The Effect of Implant Surface Design and Their Decontamination Methods in Peri-Implantitis Treatment

Different titanium implant surfaces are prone to microbial colonization and dental plaque accumulation contributing to peri-implantitis pathogens adherence and growth. In conjunction with systemic, local, and implant-based factors such as micro- and macro-designs, implant location, and region, these pathogens can cause a complex inflammatory response resulting in peri-implantitis and deleterious bone loss. Implant surface decontamination plays a crucial and important step in peri-implantitis therapy. The primary goal of implant surface decontamination is to eradicate bacteria and their products outside of implant pits and grooves reducing inflammation and promoting tissue regeneration and/or reparation. Various implant surface decontamination methods such as mechanical, chemical or physical methods have been proposed to prevent bacterial resistance development or/and surface damage. The chapter aimed to assess if implant microdesign could influence the decontamination method choice

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

Epidemiologija and etiologija pločastog karcinoma glave i vrata

Introduction: It was expected at least in Western countries that incidence of head and neck cancers (HNSCC) should become lower due to the propaganda against smoking. However, the expected decrease in HNSCC was not achieved in many countries. Tobacco and alcohol consumption are known as a major risk factors for development of HNSCC. It is well known that 15-20% of HNSCC are linked to HPV infection, however, some authors reported coexistence with other viruses as well. In the Eastern countries paan (betel nut), ghutka, that have been also linked to the development HNSCC. However, lately HNSCC have been linked to the low vegetable and fruit intake, vitamin defi ciencies, coinfection with other viruses, certain genetic syndromes and occupational exposure. Therefore, the aim of this study is to review recent literature regarding epidemiology and other risk factors in the development of HNSCC. Methods: Pubmed was searched in the past two years in order to fi nd out novelties regarding epidemiology and aetiology for HNSCC and 34 papers were included. Results and Conclusion: The results of this review paper show that smoking is a major contributing factor especially with alcohol both being dosed and time dependent in the development of HNSCC. Unhealthy diet, decrease in vitamin intake especially folate, C and E vitamin and occupational exposure were seen in the diseased. In about one fourth of the patients infection with HPV has been noticed, and in some coinfection with other viruses such as Epstein Barr, cytomegalovirus and HIV. Obviously genetic predisposition exists but also correlation with certain genetic syndromes such as Fanconi’s anaemia and Bloom syndrome.Uvod: Očekivalo se barem u Zapadnim zemljama kako će incidencija karcinoma glave i vrata biti manja uslijed propagande protiv pušenja. Ipak, očekivano smanjenje u incidenciji karcinoma glave i vrata nije postignuto u mnogim zemljama. Pušenje i konzumacija alkohola su glavni faktori rizika za nastanak karcinoma glave i vrata. Dobro je poznato da je 15-20% karcinoma glave i vrata povezao s HPV infekcijom, doduše, neki autori su izvijestili i o koegzistenciji s drugim virusima također. U istočnim zemljama paan (betel nut), ghutka su također povezani s nastankom carcinoma glave i vrata. Ipak, nedavno je karcinom glave i vrata povezan s rijetkim unosom povrća i voća, defi citom vitamina, koinfekcijom s drugim virusima, određenim genetskim sindromima i radnim okolišem. Stoga je cilj ovog istraživanja bio pregledati noviju literature s obzirom na epidemiologiju i druge rizične faktore u nastanku karcinoma glave i vrata. Metode: Pubmed je pretražen u zadnje dvije godine kako bi se ustanovilo novosti vezane uz epidemiologiju i etiologiju karcinoma glave i vrata te su 34 rada uključena. Rezultati i zaključci: Rezultati ovog preglednog rada pokazuju kako je pušenje najvažniji faktor koji doprinosi nastanku karcinoma glave i vrata uz konzumiranje alkohola, a što ovisi o dozi i vremenu izloženosti. Nezdrava prehrana,smanjeni unos vitamina, posebice folata, C i E vitamina i radni okoliš se ustanove u oboljelih. U oko četvrtine pacijenata je ustanovljena infekcija s HPV virusom, a u nekih i koinfekcija s drugim virusima poput Epstein Barrovog, citomegalovirusa i HIV-a. Očito genetska predispozicija postoji ali i korelacija sa određenim genetskim sindromima poput Fankonijeve anemije i Bloomovog sindroma

Epidemiologija and etiologija pločastog karcinoma glave i vrata

Introduction: It was expected at least in Western countries that incidence of head and neck cancers (HNSCC) should become lower due to the propaganda against smoking. However, the expected decrease in HNSCC was not achieved in many countries. Tobacco and alcohol consumption are known as a major risk factors for development of HNSCC. It is well known that 15-20% of HNSCC are linked to HPV infection, however, some authors reported coexistence with other viruses as well. In the Eastern countries paan (betel nut), ghutka, that have been also linked to the development HNSCC. However, lately HNSCC have been linked to the low vegetable and fruit intake, vitamin defi ciencies, coinfection with other viruses, certain genetic syndromes and occupational exposure. Therefore, the aim of this study is to review recent literature regarding epidemiology and other risk factors in the development of HNSCC. Methods: Pubmed was searched in the past two years in order to fi nd out novelties regarding epidemiology and aetiology for HNSCC and 34 papers were included. Results and Conclusion: The results of this review paper show that smoking is a major contributing factor especially with alcohol both being dosed and time dependent in the development of HNSCC. Unhealthy diet, decrease in vitamin intake especially folate, C and E vitamin and occupational exposure were seen in the diseased. In about one fourth of the patients infection with HPV has been noticed, and in some coinfection with other viruses such as Epstein Barr, cytomegalovirus and HIV. Obviously genetic predisposition exists but also correlation with certain genetic syndromes such as Fanconi’s anaemia and Bloom syndrome.Uvod: Očekivalo se barem u Zapadnim zemljama kako će incidencija karcinoma glave i vrata biti manja uslijed propagande protiv pušenja. Ipak, očekivano smanjenje u incidenciji karcinoma glave i vrata nije postignuto u mnogim zemljama. Pušenje i konzumacija alkohola su glavni faktori rizika za nastanak karcinoma glave i vrata. Dobro je poznato da je 15-20% karcinoma glave i vrata povezao s HPV infekcijom, doduše, neki autori su izvijestili i o koegzistenciji s drugim virusima također. U istočnim zemljama paan (betel nut), ghutka su također povezani s nastankom carcinoma glave i vrata. Ipak, nedavno je karcinom glave i vrata povezan s rijetkim unosom povrća i voća, defi citom vitamina, koinfekcijom s drugim virusima, određenim genetskim sindromima i radnim okolišem. Stoga je cilj ovog istraživanja bio pregledati noviju literature s obzirom na epidemiologiju i druge rizične faktore u nastanku karcinoma glave i vrata. Metode: Pubmed je pretražen u zadnje dvije godine kako bi se ustanovilo novosti vezane uz epidemiologiju i etiologiju karcinoma glave i vrata te su 34 rada uključena. Rezultati i zaključci: Rezultati ovog preglednog rada pokazuju kako je pušenje najvažniji faktor koji doprinosi nastanku karcinoma glave i vrata uz konzumiranje alkohola, a što ovisi o dozi i vremenu izloženosti. Nezdrava prehrana,smanjeni unos vitamina, posebice folata, C i E vitamina i radni okoliš se ustanove u oboljelih. U oko četvrtine pacijenata je ustanovljena infekcija s HPV virusom, a u nekih i koinfekcija s drugim virusima poput Epstein Barrovog, citomegalovirusa i HIV-a. Očito genetska predispozicija postoji ali i korelacija sa određenim genetskim sindromima poput Fankonijeve anemije i Bloomovog sindroma

Maxillary Sinus Floor Elevation

Distalna bezubost gornje čeljusti, povezana s jakom resorpcijom alveolarnog grebena ili jakom pneumatizacijom maksilarnog sinusa, često je limitirajući čimbenik implanto-protetske rehabilitacije. Insuficijentni koštani volumen moguće je nadomjestiti operativnim zahvatom tako da se podigne dno maksilarnog sinusa (elevacija dna maksilarnog sinusa ili osinus-lifting). Elevacija dna sinusa operativni je zahvat kojim se premješta sinusno dno prema kranijalnoj kosti, uz istodobnu augmentaciju koštanog defekta kako bi se stvorila dovoljna visina koštanog fundamenta potrebnog za ugradnju dentalnih implantata. Ta operativna tehnika uobičajena je u kliničkoj primjeni od godine 1986. i od tada se sve više modificira i usavršava. Svrha ovoga rada jest predstaviti različite tehnike podizanja dna maksilarnog sinusa sa svim prednostima i nedostacima, kako bi u kliničkoj praksi njihova primjena bila što uspješnija. Elevacija dna maksilarnog sinusa, uz augmentaciju aloplastičnim ili autolognim koštanim implantatima, pouzdana je tehnika kojom se jako proširuju indikacije za ugradnju dentalnih implantata u molarnu regiju alveolarnog nastavka, što nije bilo moguće zbog voluminoznog maksilarnog sinusa.Distal edentulousness of the maxilla, together with extensive resorption of the alveolar crest or high pneumatization of the maxillary sinus, is often a limiting factor for implant-prosthetic rehabilitation. It is possible to compensate insufficient bone volume by elevating the floor of the maxillary sinus using an operative procedure (sinus floor elevation or sinus lifting). Elevation of the sinus floor is an operative procedure based on moving the bottom of the sinus cranially while simultaneously augmenting the bone defect, with the purpose of creating sufficient height at the bone fundament needed for the placement of dental implants. This operative technique has been routine in clinical practice since 1986 and is constantly being improved and modified. The purpose of this review is to present the different techniques in sinus lifting with all their advantages and disadvantages in order to render their implementation in clinical practice as successful as possible. Elevating the maxillary sinus floor by augmentation with allograft or autologous bone implants is a reliable method which broadens the indications for the placement of dental implants in the molar region of alveolar bone A, where, due to extensive pneumatization of the maxillary sinus, it was not previously possible

Use of Statins in Dental Implantology and Their Impact on Osseointegration: Animal Studies

Statins are one of the most commonly used drugs for the prevention of atherosclerosis and ischemic heart disease. Statins have an antibacterial effect against oral pathogens, especially against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Studies on animals that we analyzed in this chapter show that statins promote angiogenesis and osteoblast differentiation. Data on the effect of statins on the process of osseointegration are important in clinical practice and should be an integral part of dental education. PubMed, Cochrane Central, and Web of Science database search was performed for animal studies on statin effects on dental osseointegration. Fifteen studies performed on laboratory animals were identified where statins were applied systemically, locally, orally, subcutaneously, or intraosseously. Titan implants of different diameters were placed in tibia and femur of animals. Statins improved osseointegration and enhanced contact of implant surface with the newly formed bone, as well as significantly increased the volume of newly formed bone in lab animals. The purpose of this chapter is to prove the relationship between local use of statins and better osseointegration, as well as a larger amount of newly formed bone around the implant. Knowledge of the effect of frequently prescribed medications on dental procedures and osseointegration is necessary for both students and physicians

Maxillary Sinus Floor Elevation

Distalna bezubost gornje čeljusti, povezana s jakom resorpcijom alveolarnog grebena ili jakom pneumatizacijom maksilarnog sinusa, često je limitirajući čimbenik implanto-protetske rehabilitacije. Insuficijentni koštani volumen moguće je nadomjestiti operativnim zahvatom tako da se podigne dno maksilarnog sinusa (elevacija dna maksilarnog sinusa ili osinus-lifting). Elevacija dna sinusa operativni je zahvat kojim se premješta sinusno dno prema kranijalnoj kosti, uz istodobnu augmentaciju koštanog defekta kako bi se stvorila dovoljna visina koštanog fundamenta potrebnog za ugradnju dentalnih implantata. Ta operativna tehnika uobičajena je u kliničkoj primjeni od godine 1986. i od tada se sve više modificira i usavršava. Svrha ovoga rada jest predstaviti različite tehnike podizanja dna maksilarnog sinusa sa svim prednostima i nedostacima, kako bi u kliničkoj praksi njihova primjena bila što uspješnija. Elevacija dna maksilarnog sinusa, uz augmentaciju aloplastičnim ili autolognim koštanim implantatima, pouzdana je tehnika kojom se jako proširuju indikacije za ugradnju dentalnih implantata u molarnu regiju alveolarnog nastavka, što nije bilo moguće zbog voluminoznog maksilarnog sinusa.Distal edentulousness of the maxilla, together with extensive resorption of the alveolar crest or high pneumatization of the maxillary sinus, is often a limiting factor for implant-prosthetic rehabilitation. It is possible to compensate insufficient bone volume by elevating the floor of the maxillary sinus using an operative procedure (sinus floor elevation or sinus lifting). Elevation of the sinus floor is an operative procedure based on moving the bottom of the sinus cranially while simultaneously augmenting the bone defect, with the purpose of creating sufficient height at the bone fundament needed for the placement of dental implants. This operative technique has been routine in clinical practice since 1986 and is constantly being improved and modified. The purpose of this review is to present the different techniques in sinus lifting with all their advantages and disadvantages in order to render their implementation in clinical practice as successful as possible. Elevating the maxillary sinus floor by augmentation with allograft or autologous bone implants is a reliable method which broadens the indications for the placement of dental implants in the molar region of alveolar bone A, where, due to extensive pneumatization of the maxillary sinus, it was not previously possible

The Interaction of the Professional, Psychological and Sociological Aspect in Planning Dental Rehabilitation

Svaki bi stomatolog u prvome redu trebao misliti na zdravlje i interese svojega pacijenta te ga potpuno i iskreno izvijestiti o potrebi i mogućnosti terapije. Kako pacijenti nemaju znanja iz područja struke, ne mogu sami odlučivati o vrsti i tijeku terapije. Uloga stomatologa je izraditi vrstan plan terapije te pripremiti pacijenta na rehabilitaciju i uputiti ga u očekivane rezultate. Planirati terapiju složen je i zahtjevan posao. On nužno traži sjedinjenje spoznaja iz područja prakse i znanosti sa sociopsihološkim pristupom pacijentu, ali i temeljima medicinske etike.The priority of each dentist should be the health and care, as well as the welfare of his patient. The dentist should explain the therapeutical process, inform the patient in detail about the chosen therapy and keep him updated. The patients, usually lacking professional knowledge, or insufficiently informed, are unable to choose the type and the course of the therapy. The role of the dentist is to prepare the therapy plan, as well as the rehabilitation of the patient, and to instruct him as to the desired results. Preparing the therapy plan is a very demanding part of the process, which necessarily unites practical knowledge and scientific and socio -psychological approach to the patient, medical ethics included

Mandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature

OBJECTIVE: Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw. ----- CASE REPORT: We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and bethamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and sutures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of microorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely. ----- CONCLUSION: This case highlights the fact that in some patients bone exposure might develop due to the pulpal-periodontal syndrome i.e. pulp necrosis

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