului de hiperkeratoză, reprezentată de creșterea grosimii stratului cheratinizat. În 2 dintre cazuri s-a evidențiat parakeratoza, caracterizată prin cheratinizarea incompletă a celulelor epiteliale, cu dispariția stratului granular și persistența celulelor cu nucleu picnoctic în stratul cornos, iar în 1 caz a relevat acantoza glicogenică. Lipsa atipismului celular, a stratificării neregulate a epiteliului și a creșterii activității mitotice a determinat prezența unor modificări morfopatologice non-displazice. Concluzii. În lipsa atipismului celular, a tabloului morfopatologic caracterizat prin hiperkeratoză, parakeratoză și acantoză glicogenică se determină un potențial scăzut de transformare malignă a afecțiunilor leucoplazice

Clinical-morphological approach of white lesions of the oral mucosa

Odontology, Periodontology and Oral Pathology chair, Faculty of Stomatology, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareINTRODUCTION. The white lesions of the oral mucosa have a wide range of clinical manifestations with different etiology and varied prognosis, from benign conditions to dysplastic or carcinomatous lesions. Besides the fact that some specific classical characteristics are known that allow the differentiation of lesions, there are a number of other similar manifestations that complicate the determination of the disease, so the diagnosis establishment represent a primary direction in their management. PURPOSE. Presentation of known aspects, but also the continuous development of terms and systems with a clinical value of white lesions, as well as information on how these terms should be used in an international consensus. RESULTS. Of the total number of patients included in the study, 4 patients (28.6%) were diagnosed with oral leukoplakia (2 patients - verrucous form, 1 - flat form, 1 - erosive form), 5 (35.7%) – oral lichen planus, 3 (21.4%) - oral candidiasis, 2 (14.3%) - chemical lesion of the oral mucosa. During the histopathological examination signs of hyperkeratosis, parakeratosis, acanthosis underlined oral leukoplakia in 4 cases and signs of hyperkeratosis, orthokeratosis, the presence of Civatte bodies cells - oral lichen planus in 3 cases. CONCLUSIONS. The characteristic aspects of white lesions of the oral mucosa are based on a various pathogenetic mechanism and are conditioned by keratinization disorders (leukoplakia, oral lichen planus), the development of surface fungal colonies (oral candidiasis), the presence of epithelial necrosis (chemical lesions)

The concept of oral pre-cancer

Rezumat Scopul lucrării date a fost de a efectua o analiză cu privire la pre-cancerul oral şi diagnosticul lui precoce. În baza studiului efectuat s-a ajuns la concluzia că leziunile precanceroase constituie una din problemele actuale ale medicinii contemporane teoretico-practice. Diagnosticul întârziat al acestor leziuni duce la creşterea numărului de cazuri de transformare a lor în cancer. În prezent, a obţinut recunoştinţă conceptul de „pre-cancer”, care pune în evidenţă schimbările precanceroase ce stau la baza stărilor precanceroase. În aspectul prezentărilor contemporane a cancerogenezei pre-cancerul este o stare dinamică de transformare în cancer. În astfel de împrejurări, veriga principală în profilaxia cancerului o constituie diagnosticul precoce al acestor leziuni, care presupune un examen clinic minuţios şi competent.Summary The purpose of this article was to carry out an analysis regarding the oral pre–cancer and its early diagnosis. Based on the study it was underlined that the precancerous lesions are one of the actual problems of theoretical and practical contemporary medicine. Delayed diagnosis of these lesions increases the number of cases of malignant transformation. Currently, the concept of “pre–cancer” has developed. It points out precancerous changes that are the background of precancerous conditions. In the aspect of contemporary presentations of carcinogenesis, pre–cancer — it is a dynamic condition of malignant transformation. The main step in cancer prophylaxis is the early diagnosis of these lesions, which involves a careful and responsable clinical examination

Diagnosis and management of recurrent caries

Odontology, Periodontology and Oral Pathology chair, Faculty of StomatologyIntroduction. Dental caries is a biofilm-mediated, diet modulated, multifactorial, noncommunicable, dynamic disease resulting in net mineral loss of dental hard tissues and it is determined by biological, behavioral, psychosocial and environmental factors. But despite the fact that today there are a lot of modern materials to restore the hard tissue affected by caries, a problem remains the appearance of reccurent or secondary caries that has developed adjacent to margins of restorations. So, a vital part is the early detection of recurrent caries that may allow provision of less invasive treatment options like resealing or repairing instead of complete removal and replacement of restorations. Purpose. To assess how to control, detect and treat secondary caries. Material and methods. It was performed the examination of 16 patients, 8 men and 8 women, between the ages of 18-55. Clinical and paraclinical examination have established the diagnosis of recurrent caries for 32 teeth. The treatment was done by cleaning the caries and repairing or replacement of existing restorations. Results. From 32 teeth taken into the study, 22 were maxilla teeth (68,75 %) and 10 were mandibular teeth (31,25 %); 25 were posterior teeth (78,13 %) and 7 - anterior teeth (21,87%). From 45 surfaces affected by recurrent caries, occlusal surfaces were involved in 10 cases (22, 3 %), mesial surfaces in 14 cases (31,2 %), distal surfaces in 16 cases (35,5 %), vestibular surfaces in 4 cases (8,8 %) and oral surfaces in 1 case (2,2 %). According to the treatment methods of recurrent caries, 19 teeth (56,37 %) were treated by using repairing method and 13 teeth (40,63%) by using replacement method. Conclusions. 1.The etiology of recurrent caries is similar to primary dental caries, but accelerated accumulation of biofilm mass is caused my microleakage, poor marginal fit of restoration and overhangs. Proximal surfaces of the teeth are the most affected. 2.The diagnosis of caries is established during visual inspection, tactile sensation with explorer usage and radiographic interpretation. Detected secondary caries can be managed by repair of the defective part of the restoration or its complete replacement. Its depends on the patient and teeth criteria. 3.The prophylaxis of recurrent caries is directed to patient dental care and doctor’s work

Etiology, pathogenesis, diagnosis and treatment options of abfraction lesions

Odontology, Periodontology and Oral Pathology chair, Faculty of StomatologyIntroduction. Abfraction lesions are noncarious cervical lesions that affect structural integrity, retention of dental plaque, tooth sensitivity, pulpal vitality and esthetics. The pathogenesis of NCCLs is considered to be multifactorial, with occlusal loading, biocorrosion in combination with cervical stress stemming from hyperfunctional or parafunctional occlusal forces, acting synergistically rather than in isolation. The way in which abfraction lesions are restored and managed depends on the etiology and risk factors. Purpose. To establish the therapeutical treatment strategy of abfraction lesions. Material and methods. 9 patients, 6 men and 3 women, between the ages of 26-63, were questioned and examined. The diagnosis of abfractions lesions was established according to careful history taking and proper clinical examination. Results. From 9 patients examined , 3 (33,3 %) patients presented generalized abfraction lesions with the association with chronic marginal generalized periodontitis and 6 (67,7%) patients with localized abfraction lesions, from them 2 patients (33,3%) with unidental edentations and 4 patients (67,7%) with occlusal interferences. 6 patients with localized lesions presented the involvement of 13 teeth. From these teeth 10 (76,9 %) were premolars (4 upper and 6 lower), 3 (23,1 %) incisors (2 central lower and 1 lateral lower). As restorative treatment, 4 patients received microfilled composite resin materials, 4 – nanohybrid composite resin materials, 1 - glass ionomer ciment. Conclusions. 1.Abfractions lesions have a multifactorial etiology, the most important being occlusal stress, erosive tooth wear or an association of these factors. 2.A careful history taking and proper clinical examination are mandatory to reach at a correct diagnosis and a differential diagnosis. 3.Therapeutical treatment of abfraction lesions involves problem identification, diagnosis, etiological factor removal or treatment and, if necessary, restoration. Materials with a low elastic modulus that will accommodate tooth flexure - such as microfilled, nanohybrid or nanofilled composite resin, glass ionomer or resin modified glass ionomer - are a good choice for restoring abfraction lesions