Usporedba nastavnog plana na Stomatološkom fakultetu Sveučilišta u Zagrebu s odgovarajućim planovima u europskim zemljama

The staff of the Zagreb School of Dentistry firmly believes that dental medicine is a differentiated profession which have been crossed over the frames of mere dentistry long time age. The guidelines in education and practice should be based on the need of training a doctor of dental medicine to deal with the prevention, diagnosis, treatment and follow-up of the diseases of stomatognathic system and perioral regions. This statement is beyond any dispute and can be realised in future by enforcement of an independent school of dentistry within the frames of a university, with appropriate corrections of the curriculum and possibilities of introducing new subjects, according to the curricula of European Community countries and other developed countries of the globe, especially United States of America and United Kingdom.Na Stomatološkom fakultetu u Zagrebu postoji čvrsto uvjerenje svih nastavnika kako je stomatologija samostalna zdravstvena struka, koja je davno prešla okvire zubarstva te se u edukaciji treba rukovoditi pretpostavkama kako stvaramo liječnika - doktora stomatologije koji se bavi preventivom, dijagnostikom, liječenjem i praćenjem bolesti stomatognatoga sustava, oralne i perioralnih regija. Takvo stajalište može se u budućnosti osigurati samo jačanjem Stomatološkoga fakulteta kao samostalne sveučilišne ustanove u svim dijelovima njegove djelatnosti. Autori prikazuju povijesni razvoj i nastavni program Stomatološkoga fakulteta u Zagrebu, uspoređujući ga s programima fakulteta nekih europskih zemalja. Plan, program i trajanje studija stomatologije na Sveučilištu u Zagrebu vrlo su slični onima u drugim europskim zemljama. Autori vide budućnost Stomatološkoga fakulteta u sadašnjoj koncepciji i okvirima, uz odgovarajuće korekcije nastavnoga plana i programa, koje znače ravnomjerniji raspored nastave, otvaraju pitanje uvođenja nekih novih programskih sadržaja i pitanje trajanja studija, a sve u namjeri približavanja promjenama u okvirima Europske zajednice i drugim razvijenim zemljama svijeta, po sebice Sjedinjenih Američkih Država i Velike Britanije

Most Frequent Reasons of Failure in Implantoprosthetic Therapy

Želja djelomično ozubljenih pacijenata za što većom udobnošću i estetikom u protetičkoj terapiji često je u vezi s ugradnjom usadaka. Usadak zamjenjuje ili nadopunjuje prirodni zub kao nosač fiksnog ili mobilnoga protetičkog rada. Zato je implantologija protetički orijentirana disciplina stomatologije u kojoj protetičar vodi plan usadnje i snosi odgovornost za provedenu IP terapiju koju primarno ostvaruje u suradnji s kirurgom, a vrlo često i u timu s parodontologom i ortodontom. Svima je pritom cilj osigurati pacijentu što bolju estetsku i funkcijsku sanaciju te postići optimalnu funkcijsku trajnost IP terapije. Zbog toga je opravdano govoriti o implantološkoj protetici. Moguće komplikacije u vezi su s pojedinim dijelovima implantatnoga sustava, a mogu nastati kliničkim radom ili su u vezi sa samim pacijentom. Svrha je rada prikazati temeljem kliničkih slučajeva najčešće pogrješke koje su uzrokom nezadovoljavajućih estetskih razultata: od izbora vrste i veličine usatka, do smjera i dubine ugradnje, od ne uzimanja u obzir stanja susjednih zuba, parodonta, koštane podloge i postojećih protetičkih radova do loše suradnje pacijenata na održavanju optimalnih higijenskih i statičkih uvjeta.The wish of partially edentulous patients for maximum comfort and aesthetics in prosthetic therapy is frequently connected with the insertion of an implant. The implant replaces or restores the natural tooth as the abutment of a fixed or mobile prosthetic device. Thus implantology is a prosthetically oriented discipline of dental medicine where the prosthodontist supervises a plan of implantation and is responsible for carrying out IP therapy, which is primarily realised in cooperation with a surgeon, and very often also in a team with a periodontologist and orthodontist. The mutual aim is maximal aesthetic and functional treatment of the patient and optimal functional durability of the IP therapy. It is, therefore, justifiable to speak of implantological prosthetics. Possible complications are connected with certain parts of the implantation system, and can arise in clinical work or are connected with the patient himself. The aim of the study was to show, based on clinical cases, the most frequent mistakes which lead to unsatisfactory aesthetic results; from the choice of type and size of implant to the direction and depth of insertion; disregard for the condition of adjacent teeth, periodontium, bone base and existing prosthetic devices, to bad patient cooperation, with regard to the maintenance of optimal hygienic and structural conditions

Gingival Hyperplasia Caused by Medications

Gingivalna hiperplazija je povećanje gingive zbog povećanja izvanstaničnoga matriksa vezivnoga tkiva gingive. Ona može biti hereditarna, idiopatska, ali može se javiti i u graviditetu. Popratna je pojava kod leukemija, difuznoga limfoma (malt lymphoma) i u sklopu pojedinih sindroma. Važno je znati da takvu kliničku sliku mogu izazvati i različiti lijekovi. Više od 20 vrsta lijekova može izazvati te promjene, i to antiepileptici, imunosupresivi i blokatori kalcijevih kanala. Hiperplastične promjene najčešće se javljaju 2-3 mjeseca nakon početka uporabe lijeka, a ovise o dozi i duljini uzimanja lijeka. Predisponirajući čimbenik za nastanak hiperplazije je loša higijena usne šupljine. Svrha je ovoga rada upoznati oralne kirurge i doktore stomatologije s vrstama lijekova koji mogu uzrokovati hiperplaziju gingive, s ostalim njezinim uzrocima te o potrebi multidisciplinarne suradnje u liječenju. Prikaz slučaja Bolesnik u dobi od 70 godina dolazi na pregled zbog povećanja gingive u objema čeljustima upućen od doktora stomatologije primarne zaštite koji traži kirurški zahvat. Iz anamneze saznajemo da je prve promjene na labijalnoj gingivi sjekutića primijetio prije 2 godine, a da su veće promjene nastale prije 6 mjeseci. Bolesnik je dugogodišnji hipertoničar i dijabetičar, već 12 godina na anihipertenzivnoj terapiji, a posljednjih sedam godina uzima Logimax forte, kombinaciju β-blokatora i antagonista Ca. Klinički su osim hiperplazije vidljive i naslage supragingivnoga kamenca. U suradnji s internistom promijenjena je dosadašnja terapija, a bolesnik je upućen i specijalistu parodontologu. Kirurški zahvat nije potreban budući da je nakon prestanka uzimanja navedene kombinacije antihipertenzivnoga lijeka nastala potpuna regresija hiperplastičnih promjena gingive.Gingival hyperplasia is the enlargement of gingiva due to increased extracellular matrix of gingival connective tissue. If may be hereditary, idiopathic, and can occur during pregnancy. It is a secondary occurrence in leukaemia, diffuse lymphoma (malt lymphoma) and within the complex of certain syndromes. It is important to know that such a clinical status can be caused by different medications. More than 20 types of medications can induce these lesions, such as antiepileptics, immunosuppressives and blockers of calcium canals. Hyperplastic lesions occur most frequently 2-3 months after initial application of the medication, and depend on the dose and duration of taking the medication. A predisposing factor for the development of hyperplasia is poor hygiene of the oral cavity. The object of this study was to acquaint the oral surgeon and dental physician with the types of medications that can cause gingival hyperplasia, other causes and the need for multidisciplinary cooperation during treatment. Case presentation A 70-year old patient was referred to the Department by his dentist because of increased size of the gingiva in both jaws, for which surgical procedure was requested. From the case history we learnt that the initial changes on the labial gingiva of the incisor had been observed two years beforehand, and that greater changes had occurred 6 months ago. The patient had been a hypertonic for many years, was a diabetic, and had received antihypertensive therapy for 12 years. For the last seven years he had taken Logimax forte, a combination of β-blockers and antagonist Ca. Apart from hyperplasia a layer of supragingival calculus could be seen. In cooperation with the internist the therapy was changed and the patient was referred to a periodontist. Surgical operation was unnecessary due to the fact that after abandoning the above combination of antihypertensive medications complete regression of the hyperplastic gingival lesions occurred

Cooperation between the School of Dental Medicine, University of Zagreb and the Croatian Dental Chamber

Hrvatska komora dentalne medicine povijesno je usko povezana sa Stomatološkim fakultetom Sveučilišta u Zagrebu. Nakon utemeljenja samostalne države Hrvatske 1994. godine, na Fakultetu je osnovana radna skupina koja je predložila prvi statut te institucije. Stomatološki fakultet Sveučilišta u Zagrebu i Hrvatski liječnički zbor, uz suglasnost Ministarstva zdravstva, prihvatili su 14. srpnja 1994. godine Odluku o osnivanju Hrvatske stomatološke komore, danas Hrvatske komore dentalne medicine.Croatian Dental Chamber is historically strongly connected to the School of Dental Medicine, University of Zagreb. After the independence of Croatia, in 1994 a working group was formed at the School that worked on the first draft of the statute of the Chamber. On 14 July 1994, the School of Dental Medicine, University of Zagreb and the Croatian Medical Association, with the confirmation by the Ministry of Health, have reached a decision on founding the Croatian Dental Chamber

Die Entwicklung des Karcinoms in der Radikularen Zyste des Oberkiefers

Razvoj karcinoma u zubnim cistama je vrlo rijetka pojava. Dosad je u literaturi opisano oko 80 slučajeva, međutim, mnogo je manji broj onih, koji su dobro dokumentirani i u kojih je i histološki dokazan prijelaz unutarnje cistične ovojnice u planocelularni karcinom. U Klinici za kirurgiju čeljust i lica i usta, od njezinog osnutkado danas, pronađen je samo jedan slučaj maligne alteracije radikularne ciste maksile, ali je, taj slučaj histološki dokazan i, po nekim karakteristikama, se razlikuje od dosada objavljenih pa smatramo da je vrijedan prilog ovoj kazuistici.Carcinoma rarely develops in dental cysts. About 80 cases have been described so far in literature and only few of them are well documented providing also histological evidence for the development of the inner cyst shell into a planocellular carcinoma. Since the foundation of the University Department for Maxillo facial and Oral Surgery only one case of malign alteration of maxillary radicular cyst has been found and histologically proved. As in some characteristics it differs from other cases described in literature so far it represents a valuable contribution to this problem.Die Entwicklung des Karcinoms in Zahnzysten ist eine sehr seltene Erscheinung. Bisher sind in der Literatur ungefähr 80 Fälle beschrieben. Jedoch ist die Zahl der gut dokumentierten und histologisch bewiesenen Übergange des zystischen Epithels in ein planozeluläres Karcinom, viel geringer. An unserer Klinik für Maxillo-Faziale Chirurgje wurde seit ihrem Bestehen (1938) bloss ein Fall von maligner Alteration einer radikulären Zyste des Oberkiefers registriert. Nach Angaben aus der Literatur kommt diese Art von Karcinomen öfter bei Männern, im durchschnittlichem Alter von 57 Jahren, und zwar im Unterkiefer, vor. In unserem Fall handelt es sich um eine jüngere Frau bei welcher sich der Tumor in einer Oberkieferzyste entwickelt hat. Da der Über-gang des normalen mehrschichtigen Plattenepithels der inneren Zystenmembran in ein Karcinom histologisch erhärtet werden konnte, kann man diesen Fall als einen wertvollen Beitrag zu dieser Kasuistik betrachten

Cooperation between the School of Dental Medicine, University of Zagreb and the Croatian Dental Chamber

Hrvatska komora dentalne medicine povijesno je usko povezana sa Stomatološkim fakultetom Sveučilišta u Zagrebu. Nakon utemeljenja samostalne države Hrvatske 1994. godine, na Fakultetu je osnovana radna skupina koja je predložila prvi statut te institucije. Stomatološki fakultet Sveučilišta u Zagrebu i Hrvatski liječnički zbor, uz suglasnost Ministarstva zdravstva, prihvatili su 14. srpnja 1994. godine Odluku o osnivanju Hrvatske stomatološke komore, danas Hrvatske komore dentalne medicine.Croatian Dental Chamber is historically strongly connected to the School of Dental Medicine, University of Zagreb. After the independence of Croatia, in 1994 a working group was formed at the School that worked on the first draft of the statute of the Chamber. On 14 July 1994, the School of Dental Medicine, University of Zagreb and the Croatian Medical Association, with the confirmation by the Ministry of Health, have reached a decision on founding the Croatian Dental Chamber

Guided Bone Regeneration in Dental Implant Treatment - a Case Report

Gubitak prednjih zuba posljedica je patoloških procesa, retenecije zuba (najčešće gornjeg očnjaka), posljedica traume (avulzija ili fraktura korijena) ili nedostatka zubnoga zametka (najčešće gornjega drugog sjekutića). Takvi slučajevi mogu se riješavati ortodontski (zatvaranjem nastaloga prostora), protetski (različitim mostnim konstrukcijama) ili implantoprotetskom rehabilitacijom. Nedostatak ortodontske terapije dugotrajna je rehabilitacija i česti estetski nedostatci.Kod mostne konstrukcije moraju se odstraniti tvrda zubna tkiva susjednih zuba, a dijasteme su kontraindikacija za njihovu primjenu. Usadci omogućuju izradbu samostalnih žvačnih jedinica, ali je preduvjet dovoljno kosti za primarnu stabilizaciju i dugotrajnost usadka. Kada postoji manjak kosti, koristimo se vođenom koštanom regeneracijom (VKR). VKR dokazana je metoda koštane regeneracije, a uporaba kolagenih membrana znatno povećava učinkovitost opisanoga postupka. Dvadesetsedmogodišnjoj pacijentici operacijom je izvađen prvi gornji sjekutić zbog upalnoga procesa i resorptivnih promjena na kosti kao posljedice uzdužne frakture korijena. Neposredno nakon ekstrakcije kohleacijom je odstranjeno granulacijsko tkivo, koštani defekt ispunjen je Bio-Oss spongioznim granulama, a operacijsko polje pokriveno je Bio-Gide resorptivnom membranom. Godinu dana nakon operacije nastala je koštana regeneracija i ugrađen je ITI Straumannov implantat duljine 12 mm i promjera 3,3 mm. Zbog djelomične bukalne dehiscencije upotrijebljen je Fiziograft. Nakon 6 mjeseci izrađen je fiksnoprotetski nadomjestak.Loss of anterior teeth can be caused by pathological processes, tooth retention (mostly upper canine), result of trauma (avulsion or root fracture) or missing tooth germ. Such defects can be solved by orthodontic treatment (orthodontic space closure), prosthetic treatment (different bridge constructions) or with surgery treatment (dental implants). Inadequancy of orthodontic therapy is long lasting rehabilitation ond mostly esthetical imperfection. At the bridge constructions, hard tissues of adjacent teeth must be removed. Another contraindication is the presence of diastemas. Dental implants enable making selfsupporting mastication units, but require sufficient bone to adequately stabilise. When there are changes in alveolar bone height and width, we use guided bone regeneration (GBR). GBR has proved to be a suitable technique for promoting bone regeneration. GBR treatment with collagen membranes may significantly enhance bone regeneration. The left first incisor of a 27 years old patient was extracted because of resorptive processes on alveolar bone as a result of longitudinal fracture of the root. Immediately after extraction, the bone defect was filled with Bio-Oss spongiosa granules and covered with Bio-Gide resorbable bilayer mambrane. After one year the defect was restored to nearly original condition and ITI Straumann implant was placed. Because of labial dehiscence Fisiograft was used. The definitive restoration was placed after 6 months

Surgical Treatment of Odontogenic Keratocysts by Intraoral Postoperative Suction

Prikazana su dva slučaja odontogenih keratocista od kojih se jedna pojavila na suprotnoj strani čeljusti nakon operacije folikularne ciste druge strane čeljusti, a druga je recidivirala u razmjerno kratku vremenu. Ni u jednome slučaju nije dokazana mogućnost postojanja Gorlin-Goltzova sindroma. Obje su odontogene keratociste kirurški liječene enukleacijom cistične čahure i poslijeoperacijskom intraoralnom sukcijom s time da je u drugome slučaju isti postupak ponovljen i prigodom pojave recidiva. Činjenica da trajna intraoralna poslijeoperacijska sukcija osigurava cijeljenje koštanoga tkiva donje čeljusti u razmjerno kratku vremenu, pri liječenju odontogene keratociste nije utjecala na mogućnost razvoja recidiva. Autori zato zaključuju da pri liječenju odontogenih keratocista nije važno koji ćemo kirurški postupak provesti, ako se služimo konzervativnim kirurškim postupkom. Metodu masupijalizacije u tim slučajevima treba potpuno napustiti. Druge konzervativne kirurške metode nose rizik recidiva i ako se recidivi više puta ponavljaju moguće je da keratocista prodre u meka tkiva gdje ju je teže kirurški pratiti. Autori smatraju da je raščlambom odgovarajućeg kliničkog uzorka potrebno procijeniti koliko se često javljaju ozbiljni recidivi odontogenih keratocista sa širenjem u meka tkiva ili druge perioralne strukture. O tim podatcima ovisi treba li pri liječenju recidiva odontogenih keratocista zauzeti stajališta kakva postoje pri liječenju svih lokalno invazivnih odontogenih tvorbi.Two cases of odontogenic keratocysts are presented of which the first occurred on the opposite side of the jaw after an operation for a follicular cyst, and the other recurred within a relatively short period. In neither case was the existence of Gorlin-Goltzov syndrome possible. Both odontogenic keratocysts were surgically treated by enucleation of the cystic capsule and postoperative intraoral suction. In the second case the procedure was repeated due to a recurrence. The fact that permanent intraoral postoperative suction ensures the healing of mandibular bone tissue in a relatively short time, it had no influence on the possibility of the development of a recurrence during the treatment of an odontogenic keratocyst. The authors therefore conclude that during the treatment of odontogenic keratocysts the surgical method used is not important if the surgical method used is conservative. In such cases the marsupialisation method should be completely abandoned. Other conservative surgical methods include the risk of recurrence, and should the recurrence occur repeatedly there is a possibility of the keratocyst penetrating into the soft tissue where it is more difficult to treat surgically. The authors consider that by analysing the relevant clinical sample it is necessary to calculate how often severe recurrences of odontogenic keratocysts occur with expansion into the soft tissue or other perioral structures. Thus these data could be used during the treatment of recurrences of odontogenic keratocysts, in view of the perspectives which exist in the treatment of all locally invasive odontogenic formations

Calcifying Odontogenic Cyst – Gorlin’s Cyst – Report of Two Cases

The authors present two cases of calcifying odontogenic cysts, which were confirmed by histological examination. In the first case the radiographic findings and clinical status did not indicate the presence of a calcifying odontogenic cyst. In the second case, differential diagnosis included COC. The histopathological findings showed that what appeared to be simple cases of bone translucencies was in fact an unusual odontogenic lesion. The two cases point out the possibility of incorrect assessment of deceptively banal cases in daily specialist practice