Implant therapy in the esthetic zone-surgical considerations

Implant placement in the esthetic zone is a complex procedure and requires a restoration-driven approach. Proper selection of patients and implant together with individual assessment of the risk of esthetic complications are very important. Correct 3D-implant positioning and sufficient bone volume should provide long-term esthetic and function. Esthetic region is a zone in which expectations and possibilities collide. Clinician should bring the important decision on the appropriate time of implant placement. Immediate implant placement is particularly challenging in the esthetic zone. Patient desire for reduced treatment time should be weighed against the possible risk factors. Protocol of immediate implant placement in conditions of unfavourable gingival biotypes, the lack of bone or soft tissue in patients with a high smile line lead to esthetic failure which is very important in the esthetic region

Uticaj lasera male snage na zarastanje oštećenja kosti - eksperimentalno istraživanje

Introduction. The stimulating effect of low-power laser on the process of wound healing is characterized by proliferation of fibroblasts, collagen production, and enhanced enzyme activity. The aim of this study was to evaluate the possible enhancing effect of low-power laser on the rate of the healing artificially created osseous defects in rats. Material and methods. Ten albino Wister rats were involved in this experimental study. Round defects (3 mm wide 2 mm deep) were made in each rat on both femurs. The right side was experimental while the left side was control. Osseous defects on the experimental side were daily treated with Galium, Aluminium, Arsenid (GaAlAs) low-power laser (Medicolaser 637, Technoline, Belgrade, Serbia), at the energy output of 4 J/cm2, with constant power density of 50 mW, and a wave length 637 nm (visible red light) per defect during seven days. Defects on the control side healed spontaneously. The effects of laser were evaluated two and three weeks postoperatively. Results. Histological analysis showed the powerful osteoblastic activity on the bone defects of the experimental side two weeks after surgery. On the control side, a new bone formation was noticed at the periphery of the bone defects but fibroblastic tissue with no signs of new bone was presented in the central areas. Three weeks after surgery, on the experimental side, bone defects were completely filled with spongious, lamellar bone while non-treated bone defects were characterized by mature lamellar bone at the peripheral areas and immature bone at the central areas. Conclusion. The results showed that the use of low-power laser could have a significant influence on the speed of curing bone defects in rats.Uvod. Laseri male snage utiču na proces zarastanja rana, koji odlikuju proliferacija fibroblasta, brže stvaranje kolagena i pojačana aktivnost enzima. Cilj ovog rada je bio da se proceni efekat lasera male snage na zarastanje veštački izazvanih oštećenja kosti laboratorijskih pacova. Materijali i metode rada. U istraživanju je korišćeno 10 albino vister pacova. Kod svakog od njih su na obe butne kosti načinjena okrugla oštećenja (3 mm široka i 2 mm duboka), s tim da je desna bila eksperimentalna strana, a leva kontrolna. Eksperimentalne strane su svakodnevno tretirane galijum-aluminijum-arsenid (GaAIAs) mekim laserom (Medicolaser 637, Technoline, Belgrade, Serbia) sa izlaznom snagom od 50 mW, koristeći 4J/cm2 po oštećenju tokom sedam dana. Kontrolne strane su ostavljene da spontano zarastu. Efekti ozračenosti laserom su procenjivani dve i tri nedelje posle operacije. Rezultati. Dve nedelje nakon operacije histološkom analizom oštećenja kosti eksperimentalne strane uočena je snažna aktivnost osteoblasta. U istovremena kontrolnoj strani zapaženi su novoformirani koštani izdanci na periferiji oštećenja kosti, odnosno fibroblastično tkivo bez znakova stvaranja nove kosti u centralnom delu oštećenja. Tri nedelje nakon operacije eksperimentalna oštećenja kosti su potpuno bila ispunjena sunđerastom lamelarnom kosti, dok su netretirana oštećenja kosti odlikovale zrela lamelama kost na perifernim delovima i nezrela kost u centralnim delovima. Zaključak. Dobijeni nalazi pokazuju da korišćenje lasera male snage može značajno uticati na brzinu zarastanja oštećene kosti kod laboratorijskih životinja

Closure of large oroantral fistula with resorbable collagen membrane: Case report

Oroantral fistula is pathologic communication between oral cavity and maxillary sinus, usually localized between antrum and buccal vestibulum. Persisting OAF always causes chronic maxillary sinusitis. A technique for closure of a large oroantral fistula with resorbable collagen membrane is described

Retrospetkivna studija spontane regeneracije kosti posle dekompresije velikih odontogenih cističnih lezija kod dece

Background/Aim. Surgical treatment of odontogenic cysts in childhood could be accompanied by injury of important anatomical structures. Even though enucleation is considered to be preferable treatment of odontogenic cysts, the specificities of pediatric age favor more conservative surgical approach. The aim of this study was to assess the effectiveness of decompression as the uttermost treatment of odontogenic cysts in the pediatric age. Methods. This retrospective study included 22 patients, 7-16 years old, with a single jaw cystic lesion. The majority of these lesions were dentigerous cyst (14), and the rest belonged to keratocystic odontogenic tumor (KCOT) (8). All lesions were primarily treated with decompression; it was a final treatment (one-stage procedure) in 13 dentigerous cysts, and it was followed by enucleation (two-stage procedure) in one dentigerous cyst and all the KCOT. Results. A total of 13 (59.1%) dentigerous cysts were treated successfully only with decompression as one stage procedure, while the other 9 (40.9%) cysts required enucleation (1 dentigerous and 8 KCOT), after decompression (p ≤ 0.001). Conclusion. Related to non-aggressive lesions, more conservative treatment approach, such as decompression as one-stage procedure, should be considered. On the other hand, KCOTs in children require a two-stage procedure for a successful treatment outcome.Uvod/Cilj. Hirurška terapija odontogenih cista u dečjem uzrastu može da bude udružena sa povredama važnih anatomskih struktura. Mada se enukleacija smatra terapijom izbora viličnih cista, specifičnosti dečjeg uzrasta nameću primenu konzervativnijeg hirurškog pristupa. Cilj istraživanja bio je da se proceni efikasnost dekompresije kao definitivnog terapijskog modaliteta kod odontogenih cista u dečjem uzrastu. Metode. Ova retrospektivna studija obuhvatila je 22 pacijenta, uzrasta 7-16 godina, sa solitarnim cističnim lezijama. Najčešće među njima su bile folikularne ciste (14), a ostale su bile keratocistični odontogeni tumori (KCOT). Sve cistične lezije prvo su tretirane dekompresijom; to je bio i jedini poduhvat (jednofazni postupak) kod 13 folikularnih cista, a potreba za sekundarnim zahvatom - enukleacijom, ukazala se posle dekompresije jedne folikularne ciste i svih KCOT (dvofazni postupak). Rezultati. Ukupno 13 (59,1%) cističnih lezija, od kojih su sve bile folikularne ciste, uspešno je podvrgnuto jednofaznom hirurškom postupku, dok je preostalih 9 (40,9%) cista (1 folikularna i 8 KCOT) zahtevalo naknadnu enukleaciju. Zaključak. Kod neagresivnih cističnih lezija preporučuje se konzervativniji hirurški pristup kao što je dekompresija (jednofazna procedura). Nasuprot tome, KCOT u dečjem uzrastu zahtevaju dvofazni hirurški postupak - dekompresiju praćenu enukleacijom

Evaluation of photodynamic therapy efficacy vs. conventional antifungal therapy in patients with poor-fitting dentures suffering from denture stomatitis. A prospective clinical study

Background: The long-term use of antifungal therapy in denture stomatitis (DS) treatment could be accompanied by antifungal-resistant strain onset, leading to compromised therapeutic procedure and disease reappearance. Photodynamic therapy (PDT) has shown the ability to eradicate oral infections and resistance strains. This prospective clinical study aimed to assess the PDT’s effectiveness compared to the conventional treatment on clinical and microbiological parameters in patients with DS without denture wear during the treatment and follow-ups. Methods: Forty-two patients diagnosed with DS were randomly assigned to one-session single PDT application (test group) or conventional antifungal therapy (control group). Clinical and microbiological parameters were assessed and analyzed before and at 3rd, 15th, and 30th day following the treatments. Microbiological samples were analyzed by a Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The data was statistically analyzed. Results: Prior to the treatment, Candida species, including C. albicans (100%), C. glabrata (33%), C. tropicalis (31%), C. krusei (31%) were isolated in all patients. Both treatment procedures demonstrated a statistically significant reduction in C. albicans at all follow-up time intervals (p < 0.05). However, PDT displayed a statistically significant reduction in C. krusei compared to the conventional treatment at all follow-up periods (p < 0.05). Clinical parameters improved considerably in the test group compared to the control group at the 3rd and 15th day of follow-up. Conclusion: One-session single PDT application demonstrated significant improvement in both clinical and microbiological outcomes in a short-term period, resulting in complete Candida spp. eradication compared to conventional antifungal therapy

Analiza distribucije opterećenja kod mešovito nošenih mostova primenom rezilijentnih abatmenata

Introduction Differences between the tooth and implant response to load can lead to many biological and technical implications in the conditions of occlusal forces. Objective The objective of this study was to analyze load distribution in tooth/implant-supported fixed partial dentures with the use of resilient TSA (Titan Shock Absorber, BoneCare GmbH, Augsburg, Germany) abutment and conventional non-resilient abutment using finite element method. Methods This study presents two basic 3D models. For one model a standard non-resilient abutment is used, and on the implant of the second model a resilient TSA abutment is applied. The virtual model contains drawn contours of tooth, mucous membranes, implant, cortical bones and spongiosa, abutment and suprastructure. The experiment used 500 N of vertical force, applied in three different cases of axial load. Calculations of von Mises equivalent stresses of the tooth root and periodontium, implants and peri-implant tissue were made. Results For the model to which a non-resilient abutment is applied, maximum stress values in all three cases are observed in the cortical part of the bone (maximum stress value of 49.7 MPa). Measurements of stress and deformation in the bone tissue in the model with application of the resilient TSA abutment demonstrated similar distribution; however, these values are many times lower than in the model with non-resilient TSA abutment (maximum stress value of 28.9 MPa). Conclusion Application of the resilient TSA abutment results in more equal distribution of stress and deformations in the bone tissue under vertical forces. These values are many times lower than in the model with the non-resilient abutment.Uvod Razlike u odgovoru zuba i implantata na opterećenje mogu imati za posledicu niz bioloških i tehničkih komplikacija u uslovima delovanja okluzalnih sila. Cilj rada Cilj ovog rada je da se analizira distribucija opterećenja kod mešovito nošenih mostova sa primenom rezilijentnog TSA abatmenta (Titan Shock Absorber, BoneCare GmbH Germany), kao i konvencionalnog nerezilijentnog abatmenta primenom metode konačnih elemenata (MKE). Metode rada U ovom radu napravljena su dva osnovna 3D modela. Na jednom implantatu i modelu korišćen je standardni nerezilijentni abatment, a na implantatu drugog modela korišćen je rezilijentni TSA abatment. Na virtuelnom modelu su modelirane konture zuba, PDL-a, sluzokože, implantata, kortikalne i spongiozne kosti, abatmenta i suprastrukture. U eksperimentu je korišćena vertikalna sila od 500 N, koja je primenjena u tri različita slučaja aksijalnog opterećenja. Metodom konačnih elemenata izračunavani su potom Fon Mizesovi ekvivalentni naponi u korenu zuba i parodoncijumu, implantatu i periimplantatnom tkivu. Rezultati Na modelu kod koga je primenjen nerezilijentni abatment, maksimalne vrednosti napona i deformacije u sva tri slučaja su registrovane u kortikalnom delu kosti oko zuba i implantata u zavisnosti od napadne tačke sile (maksimalan napon 49,7 MPa). Vrednosti napona i deformacija na modelu sa primenom rezilijentnog TSA abatmenta pokazale su sličnu raspodelu u kosti, međutim ove vrednosti su višestruko manje nego kod modela sa nerezilijentnim abatmentom (maksimalan napon 28,9 MPa). Zaključak Primena rezilijentnog TSA abatmenta dovodi do ravnomernije raspodele napona i deformacije u koštanom tkivu oko zuba i implantata pod dejstvom vertikalnih sila. Izmerene vrednosti su višestruko manje nego na modelu sa nerezilijentnim abatmentom

Uticaj postoperativne terapije laserom male snage na oseointegraciju samourezujućih implantata u bočnoj regiji gornje vilice - šestonedeljna split-mouth klinička studija

Background/Aim. Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-tapping implants (n = 44) were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group), while the other side was placebo (control group). For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs) laser (Medicolaser 637, Technoline, Belgrade, Serbia) with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm² per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP) activity and early implant success rate. The follow-up took 6 weeks. Results. Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030). The difference in ALP activ- ity between the groups was insignificant in any observation point (paired t-test, p > 0.05). The early implant success rate was 100%, regardless of LLLT usage. Conclusion. LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of self- tapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.Uvod/Cilj. Terapija laserom male snage (TLMS) stimuliše reparatorne sposobnosti kosti utičući na ćelijsku proliferaciju, diferencijaciju i adheziju, i ima potencijal da skrati vreme zarastanja kosti nakon ugradnje implantata. Cilj ove kliničke studije bio je da se ispita uticaj postoperativne primene TLMS na oseointegraciju i rani uspeh ugradnje samourezujućih implantata u kost male gustine. Metode. Prateći split- mouth dizajn, samourezujući implantati (n = 44) ugrađeni su u posteriorne regije gornje vilice 12 pacijenata. Slučajnim izborom, jednoj od strana vilice je dodeljena TLMS (test grupa), dok je druga strana bila placebo (kontrolna grupa). Za TLMS korišćen je galijum-aluminijum-arsenid (GaAlAs) laser (Medicolaser 637, Technoline, Beograd, Srbija) talasne dužine 637 nm, snage 40 mW, neprekidnog režima rada. Tretman laserom male snage sprovodio se neposredno po ugradnji, a zatim svakodnevno, tokom narednih sedam dana. Ukupna zračna doza po tretmanu bila je 6,26 J/cm² po implantatu. Praćeni su stabilnost implantata, aktivnost alkalne fosfataze (ALP) i procenat rane uspešnosti implantatne terapije. Period praćenja bio je šest nedelja. Rezultati. Zračeni implantati imali su veću stabilnost u odnosu na kontrolne tokom celog perioda praćenja, a statistički značajno veća stabilnost bila je u petoj postoperativnoj nedelji (t-test za vezane uzorke, p = 0.030). Razlika u aktivnosti ALP između grupa nije bila statistički značajna ni u jednoj tački posmatranja (t-test za vezane uzorke, p > 0.05). Procenat rane uspešnosti terapije implantatima bio je 100%, bez obzira na primenjenu TLMS. Zaključak. Svakodnevna primena TLMS u prvoj postoperativnoj nedelji nije pokazala značajan uticaj na oseointegraciju samourezujućih implantata u kost male gustine bočne regije gornje vilice. Primena implantata samourezujućeg makrodizajna u kosti male gustine mogla bi predstavljati predvidljivu terapijsku proceduru sa visokim procentom rane uspešnosti, bez obzira na primenjenu TLMS

C-reaktivni protein kao inflamatorni marker u proceni efikasnosti lečenja akutnih dentogenih infekcija

Introduction. Clinical presentation of acute odontogenic infections may vary, while adequate evaluation of its severity is of great importance for determination of appropriate and effective therapy. Objective. The aim of the present study was to monitor changes of C-reactive protein (CRP) levels, to correlate its values with symptoms of different acute odontogenic infections (AOI), and to monitor the effectiveness of the applied therapy. Methods. Fifty-four patients with AOI were included in the study. Eighteen patients with good drainage and normal body temperature were treated only by surgical incision without using antibiotics. Twenty-two patients with poor drainage after incision and normal body temperature were treated by surgical incision and antibiotics. Fourteen patients with elevated body temperature were treated by incision and antibiotics, irrespective of the quality of the drainage. CRP levels were measured on admission, on the 3rd and 7th day after therapy initiation. Results. On admission CRP levels were higher in AOI with elevated body temperature compared to poorly and well-drained AOI. There were no differences in CRP levels between well and poorly drained AOI on admission. On the 3rd day, a decline in the CRP levels was evident in all three groups of patients, and there was no difference among the groups. On the 7th day, the CRP levels normalized in all groups. Conclusion. CRP levels correlate well with the severity and resolution of AOI and could be used as a reliable parameter in monitoring the effectiveness of AOI therapy.Uvod. Klinička slika akutne dentogene infekcije (ADI) je raznolika, a pravilna procena težine ADI od velikog značaja za određivanje odgovarajuće i efikasne terapije. Cilj rada. Cilj rada je bio da se uporede vrednosti i promene nivoa C-reaktivnog proteina (CRP) s kliničkim simptomima ADI različitog stepena težine tokom lečenja bolesnika, te na taj način utvrdi efikasnost primenjene terapije. Metode rada. Istraživanjem su obuhvaćena 54 pacijenta sa ADI. Osamnaest pacijenata sa dobrom drenažom nakon incizije i normalnom telesnom temperaturom lečeno je bez antibiotika. Dvadeset dva pacijenta s lošom drenažom nakon incizije i normalnom telesnom temperaturom lečena su incizijom i antibioticima. Četrnaest pacijenata s povišenom telesnom temperaturom lečeno je incizijom i antibioticima bez obzira na kvalitet drenaže. Nivo CRP je meren na prijemu, trećeg i sedmog dana od početka primene terapije. Rezultati. Na početku lečenja nivo CRP bio je veći kod bolesnika s povišenom telesnom temperaturom u poređenju s ostalim ispitanicima. Na početku lečenja nije bilo razlike u nivou CRP između ispitanika sa dobrom i lošom drenažom. Trećeg dana uočeno je smanjenje nivoa CRP u sve tri grupe ispitanika bez ikakve razlike. Sedmog dana nivo CRP se normalizovao u svim grupama. Zaključak. Nivo CRP je u dobroj korelaciji sa stepenom težine i povlačenjem dentogene infekcije, tako da može biti pouzdan parametar u proceni efikasnosti lečenja ADI

Effect of deposition current density and annealing temperature on the microstructure and magnetic properties of nanostructured ni-fe-w-cu alloys

Ni-Fe-W-Cu alloy powders were obtained by electrodeposition from an ammonium citrate bath at current densities ranging between 70 and 600 mA cm-2. As the deposition current density increased, the contents of Fe and W in the alloy increased, and those of Ni and Cu decreased. The total cathodic polarization curve was recorded, and partial polarization curves for Ni, Fe and W deposition and hydrogen evolution were determined. The current efficiency of alloy deposition was measured. The powders contained an amorphous matrix and FCC nanocrystals of the solid solution of Fe, W and Cu in Ni. At high current densities, small-sized nanocrystals exhibiting high internal microstrain values were formed. Powder particles were dendrite-and cauliflower-shaped. The dendrites had a large number of secondary branches and higher-order branches containing interconnected globules. The density of branches was higher in particles formed at high current densities. The powders formed at high current densities exhibited higher magnetization. Annealing at temperatures up to 460 °C resulted in structural relaxation, accompanied by an increase in magnetization. At temperatures above 460 °C, amorphous matrix crystallization and FCC crystal growth took place, accompanied by a decrease in magnetization

The effect of supplementing chestnut tannins on the productive results of finishing lambs fed rations deficient in metabolizable protein

The aim of this study was to investigate the effects of chestnut tannins in metabolizable protein deficiency, on dry matter (DM) intake, growth performance of finishing lambs, feed efficiency and digestibility of nutrients. The study included 30 crossbred lambs, blocked by body weight (BW) and divided into three groups, depending on the concentrations of added chestnut tannins in the rations (0, 10 and 20 g/kg DM for CON, 10T and 20T group, respectively). Rations were determined by BW and expected average daily gain (ADG), with a deficiency in metabolizable protein of about 15%. All groups received the same amount of daily feed. Dry matter intake, ADG and indicators of efficiency such as the Kleiber ratio (KR) and protein efficiency ratio (PER) were estimated. The digestibility of the rations was determined in three collection periods. Dry matter intake did not differ among groups. Growth performances for the whole experiment were significantly better for the 20T group than CON (p < 0.05), while no differences were established for group 10T. Group 20T achieved the highest ADG and total gain (228 g/day ± 27.8; 13.7 kg ± 1.7), with the best average conversion of dry matter (4.4 kg DM/kg BW), KR (15.6), and PER (1.6). In all three collections, dry matter and crude protein digestibility was higher for CON, while the digestibility of ether extract was higher for the 20T group than CON. Based on these results, it can be concluded that a ration of chestnut tannins in the concentration of 20 g/kg DM, in conditions of protein deficiency, can have a positive effect on lamb performances. This can be partially explained by the ability of tannins to form complexes with proteins, which can change intestinal protein flow and utilization.Das Ziel dieser Studie war, die Wirkungen von Kastanien-Tanninen in Rationen mit unzureichender Versorgung mit metabolisierbarem Protein auf die Aufnahme von Trockenmasse (DM), die Wachstumsleistung von Mastlämmern, den Futteraufwand und die Verdaulichkeit von Nährstoffen zu untersuchen. Die Studie umfasste 30 Kreuzungslämmer, die durch das Körpergewicht (BW) und die Konzentrationen von zugesetzten Kastanien-Tanninen in der Nahrung (0, 10 und 20 g/kg DM für die Kontrolle, 10T- bzw. 20T-Gruppe) in drei Gruppen unterteilt wurden. Die Rationen wurden durch das Körpergewicht (BW) und die erwartete durchschnittliche tägliche Zunahme (ADG) mit einem Mangel an metabolisierbarem Protein von etwa 15% definiert. Alle Gruppen erhielten die gleichen Futtermengen. Die DM-Aufnahmen, ADG-Werte, und Verwertungsgrößen wie das Kleiber-Verhältnis (KR) und das Protein-Effizienz-Verhältnis (PER) wurden geschätzt. Die scheinbare Verdaulichkeit wurde in drei Sammelperioden ermittelt. Die DM-Aufnahme unterschied sich nicht zwischen den Gruppen. Die Wachstumsleistungen für das gesamte Experiment waren für die 20T-Gruppe signifikant besser als für die Kontrollgruppe (p < 0,05), während für die 10T-Gruppe keine Unterschiede festgestellt wurden. Gruppe 20T erreichte den höchsten ADG und Gesamtzuwachs (228 g/Tag ± 27,8; 13,7 kg ± 1,7) mit der besten durchschnittlichen Umwandlung von Trockenmasse (4,4 kg DM/kg BW) und den günstigsten Werten für KR (15,6) und PER (1,6). In allen drei Sammelperioden war die Verdaulichkeit von DM und Rohprotein bei der Kontrolle höher, während die Verdaulichkeit des Rohfetts bei der 20T-Gruppe höher war als bei der Kontrolle. Aus den Ergebnissen kann geschlossen werden, dass Kastanientannine in einer Konzentration von 20 g/kg DM Futter bei Proteinmangel einen positiven Effekt auf die Leistung von Mastlämmern haben können. Dies kann teilweise durch die Fähigkeit von Tanninen erklärt werden, Komplexe mit Proteinen zu bilden, die den Proteinfluss durch den Verdauungstrakt und seine Verwertung verändern können