Craniofacial morphology in Turner syndrome karyotypes

ABSTRACT Introduction: A complete or partial absence of an X chromosome in the karyotype of phenotypic females has an impact on craniofacial morphology. The aim of this study was to determine the characteristics of the craniofacial complex in patients with Turner syndrome (TS), and to evaluate the influence of various karyotypes on craniofacial morphology. Material and methods: The study population was comprised of 40 TS female patients, aged 9.2 to 18 years, and 40 healthy females, aged 9.3 to 18 years, as the control group. The TS patients were subdivided according to karyotype. All study participants were evaluated cephalometrically. An analysis of variance (ANOVA) and Tukey’s multiple comparison test were used for analysis of the differences between the means in Turner subgroups and the control group. Results: In general, the girls with TS were characterized by smaller dimensions and an altered morphology of the craniofacial complex compared with the unaffected girls. The curvature of the frontal bone was significantly increased, while the diameter of the head was reduced. Both the maxilla and mandible were retrognathic, posteriorly rotated, and reduced in antero-posterior length. The cranial base was shorter and flattened. Among the different karoytypes, no significant differences were determined in the dimensions of the craniofacial complex in girls with TS. Conclusions: Our findings indicate that the karyotype has no effect on craniofacial morphology and we confirmed that a specific model of craniofacial morphology in individuals with TS is present in early childhood

Prosthodontic management of hypohidrotic ectodermal dysplasia: a case report

Introduction: Ectodermal dysplasia (ED) is a hereditary disorder associated with developmental disorders of two or more structures of ectodermal embryonic origin. Hypodontia or anodontia of the primary and permanent dentition, poorly developed alveolar ridges and improper maxillo – mandibular relations, are the most common oral manifestations. Management of patients with ectodermal dysplasia requires a multidisciplinary team approach. Case presentation: A 6.5 year-old boy with hypohidrotic ectodermal dysplasia (HED) presented in this article, had typical features of HED: hypohidrosis, hypotrichosis, severe hypodontia, atrophic alveolar ridges, old-looking facial expression. According to the patient’s age and clinical findings, removable complete over-denture prosthesis in both arches was the treatment of choice. Conclusion: In patients with ED, it is important to establish correct maxillo – mandibular relations and normal function of the dento-facial system (chewing, swallowing, and speaking). Prosthodontic treatment has a major impact on aesthetics and functions,facilitates psychological development and improves emotional condition and social life of the patient

Implant-prosthetic therapy failure in smoker and nonsmoker patients

Introduction: Implant-prosthetic therapy has predictable success, and the complications are associated with a lot of factors. Smoking cigarettes is reason for different oral diseases, bone loss, loss of soft tissue and teeth, appearance of periimplantitis and implant loss. The corellation of smoking and implant-prosthetic therapy failure was examined in the clinical study. Materials and method: Fifty patients with FDP on 61 implants in frontal and molar region were investigated. They were divided in two groups: smokers and nonsmokers. Thirty four patients were smokers, and sixteen didn’t smoke cigarettes in the last two years. Criteria data for the success of the therapy were mobility of the implant, pain, peri-implant bone loss higher than 1.5 mm, absence of technical complications and function and aesthetics appeal. Control checkups were made after six months, one and two years. Patients had questionnaires, clinical examination and X-ray. Results: There is a statistically significant difference between smokers and nonsmokers in the failure rates of dental implants. During first year 0,5 mm of bone was lost around eleven implants, and 0,05 mm next years.Total seven implants failed, five in smoker group at the beginning of the first year, and 2 in nonsmoker group during second year. Conclusion: Results showed that smoking habit can increase the risk of early implants loss two times more often in smokers. For some complications like periimplantitis, local factors have greater influence. Smoking does not increase the risk of late implant loss, but the implants at patients with smoking habit, in correlation with several different local risk factors, is contraindicated. Early complications are results of smoking, while quality and quantity of surrounding bone are responsible for late complications.The results from the investigation, also give informations for proper treatment planning, and patient education for quiting their harmfull habit. Keywords Implants, therapy failure, smoking, periimplantitis

Contemporary Dental Ceramic Materials, A Review: Chemical Composition, Physical and Mechanical Properties, Indications for Use

BACKGROUND: The high esthetic expectations from the prosthodontic restorations have directed the qualitative development of the materials towards the all-ceramic materials that are capable of replacing porcelain-fused-to-metal systems. AIM: This article reviews the literature covering the contemporary all-ceramic materials and systems with a focus on the chemical composition and materials’ properties; also it provides clinical recommendations for their use. RESULTS: The glass-matrix ceramics and polycrystalline ceramics are presented, as well as recently introduced machinable materials, all-zirconia and resin-matrix ceramics. The specific properties of zirconia, such as transformation toughening, stabilisation of the crystallographic structure, low-temperature degradation and factors affecting the zirconia’s ageing, are emphasised. CONCLUSION: The favourable properties of the resin-matrix ceramics, such as modulus of elasticity similar to dentin, shock-absorbing characteristics and high resilience and fracture resistance, are also covered in this article

Проценка на оралното здравје кај геријатриски пациенти

The geriatric population in R. Macedonia presents a specific group that needs continuous evaluation of their oral health. According to WHO data in 2010, 12 % of the population was aged 65+ years in Macedonia. Aging is the process with different specific changes in all systems and organs, including the orofacial system. The most common conditions associated with age in the geriatric population are teeth loss, parodontopathy, precancerous lesions and oral carcinomas, xerostomia, resorption of the residual alveolar ridge, and overall dysfunction of the orofacial system. There is a great influence of the performed prosthodontic therapy in geriatric patients on the overall and general health. The aim of this study was to evaluate the condition of the soft tissues in geriatric patients, especially in patients with prosthodontic treatments, their oral health, and the influence of oral health on life quality. Мaterial and methods: Оbservational cross-sectional study was conducted in geriatric patients and Geriatric Oral Health Assessment Index (GOHAI) was used for self-assessment of their oral health and the impact of oral conditions and performed dental treatment on quality of life. Results: Participants witha mean age of 72.88 years reported several general and systemic diseases, and the main risk factors for their oral mucosal changes were smoking and drinking alcohol. Total anodontiа was observed in 37.5% of respondents and partial anodontia in 62.5%. The average period of wearing dentures was 7.8 years. The total scoreof the quality of life and oral health of the respondents varied in the interval 1.93 ± 0.65, and the average value in the subjects with prosthetic constructions for p> 0.05 (p = 0.19) was slightly higher in relation to the subjects without any prosthodontic device. Conclusion: GOHAI-12 score in the study had a low value, less than 50 indicated that the respondents were in poor oral health. According to the results of the self-assessment, there was a weak to moderate perception of oral health. An integrated approach is needed to achieve a critical positive level of general and oral health in geriatric patients    Геријатриската популација во  Македонија претставува специфична група која има потреба од континуирана евалуација на нивното орално здравје. Според податоците на СЗО во 2010 година, 12 % од населението во Македонија било на возраст 65+ години. Стареењето е процес со различни специфични промени во сите системи и органи, вклучувајќи го и орофацијалниот систем. Најчестите состојби поврзани со возраста кај геријатриската популација се губење на забите, пародонтопатија, преканцерозни лезии и орални карциноми, ксеростомија, ресорпција на резидуалниот алвеоларен гребен и целокупна дисфункција на орофацијалниот систем. Големо е влијанието на извршената протетичка терапија кај геријатриските пациенти врз нивното целокупно и општо здравје. Целта на оваа студија беше да се процени состојбата на меките ткива кај геријатриските пациенти, особено кај пациентите со протетички третмани, нивното орално здравје и влијанието на оралното здравје врз квалитетот на животот. Материјал и методи: Спроведовме опсервациона студија на пресек кај геријатриските пациенти, а геријатрискиот индекс за проценка на оралното здравје (GOHAI) беше употребен за да се изврши евалуација  на нивното орално здравје и влијанието на оралните состојби и извршениот дентален третман врз квалитетот на животот. Резултати: Испитаниците со просечна возраст од 72,88 години пријавиле повеќе општи и системски заболувања, а главните фактори на ризик за промените на оралната мукоза биле пушењето и пиењето алкохол. Вкупна анодонција е забележана кај 37,5% од испитаниците и делумна анодонција кај 62,5%. Просечниот период на носење протези изнесуваше 7,8 години. Вкупната оценка за квалитетот на животот и оралното здравје на испитаниците варираше во интервалот 1,93 ± 0,65, а просечната вредност кај субјектите со протетички конструкции за p> 0,05 (p = 0,19) беше нешто повисока во однос на субјектите без било каква протетичка изработка. Заклучок: Резултатот на GOHAI-12 во студијата имаше ниска вредност, помалку од 50 што покажа дека испитаниците беа со слабо орално здравје. Според резултатите од самооценувањето, имаше слаба до умерена перцепција за нивното оралното здравје. Потребен е интегриран пристап за да се постигне критично позитивно ниво на општото и оралното здравје кај геријатриските пациенти

Acid Etching as Surface Treatment Method for Luting of Glass-Ceramic Restorations, part 1: Acids, Application Protocol and Etching Effectiveness

AIM: The purpose of this review is to represent acids that can be used as surface etchant before adhesive luting of ceramic restorations, placement of orthodontic brackets or repair of chipped porcelain restorations. Chemical reactions, application protocol, and etching effect are presented as well.STUDY SELECTION: Available scientific articles published in PubMed and Scopus literature databases, scientific reports and manufacturers' instructions and product information from internet websites, written in English, using following search terms: “acid etching, ceramic surface treatment, hydrofluoric acid, acidulated phosphate fluoride, ammonium hydrogen bifluorideâ€, have been reviewed.RESULTS: There are several acids with fluoride ion in their composition that can be used as ceramic surface etchants. The etching effect depends on the acid type and its concentration, etching time, as well as ceramic type. The most effective etching pattern is achieved when using hydrofluoric acid; the numerous micropores and channels of different sizes, honeycomb-like appearance, extruded crystals or scattered irregular ceramic particles, depending on the ceramic type, have been detected on the etched surfaces.CONCLUSION: Acid etching of the bonding surface of glass - ceramic restorations is considered as the most effective treatment method that provides a reliable bond with composite cement. Selective removing of the glassy matrix of silicate ceramics results in a micromorphological three-dimensional porous surface that allows micromechanical interlocking of the luting composite

Ectodermal Dysplasia, a Case Report: a Challenge for Prosthodontic Solution

Introduction: Ectodermal dysplasia (ED) is an inherited disruption of two or more tissues and structures of ectodermal origin during their embryonal development. Hypodontia or anodontia of the primary and permanent teeth, poorly developed alveolar ridges and inappropriate мaxillo-mandibular relations are the most common oral manifestations. Management of patients with ED (depending on the phenotypic characteristics) needs a multidisciplinary team approach that involves maxillo-facial surgeon, pedodontist, orthodontist and prosthodontist. Case report: A 6-year-old girl with ectodermal dysplasia having a normal intellectual development has typical facial expresion: square forehead, prominent ears and supraorbital ridges, pigmented and wrinkled eyelids, nose with anteverted nostrils, thin inward lips, and pointed chin. Hypotrichosis is characterized by almost no eyebrows, eyelashes and skin hairs; the sculp is covered with a wig. The skin is dry, thin and rough as a result of decreased function of the sweat glands. Finger and toe nails are short, thick and striated. Decreased lower facial height, together with deep mentolabial and nasolabial folds contributed to an old-looking facial expression. Complete bilateral cleft palate was partially solved on 1.5 year of age, with remained oro-nasal communication and a presence of soft palate only. An alveolar ridge in the mandible is rather atrophic with deciduous canines destroyed by caries and and carious permanent molar teeth in both jaws (severe hypodontia). The gingiva is rather swollen, with dark-red color especially around the teeth. Treatment procedure: Taking into consideration the patient’s age and clinical findings, removable complete over-denture prosthesis was the treatment of choice. The preliminary impressions were taken with stock trays and irreversible hydrocolloid material, while the functional impressions were taken using custom trays and thermoplastic material for border molding and polyvinyl siloxane impression material. Maxillo-mandibular relations were determined using temporary bases with wax rims. The final trial with artificial teeth arranged according to a balanced occlusion was conducted to verify horizontal and vertical relations, phonetics and esthetics. The maxillar and mandibular prosthesis were produced in the heat cure acrylic resin. Disrupted functions of the oro-facial system such as mastication, swallowing and phonetics are improved significantly with complete dentures. Conclusion: Correct maxillo - mandibular relations and normal function of the dentofacial system in patients with ED, can be achieved by the acrylic dentures. Prosthodontic treatment has a major impact not only on the functions and esthetics, but on the psychological development and emotional state as well. Keywords Cleft palate, Ectodermal Dysplasia, Hypodontia, Removable dentures

Bonding Effectiveness of Luting Composites to Different CAD/CAM Materials

PURPOSE: To evaluate the influence of different surface treatments of six novel CAD/CAM materials on the bonding effectiveness of two luting composites. MATERIALS AND METHODS: Six different CAD/CAM materials were tested: four ceramics - Vita Mark II; IPS Empress CAD and IPS e.max CAD; Celtra Duo - one hybrid ceramic, Vita Enamic, and one composite CAD/CAM block, Lava Ultimate. A total of 60 blocks (10 per material) received various mechanical surface treatments: 1. 600-grit SiC paper; 2. sandblasting with 30-μm Al2O3; 3. tribochemical silica coating (CoJet). Subsequent chemical surface treatments involved either no further treatment (control), HF acid etching (HF), silanization (S, or HF acid etching followed by silanization (HF+S). Two specimens with the same surface treatment were bonded together using two dual-curing luting composites: Clearfil Esthetic Cement (self-etching) or Panavia SA Cement (self-adhesive). After 1 week of water storage, the microtensile bond strength of the sectioned microspecimens was measured and the failure mode was evaluated. RESULTS: The bonding performance of the six CAD/CAM materials was significantly influenced by surface treatment (linear mixed models, p < 0.05). The luting cement had a significant influence on bond strength for Celtra Duo and Lava Ultimate (linear mixed models, p < 0.05). Mechanical surface treatment significantly influenced the bond strength for Celtra Duo (p = 0.0117), IPS e.max CAD (p = 0.0115), and Lava Ultimate (p < 0.0001). Different chemical surface treatments resulted in the highest bond strengths for the six CAD/CAM materials: Vita Mark II and IPS Empress CAD: S, HF+S; Celtra Duo: HF, HF+S; IPS e.max CAD: HF+S; Vita Enamic: HF+S, S. For Lava Ultimate, the highest bond strengths were obtained with HF, S, HF+S. Failure analysis showed a relation between bond strength and failure type: more mixed failures were observed with higher bond strengths. Mainly adhesive failures were noticed if no further surface treatment was done. The percentage of adhesive failures was higher for CAD/CAM materials with higher flexural strength (Celtra Duo, IPS e.max CAD, and Lava Ultimate). CONCLUSION: The bond strength of luting composites to novel CAD/CAM materials is influenced by surface treatment. For each luting composite, an adhesive cementation protocol can be specified in order to obtain the highest bond to the individual CAD/CAM materials.status: publishe

Oral surgery treatment in the patients with combination syndrome

Introduction: Combination syndrome is periodicly associated in wearers with removable dentures, were upper is complete denture and lower is partial denture with some of the anterior natural teeth still in the mouth. Material and method: The study was provided on five patients with removable dentures at the Department of prosthodontics in the period of last three years. Three of them have weared the dentures more then ten years, and came to the clinic for new one. Another two patients have weared removable dentures between two and four years, and came because in the frontal part of the upper jaw appeared swollen. By clinical examination in all patients we noticed: hyperplastic tissue in the pre-maxillary region, reduction of the residual ridge on the frontal part of the maxilla as a result of the increasing pressure from the anterior teeth of thelower jaw.This tissue was removed by oral surgery (laser removing of hyperplastic tissue). Also we noticed periodontal changes and extrusion of natural lowerfrontal teeth and increased reduction of mandibular residual ridge. Results and conclusion: After healing period we made: new dentures in the three patients which were covered by the HIFM andin another two patients we made indirect relining on the upper denture, re-occlusion and re-articulation achieving a weak contacts between the lower natural teeth and upper teeth of the complete denture. We cautioned the patients not to bite food with anterior teeth and to avoid chewing very hard food which tends to imprint and displace dentures and of course to came to regular controls. Keywords removable dentures, combination sindrom, hyperplastic tissue, oral surgery treatment

Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment

BACKGROUND: Hydrofluoric acid is a commonly used chemical in many industrial branches, but it can also be found as an ingredient in household products such as cleaning agents. Possessing high corrosive potential, HF acid causes burns and tissue necrosis, while when absorbed and distributed through the bloodstream, its extremely high toxic potential is expressed. Acute symptoms are often followed by pain, particularly in the case of skin burns, which intensiveness does not often correlate with the expressiveness of the clinical findings. Even exposure to low-concentrated solutions or gasses, or low-doses of high-concentrated acid, may provoke delayed systemic disorder which may eventually have a lethal outcome. AIM: Therefore, having information regarding the possible hazardous effects of hydrofluoric acid usage, a variety of symptoms, as well as a treatment approach, is of great importance in the case of HF exposure. METHODS: Available scientific articles published in literature databases, scientific reports and governmental recommendations from the internet websites, written in English, using the following search terms “Hydrofluoric acid, skin burns, eye injury, ingestion, inhalation, systemic toxicity, decontamination, antidote, medical treatment” have been reviewed. RESULTS: This review is useful not only for physicians but for everyone who may come in contact with a person exposed to HF acid. CONCLUSION: It highlights the mechanism of action, presents the acute and chronic symptoms, personal and general protective measures and devices that should be used, as well as decontamination procedures, immediate, antidote and hospital medical treatment