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

Application of piezosurgery in extraction of impacted third molars

Removal of impacted permanent third molars is considered to be one of the most common and routine oral surgical procedures. This intervention is usually performed in the classical way with the use of rotatory instruments and burs. As an alternative to this classical approach, piezosurgery can be used, which is an osteotomy technique based on ultrasonic vibrations. The crucial advantage of piezosurgery is that it is inert to soft tissues. The aim of this study was to compare piezosurgery with the rotatory osteotomy technique, with particular reference to the time required to perform the intervention and the intensity of postoperative sequelae: pain, swelling, and trismus. This paper summarizes published experiences and knowledge of piezosurgery, with special regard to the extraction of mandibular third molars. For the purposes of this research, an automatic detailed search was performed on the electronic database PubMed for the period 2012-2022. Keywords used in the search were: piezosurgery, impacted third molars. The initial filtration resulted in 47 scientific papers, 17 of which met the selection criteria. Of particular interest were papers such as Meta-analyzes and systematic reviews. A review of the literature indicates that although patients undergoing piezosurgery required longer operating times, they had less postoperative pain, swelling, and trismus. Keywords: impacted molar, piezosurgery

Comparative evaluation of clinical effects after operative extraction of impacted mandibular third molars using piezosurgery and rotary instruments

Background: Impacted mandibular third molars are frequently encountered in daily oral surgery practice. Surgical extraction of these teeth is indicated when they cause multiple problems that interfere with the normal functioning of the masticatory system, or as a prophylactic measure to prevent clinical symptoms. Due to the shortcomings of traditional rotary instruments, piezosurgery appears as an alternative technique to osteotomy whose main benefits are that it is inert to soft anatomical structures and it reduces the risk of damage or thermal necrosis of osteocytes. Aim: The aim of this study is to compare piezosurgical and conventional osteotomy with hand piece and burs evaluating the time needed for the osteotomy and the intensity of postoperative complications, including pain and trismus. Materials and Methods: Intraoperative and postoperative aspects were evaluated for the comparison between piezosurgical osteotomy and osteotomy with rotary instruments in the surgical removal of mandibular impacted wisdom teeth in total of 15 young patients through a split-mouth study. Results: It takes more time to perform an osteotomy using piezosurgery compared to the conventional technique with rotatory instruments, but statistically non-significant. Postoperative pain and trismus were lower in the test group where the osteotomy was performed piezosurgically, also without statistical significance. Conclusion: Due to the lower intensity of postoperative symptoms, piezosurgery is a good therapeutic option for osteotomy, especially in cases where there is a high risk of injury to adjacent soft tissues. Keywords: Impacted mandibular third molars; rotary instruments; piezosurgery; osteotom

Употреба на пиезохирургија за екстракција на импактирани мандибуларни трети молари

Отстранувањето на импактираните трајни трети молари се смета за една од најчестите и рутински оралнохируршки постапки. Оваа интервенција вообичаено се изведува на класичен начин со употреба на насадни инструменти и борери. Како алтернатива на конвенционалниот пристап може да се користи пиезохихургијата која претставува техника на остеотомија заснована на ултрасонични вибрации. Круцијалната предност на пиезохирургијата е што таа е инертна кон меките ткива. Во литературата се среќаваат податоци дека е поприфатлива од аспект на интраоперативниот тек и постоперативниот морбидитет компарирано со ротирачките инструменти. Цел: Да се компарира пиезохирургијата со ротирачката техника на остеотомија при екстракција на импактирани мандибуларни трети молари со евалуација на времето потребно за изведување на интервенцијата и интензитетот на постоперативните секвели, вклучувајќи болка, оток и тризмус. Материјал и метод: Приказ на случај: пациентка кај која беа присутни импактирани мандибуларни трети молари симетрично поставени беше примена на Клиниката за орална хирургија. Поради поставеноста на импактираните молари во близина на мандибуларниот канал, се одлучивме едниот умник да се отстрани со помош на пиезоелектрична хирургија, а кај контралатералниот трет молар остеотомијата беше направена со помош на хируршки насадник и карбиден борер. Различни критериуми беа земени во обзир во текот на интервенцијата и во постоперативниот тек, со цел да се споредат двете техники. Резултат: За пиезоелектричната техника е потребно повеќе време отколку при конвенционалниот метод. Постои намален постоперативен дискомфорт после пиезохирургија. Заклучок: Постојат одредени предности за екстракција на импактирани мандибуларни трети молари со пиезохируршка техника на работа компарирано со конвенционалните ротирачки насадни инструменти. Достапните податоци ја истакнуваат можноста за помалку постоперативни секвели и подобрено заздравување во случаите каде е употребена пиезохирургијата, но со прологирано оперативно време

Maxillary Follicular Cyst with Mesiodens–case Report

Abstract Previous studies have shown that follicular cysts are the most frequent cystic lesions around supernumerary teeth. Most often (in more than 90% of cases), they develop around the crown of a mesiodens in the upper jaw. Follicular cysts may grow to a large size before they are identified. Most are diagnosed upon investigation of a tooth that has failed to erupt, or as an incidental radiographic finding, as they are usually not painful unless secondarily infected. Many patients first become aware of the cyst as a slowly enlarging swelling. The purpose of this report is to describe a case of a large follicular cyst located in upper jaw with mesiodens in it. Anyway, the most applied approach for the surgical removal of follicular cysts is enucleation of the entire cyst including both the epithelial layer and the capsule and removal of the associated tooth with appropriate management of the resultant dead space. The prognosis for most histopathologically diagnosed follicular cysts is excellent, recurrence being a rare finding. In all dentigerous cysts, the microscopic features must be determined, to rule out its transformation in an ameloblastoma or, to squamouscell carcinoma. Cooperation of a dentist, an oral surgeon, a pathologist, and other specialists can lead to early diagnose and prevention of further growth of a follicular jaw cyst, thus preventing substantial bone damage

Matrix metalloproteinases (with accent to collagenases)

Matrix metalloproteinases (MMPs) are a major group of enzymes that regulate cell–matrix composition. The MMPs are zinc-dependent endopeptidases known for their ability to cleave one or several extracellular matrix (ECM) constituents, as well as nonmatrix proteins. This review focuses on structural and functional elements of MMPs, and their roles in physiological and pathological processes, in which it is believed the MMPs play an important, or even indispensable role. According to their structural and functional characteristics, MMP family members have been classified into six different but closely related subgroups with fairly characteristic but often overlapping substrate specificities. MMP synthesis and functions are regulated by transcriptional activation, post-transcriptional processing (release of pro-domain, cell surface shedding), and control of activity by a family of endogenous inhibitors collectively known as tissue inhibitors of metalloproteinases (TIMPs). The balance of MMPs to TIMPs therefore determines matrix turnover, where either an excess of MMPs or a deficit of TIMPs may result in excess ECM degradation. Moreover, the recent development of selective and nonselective inhibitors of MMPs would also provide new insights in the knowledge of the relationship between activation of inflammatory cells and tissue remodeling and propose new therapeutic possibilities to the treatment of inflammatory disease. Key words: Extracellular matrix, matrix metalloproteinases, inflammation

Matrix metalloproteinases

Matrix metalloproteinases (MMPs) are a major group of enzymes that regulate cell–matrix composition. The MMPs are zinc-dependent endopeptidases known for their ability to cleave one or several (extracellular matrix) ECM constituents, as well as nonmatrix proteins. This revue was focused on structural and functional elements of MMPs, and their role in physiological and pathological processes in which it is believed the MMPs play an important, or even indispensable role. According to their structural and functional characteristics, MMPs family members have been classified into six different but closely related subgroups with fairly characteristic but often overlapping substrate specificities. MMP synthesis and functions are regulated by transcriptional activation, post-transcriptional processing (release of pro-domain, cell surface shedding), and control of activity by a family of endogenous inhibitors collectively known as tissue inhibitors of metalloproteinases (TIMPs). The balance of MMPs to TIMPs therefore determines matrix turnover, where either an excess of MMPs or a deficit of TIMPs may result in excess ECM degradation. Moreover, the recent development of selective and non-selective inhibitors of MMPs would also provide new insights in the knowledge of the relationship between activation of inflammatory cells and tissue remodeling and propose new therapeutic possibilities to the treatment of inflammatory disease. Key words: extracellular matrix, matrix metalloproteinases, inflammatio