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

Biological Bases of Dentin Hybridization

The aims of this study were threefold: (1) to characterize and quantify the number, diameter and surface area of exposed dentinal tubules on the cross section of the human coronal dentin; (2) to determine if any such differences in these properties arise in relation to the distance from the dentinoenamel junction; and (3) to evaluate whether such differences can influence dentin hybridization. To accomplish these aims, scanning electron microscopy comparative observation was carried out on 60 prepared human premolars, which were divided into three groups of 20 samples each. The three sample groups were cut as follows: (1) in the central fissure region, one millimeter from the enamel-dentine junction; (2) halfway between the enamel-dentine junction and the pulp; and (3) one millimeter from the roof of the pulp chamber. Using one-way analysis of variance (one-way ANOVA) and a regression linear model, the data enumerated below were obtained. First, the mean number of the tubule openings was 19600/mm2 on the first level, 32400/mm2 on the second and 42300/mm2 on the third. The mean tubule diameter on the first level was 0.67 mm, 1.52 mm on the second and 2.58 mm on the third. Finally, exposed tubules on the first level occupied 2.79% of of total dentinal surface area, 23.90% on the second, and 87.78% on the third level. Therefore, significant statistical differences (p<0.01) between all three groups of the specimens for all three properties were observed, as well as positive correlation between the dentin depth and each of these properties. This indicates that the dentin structural variety, which ultimately determines adhesion to dentine, involves a complex interaction between biological material (dentin) and the particular adhesion system applied

Influence of Different Etching Times on Dentin Surface Morphology

The aim of this study is to investigate the influence of different etching times on demineralized dentin surface morphology using scanning electron microscopy and qualitative line microanalysis of chemical structure. Two sample groups, consisting of 30 first premolar teeth in each group, were established. Teeth were cut at the half-distance between the enamel-dentin junction and the pulp. The first group of specimens was etched for 10 seconds and the second group for 30 seconds. 37% ortophosphoric acid was used. SEM (scanning electron microscopy) was utilized to observe the following parameters: number and diameter of dentinal tubules, dentinal and intertubular dentinal surface percentage, appearance of the dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules, and dissolved peritubular dentin cuff. After calculating measurements of central tendency (X,C, Mo, SD), Kolmogorov-Smirnov and Student t-test were performed to confirm the quantitative results, and the c²-test was run to produce qualitative data. In contrast to the 10-second etching time, the increased etching time of 30 seconds resulted in the following findings: (1) an increased number of dentinal tubules (p<0.05), (2) an increase in dentinal tubule diameter (p<0.05), (3) an increase in dentinal tubule surface percentage (p<0.001), (4) a decrease in intertubular dentinal surface percentage (p<0.001), (5) appearance of dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules (p< 0.001), and (6) completely dissolved peritubular dentin cuff (p<0.001). Therefore, different etching times using the same phosphoric acid concentration result in different morphological changes in demineralized dentin surface. Moreover, based on a comparison with current studies, prolonged etching time causes morphological changes to dentin surface. Such changes, have, in turn, negative effects on the dentin hybridization process

Oral Mucosa Status of Patients Undergoing Orthodontic Treatment

Svrha istraživanja bila je ispitati koliko je česta upala sluznice tijekom ortodontske terapije s obzirom na stupanj higijene i vrstu ortodontske naprave. Ispitanici i postupci: Sudjelovalo je 110 djece u dobi od 6 do 18 godina - 60 je imalo fiksne ili mobilne ortodontske naprave, a u kontrolnoj skupini bilo ih je 50 tek upućenih na ortodontsko liječenje. Primjenom verificiranih kliničkih testova svima je bio određen stupanj oralne higijene, stupanj upale gingive i intezitet upale sluznice. Rezultati: Učestalost i intezitet upale gingive bio je obrnuto proporcionalan stupnju oralne higijene (p<0,05). Lošiju oralnu higijenu imali su ispitanici u kontrolnoj skupini. Jače upalne promjene bile su uočene samo kod malobrojnih nositelja fiksnih ortodontskih naprava. Nije bila dokazana statistički znatna povezanost između upale sluznice i vrste ortodontske naprave. Zaključak: Rezultati pokazuju da nositelji ortodontskih naprava imaju bolju oralnu higijenu i rjeđe upaljenu sluznicu negoli oni u kontrolnoj skupini.Objective: The aim of this study was to examine the impact of oral hygiene and the type of orthodontic appliance on oral mucosa in orthodontic patients. Methods: The study included 110 children, aged between 6-18 years (60 subjects were wearers of fixed and removable orthodontic appliances and 50 subjects were control group who had just been referred to orthodontic treatment). A degree of oral hygiene, dental status, and periodontal status as well as the intensity of inflammation of oral mucosa was recorded in all subjects by using verified clinical tests. Results: The frequency and intensity of inflammation were reversely proportional to oral hygiene degree (p<0.05). The controls had poorer oral hygiene findings. Only a small number of fixed orthodontic appliance wearers had inflammatory changes of higher intensity (5%). A significant correlation between oral mucosa inflammation and type of orthodontic appliance was not found. Conclusion: Orthodontic appliance wearers had better oral hygiene and less frequent inflammatory changes than controls

Schwannoma with secondary erosion of mandible: case report with a review of the literature

Schwannoma (neurilemmoma) is a common, histologically distinctive, benign, usually encapsulated, peripheral nerve tumour of Schwann cell origin. We report a case of schwannoma arising from soft tissue near the mandible. A 53-year-old female presented at our department with painless swelling of lingual mucosa of the mandible. The first molar was extracted 20 months before. Panoramic radiograph showed a suspected residual cyst. It was impossible to determine prior to surgery whether this was a peripheral nerve sheath tumour. The lesion was completely removed; the tumour appears to have originated in soft tissue and caused secondary erosion of the mandible

Colorectal adenocarcinoma metastasizing to the oral mucosa of the upper jaw

Introduction. Metastases to the oral cavity are uncommon, accounting for only 1% of all oral malignant tumors. When they occur they mostly originate from primary tumors of the lungs, kidney, breast and prostate. Oral metastases from the primary colorectal carcinoma are much more infrequent. Case Outline. We present an unusual case of a 78-year-old man with a soft tissue oral metastasis originating from the primary colorectal carcinoma. The patient was referred to the Department of Otorhinolaryngology, Head and Neck Surgery with an intraoral mass on the right side of the maxilla. The diagnosis was confirmed by histopathologic examination and immunohistochemical analysis. Conclusion. Oral metastases occur rarely and often can mimic much more common benign lesions, therefore they should be considered as a possibility in a differential diagnosis