Highlighted Steps of the Management Algorithm in Acute Lower Gastrointestinal Bleeding -Case Reports and Literature Review

Etape importante ale algoritmului de management în hemoragiile gastrointestinale inferioare acute -raportare de cazuri aei recenzie a literaturii Hemoragiile gastrointestinale inferioare reprezintã o problemã majorã în întreaga lume, fiind o afecåiune relativ rarã cu o ratã a mortalitaåii situatã între 2 aei 4%. Reprezintã 1 -2% din totalul urgenåelor intraspitaliceaeti, 15% din ele fiind hemoragii masive aei pânã la 5% necesitând intervenåii chirurgicale. Pot fi clasificate în funcåie de localizare în hemoragii ale intestinului subåire sau ale colonului. Hemoragiile de la nivelul intestinului subåire sunt cele mai rare (5%). Atunci când terapia endoscopicã asociatã cu cea medicalã sunt insuficiente, intervenåiile endovasculare pot fi salvatoare de viaåã. Din pãcate, în unele cazuri de hemoragie digestivã inferioarã cu instabilitate hemodinamicã aei angiografie nonterapeuticã, ultima resursã rãmâne intervenåia chirurgicalã. În cele ce urmeazã exemplificãm douã cazuri de hemoragie gastrointestinalã inferioarã acutã care au fost rezolvate în modalitãåi diferite, descriem detaliat diferitele tipuri de tratament disponibile aei în final, concluzionãm, sistematizâd cele mai importante etape ale algoritmului de management în hemoragiilor digestive inferioare acute. Cuvinte cheie: hemoragii gastrointestinale inferioare acute, etape importante, algoritm de management Abstract Acute lower gastrointestinal bleeding is a major problem worldwide, being a rare and life threatening condition, with a mortality rate situated between 2 and 4%. Acute lower gastrointestinal bleeding is solvent for 1 -2% of the entire hospital emergencies, 15% presenting as massive bleeding and up to 5% requiring surgery. Lower gastrointestinal bleeding can be classified depending on their location in the small or large intestine. The small bowel is the rarest site of lower gastrointestinal bleeding, at the same time being the commonest cause of obscure bleeding. 5% of total lower GI bleeding appears in the small bowel. When endoscopic therapy associated with medical treatment are insufficient, endovascular intervention can be lifesaving. Unfortunately in some rare cases of acute lower gastrointestinal bleeding with hemo-dynamic instability and the angiography performed being unable to locate the source of bleeding, the last therapeutic resource remains surgery. In the following we exemplify two cases of acute lower gastrointestinal bleeding which were resolved in different ways, followed by a thorough description of the different types of available treatment and finally, in the conclusions, we systematize the most important stages of the management algorithm in acute lower gastrointestinal bleeding

TRANSMIGRATION OF IMPACTED MANDIBULAR CANINES – CASE REPORT

Transmigration is a rare dental anomaly, characterized by the presence of the mandibular canine impacted who crosses the midline without signs or subjective manifestations. The formation of the impacted cuspid tooth takes place is in normal parameters, but at a given time, without a specific causal factor, the direction of the impacted canine is deviated towards the median and mandibular symphysis line, horizontally. Orthodontic treatment of mandibular canine transmigration is determined by radiographic examination, which specifies the intraosseous position of the tooth, the direction of migration, and the quality of the mandibular bone. In this article is presented the case of a 10-year-old girl with mixed dentition, 33 impacted, but palpable bucally, located at the apex of the mandibular incisors, with sagittally-elongated symphysis chin, anterior reverse occlusion and inclination of the vestibule of the lower incisors. On the orthopantomogram, the horizontally impacted mandibular canine was identified, the crown exceeding the median line at the apex of the mandibular incisors. Surgical orthodontic treatment aimed at the alignment of the arches and the alignment of the included mandibular canine, obtaining the correspondence of the median and inter-incisal lines and correcting the frontal inverse occlusion

CONSIDERATIONS REGARDING THE PARTICULARITIES OF ORTHODONTIC TREATMENT IN ADULTS

Introduction. Adult patients frequently require orthodontic treatment for dental alignment that provides a beautiful, "healthy" smile that gives a pleasant facial aspect, increased self-confidence, and psycho-socio-professional integration. Most often the patients 25 to 40 years old want to have "straight" teeth because they refused the orthodontic treatment in their childhood and adolescence or had no financial possibilities for it at that moment. Adults over the 40 years age require orthodontic treatment either on their own initiative due to migrations or dental maloclussion, or at the recommendation of specialists in periodontics, prosthetics, implantology, for complex oral rehabilitation. Clinical case. The case of a 45-year-old patient, who requested the orthodontic treatment for esthetic reasons, to correct dental malpositions resulting from bone generalized horizontal atrophy with moderate reduction in periodontal attachment. Conclusions. Compared to other dental treatments where results are visible in a relatively short time, orthodontic therapy requires an average duration of 18-24 months, depending on age, home environment, severity of dento-maxillary abnormality, genetic predisposition, vicious habits, etc. It is important to establish a correct diagnosis for a proper treatment plan with reduction of risks, complications and orthodontic relapse

EVALUATION OF CLINICAL AND BIOLOGICAL PARAMETERS CONCERNING THE IMPLICATIONS OF SMOKING ON THE PERIODONTIUM

Introduction. Numerous studies have revealed the connection between various oral disease and smoking, and there is a concern to raise public awareness of the harmful effects of smoking. The mechanisms which smoking acts in periodontal disease are not fully elucidated. It has been shown that there is a qualitative change in the microorganisms involved in the production of periodontal disease in smokers. Material and method. There were 40 patients, 18 female and 22 male subjects aged 18-28 who underwent examination and treatment. The evaluation was based on a general data collection questionnaire, combined with OPG radiographs and supplemented by a rigorous clinical examination. As additional investigations, determination of the plasma level of reactive C-reactive protein (CRP) was performed. For the diagnosis of pathogens related to the occurrence and progression of periodontitis, the PET test (Periodontitis/Periimplantitis Patogen Test) was used. Results and discussions. The higher the consumption of tobacco, it was found that the periodontal disease was more severe. Consumption of up to 10 cigarettes per day determine in marginal periodontium changes, but quitting smoking makes periodontal disease more responsive to treatment than large smokers who, even if they do not, have a modified local reactivity. Conclusions. The results of the study confirm that smoking has a masking effect of inflammatory phenomena at the periodontium level by reducing the periodontal haemorrhagic response. Smoking affects the subgingival bacterial profile, being responsible for decreasing the number of beneficial bacteria and increasing parodontopathogenic bacteria

Clinical-imagistic aspects of supernumerary teeth

Supernumerary teeth represent isolated dental abnormalities by dental excess occurring when the disruptive factor acts in the stage of dental formation (induction and proliferation). It may be the result of the intervention of some hereditary, phylogenetic, local factors (disturbing factors in the dental proliferation stage), but may appear as clinical manifestations in genetic syndromes (cleido-cranial dysplasia and Gardner's syndrome). It determines aesthetic, occlusal, periodontal, clinical and functional changes, the diagnosis of certainty being given by radiological investigations. Since supernumerary teeth do not affect the quality of the alveolar bone, the prognosis is favorable, and surgical (extraction) and orthodontic treatment restores the normal aesthetic and functional aspect of the dental-maxillar apparatus

CLINICAL STUDY OF PERIODONTAL PARAMETERS DURING THE ORTHODONTIC TREATMENT

Introduction. Dento-maxillary abnormalities are an important factor affecting periodontal health, so one of the goals of orthodontic treatment is to promote better dental health and to prolong the life of the teeth. Orthodontic treatment contributes to improving oral hygiene by correcting dental irregularities and reducing (or eliminating) occlusal trauma. The placement of orthodontic appliances near the gingival sulcus, the accumulation of the plaque and the impediments they pose to the oral hygiene habits affect the periodontal health condition and complicate the orthodontic recovery process. Aim of the study. The purpose of this study was to clinically assess the evolution of the relationship between orthodontic therapy and gingival health. Material and methods. The study group comprised 31 patients with dento-maxillary abnormalities treated with orthodontic treatment. In 20 patients, was applied fixed orthodontic treatment and, at 11, functional mobile device. In these patients a periodontal clinical examination was performed at different times throughout the orthodontic therapy. Results. In this study, it was observed that plaque index values and those of gingival inflammation increased in all patients between baseline and end of treatment. These increases were statistically significant in patients treated with fixed orthodontic appliances. Also, in patients treated with functional devices have seen these parameters increase but after treatment they were not statistically significant. Conclusions. Regardless of the quality of bacterial plaque control, patients undergoing orthodontic treatment have an increased risk of developing generalized gingivitis in a very short time. In addition, the duration and type of orthodontic treatment significantly influence the development and development of this type of pathology

CONSIDERATIONS REGARDING ORTHODONTIC TREATMENT IN ADULT PATIENTS WITH EXTRACTION OF ECTOPIC CANINES

Orthodontic treatment aims to give patients a more satisfactory dental and facial appearance and to improve the functions of the dentomaxillary apparatus. Orthodontic treatment is influenced by the pattern of facial growth, the development of dentition and occlusion, and the severity of the dento-maxillary abnormality. Patients often require orthodontic treatment for dental crowding, especially in the anterior dental area. Following the clinical examination and study models, the radiological examination (orthopantomogram and cephalography) and after establishing the orthodontic diagnosis and prognosis, the orthodontist may recommend performing dental extractions to achieve dental alignment and stable occlusal relationships, with maximum intercuspidation. Depending on the clinical situation and the severity of the dento-maxillary abnormality, is recommended extraction of the premolars, the wisdom molars , the teeth affected by carious lesions, with large and irreparable coronary destruction. The indication of definitive canine extraction should be avoided in view of their coronadicular anatomy and the importance of facial aesthetics and mandibular functional movements. In this article we will present orthodontic treatment in one case of adult patient who have requested dental alignment and occlusal balancing after definitive canine extractions. The extractions were carried out in childhood by dentists, dued to the canine vestibular ectopic position, the dental crowding, without subsequent orthodontic treatment

EFFECTS OF PERIODONTAL THERAPY ON CLINICAL PARAMETERS IN PATIENTS WITH RENAL DISORDERS

Introduction. Chronic renal disease (BRC) is considered worldwide as a public health problem, mainly due to high morbidity and mortality. Chronic periodontitis (PC) is an immune-inflammatory disease caused by Gram-negative bacteria that destroy tooth support tissues and which induce local inflammation associated with an inflammatory systemic response. Recent studies have shown an association between high levels of reactive protein C PCR) and interleukin-6 (IL-6) and periodontitis, an association that decreases after periodontal treatment (periodontal therapy). Because of this association with the systemic inflammatory response, PC has recently been included as a risk factor for BRC. The purpose of the study. In this study we wanted to evaluate the clinical effect of periodontal treatment in patients with CKD and CP. Materials and methods. The patients were divided into two groups: the first group consisted of CKD patients who were conservatively treated with periodontal treatment and the second group was a control group consisting of patients without any systemic disease who presented moderate to severe CP, also undergoing conservative periodontal treatment. Results. At baseline, PC was more severe in BRC group than in the control group, as most of the sites with the periodontal pocket depth PPD ≥ 5mm periodontal (p = 0.03) and loss of attachment CAL (p = 0.003). However, the results of periodontal treatment were noticeably improved only in the group of patients with periodontal disease but without chronic conditions. Conclusions. Successful periodontal disease reduces the abnormal level of clinical parameters and that can induce an increase of systemic inflammatory response, indicating that it can be animportant intervention therapy at patients with chronic kidney disease

IS INLAY A CURRENT METHOD OF TREATMENT ?

Introduction. Incrustation is indicated in the treatment of coronary lesions as an alternative to obturations by direct techniques but also has a number of specific prosthetic indications. At present, most of the cases are based mainly on conservative odontal techniques, whereby the defect or lack of hard dental material is rehabilitated with the help of obturations made of suitable materials. Material and method. The study was conducted over a period of 24 months (between 2016 and 2018), on a batch of 10 patients 20 composites (“Nexco Paste” – Ivoclar-Vivadent) were made by the indirect method for 20 teeth (10 premolars and 10 molars respectively), of which 10 for Class I and 10 cavities for Mezio- occlusal or Disto- occlusal class II cavities. Results. For the evaluation of the results, a set of direct clinical assessment criteria, following the USPHS model (based on the modified CVAR / RYGE criteria), was used. The criteria used to evaluate the results were as follows: 1. Coronary aesthetic / physiognomic aspect; 2. Anatomical coronary form; 3. Coronary axial contour; 4. proximal interdental contact area; 5. Marginal adaptation; 6. Marginal discoloration; 7. Marginal side caries; 8. Postoperative sensitivity. The evolution of the results was followed at 1 year and 2 years respectively. Conclusions. In dentistry, as well as in biology, boundaries can generally be placed only taking into account the particularities of each case. There are clear indications for each type of direct and / or indirect restoration

PERIODONTAL SYMPTOMATOLOGY IN CRANIO-MANDIBULARY SYNDROME

The cranio-mandibulary syndromes are pathological entities in which at least one of the components of the dento-maxillary apparatus (jaws) is not structurally or functionally adapted to its own activity. These disorders include manifestations at the temporomandibular joint or neuro-muscular system and occlusal disarmony manifested in the dento-periodontal component of the dento-maxillary apparatus. Unfavorable occlusal relations causes changes to the fundamental positions of the mandible, resulting in non-physiological forces exerting a negative impact on the periodontium manifested clinically and radiologically through: dental mobility, gingival retraction, periodontal bags, widening of the desmodontal space. Aim of study: The purpose of this study was to identify periodontal signs produced by occlusal trauma and to remove potentially harmful periodontium factors by obtaining a mandibular-maxillary relationship that maintains the health of the dentomaxillary apparatus. Materials and methods: The study based on the clinical, paraclinical and dental treatment of the patients included in the study group was performed. A group of 20 persons with at least one of the following signs considered to be inherited from cranio-mandibulary disorder: dental mobility, pathogenic dental wear, root resorption, widening of the desmodontal space, Stielmann cracks, occlusal parapuncture (bruxism), hypercementhosis, false or true periodontal pockets. Results: During the study, we were able to highlight that primary or secondary occlusal trauma is a cofactor in the production of periodontal disease. In the absence of microbial plaque, occlusal trauma, does not produce gingivitis or periodontitis, and minor periodontal lesions are reversible. Conclusions: Occlusive trauma occurs when one or more teeth are harmful to excess strain, by intensity, duration, frequency, direction. Occlusal trauma is a cofactor in the production of periodontal disease; therefore, treatment should begin early by correctly identifying the causes of occlusal disharmony and removing the