Clinical evaluation of metal-ceramic fixed partial dentures.

Department of Dental Propedeutics Pavel Godoroja, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Edentulism - a pathological condition characterized by the absence of one or more teeth in the dental arch - is a major health problem regardless of societies, regions, ethnicities and social stratification. A fixed bridge (called also as fixed bridge prosthesis, bridge or fixed partial denture) is attached to remaining teeth to replace a missing tooth, and teeth serving as attachments for a fixed bridge are called abutments. The part of the fixed bridge, which veneers the abutment tooth is called a retainer and the part which replaces a missing tooth is called a pontic. Aim of the study. The study aims to evaluate the treatment need of fixed bridges according to the distribution of pontics in dentition, in different age groups and to investigate the primary and late complications and survival of the conventional fixed metal ceramic prostheses, as well as patients' satisfaction with the prosthetic treatment. Materials and methods. An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. The whole material consisted of the patients treated with fixed metal ceramic prostheses at the Department of Dental Propaedeutics, Nicolae Testemitanu State University of Medicine and Pharmacy, during the years 2014–2018. Patients had to have been examined clinically at the follow-up visit. The study included 18 patients (6 men and 12 females) with partial edentulism. After clinical and paraclinical examination, patients were devided into two groups: first group consisted of 8 patients with dental bridges fixed on vital teeth. The second group consisted of 10 patients with dental bridges fixed on endodontically treated teeth. Results. Fixed bridges are most often prepared to replace upper first premolars and lower first molars also in the future. The most usual primary complications related to fixed bridges occurred during preprosthetic endodontic treatment of abutment teeth and during the preparation of the root canals. Patients were satisfied with aesthetics and function of the fixed metal ceramic prostheses. Late complications found in clinical examinations were few, and the survival rate for the fixed metal ceramic bridge prostheses was calculated to be 84 % after 10 years, long fixed bridges having a lower survival than the shorter ones. The treatment need for conventional fixed bridges seems to be highest among patients over 50 years of age in the future. No patients reported adverse reactions to the material. Conclusions. The success of prosthetic rehabilitation with metal-ceramic fixed partial dentures is the result of a medical reasoning based on theoretical and practical skills. Avoidance of tempestuous preparation, deficitary marginal closing, partial filling of the root canal, crown perforation with interradicular pivots, pushing the filling material by apex can prevent pulpits, necrosis, gangrene and other severe complications appearance, occurred in the post-prosthetic belated period

Tratamentul protetic în edentaţia unidentară

La moment sunt disponibile o varietate largă de posibilităţi pentru restabilirea integrităţii arcadelor dentare în cazul breşelor unidentare: proteza parţială mobilizabilă, proteza fixă şi construcţii implanto-protetice. Scopul: studierea surselor bibliografice în vederea evaluării metodelor de tratament în edentaţiile unidentare. Material şi metode. Au fost examinate manuale de specialitate, articole din surse medicale naţionale, cât şi internaţionale on-line aşa ca: Medline, PubMed, Catalogul electronic al USMF „Nicolae Testemiţanu“ Bibliotecii Ştiinţifi ce Medicale (OPAC), Biblioteca Electronică Didactică a USMF„Nicolae Testemiţanu“. Au fost selectate 40 surse bibliografice, fiiind cele mai informative pentru aplicarea în studiul dat. Rezultate. Tratamentul edentaţiei parţiale unidentare utilizează mijloace protetice pentru a reconstitui arcadele dentare în funcţie de topografi a edentaţiei, obiectivele şi criteriile de tratament. Mijloacele de tratament protetic sunt clasificate după diverse criterii: modalitatea de transmitere a presiunilor asupra oaselor maxilare; raportul cu grupul dentar restant; modalitatea de integrare a piesei protetice la sisitemul stomatognat. În dependenţă de suportul pe care sunt realizate, mijloacele de tratament protetic pot fi cu suport odonto-paradontal, muco-osos şi suport implantar. Concluzii. Puntea dentară duce la deteriorarea dinţilor limitrofi breşei, iar proteza parţial mobilizabilă provoacă rezorbţia procesului alveolar, ceea ce limitează mult utilizarea acestor metode de tratament în edentaţia unidentară. Reabilitarea implanto-protetică permite menţinerea integrităţii dinţilor vecini unei breşe, micşorează rezorbţia procesului alveolar, îmbunătăţind estetica dentară. Rezolvarea estetică şi funcţională a edentaţiilor unidentare prin intermediul protezării pe implanturi necesită o colaborare perfectă între medicul chirurg, medicul protetician şi tehnicianul dentar. Sarcina evaluării şi echilibrării forţelor ocluzale exercitate pe restaurarea finală îi revine proteticianului, care va evita dereglări ale ocluziei dentare printr-o refacere protetică corectă

Implant supported restoration in single-tooth replacement

Pavel Godoroja Department of Dental Propaedeutics, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: The implant-prosthetic restoration in single missing tooth is a viable treatment option for the functional rehabilitation of tooth loss. Several published studies show that the deadline and the type of functional loading of the implant for single missing teeth is not decisive for the survival and success rate of the implant. Although the conventional protocol is still the “gold standard”, the immediate loading of dental implants in the fresh postextraction socket of the aesthetic area has an excellent prognosis. Immediate functional loading is successfully adopted to minimize the treatment time with immediate and impact benefit on the patient’s quality of life and satisfaction. The aesthetic result is not yet systematically included in the success criteria of the therapy through implant, although a trend for this is more common in recent publications, particularly in publications evaluating the implant prosthetic rehabilitation in the anterior maxilla and mandible. In order to obtain optimal aesthetic results, it is necessary to take into account the other aesthetic parameters, together with the chosen material for the fabrication of the implant-supported single crown and the type of prosthetic abutment. Conclusions: The systematic review of the contemporary specialty literature examines the types of implantations and implant-supported restorations for single tooth replacement, the survival rates of the implant, the survival of the crown on the implant and the successful implant, incidence of biological, technical and aesthetical complications of the implants and prosthetic restorations on implants, the quality of life related to the oral health to patients with implant-prosthetic treatment

Opțiunile de tratament protetic în edentațiile unidentare

Background. Preservation of soft and hard tissues after tooth loss in order to restore function and aesthetics through prosthetic treatment is one of the main goals of clinicians. The treatment of single missing tooth can be achieved by several methods. Objective of the study. Elaboration and argumentation of a management algorithm of patients with single tooth edetulism based on the comparative estimation of the treatment results with implant supported prostheses or with conventional fixed partial dentures. Material and Methods. The prospective controlled clinical trial included 180 consecutive patients aged 18-60 years with single missing tooth in the upper or lower jaw, restored with fixed partial conventional dentures (90 patients) or with crowns on implant support (90 patients), which signed the written consent to participate in the study. Results. In this study, the survival rate of fixed partial dentures (FPD) was statistically significantly lower compared to the implant supported crown (94.4% and 100.0%, p<0.05). Total complication rates (61.1% and 43.3%; p<0.05), technical(5.6% and 0%; p <0.05) and biological complications were statistically significantly higher in patients with single missing tooth treated with FPD, and the rate of aesthetic complications (23.3% and 43.3%,p <0.01) - statistically significantly higher in patients with single missing tooth treated with implant supported prostheses. By the results of our study, we developed a management algorithm for patients with single tooth edentulism. Conclusion. Given the large number of variables that affect treatment decisions, there is no universally effective solution for treating single missing tooth. The selection of the treatment method must be made on the basis of a risk profile specific to the situation of each patient. Introducere. Conservarea țesuturilor moi și dure după pierderea dinților în scopul restaurării funcției și esteticii prin intermediul tratamentului protetic este unul din obiectivele principale ale clinicienilor. Tratamentul edentației unidentare poate fi realizat prin mai multe metode. Scopul lucrării. Elaborarea și argumentarea unui algoritm de management al pacienţilor cu edentații unidentare în baza estimării comparative a rezultatelor tratamentului cu proteze pe suport implantar sau cu proteze parțiale fixe convenționale. Material și Metode. În studiul clinic prospectiv controlat au fost incluși consecutiv 180 de pacienți cu vârsta cuprinsă între 18-60 de ani, cu edentații unidentare la maxilarul superior sau inferior, restabilite cu proteze parțiale fixe convenționale (90 de pacienți) sau cu coroane pe suport implantar (90 de pacienți), care au semnat consimțământul scris pentru participare în studiu. Rezultate. În studiul dat, rata de supraviețuire a protezelor parțiale fixe (PPF) a fost semnificativ statistic mai mică, comparativ cu rata de supraviețuire a coroanei pe suport implantar (94,4% și 100,0%, p<0,05). Ratele de complicații total (61,1% și 43,3%, p<0,05), tehnice (5,6% și 0%; p<0,05) și biologice erau semnificativ statistic mai mari la pacienții cu edentații unidentare tratați cu PPF, iar rata de complicații estetice (23,3% și 43,3%; p<0,01) – statistic semnificativ mai mare la pacienții cu edentații unidentare tratați cu proteze pe suport implantar. În baza evaluării rezultatelor studiului nostru, am elaborat un algoritm de management al pacienţilor cu edentații unidentare. Concluzii. Având în vedere numărul mare de variabile care afectează deciziile de tratament, o soluție universal eficientă de tratament a edentației unidentare nu există. Selectarea metodei de tratament trebuie efectuată în baza unui profil de risc specific pentru situația fiecărui pacient

The incidence of oral mucosa diseases to the patients with chronic viral hepatitis

Actualitatea În activitatea zilnică profesională, medicul stomatolog este confruntat cu o largă paletă de afecţiuni ale cavităţii orale inclusiv şi cele care pot reflecta îmbolnăviri grave ale întregului organism. Printre acestea trebuie menţionate, în mod cert, cele legate de manifestările orale asociate hetatitelor virale, care, în ultima perioadă de timp, au devenit din ce în ce mai frecvente şi mai răspândite. Scopul este de a efectua o totalizare şi de a crea o viziune ce ţine de incidenţa maladiilor mucoasei bucale la pacienţii cu hepatite cronice virale pe plan mondial. Materiale si metode Au fost selectate şi studiate articole ştiinţifice internaţionale din mai multe ţări. S-a efectuat o reprezentare grafica a analizei statistice conform datelor selectate privind incidenţa afecţiunilor mucoasei bucale la pacienţii cu hepatite cronice virale. Rezultate In urma datelor selectate s-a constatat că afecţiunile mucoaselor bucale cel mai des se manifestă ca rezultatul reacţiei imune a organizmului in bolile sistemice. În Germania — 68,7% din pacienţii cu HCV (hepatita C) fiind diagnosticaţi cu lichen plan bucal. În Iran s-a efectuat un studiu mai amănunţit privind asocierea lichenului plan bucal cu HCV unde s-a constatat o prevalenţă nesemnificativă. În Japonia rezultatele arată o prevalenţă de 68% a pacienţilor cu lichen plan bucal si HCV. In Rusia fiind efectuat un studiu generalizat privind asocierea afecţiunilor mucoaselor bucale cu hepatitele cronice virale in 87,5% din cazuri. Concluzii Totuşi reieşind din faptul ultimilor date epidemiologice privind creşterea cazurilor de hepatite cronice virale şi lipsa unor studii in Republica Moldova care dovedesc corelaţiile cu alte maladii aşa cum sunt afecţiunile mucoasei cavităţii bucale aparute pe fundalul imudeficienţei acestor pacienţi, această problemă necesită să fie cercetată mai amănunţit pentru monitorizarea acestui grup de pacienţi.Actuality Every working day, the dentist meets a lot of oral cavity diseases including those which can be reflected as a result of systemic diseases. We should mention an important point of association of oral mucosa diseases with chronic viral hepatitis which frequency were increased last period of time. The aim of study is to create a vision about the incidence of oral mucosa diseases in correlation with chronic viral hepatitis in the world. Materials and methods In this study were selected the dates from the scientific articles from different countries. There were created the graphical presentation of statistical analyses of incidence of oral mucosa lesions to the patient with chronic viral hepatitis. Results According to the selected information we can mention that oral mucosa diseases appear as a result of immunodeficiency of the organism with systemic diseases. In Germany — 68,7% of the patients with viral hepatitis C manifest oral lichen planus (OLP). In Iran were made a deep study of association of OLP with chronic viral hepatitis C, the result of prevalence were not insignificant. The prevalence of 68% of the patient with OLP in association with chronic viral hepatitis C were identified in Japan. In Russia were made a general study of prevalence of association of oral mucosa diseases with chronic viral hepatitis being 87,5% of cases. Conclusions According to the last epidemiological dates which show the increasing of the cases of chronic viral hepatitis and absence of any studies in Republic of Moldova which confirm the correlation with oral mucosa diseases, this problem needs to be investigated deeply in order to be able to monitoring this group of patients

Maloclussion patterns in physically, auditory and visually handicapped patients in Republic of Moldova

Department of Dental propedeutics Pavel Godoroja, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The main problems of orthodontics from Republic of Moldova is to determine either the genetics or enviromental factors influence the development of malocclusions Aim of the study. The purpose of the study is to determine the prevalence of maloclusion in children with special needs and relation with neurological disorders in the process of social behavoir of children. Materials and methods. It was examined 2057 children with special needs (physically, visually, auditory, others) aged between 7-15 from diferent orphaned school from Republic of Moldova. Clinical examination of children included: disponsable dental mirror, chemical pencil, wooden spatula, calipser, portable light. Control group were selected 1345 children from normal school who did not have any neurological disorders and treatment of maloclusions. Results. In sagital plan maloclusion was associated with 69 (9,75%) cases with auditory handicapped, 74(14,8%) children with visually handicapped, but in 33(18,33%) - with physically handicapped children. Mostly, malocclusion have been detected in physically handicapped children in vertical and transversal plan. Malocclusion varied in boys between 58,8% and 63,89% and in girls between 36,11% and 41,21%. The most affected age is 12-15 in visually handicapped children, 9-12 – auditory handicapped children and 7-9 age- in physically handicapped children. Conclusions. Auditory, visually and physically disorders can be considered as key predictors and risk factors in appearance of malocclusion in children. Children with special needs may be treated according to the age and the nature of maloclusions

Contemporary treatment of single missing tooth — systematic literature review

Rezumat. Revizuirea sistematică a literaturii de specialitate contemporană analizează tipurile, rata de supravieţuire, rata de succes, incidenţa complicaţiilor biologice și tehnice ale implanturilor, restaurărilor protetice pe implanturi și protezelor parţiale fixe, calitatea vieţii legată de sănătatea orală la pacienţii cu tratament implanto-protetic sau cu proteze parţiale fixe în edentaţiile unidentare. Deși protezele parţiale fixe sunt larg folosite în ultimele 6 decenii, s-a demonstrat că acestea prezintă o rată scăzută de supravieţuire: 90- 92% la 10 ani și 74-75% la 15 ani de încărcare funcţională. Cele mai frecvente complicaţii biologice în timp la pacienţii cu edentaţii unidentare trataţi prin metoda tradiţională (punţi protetice convenţionale) sunt: cariile dinţilor stâlpi, pierderea vitalităţii dinţilor stâlpi, resorbţia osului crestei alveolare, recesiuni gingivale, iritaţia parodontală profundă și fractura dinţilor stâlpi. Cele mai frecvente complicaţii tehnice la acest grup de pacienţi sunt: pierderea de retenţie, cu sau fără pierderea de reconstrucţie, și fracturi ale materialului de faţetare, cu sau fără pierderea de reconstrucţie. Mai multe studii publicate arată că termenele și tipul de instalare a implantului, restaurării protetice pe implant și încărcării funcţionale a implantului pentru edentaţia unidentară nu este decisiv pentru supravieţuirea şi succesul implantului. Deși protocolul convenţional reprezintă încă ”standardul de aur”, restaurarea şi încărcarea funcţională imediată a implanturilor instalate în alveolele post-extracţionale proaspete ale zonei estetice prezintă un prognostic excelent și este adoptată cu succes pentru minimizarea timpului de tratament cu beneficiu imediat și impact relevant asupra calităţii vieţii și satisfacţiei pacientului. Rezultatul estetic nu este încă inclus sistematic în criteriile de succes ale terapiei prin implant, cutoate că o tendinţă pentru acest lucru este mai frecventă în publicaţiile recente, în special în lucrările care evaluează reabilitările protetice pe suport de implant în sectoarele anterioare maxilare și mandibulare.Summary. The systematic review of the contemporary literature analyzes the types, survival rate, success rate, the incidence of the biological and technical complications of implants, prosthetic restorations on implants and fixed partial prostheses, the quality of life related to oral health in implanto-prosthetic or fixed partial prostheses in single missing tooth. Although fixed partial prostheses have been widely used over the past 6 decades, they have been shown to exhibit a low survival rate: 90-92% at 10 years and 74-75% at 15 years of functional load. The most common biologic complications over time in patients with single missing tooth treated by the traditional method (conventional prosthetic bridges) are tooth decay, loss of vitality tooth poles, alveolar crest bone resorption, gingival recession, deep periodontal irritation, and tooth fracture fracture. The most common technical complications in this group of patients are: loss of retention, with or without loss of reconstruction, and fracture of the veneer with or without loss of reconstruction. Several published studies show that the timing and type of implant installation, prosthetic restoration on the implant and functional loading of the implant for a one-day editorial are not decisive for the survival and success of the implant. Although the conventional protocol is still the „gold standard“, the immediate restoration and immediate loading of implants installed in the fresh postextraction areas of the aesthetic area have excellent prognosis and are successfully adopted to minimize treatment time with immediate benefit and impact on quality life and patient satisfaction. The aesthetic result is not yet systematically included in the success criteria of mediciimplant therapy, although a trend for this is more common in recent publications, especially in works evaluating prosthetic rehabilitation on implant support in anterior maxillary and mandibular sectors

MALOCLUSSION PATTERNS IN PHYSICALLY, AUDITORY AND VISUALLY HANDICAPPED PATIENTS IN REPUBLIC OF MOLDOVA

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Department of Dental propedeutics Pavel GodorojaIntroduction. The main problems of orthodontics from Republic of Moldova is to determine either the genetics or enviromental factors influence the development of malocclusions Aim of the study. The purpose of the study is to determine the prevalence of maloclusion in children with special needs and relation with neurological disorders in the process of social behavoir of children

Prosthetic treatment options in single tooth edentulism

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de propedeutică stomatologică „Pavel Godoroja”, Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Preservation of soft and hard tissues after tooth loss in order to restore function and aesthetics through prosthetic treatment is one of the main goals of clinicians. The treatment of single missing tooth can be achieved by several methods. In order to make an optimal decision, it is necessary to evaluate all treatment alternatives. Purpose. Elaboration and argumentation of a management algorithm of patients with single tooth edetulism based on the comparative estimation of the treatment results with implant supported prostheses or with conventional fixed partial dentures. Material and methods. The prospective controlled clinical trial included 180 consecutive patients aged 18-60 years with single missing tooth in the upper or lower jaw, restored with fixed partial conventional dentures (90 patients) or with crowns on implant support (90 patients), which signed the written consent to participate in the study. The main reasons for the lack of teeth were complications of dental caries, periodontitis, dental trauma and orthodontic causes. Results. In this study, the survival rate of fixed partial dentures (FPD) was statistically significantly lower compared to the implant supported crown (94.4% and 100.0%, p<0.05). Total complication rates (61.1% and 43.3%; p<0.05), technical(5.6% and 0%; p <0.05) and biological complications were statistically significantly higher in patients with single missing tooth treated with FPD, and the rate of aesthetic complications (23.3% and 43.3%,p <0.01) - statistically significantly higher in patients with single missing tooth treated with implant supported prostheses. By the results of our study, we developed a management algorithm for patients with single tooth edentulism. Conclusions. Given the large number of variables that affect treatment decisions, there is no universally effective solution for treating single missing tooth. The selection of the treatment method must be made on the basis of a risk profile specific to the situation of each patient

The Clinical Characteristics, Diagnosis and Treatment of Oral Candidosis

Catedra Stomatologie terapeutică USMF „Nicolae Testemiţanu”, Firma BosnalijekIn the last few years a growth of oral candidosis frequency was observed. 38 patients with oral candidosis were examined and treated. For diagnosis, laboratory investigations were estabilished ( direct microscopic examination and seeding with Sabouraud media). The systemic antifungus medicine – Funzol (Fluconazol) from Bosnalijek Company was used, which demonstrated to be a good drug in treatment of oral candidosis. Pe parcursul ultimilor ani s-a observat o creştere a frecvenţei candidozelor orale. Au fost examinaţi complex şi trataţi 38 pacienţi cu candidoză orală.. Pentru stabilirea diagnosticului s-au efectuat cercetări de laborator ( examenul microscopic direct şi însămînţări pe mediul Sabouraud). S-a utilizat preparatul antifungic sistemic – Funzol, firma Bosnalijek (Fluconazol), care a demonstrat că este un preparat de elecţie în tratamentul candidozelor orale