Pain After Tooth Extraction Masking Primary Extranodal Non-Hodgkin’s Lymphoma of the Oral Cavity

Maligni su limfomi u usnoj šupljini rijetki i čine približno 3,5 posto svih malignih promjena u oralnoj regiji. Opisan je slučaj primarnog non-Hodgkinova limfoma na lijevoj strani mandibule. Nakon što je pacijentu izvađen donji lijevi umnjak, perzistirala je spontana i intermitentna bol na lijevoj strani donje čeljusti. Intraoralnim pregledom ustanovljeno je da sporo cijeli postekstrakcijska alveola. Panoramska radiološka snimka pokazala je radiolucenciju s nepravilnim rubovima u stražnjoj mandibularnoj regiji na lijevoj strani. Nakon desetodnevne terapije antibiotikom, bol se smanjila, ali postekstrakcijska je alveola još neadekvatno cijelila. Inicijalno je bila pogrešno postavljena dijagnoza kroničnog osteomijelitisa. Na temelju histološkog i imunohistokemijskog nalaza postavljena je konačna dijagnoza - difuzni velikostanični limfom B-imunofenotipa. Nakon kombinacije radioterapije i kemoterapije, kod pacijenta se postigla potpuna remisija te su se povukli svi klinički znakovi bolesti. Dijagnosticiranje ekstranodularnog limfoma čeljusti je izazov, jer gotovo uvijek postoji sumnja na malignu tvorbu, a često je prikriven oralnim i dentalnim patološkim stanjima. Stomatolog je vrlo važan u ranom otkrivanju malignih limfoma usne šupljine.Malignant lymphoma of the oral region are uncommon and account for approximately 3.5% of all oral malignancies. In this report, a case of primary non-Hodgkin lymphoma of the left mandible is presented. The spontaneous and intermittent pain of the left mandible had continued after third left molar extraction. Intraoral examination revealed healing retardation of the postextraction socket. A panoramic radiograph revealed a radiolucency in the posterior mandibular region with irregular margins. After the 10-day course of antibiotics the spontaneous pain diminished, but the inadequacy of the healing at the extraction site was still present. We initially misdiagnosed it as chronic osteomyelitis. Based on the histological and immunohistochemical examination, we made the diagnosis of diffused large cell lymphoma of the B-cell type. After the combination of chemotherapy and radiotherapy patient showed complete remission with the disappearance of all clinical evidence of disease. The diagnosis of extranodal lymphoma of the jaw may be chalenging, because frequently there is a low index of clinical suspicion and malignant tumor may mimic common oral and dental pathological conditions. Dentists can play the important rule in the early detection of the malignant lymphoma of the oral cavity

Minimally Invasive One-Stage Flapless Technique with Immediate Non-Functional Implant Loading

U suvremenoj dentalnoj implantologiji koriste se tehnike koje uz najmanji mogući invazivni pristup omogućuju pacijentu funkciju, estetiku i ugodnost. Takva jednofazna flapless tehnika u prednjom dijelu gornje čeljusti često se kombinira s funkcionalnim ili nefunkcionalnim imedijatnim opterećenjem implantata. U predstavljenom kliničkom slučaju koristila se neznatno invazivna jednofazna flapless tehnika ugradnje dentalnih implantata, kako bi se nadomjestio gornji desni središnji sjekutić s imedijatnim nefunkcijskim opterećenjem. Opisan je slučaj pacijenta u dobi od 21 godine s kliničkim i radiološkim znakovima vertikalne frakture endodontski liječenoga gornjega desnog središnjeg sjekutića. Nakon ekstrakcije zuba primijenjena je tehnika koštano vođene regeneracije kako bi se prevenirao kolaps postekstrakcijske alveole i osiguralo bolje ležište budućega dentalnog usatka. Četiri mjeseca kasnije transmukoznim kirurškim pristupom ugrađen je dentalni implantat. Položaj usatka određen je na osnovi ortopantomograma te je pomoću kirurške šablone precizno definirano ležište i angulacija implantata. Ugrađeni implantat je imedijatno opskrbljen konačnim batrljkom od cirkonijeve oksidne keramike te privremenom akrilatnom krunicom bez okluzalnih kontakata. Nakon što je cijelila šest mjeseci, oseointegracija implantata procijenjena je adekvatnom nakon analize rezonantnom frekvencijom (vrijednost 75,3). Implantat je tada opskrbljen konačnim fiksno-protetskim nadomjeskom. Tijekom šestomjesečnoga praćenja, pacijent nije imao ni kliničke ni radiološke komplikacije.The current trend in dental implantology is to develop techniques that can provide function, esthetics, and comfort with a minimally invasive surgical approach. Minimally invasive one-stage flapless technique in maxillary anterior region is usually considered in conjunction with functional or non-functional immediate loading. In this report, a clinical case of using minimally invasive one-stage flapless technique for maxillary right incisor replacement with immediate non-functional loading is presented. A patient was a 21-year-old male with clinical and x-ray signs of a vertical fracture of the endodontically treated maxillary right incisor. After the tooth extraction, guided bone regeneration procedure was performed to prevent post extraction alveolus collapse and provide a better site for the future implant. After 4 months transmucosal surgical approach was used to insert a tapered implant. Location was determined on the basis of slice ortopantomogram x-rays and surgical drill guide was made for precise definition of implant site and angulation. The implant was immediately restored with final zirconium oxide ceramic abutment and temporary acrylic crown without any occlusal contacts. After a healing period of 6 months, the osseointegration was assessed with resonance frequency analysis (value 75.3) and considered adequate. The implant was then treated with the final fixed prosthetic restoration. The patient exhibited neither clinical nor radiologic complications throughout the 6 months period of clinical monitoring

Use of Recombinant Human Bone Morphogenetic Protein (rhBMP2) in Bilateral Alveolar Ridge Augmentation: Case Report

In recent years, the delivery of osteoinductive factors such as bone morphogenic proteins (BMPs) has become an alternative approach to traditional bone grafting due to their capacity to produce bone healing and new bone formation. BMP-2 has proved to possess the highest osteoinductive potential among BMPs. The case reported the clinical use of recombinant human BMP-2 for bilateral vertical alveolar ridge augmentation. In a case of 61 year-old patient with a significant bilateral vertical bony deficiency of the mandible, rhBMP-2 administered via an absorbable collagen sponge carrier (ACS) was used for bilateral alveolar ridge bone induction. Augmented sites were covered and fixed with titanium mesh. Augmented sites were reopened 6 months after surgery. Titanium membrane and retaining screws were removed and three dental implants were placed. The tissue samples for the histologic analysis were harvested. Following 3 months healing period, the submerged implants were uncovered and restored with zirconium-ceramic crowns. Cone beam computed tomography (CBCT), panoramix and 3D radiographic evaluation were obtained prior to and after the surgical procedure. Vertical gain of the bone was 5,5 mm on the left and 5 mm on the right side, with 6 mm width of the bone. Histologic analysis revealed formation of mature trabecular bone with signs of osteoblastic proliferation. Implant stability quotient (ISQ) values were in the range between 69 and 75 for all three implants. No suppuration, gingival recession or pain were present 24 months after surgery. Vertical bone augmentation using rhBMP-2 is optional treatment modality to consider when planning dental implant placement in sites where severe vertical insufficiency exists

Use of Recombinant Human Bone Morphogenetic Protein (rhBMP2) in Bilateral Alveolar Ridge Augmentation: Case Report

In recent years, the delivery of osteoinductive factors such as bone morphogenic proteins (BMPs) has become an alternative approach to traditional bone grafting due to their capacity to produce bone healing and new bone formation. BMP-2 has proved to possess the highest osteoinductive potential among BMPs. The case reported the clinical use of recombinant human BMP-2 for bilateral vertical alveolar ridge augmentation. In a case of 61 year-old patient with a significant bilateral vertical bony deficiency of the mandible, rhBMP-2 administered via an absorbable collagen sponge carrier (ACS) was used for bilateral alveolar ridge bone induction. Augmented sites were covered and fixed with titanium mesh. Augmented sites were reopened 6 months after surgery. Titanium membrane and retaining screws were removed and three dental implants were placed. The tissue samples for the histologic analysis were harvested. Following 3 months healing period, the submerged implants were uncovered and restored with zirconium-ceramic crowns. Cone beam computed tomography (CBCT), panoramix and 3D radiographic evaluation were obtained prior to and after the surgical procedure. Vertical gain of the bone was 5,5 mm on the left and 5 mm on the right side, with 6 mm width of the bone. Histologic analysis revealed formation of mature trabecular bone with signs of osteoblastic proliferation. Implant stability quotient (ISQ) values were in the range between 69 and 75 for all three implants. No suppuration, gingival recession or pain were present 24 months after surgery. Vertical bone augmentation using rhBMP-2 is optional treatment modality to consider when planning dental implant placement in sites where severe vertical insufficiency exists

Risk Factors of Traumatic Injuries to the Upper Incisors

Svrha studije bila je ustanoviti učestalost i čimbenike rizika za nastanak traumatskih ozljeda kruna gornjih sjekutića. Ispitanici i postupci: U ispitivanje je bilo uključeno 580 ispitanika (302 dječaka i 278 djevojčica) u dobi između 7 i 15 godina, a slučajno su odabrani u nekoliko osnovnih škola u Republici Hrvatskoj. Analizirana su sljedeća svojstva: čestoća trauma kruna sjekutića, spol, ortodontska anomalija, eksponiranost sjekutića, kompetentnost usana, overjet i vrijednost maksimalnog otvaranja usta. Rezultati: Trauma krune pronađena je kod 12,4% ispitanika. Bila je češća kod dječaka (17,8%) nego kod djevojčica (6,5%). Najzastupljeniji oblik bila je nekomplicirana trauma, koja je zahvaćala samo caklinu zuba (80%). Zaključak: Učestalost pojavljivanja trauma nije bila povezana s izmjerenom vrijednosti maksimalnog otvaranja usta, ni s vrstom malokluzije ili overjetom. Ispitanici s većom vrijednošću razmaka između usana (inkompetentne usne) i većom eksponiranošću sjekutića pokazali su više rizika za nastanak traume gornjih sjekutića.Purpose: The purpose of this study was to determine the frequency of the upper incisors crown trauma and its relationship to orthodontic anomalies, as well as the influence of age, gender and occlusal characteristics. Material and Methods: In this study 580 subjects (302 boys and 278 girls) between 7 and 15 years were randomly selected from several primary schools in the Republic of Croatia. Following characteristics were examined: frequency of incisor trauma, gender, age, skeletal relationship, incisor exposure, interlabial distance, overjet and maximum vertical opening of the mandible. Results: crown trauma was found in the total of 12.4% frequency. It was more frequent in boys (17.8%) than in girls (6.5%). The most frequent type of trauma was a non-complicated trauma affecting only the enamel (80%). Conclusions: The trauma frequency was not related to the size of the maximum vertical opening of the mandible, to the type of malocclusion and the overjet. Subjects with greater size of interlabial distance and incisors exposure had shown more risk to upper incisor trauma

Densitometric Analysis of Dental Implant Placement between Flapless Technique and the Two-Stage Technique – A Pilot Study

Flapless technique is a surgical approach of implant placement without raising a mucoperiosteal flap. Such approach has many advantages: shorter surgical treatment, minimal bleeding, postoperative discomfort for the patient is reduced; possibility of immediate loading of the inserted implant, faster procedure of implant placement and by that less time is needed for the complete implant-prosthetic restoration. Purpose of this pilot study was radiographic assessment of flapless technique and determination of its clinical values in comparison with two-stage dental implant technique through computerized densitometric analysis. The sample consisted of 10 patients with missing teeth in the premolar region in the upper jaw. An implant was placed in that position. In the first group of 5 patients the implants were inserted with the flapless technique, and in the other group of 5 patients implant insertion was done with a two-stage technique. All inserted implants were loaded with metal-ceramic crowns 3 months after placement. The patients were followed for 18 months through clinical follow-ups and radiovisiographical (RVG) images made after 3, 12 and 18 months. After comparing the average densities, the results showed similar decrease of density in both groups, conventional two-stage technique showed 3.24 and flapless technique 1.23. It can be concluded that flapless technique in everyday clinical usage has the same result as the two-stage dental implant technique

Immediate Implant Placement Following Odontogenic Cyst Enucleation: a Case Report

Svrha ovog prikaza jest opisati restauraciju koštanog defekta nakon enukleacije radikularne ciste koristeći se vođenom koštanom regeneracijom uz imedijatnu implantaciju. Pacijentica je bila u dobi od 50 godina i imala je odontogenu cistu na prvom desnom maksilarnom premolaru i na istoj strani resorpciju korjenova drugog molara uzrokovanu impaktiranim umnjakom. Kirurškim zahvatom enukleirana je cista, a zatim je slijedila vođena koštana regeneracija, imedijatna implantacija te kirurško uklanjanje impaktiranog umnjaka. Pacijentica je nakon toga tijekom osteointegracijskog razdoblja dobila privremeni mobilni protetički nadomjestak. Šest mjeseci nakon zahvata stabilnost implantata provjerena je analizom rezonantne frekvencije. Srednja vrijednost za prvi premolar iznosila je 74, a za prvi molar 78. Oba implantata šest su mjeseci promatrana klinički i radiografski. Njihova stabilnost ocijenjena je umjerenom. U tom postoperativnom razdoblju nije bilo nikakvih kliničkih ili radioloških komplikacija. Implantati su iskorišteni kao sidra za fiksni proteički nadomjestak. Imedijatne implantacije nakon enukleacije odontogene ciste daju zadovoljavajuće rezultate te su smanjile broj kirurških zahvata.The purpose of this case report is to present a bone defect restoration after radicular cyst enucleation using guided bone regeneration procedure with immediate implant insertions. The patient was a 50-year old female with an odontogenic cyst of the first premolar in the right maxilla and a second molar root resorption caused by an impacted third molar. The surgical procedure involved a cyst enucleation followed by guided bone regeneration, immediate implantations, and surgical removal of the impacted third molar. The patient was supplied with an interim partial denture during the osseointegration period. Six months after surgical treatment, the implant stability was assessed by resonance frequency analysis. Mean scores for the first premolar and first molar implants were 74 and 78, respectively. Both implants were monitored clinically and radiographically during the following 6-month period. Implant stability was considered adequate. Neither clinical nor radiological complications were present throughout the postoperative 6-month period. The implants were used to support a fixed partial denture. Immediate implantations after odontogenic cyst enucleation minimized the number of surgical procedures and led to a satisfactory result

Immediate Implant Placement Following Odontogenic Cyst Enucleation: a Case Report

Svrha ovog prikaza jest opisati restauraciju koštanog defekta nakon enukleacije radikularne ciste koristeći se vođenom koštanom regeneracijom uz imedijatnu implantaciju. Pacijentica je bila u dobi od 50 godina i imala je odontogenu cistu na prvom desnom maksilarnom premolaru i na istoj strani resorpciju korjenova drugog molara uzrokovanu impaktiranim umnjakom. Kirurškim zahvatom enukleirana je cista, a zatim je slijedila vođena koštana regeneracija, imedijatna implantacija te kirurško uklanjanje impaktiranog umnjaka. Pacijentica je nakon toga tijekom osteointegracijskog razdoblja dobila privremeni mobilni protetički nadomjestak. Šest mjeseci nakon zahvata stabilnost implantata provjerena je analizom rezonantne frekvencije. Srednja vrijednost za prvi premolar iznosila je 74, a za prvi molar 78. Oba implantata šest su mjeseci promatrana klinički i radiografski. Njihova stabilnost ocijenjena je umjerenom. U tom postoperativnom razdoblju nije bilo nikakvih kliničkih ili radioloških komplikacija. Implantati su iskorišteni kao sidra za fiksni proteički nadomjestak. Imedijatne implantacije nakon enukleacije odontogene ciste daju zadovoljavajuće rezultate te su smanjile broj kirurških zahvata.The purpose of this case report is to present a bone defect restoration after radicular cyst enucleation using guided bone regeneration procedure with immediate implant insertions. The patient was a 50-year old female with an odontogenic cyst of the first premolar in the right maxilla and a second molar root resorption caused by an impacted third molar. The surgical procedure involved a cyst enucleation followed by guided bone regeneration, immediate implantations, and surgical removal of the impacted third molar. The patient was supplied with an interim partial denture during the osseointegration period. Six months after surgical treatment, the implant stability was assessed by resonance frequency analysis. Mean scores for the first premolar and first molar implants were 74 and 78, respectively. Both implants were monitored clinically and radiographically during the following 6-month period. Implant stability was considered adequate. Neither clinical nor radiological complications were present throughout the postoperative 6-month period. The implants were used to support a fixed partial denture. Immediate implantations after odontogenic cyst enucleation minimized the number of surgical procedures and led to a satisfactory result

The Prevalence of Proximal Fractures of Dental Crowns with Amalgam Fillings

The purpose of this paper was to determine the prevalence and impact of various etiological factors on marginal ridge fractures of teeth with amalgam fillings. 50 subjects participated in this research, 172 teeth restored with amalgam were examined out of which 28 premolars and 144 molars of both jaws. Data used in the research was obtained by nonaggressive exploration of oral cavity and by checking dental charts and radiographic charts of patients. Patients were divided in three gendered age groups. Etiological factors used in the research were: the position of teeth in jaws, classification of amalgam fillings according to Black, the duration of fillings, the presence of caries on proximal surfaces not included in restoration and tooth vitality. Also, Angle Class, habits and presence of fixed prosthetic appliances in opposite jaw were taken into consideration. Results for each patient were separately written in the questionnaire. Statistical analysis was carried out by Pearson’s c2-test. According to obtained results 51% of teeth with amalgam fillings have a fracture of marginal ridge. Statistically significant factors that influenced the occurrence of fractures of proximal surfaces in this research were classification of amalgam fillings according to Black, the patient’s age and the existence of caries on proximal surface

Assessing Health-Related Quality of Life with Antimicrobial Photodynamic Therapy (APDT) and Low Level Laser Therapy (LLLT) after Third Molar Removal

Introduction: The purpose of this study was to evaluate the antimicrobial photodynamic therapy (APDT) and low level laser therapy (LLLT) on wound healing, pain intensity, swelling problems, halitosis and the postoperative usage of analgesics after surgical removal of lower third molars.Methods: One hundred and fifty patients, randomly divided into three groups were selected (50 per each group). The P1 group received the APDT after a third molar surgery, the P2 group received the LLLT and the C group (control group) was without any additional therapy after surgery. A photoactive substance was applied in the APDT study group before suturing. After 60 seconds the photosensitive substance was thoroughly washed with saline water and the laser light was applied in two intervals (30 seconds each). The irradiation power was 50 mW while the wavelength was 660 nm. The laser therapy in P2 group was performed before suturing and the laser light was applied also in two intervals (90 seconds each), the irradiation power was 90 mW while the wavelength was the same as in the first group – 660 nm. Postoperative follow-ups were scheduled on the third and the seventh day in patients who received laser therapy.Results: The results of the postoperative evaluation showed that there was a statistically significant difference in the postoperative wound healing, pain intensity, swelling problems, halitosis and analgesics intake between patients in all three groups (p<0.001). The patients that were subjected to APDT (P1) had the least postoperative problems. After the laser therapy (P1 and P2) wound healing was without any complications, opposite from the patients from the C group (p<0.001). Postoperative application of a laser therapy significantly reduced patient’s use of analgesics over the observed period of time (p<0.001).Conclusion: Both modalities of laser therapy significantly reduced postoperative problems after surgical removal of third lower molars with the best results in both laser groups