Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os

Impact of contamination cleanliness of the implant surface review paper

Dental implantology, as a part of dental medicine, is a modern science that deals with the placement of dental implants in a place where one or more teeth are missing, enabling the rehabilitation of the stomatognathic system, improving aesthetics, function, and occlusion. For this purpose, dental implants are used, from different manufacturers, with different shapes, diameters, sizes, and lengths. Important and desirable properties of the materials used for implant placement are: biocompatibility, bio inertness, bio functionality and bio adhesion. Implant companies always advertise a 95-99% success rate on their implants for their implantology system. Very rarely they talk about implant failure. The purpose of this paper is to indicate the influence of the implant surface modifications (the microtopography and micro design of the implants) on the osseointegration process success as well as the long- term success of the implant-prosthetic rehabilitation. There are differences between manufacturers in terms of materials and metal alloys they use in the implant production process, the type of surface of the implants, but also in the way they are cleaned and prevent possible contamination before they are put on sale. In this study, several types of implants, their surface characteristics, and the possible influence of contaminated implant surfaces on the success/failure of the implant were analyzed. To achieve the set goal, an electron microscope was used, which will allow a detailed analysis of the surface of the implants in three implant zones: apical, midline and implant neck. A scanning electron microscope sem is a type of electron microscope that produces images of a sample by scanning its surface with a focused beam of electrons. Keywords: implants, materials, success, surface, types

Types of suturing materials in oral surgery

Aim: In everyday surgical practice, different types of suturing materials are available. They play an important role in tissue healing, facilitate the process of hemostasis, enable the reconstruction and reunification of tissue whose integrity has been compromised during surgery or trauma. The aim of this study is to examine the reaction of the tissue to different suturing materials, as well as to determine the speed of wound healing and the incidence of complications after their use, in order to prove which of them is most suitable for oral surgery procedure. Material and methods: These researches were done based on analyzes presented on "MEDLINE" and "PubMed" databases, from 1970 to 2018, using the following keywords: oral surgery, suture materials, flap, periodontium, polyglucapron, polytetrafluoroethylene, polyglycolic acid, polylactic acid, silk. Results: Tissue reactions to suturing materials vary depending on the surface properties and the adhesion properties of the bacteria to the material. Silk is the most commonly usedsuturing material in oral surgery. The application of silk sutures increases the risk of infections, because they react with the connective tissue, allowing the accumulation of dental plaque and bacterial adhesion around them. Studies about tissue response to suturing material confirm the presence of inflammation when using silk and cotton threads, and minimal reaction in others (nylon, polyester, polytetrafluoroethylene (ePTFE), polyglycolic acid (PGA). Conclusion: In addition to the observance of surgical suturing techniques, and the proper maintenance of oral hygiene in the postoperative period, the choice of suturing material has a significant impact on tissue healing. This underscores the need for careful selection of suturing material during oral surgery. Key words: oral-surgical interventions, suturing material, resorbable and non-resorbable sutures

The link between the presence of an odontogenic radicular cyst and the body 's immune response (case report)

Odontogenic radicular cysts are the most common odontogenic inflammatory cysts. Immunopathological reactions play a dominant role in their etiopathogenesis. This study aimed to determine the presence of T and B lymphocytes, cells in the inflammatory infiltrate and, the impact of the cystic lesion on the systemic immune response by verifying the changes in the immune system by applying the immunohistochemical method in a patient with a residual cyst in the lower jaw. and one month after surgery. Case Report: A 60-year-old woman with a residual cyst in her lower jaw was admitted to the Oral Surgery Clinic. Immunoassay of blood was performed to determine the values of immunoglobulins IgA, IgG and Ig M before surgery, cyst enucleation in toto, pathohistological and immunohistochemical analysis of CD3, CD4, CD8, CD20, and CD68 markers. Immunological blood tests were performed one month after surgery. Pathohistological and immunohistochemical analysis confirmed the diagnosis of radicular (residual) cyst in the mandible with the presence of multilayered squamous epithelium beneath which is an inflammatory infiltrate with granulation tissue and deposited cholesterol crystals with predominant lymphadenopathy of predominant lymphadenopathy. %), are dominated by macrophages and histiocytes. Serum immunoglobulin IgA, Ig G, and IgM levels were reduced after surgery. The use of pathohistological and immunohistochemical analyzes proves the presence of cellular and humoral immune responses and their role in the etiopathogenesis and development of cysts, while immunoassays confirm the presence of human immunoglobulin this suggests the importance of early detection and therapeutic approach to radicular cysts. Keywords: residual cyst, pathohistological, immunohistochemical and immunological analysis, human immune response

Clinical effects of using PRF in socket preservation

Introduction: Preservation of the post-extraction socket, as part of guided bone regeneration, is recommended to create the biological foundation for future implant-prosthetic or prosthetic construction. For this purpose, are used many graft materials, alone or in combination. A-PRF as an autologous blood derivative has been increasingly used in recent years due to its properties in angiogenesis, epithelialization and hemostasis. Easy preparation, low cost and no use of anticoagulants and bovine fibrin are advantages for its widespread use. Aim: To evaluate the effectiveness of the two methods used in the preservation of hard and soft tissues volume, bone quality and the impact of A-PRF on postoperative morbidity. Material and method: Two case studies are described, the one using a combination of A-PRF with xenograft, and the other one using solo A-PRF as post-extraction socket preservation methods. Results: Clinical measurements of the height and width of the post-extraction alveolus and the height of the interdental papilla were performed, and the density of the newly formed bone was measured through CBCT, noted in a tabular view. Postoperative morbidity was also evaluated. Conclusion: From the results obtained in the two case reports shown, it can be concluded that A-PRF, is an economical, autologous and simple autologous graft material is recommended for use in the of a post-extraction socket preservation, as a solo graft material, or in combination with a particulate graft. The volume-preserving properties were confirmed, with better quality and architectonics of the de nuovo formed bone, as well as an easier period of postoperative convalescence are confirmed

Replacement of teeth by immediate implantation in infected site

Background: The literature reports success rates of 92%–100% for immediate implantation in infected sockets, which is comparable to the 98.4% survival rate found for immediate implants in non-infected sockets. There is no evidence that points towards decreased survival rates of implants placed in infected sockets compared to placement in non-infected sites. Aim/Hypothesis: To evaluate the successes of the immediate implant placement in areas exhibiting periapical lesions, gaining aesthetics and function by establishing a successful protocol for safe implant installation. Material and Methods: Surgical intervention and bone grafting were performed in advance of tooth extraction in order to resolve the infection and develop the site for immediate implantation, helping ensure the bone volume needed for high primary stability. Results: The reported case has clinically demonstrated that the presented protocol with the laser decontamination of the socket, grafting with an in situ hardening material, and non submerged healing is an acceptable protocol for the management of the implant rehabilitation of patients with infected teeth requiring extraction. Conclusion and Clinical Implications: This study is proof of the principle that sockets can heal naturally with immediately placed implants in infected sites and tissue shrinkage can be reduced by utilizing the least invasive surgical and prosthetic protocol. Keywords: Alveolar ridge preservation, Bone graft, Immediate implant placement

Effectiveness of the impact of second-generation platelet-rich fibrin prf in the treatment of localized individual gingival recessions miller I and II (case report)

The muco-gingival surgical modality SCTG + CAF(subepithelial connective tissue graft-SCTG + coronary positioned flap-CAF) in the treatment of Miller I and II gingival recessions is considered the “gold standard” technique for predictive and complete root coverage of the gingival defects, with long-term clinical stability of the results obtained. The counterpart of this type of technique is the relatively young PRF + CAF operating mode, which recently has a large number of supporters, primarily due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation and stem cell entrapment). Aim: The aim of this paper is to evaluate the clinical efficiency of the CAF + PRF combined technique in the treatment of localized individual gingival recessions Miller I and II, by comparing the values of periodontal clinical parameters measured preoperatively and 1 month postoperatively, as well as by the obtained immunohistochemical analysis of the biopsy material taken from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. Material and method: Case report: A 37-year- old man was admitted to the Clinic “St. Panteleimon-Skopje, at the Oral Surgery department for surgical treatment of localized maxillary gingival recession Miller II, tooth 31. Preoperative measurements of periodontal clinical parameters were performed: vertical dimension of gingival recession (RD / VGR), depth of periodontal pocket (PPD/PD) keratinized / attached gingival level (CAL), keratinized gingival width (KTW/ KMW) and gingival thickness (GT) all measured in mm, including gingival biotype. CAF + PRF therapeutic modality is used to treat gingival defect. One month postoperatively, re-measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. Results: Significant reduction of RD, PPD and CAL values were determined on the measurements 1 month postoperatively. Conclusion: Insignificant values of KTW and GT were noted one month post.opp. There are no changes in gingival biotype before and postoperatively. PRF as a second generation of autologous concentrate is not only an adjuvant and / or replacement of the SCTG- “gold standard” in the treatment of Miller I and II, but is also a superior alternative in the surgical treatment of this type of superficial mucogingival defects

Types of suturing material in oral surgical intervention

In everyday surgical practice, different types of suturing materials are available which have an important role in tissue healing, facilitate the process of hemostasis, and enable the reconstruction and reunification of tissue. The aim of this study is to examine the reaction of the tissue to different suturing materials, as well as to determine the speed of wound healing and the incidence of complications after their use, in order to prove which of them is most suitable for oral surgery procedure. These researches were done based on analyzes presented on “MEDLINE” and “PubMed” databases, from 1970 to 2018, using the following keywords: suture materials, flap, polyglucapron, polytetrafluoroethylene, polyglycolic acid, polylactic acid, silk. Tissue reactions to suturing materials vary depending on the surface properties and the adhesion properties of the bacteria to the material. Silk is the most commonly used suturing material in oral surgery. The application of silk sutures increases the risk of infections. Studies about tissue response to suturing material confirm the presence of inflammation when using silk and cotton threads, and minimal reaction in others (nylon, polyester, polytetrafluoroethylene, polyglycolic acid. In addition to the observance of surgical suturing techniques, and the proper maintenance of oral hygiene in the postoperative period, the choice of suturing material has a significant impact on tissue healing. Keywords: oral-surgical interventions, suturing material, resorbable and non-resorbable sutures

Pulp changes in the presence of denticles

Aim: To determine the histopathological changes of the pulp, in which denticles are present. Material and method: The research was made on 40 pulps after indicated tooth extraction, we made a vertical section of the teeth, removed them, and 60 extirpated pulps of teeth with an endodontic diagnosis of chronic pulpitis. According to the method of light microscopy, and by using standard differential histo-chemical coloring, results were obtained at the Institute of Pathology of the Faculty of Medicine in Skopje. Results: The obtained results showed that in some specimens, tangential sections of denticles showed a continuous surface of loose connective tissue of the pulp, in which there was a collection of mononuclear inflammatory cells. Between the loose connective tissue of the pulp and the denticles, there is a layer of odontoblasts. In the other parts of the pulp, there are no major deviations in the cellularity, as well as in the vascular and nerve morphological compartments. The interstitium is proportional to that of relatively preserved pulps. Keywords: dental pulp, denticles, histopathological analysis

Simplified surgical extraction planning using cone beam computed tomography

Introduction: An impacted tooth is one that fails to erupt within the dental arch in the expected time and away from its anatomic position. Treatment decision depends on several factors: location of the impaction, prognosis of the intervention on the impacted tooth and adjacent teeth, surgical accessibility, impact of treatment on the final functional occlusion, and possible surgical morbidity. This decision has traditionally been based on planar 2-dimensional (2D) radiography. New imaging techniques like cone-beam computed tomography (CBCT), which has a lower-dose and lower-cost alternative to conventional CT can direct us in proper planning and make it easier. Case presentation: A 43-year-old woman complained of facial pain and headache, with no signs of any disorders but, based on a panoramic radiograph, with the presence of impacted maxillary wisdom teeth. 3D CBCT scans were performed to evaluate the position and direction of the impacted teeth in the maxillary sinus and related teeth. We noticed that the left third maxillar molar lying on the root of the second maxillar molar and the right one located inside the maxillary sinus, were not clearly demonstrated on panoramic radiography. After that, an appropriate and concise treatment plan was set up and successful surgical removal was done. Conclusion: CBCT offers 3-dimensional and multi-planar views for a more accurate diagnosis and easier and more appropriate planning for a minimally possible invasive treatment approach without radiation exposure of conventional computed tomography (CT) scans. Keywords: Ectopic wisdom teeth, Cone Beam Computed Tomography, surgical planning, extractio