Ankylos Dental Implant System - for Which Cases are Implants Suitable?

Oseointegrirajući dentalni usadak možemo definirati kao napravu izrađenu od biokompatibilnoga materijala (titana) koja se postavlja u maksilu ili mandibulu, a uloga mu je osigurati sidrište za restorativnu stomatologiju. Usadcima se mogu riješiti različiti klinički slučajevi, od potpune ili djelomične bezubosti do nadomjestka jednoga zuba. Danas se osobita pozornost daje estetskom, fonetskom i higijenskom aspektu takve terapije, a ne samo restauracije pacijentove mastikatorne funkcije. U kojim slučajevima možemo upotrijebiti usadak ovisi o mnogim čimbenicima. Prikazati ćemo nekoliko slučajeva potpune bezubosti, djelomične bezubosti (manjka distalnih zuba jednostrano i obostrano), manjka jednoga zuba te traumatski gubitak dijela čeljusti.The target for every prosthodontic treatment - due to tooth decay or tooth loss was and is, to construct and simulate the natural dentition as close as possible. Decreasing the number of teeth means increasing difficulties to achieve such a target. It is often impossible to achieve perfect function with dentures over a long period because of permanent soft tissue and bone changes. By then, the denture does not fit any more and has lost its retention. Tooth implants can be the favourable solution in most of these cases. Ankylos implants are manufactured from biologically neutral pure Titanium and they have a rogh surface. The special design ensures excellent anchorage even immediately after implantation ( primary stability) and the protection of the jaw bone under chewing pressure. For which cases are implants suitable? This depends very much on the situation. We will show you a few examples when it is suitabel to use on implant as a solution to conventional prostheses. If a single tooth is to be replaced; if teeth are missing on the end of the arch in either the upper or lower jaw; if there are large gaps between the few remaining teeth, and if there are no more teeth remaining

Epidural Spinal Abscess after Extraction of a Tooth - a Rare but Possibly Fatal Complication

Poznate su komplikacije odontogenog apscesa, a otežano gutanje kod submandibularnog ili pterigomandibularnog apscesa ozbiljan je i pažnje vrijedan znak. Ali većini liječnika nije poznato da ukočen i bolan vrat može biti pokazatelj komplikacije odontogene infekcije. Upravo je to jedan od prvih, a ujedno i glavni simptom kod epiduralnoga spinalnog apscesa. U literaturi se navodi samo nekoliko slučajeva obrađenih pacijenata s takvim apscesom. Specifičnost epiduralnog spinalnog apscesa jest što se javlja u vrlo malo pacijenata (0,2 do 1,2 na 10000 pacijenata), naglo nekoliko dana ili tjedan nakon infekcije bilo gdje u tijelu, najčešće u imunokompromitiranih pacijenata. Glavni su simptomi: 1. bol u kralježnici unutar 24 sata, koja se pojača unutar tri dana od zahvata, 2. postupno se pojačava ukočenost, 3. slabija kontrola mjehura i crijeva, 4. brza progresija prema paralizi. Kako je najraniji znak epiduralnoga spinalnog apscesa ukočenost vrata, upravo zbog mogućeg letalnog uzroka takva apscesa ne treba olako shvatiti kada nam se javi pacijent sa znakovima akutnog tortikolisa, a nedavno mu je izvršen zahvat na zubima i usnoj šupljini. Posumnjali smo na takvu patologiju u dva pacijenta primljena u Kliniku za kirurgiju lica, čeljusti i usta KB “Dubrava”, koji su bili zadržani na liječenju i promatranju.The complications of an odontogenic abscess are well known, and difficulty swallowing in the case of a submandibular or pterygomandibular abscess is a serious and a valuable sign. However, the majority of physicians are unaware that a stiff and painful neck can indicate complications of odontogenic infection. In fact it is one of the first, and at the same time the main symptom in epidural spinal abscess. Only a few cases have been presented in the literature of patients treated with such an abscess. The specificity of an epidural spinal abscess is that it occurs in a very small number of patients (0.2 to 1.2 in 10000 patients), abruptly or a few days or a week after infection, anywhere in the body and most often in immunocompromised patients. The main symptoms are: 1. Pain in the spine within 24 hours, which increases within three days of the operation. 2. Stiffness gradually increases. 3. Reduced control of the bladder and intestines. 4. Rapid progression toward paralysis. As stiffness of the neck is the earliest sign of epidural spinal abscess it should not be treated lightly, because of the possibility of a lethal cause of such an abscess, particularly when a patient arrives with signs of acute torticolis, after a recent operation in connection with the teeth and oral cavity. We contemplated such pathology in two patients admitted to the Clinic of Maxillofacial and Oral Surgery, University Hospital Dubrava, and retained for treatment and observation

Analysis of Emergency Cases in the Clinic of Maxillofacial and Oral Surgery, Clinical Hospital “Dubrava”

Analizirali smo hitne slučajeve da bismo utvrdili razloge dolaska pacijenata, njihovu dob i spol, razdoblja češćih posjeta za pojedine bolesti, te povezanost određenih bolesti s dobnim skupinama. U istraživanje je uključeno 2.766 hitnih pacijenata pregledanih u Klinici za kirurgiju lica, čeljusti i usta KB “Dubrava” u razdoblju od 1. siječnja do 31. prosinca 1998. godine. Pratili smo sljedeće parametre: spol, dob, dan, mjesec i razlog dolaska, te potrebu za hitnom hospitalizacijom. Od 2.766 pacijenata bilo je 58,10 % mušaraca, najčešće u dobi od 16 do 30 godina. Subota i nedjelja su dani, a svibanj je mjesec s najvećim brojem hitnih slučajeva. U svibnju je zabilježen najveći broj slučajeva s traumom zubi u dobi do petnaeste godine, te fraktura kostiju. Odontogene upale najčešće su u dobi od 16-te do 30-te godine i ne pokazuju učestaliju pojavu s obzirom na mjesece u godini. Odontogene upale koje po svojoj kliničkoj slici ne odgovaraju pravim kirurškim slučajevima najčešći su razlog dolaska pacijenata. S obzirom na to, nameće se potreba za zdravstvenom edukacijom pacijenata i boljim općim stomatološkim uslugama u smislu preventivnog djelovanja.We analyzed emergency cases in order to define the reasons for patient admittance age group and gender, the periods of more frequent arrivals for certain diseases and correlation of particular diseases with age groups. The investigation included 2.766 emergency cases, examined in the Department of Oral and Maxillofacial Surgery during the period from 1 January to 31 December 1998. We took into consideration the following parameters: gender, age, day, month, the reason for admission and the need for urgent hospitalization. Of the 2.766 patients 58,10 % were men, most frequently aged from 16 to 30 years. Saturday and Sunday are the days and May the mounth with the greatest number of emergency cases. The greatest number of dental trauma occur in patients yunger than 15 years and the greatest number of bone fractures occur in May. Odontogenic inflammation is most frequent from 16 to 30 years and their occurrence cannot be ralated to any specific time of the year. Odontogenic inflammation which is not a true surgical case according to the clinical appearance is the most common reason for admittance of patients. With regard to the aforementioned, the need for improvement of medical education of patients and general dental services in terms of prevention is required

Alveotomy of the Wisdom Tooth: Indications and Contraindications in Theory and Practice

NIH (National Institute of Health) godine 1979. postiže dogovor o indikacijama te kontraindikacijama za vađenje umnjaka. U okolnostima u kojima postoji indikacija osobitu pažnju treba posvetiti općem pacijentovu zdravlju i lokalnim čimbenicima. U stroge indikacije ubrajaju se: česti perikoronitisi, apscesi, pulpna i periapikalna patologija, karijes, parodontne bolesti, cistične i tumorozne promjene te eksterna resorpcija drugoga kutnjaka kojoj je uzrok umnjak. Ostale su indikacije: autogena transplantacija na mjesto prvoga kutnjaka, frakturne linije na mjestu umnjaka, specifična medicinska stanja poput bolesti srčanih zalistaka ili radioterapija kad postoji rizik infekcije itd. Kontraindikacije vađenja umnjaka jesu: pravilna erupcija i opravdana funkcija u denticiji, duboka impakcija bez lokalnih i sustavskih smetnji, potencijalno narušavanje integriteta susjednih struktura alveotomijom, neprihvatljiv rizik za pacijentovo zdravlje te njegova dob. Svakoj pravilnoj dijagnozi prethodi anamneza, klinički ekstraoralni i intraoralni pregled te radiološka obradba, tj. ortopantomografska snimka. Pri donošenju ispravne odluke utječe vrlo mnogo čimbenika. Ako anatomske strukture dopuštaju, treba pričekati erupciju te osobitu pozornost obratiti pacijentovoj dobi. Svrha je provedenog istraživanja prikazati razloge zbog kojih se umnjaci ambulantno alveotomiraju.In 1979 the National Institute of Health reached agreement on indications and contraindications for extraction of the wisdom tooth. In situations where there are indications special attention should be paid to the general health of the patient and local factors. The following are considered strict indications. Frequent pericoronitis, abscesses, pulpal and periapical pathology, caries, periodontal diseases, cystic and tumorous lesions and external resorption of the second molar, caused by the wisdom tooth. Other indications are: autogeneic transplantation on the site of the first molar, fracture lines on the site of the wisdom tooth, specific medical situations such as cardiac valvular disease or radiotherapy, when there is a risk of infection etc. Contraindications for extraction of the wisdom tooth are: normal eruption and justified function in dentition, deep implication without local and systemic disturbance, potential disruption of the integrity of neighbouring structures by alveolectomy, unacceptable risk for the health of the patient, and the age of the patient. Correct diagnosis must be preceded by case history, clinical extraoral and intraoral examination, and radiographic treatment, i.e. orthopantomographic recording. The correct decision depends on a large number of factors, and if the anatomic structures allow, eruption should be awaited and special attention paid to the age of the patient. The aim of this investigation was to present the reasons for which alveoletomy of wisdom teeth can be performed in the dental surgery

About Etiology of Oral Cavitiy Cancer

Uz pregled literature o etiologiji karcinoma usne šupljine navode se osnovni epidemiološki podatci koji su upozorili na nekoliko etioloških čimbenika. Alkohol i duhan smatraju se najvažnijim etiološkim čimbenicima, ali ne zna se do-voljno jesu li ti čimbenici podjedanko važni u nastanku karcinoma na pojedinim lokalizacijama u usnoj šupljini. Raspravlja se o pretpostavci da je izravni doticaj sluznice s alkoholom i duhanom uzrokom što je među intraoralnim karcinomima najčešći karcinom dna usne šupljine. Raspravlja se i o prehrani, zubnome statusu, endogenim čimbenicima, virusnih infekcijama, okolinskim utjecajima i prekanceroznim stanjima i lezijama koje također mogu utjecati na nastanak karcinoma usne šupljine.A summary of literature on the etiology of oral cancer is given. Alcohol and tobacco have been accepted as independent risk factors for oral cancer. Factors such as occupation, nutrition, dental status, host factors, viral infections and premalignant lesions are related to the etiology of oral cancer. Is appears that the lower part of the oral cavity is more related to carcinogens than other sites in the oral cavity. Possible local and systemic factors and alcohol carcinogenesis responsible for these variations of susceptibility for the use of alcohol and tobacco within the oral cavity are discussed

Mucocele

U ambulanti oralne kirurgije gotovo se danomice susrećemo sa salivarnim cistama. Liječimo ih kirurškim putem - izljuštivanjem ili marsupijalizacijom. Smatrali smo vrijednim te promjene raščlaniti klinički, patohistološki i patogenetski. Postoje dva tipa salivarnih cisti: retencijske ciste (histološki žlijezda slinovnica s dilatiranim izvodnim kanalićima obloženima krupnim stanicama sa saćastom citoplazmom) i ekstravazacijske ciste (šuplja tvorba ispunjena staničnim detritusom i bakterijama, obložena cilindričnim i višeslojnim epitelom). Mukokele su obložene stijenkom granulacijskoga tkiva i sadržavaju eozinofilni hijalini materijal. Raspoređene su po cijeloj sluznici usne šupljine, ali najviše na donjoj usnici. Najčešće nastaju mehaničkim ozljedama izvodnih kanala malih žlijezda slinovnica i retencijom. Promjera su oko 1,5 cm. Izazivaju laganu cijanozu područja i plavkasto-bijelo prosijavanje koje nastaje kao posljedica sužavanja krvnih žila i tanke stijenke mukokele. Retrospektivno smo analizirali patohistološke nalaze s kliničkom dijagnozom “mukokela” u razdoblju od 1. siječnja 1995. do 31. prosinca 2000. godine. U tome razdoblju ukupno je operirano 9047 osoba. Od 1358 nalaza koji su poslani na patohistološku raščlambu (PHD) 89 je klinički dijagnosticirano kao mukokele. Od 89 navedenih lezija u samo je 72 slučaja patohistološki potvrđena dijagnoza mukokela. Razlike u spolu nisu bitno utjecale na nastanak mukokela, a prema istraživanju nalazimo da se mukokele javljaju u svim dobnim skupinama, no ipak češće u mladih ljudi u drugom i trećem desetljeću života. Mukokele su najvećim dijelom bile na donjoj usnici, 83,3% u našem istraživanju. Ostale mukokele bile su u sublingvalnom prostoru, na obraznoj sluznici i u vestibulumu usne šupljine. Prema patohistološkom opisu zaključili smo da su 23 mukokele bile retencijskoga tipa, a dvije su bile ekstravazacijske promjene.In the Out-Patient Department of Oral Surgery we daily come across salivary cysts which we treat surgically - by scaling or marsupialisation. We considered that it would be helpful to analyse these changes clinically, histopathologically and pathogenetically. There are two types of salivary cysts: retention cysts (histologically a salivary gland with dilated secretory canals lined with large cells with honeycomb cytoplasm) and extravasation cysts (a hollow mass filled with cellular detritus and bacteria, coated with cylindrical and stratified epithelia). Mucocele are coated with a lining of granulation tissue and contain eozinophyllic hyaline material. They occur throughout the whole of the mucous membrane of the oral cavity, although the majority are on the lower lip. They most frequently occur because of mechanical injury to the secretory canals of the small salivary glands and retention. They are approximately 1.5 cm in diameter. They cause slight cyanosis of the area and bluish-white surface which occurs as a result of the narrowing of the blood vessels and thin walls of the mucocele. We retrospectively analysed histopathological findings with a clinical diagnosis “mucocele” during the period 1 January 1995 to 31 December 2000. During that period a total number of 9047 people were operated. Of 1358 findings sent for histopathological analysis (PHD), 89 were clinically diagnosed as mucocele. Of these 89 lesions in only 72 cases was the diagnosis of mucocele confirmed histopathologically. Differences in gender did not essentially have an effect on the occurrence of mucocele, and according to the results of the investigation we found that although mucocele occurs in all age groups, it is more frequent in younger people during the second and third decade of life. In our investigation mucocele were largely located on the lower lip, 83.3%. Other mucocele were located in the sublingual space, on the mucous membrane of the cheek and in the vestibulum of the oral cavity. According to the histopathological description we concluded that 23 mucocele were of retention type and two extravasation lesions

Frenulectomy - When and Why?

Podatci iz literature često su dijametralno suprotni što se tiče potrebe da se izvede kirurški zahvat kod perzistentnoga frenuluma, bilo da se radilo o njegovoj izravnoj povezanosti s dijastemom medijanom ili ne. Različita su mišljenja o najpovoljnijem vremenu za zahvat ili na redoslijed intervencije kirurga, odnosno ortodonta. Većina se autora slaže u tome da je zahvat potreban, ali i da se s njim ne treba žuriti. Pojedini autori smatraju kako treba pričekati da iznikne trajni očnjak, a drugi upozoravaju i na mogućnost spontanoga zatvaranja dijasteme još i u vrijeme nicanja drugoga trajnog molara. Prema navodima u literaturi frekvencija tektolabijalnoga frenuluma djece je 7,3%, a odraslih samo l,3%, što upućuje na neopravdanost ranih kirurških tretmana. Naše istraživanje pokazuje sukladne podatke, jer je najveća zastupljenost frenulektomija (80%) u dobi do 20 godina. Od svih lokalizacija koje zahvaća hipertrofični frenulum njih 90% je u području gornje usne. Upravo ta povezanost između dobi i lokalizacije govori nam da se radilo o ortodontskoj indikaciji, zapravo o dijastemi medijani. Najveći broj dijastema zatvara se u vrijeme nicanja lateralnih sjekutića, pa ako dijastema i dalje perzistira, a popraćena je hipertrofičnim frenulumom, postoje male mogućnosti kasnijeg spontanog zatvaranja. Zato operativni zahvat izvodimo ne čekajući da niknu trajni očnjaci. Sve operativne intervencije za uklanjaje abnormalno razvijenog frenuluma svode se na inciziju, eksciziju ili transpoziciju tkiva u području frenuluma, odnosno kombinaciji svih triju postupaka. Operativne metode koje se najčešće preporučuju zbog zadovoljavajućeg postoperativnog rezultata, brzine samog zahvata i jednostavnosti tehnike jesu “V” ekscizija, te horizontalna incizija interdentalnoga tkiva i dijela papile incizive. Nakon toga kirurškoga tretmana moguće je učiniti i kortikotomiju na tome području ako je to potrebno. Svrha je ovoga istraživanja prikazati indikacije za frenulektomiju, s posebnim osvrtom na vrijeme kirurškoga zahvata.Data from the literature are often diametrically contradictory with regard to the need to carry out a surgical procedure in the case of a persistent frenulum, either when it is a case of its direct connection with the diastema median or not. Opinions vary on the most suitable time to perform the operation, or on the chronology of the intervention of the surgeon or orthodontist. The majority of authors agree that the operation is necessary but that there is no need for urgency. Some authors consider that one should wait until the eruption of the permanent molar, while others warn of the possibility of spontaneous closing of the diastema at the time of the eruption of the second permanent molar. According to reports in the literature the frequency of tectolabial frenulum in children is 7.3%, and in adults only 1.3%, which indicates that early surgical treatment is unjustified. Our investigation shows consistent data, because the greatest incidence of frenulectomia (80%) occurred up to the age of 20 years. Of all the sites affected by a hypertrophic frenulum, 90% were in the area of the upper lip. The connection between age and the localisation indicates orthodontic indication, of just the diastema median. Most diastema close during eruption of the lateral incisors, but if the diastema persists, and is accompanied by hypertrophic frenulum, the possibility of later spontaneous closing is slight. Thus the operative procedure can be carried out without waiting for the eruption of the canines. All operations for removal of abnormally developed frenulum comprise incision, excision or transposition of tissue in the region of the frenulum, i.e. a combination of all three procedures. The operative methods most frequently recommended because of the satisfactory postoperative result, speed of procedure and simple technique are “V” excision and horizontal incision of the interdental tissue and part of the papilla incisiva. After such surgical treatment it is possible to carry out corticotomy in the area if necessary. The aim of this study was to present indications for frenulectomy, with special reference to the time of the surgical procedure

Interdisciplinary Approach to Solving Edentulousness

Stomatolozi, ortodonti, oralni kirurzi i protetičari u svojemu svakodnevnom radu rješavaju probleme bezubosti. Prerani gubitak zuba neminovno uzrokuje promjene koje se jasno opažaju na licu, posebice na oblik i veličinu gornje i donje čeljusti. Međučeljusni nesklad nastao kao posljedica gubitka zuba čini velike probleme pacijentima, i estetski i funkcionalno, ali i liječniku koji nastoji rehabilitirati pacijenta. Ortodontsko liječenje uspješno rješava mnoge malokluzije. Kirurško liječenje može riješiti mnoge dentofacijalne deformitete. Protetska rehabilitacija u većini slučajeva funkcionalno i estetski zadovoljava pacijentove potrebe. Ipak, kombinacija ortodontskog i kirurškog liječenja, te protetska rehabilitacija ne osigurava samo stabilan međučeljusni odnos nego i odgovarajući pacijentov izgled. Ortodontsko liječenje mora prethoditi kirurškom, kako bi se riješila dentalna kompenzacija, te osigurati dovoljan prostor za postavljanje zubnih usadaka i u konačnici mora osigurati, kroz vrijeme retencije, stabilnost rezultata. Prikazat ćemo na nekoliko primjera uspješnost interdisciplinarnoga pristupa rješavanja bezubosti.In their everyday work dentists, orthodontists, oral surgeons and prosthodontists solve the problem of edentulousness/edentia. The premature loss of teeth inevitably leads to changes which are clearly seen on the face, particularly the shape and size of the upper and lower jaws. Intermaxillary disharmony, arising as a result of the loss of teeth, causes great problems to the patient, both aesthetic and functional, and also to the physician who attempts to rehabilitate the patient. Orthodontic treatment successfully solves numerous malocclusions. Surgical treatment can solve a large number of dentofacial deformities. Prosthetic rehabilitation in the majority of cases functionally and aesthetically satisfies the needs of the patient. However, a combination of orthodontic and surgical treatment, and prosthetic rehabilitation not only ensures stable intermaxillary relations but also the appropriate appearance of the patient. Orthodontic treatment must precede surgical treatment, in order to solve dental compensation and to ensure sufficient space for placement of dental implants and finally it must ensure, through a period of retention, stability of the result. We will show several examples of successful interdisciplinary approach to solving edentulousness

Dental Implants In Medically Compromised Patients

Terapija djelomične ili potpune bezubosti zubnim usadcima danas ima znatnu ulogu u oralnoj rehabilitaciji bolesnika, sve je češća, a za očekivati je da će u budućnosti biti u još većem porastu zajedno i u skladu s razvojem ostalih polja medicine. Unatoč tomu, svi gorljivi zagovornici ugradnje zubnih usadaka i implantološki entuzijasti ipak svoje djelovanje moraju znati kontrolirati i ispravno usmjeriti kroz prizmu poznavanja fizioloških i patofizioloških zbivanja u svakoga pacijenta, bio on potpuno zdrav ili pod utjecajem nekoga patološkog poremećaja, kako bi postignuli njegovo konačno opće i oralno zdravlje. Mnogo je medicinski kompromitiranih pacijenata koji traže implantološku terapiju u svrhu svoje oralne rehabilitacije. Smatramo da još danas nisu potpuno razjašnjene smjernice za pre i postimplantološkom terapijom takvih pacijenata i zato nepotpuno jasne stomatolozima praktičarima i oralnim kirurzima. Svrha ovoga izlaganja jest prikazati kritičku procjenu dosadašnjih stajališta i literature te dati jasne i znanstveno utemeljene smjernice za implantološku terapiju u takvih pacijenata. Bit će razjašnjene dosadašnje spoznaje utjecaja najčešćih sustavskih i lokalnih bolesti, poremećaja i stanja na terapiju zubnim usadcima, kao što su poremećaji i promjene u metabolizmu kosti (osteomalacija, osteopenija, osteoporoza, osteoradionekroza) i kod starenja bolesnika, diabetes mellitus, kserostomija, stanja nakon radioterapije u području čeljusti, ektodermalne displazije, kardiopulmonalne bolesti, pušenje, hipotireoza, autoimune bolesti (sklerodermija, Chronova bolest...), Parkinsonova bolest te hematološke bolesti (anemije, leukemije, poremećaji hemostaze...) i stanja uzrokovana raznim medikamentima (kortikosteroidima, citostaticima, fenitoinom, blokatorima kalcijevih kanala...). Specifični patofiziološki aspekti utjecaja navedenih stanja na sam proces oseointegracije i njihovih potencijalnih daljnjih mogućih utjecaja na zubne usatke bit će potanko razjašnjeni u svrhu njihove moguće i što jednostavnije primjene u svakodnevnoj praksi svakog kliničara koji se bavi zubnom implantologijom. U skladu s time izložit ćemo naše smjernice za pre i poslijeoperativnim tretmanom implantiranih medicinski kompromitiranih pacijenata.Today, therapy of partial or complete edentulousness by dental implants plays an increasingly significant role in the oral rehabilitation of patients, and is expected in the future to further increase in accordance with the development of other medical fields. However, all ardent advocates of dental implants and implantological enthusiasts, must know how to control and direct their activity through the prism of physiological and pathophysiological events in each patient, regardless of whether he/she is entirely healthy or effected by some pathological disorder, having in view his/her general and oral health. Many medically compromised patients seek implantological therapy for the purpose of their oral rehabilitation. We are of the opinion that today guidelines for pre and post implantological therapy of such patients have still not been entirely clarified, and consequently are not completely clear to dental practitioners and oral surgeons. The purpose of our presentation is to give a critical assessment of opinions and literature to date, and to give clear and scientifically founded guidelines for implantological therapy in such patients. Current knowledge will be discussed on the influence of the most frequent systemic and local diseases, impairments and conditions on therapy by dental implants. They include disorders and changes in bone metabolism (osteomalacia, osteopenia, osteoporosis, osteoradionecrosis) and ageing of the patient - diabetes mellitus, xerostomia, conditions in the area of the jaw following irradiation, ectodermal dysplasia, cardiopulmonary disease, smoking, hypothyrosis, autoimmune diseases (sclerodermia, Chron’s disease), Parkinson’s disease and haematological diseases (anaemia, leukaemia, haemostasis disorders....) and conditions caused by various medications (corticosteroids, cytostatics, phenitoin, blockers of calcium canals....). Specific pathophysiological aspects of the influence of the aforementioned conditions on the process of osseointegration and their possible effect on dental implants, will be explained in detail for the purpose of their possible and more simple application in the daily practice of every clinician engaged in dental implantology. Accordingly, we will present our guidelines for pre and post surgical treatment of implanted, medically compromised patients

Treatment of Acute Odontogenic Inflammation in National Health Care

Akutna odontogena upala najčešća je bolest zbog koje bolesnici dolaze u ambulantu oralne kirurgije. U većini slučajeva pomoć se može i treba pružiti u ambulantama primarne zdravstvene zaštite. Svrha našega istraživanja bila je utvrditi na koji način neki opći stomatolozi liječe akutne odontogene infekcije i zašto upućuju bolesnika s akutnom odontogenom oteklinom u ambulantu oralne kirurgije. Prospektivno ispunjavajući anketne listiće za 38 nasumce odabranih bolesnika, koji su zbog otekline odontogene etiologije došli u ambulantu oralne kirurgije Klinike za kirurgiju lica, čeljusti i usta KB “Dubrava”, došli smo do sljedećih podataka. Stomatolozi su uputili 79% bolesnika, liječnici opće prakse l3%, a 8% bolesnika došlo je samoinicijativno. Dvije trećine svih bolesnika uputili su žene stomatolozi prosječne dobi 38 godina, a preostale su uputili muški stomatolozi prosječne dobi 41 godinu. Žene stomatolozi najčešće ordiniraju samo antibiotike, 60% u našoj anketi, 20%, njih šalju bolesnike bez ikakve terapije ili poslije trepanacije i ordiniranja antibiotika. Muški stomatolozi u 40% slučajeva šalju bolesnike bez ikakve terapije ili samo ordiniraju antibiotike, a najmanje ih učini trepanaciju i ordinira antibiotike, 20%. Najstariji stomatolozi, prosječne dobi 43 godine, ne provode nikakvu terapiju; samo antibiotike ordiniraju stomatolozi prosječne dobi 39 godina, a trepaniraju zube i ordiniraju antibiotike najmlađi, prosječne životne dobi 34 godine. Najčešća obrazloženja zbog čega su uputili bolesnika u našu ambulantu jesu: ne smije ništa raditi jer je otečen, alergija na lijekove, ne smije se dati injekcija jer je otečen i nemam instrumente. Trećini pacijenata nije dana nikakva terapija prije nego što su ih uputili u našu ambulantu. Samo je u 18% slučajeva učinjena trepanacija i ordinirani su antibiotici. Najzastupljeniji način liječenja, u ovom istraživanju, jest samo ordiniranje antibiotika (53%). Prije upućivanja pacijenata, nije učinjena ni jedna intraoralna incizija. U 2/3 upućenih mi smo učinili intraoralnu inciziju, a samo je 13 % opravdano upućeno u našu ustanovu jer im je rađena ekstraoralna incizija, i to 3 ambulantno i 2 hospitalno. Rezultati ove ankete pokazuju neprihvatljiv odnos nekih stomatologa prema liječenju akutnih odontogenih oteklina. Zato se nameće potreba da se intenzivira dodiplomska nastava i uspostavi trajna izobrazba stomatologa primarne zdravstvene zaštite o problemu liječenja akutne odontogene upale te za podizanje kakvoće primarne stomatološke službe kako bi se smanjio nastanak odontogenih upala, njihovih komplikacija i potrebe za hospitalizacijom takvih bolesnika.Acute odontogenic inflammation is the most frequent disease because of which patients come to the Out-Patient Clinic of Oral Surgery. In the majority of cases help can, and should, be ensured in the dental surgeries of National Health clinics. The object of our investigation was to determine how and in what way, some dentists treat acute odontogenic infections and why they refer patients with acute odontogenic swelling to the Out-Patient Clinic of Oral Surgery. We arrived at the following data by prospectively completing a questionnaire for 38 patients, selected at random, who had come to the Out-Patient Clinic of Oral Surgery, Clinic for Maxillofacial and Oral Surgery, University Hospital Dubrava, because of swellings of odontogenic aetiology. Of these patients, 79% were referred by dentists, 13% general practitioners and 8% came on their own initiative. Two-thirds of the patients were referred by female dentists, mean age 38 years, while the remaining patients were referred by male dentists, mean age 41 years. Female dentists most frequently prescribe only antibiotics, 60% in our questionnaire, and 20% refer patients without any therapy at all or after trepanation and prescribed antibiotics. In the same way in 40% of cases male dentists refer patients without any therapy at all or only prescribed antibiotics, and only 20% perform trepanation and prescribe antibiotics. The oldest dentists, mean age 43 years, do not carry out any therapy at all, and antibiotics are only prescribed by those aged around 39 years, and trepanation of the tooth and antibiotics are prescribed by the youngest dentists, mean age 34 years. The most frequent explanation for referring patients to our Out-Patient Department are: “cannot do any work because of the swelling”, allergy to medications, “cannot give an injection because of the swelling” and “does not have the instruments”. One third of the patients did not receive any kind of therapy prior to being referred to our Department. Trepanation and antibiotics were performed in only 18% of cases. In this investigation the most frequent method of treatment was the application of antibiotics (53%). Not one intraoral incision was performed prior to being referred to our Department. We performed intraoral incision in two-thirds of the patients and only 13% were justifiably referred to our Department because extraoral incision had been performed, i.e. three in out-patient departments and two in hospital. The results of this questionnaire indicate the unacceptable attitude of some dentists towards treatment of acute odontogenic swellings. Thus, there is clearly a need for more intense undergraduate teaching and permanent training of the national health dentist on the problem of treating acute odontogenic inflammation, and for raising the quality of national health dental care with the object of reducing the occurrence of odontogenic inflammations and their complications, and the need for hospitalisation of such patients