Therapeutic efficacy of connective tissue autotransplants with periosteum and platelet rich plasma in the management of gingival recession

Background/Aim. Gingival recession progression in clinical practaice has influenced the development of various surgical procedures and techniques for solving esthetic imperfections and subjective difficulties coused by gingival recession. The aim of this study was to verify efficacy of surgical procedures and to compare both of surgical procedures through the keratinized tissue width. Methods. The study included 20 teeth with gingival recesion, Müller class I and II. Ten teeth with gingival recession were treated with connective tissue autotransplants with periosteum in combination with coronary guided surgical flap (CTG group). On the contralateral side 10 teeth with gingival recession were treated with the same surgical procedures but in combination with platelet-rich plasma (CTGPRP group). We measured the keratinized tissue width. For statistical significance we used the Student's t-test. Results. The study reveled a statistical significance in reducing vertical deepress of recession by both used treatments. Root deepness in CTG and CTG-PRP group was 90% and 93.5%, respectively. With both surgical techniques we achieved larger zone of keratinized gingiva but with a wide zone of keratinized tissue in CTG - the PRP group. Conclusion. The concept regeneration technique with PRP and with the stimulating influence of platele activated growth factors results in the regeneration of deep periodontal tissue as an important prerequisite for the successful treatment of gingival recession

Clinical effects of fixed functional Herbst appliance in the treatment of class II/1 malocclusion

Introduction. Sagittal mandible deficiency is the most common cause of skeletal Class II malocclusion. Treatment objective is to stimulate sagittal mandible growth. Fixed functional Herbst appliance use is beneficial for shortening the time required for treatment and does not depend on patient compliance. Case outline. A 13-year-old girl was referred to the Clinic of Orthodontics, School of Dentistry in Belgrade following previous unsuccessful treatment of her skeletal Class II malocclusion using an activator. The patient's poor cooperation had led to failure of the treatment. Patient was subjected to the Herbst treatment for 6 months followed by fixed appliance for another 8 months. Lateral cephalograms before and after the treatment was performed. The remodelation of condylar and fossal articulation was assessed by superimposition of pre- and post-treatment temporomandibular joint tomograms. The promotion of oral hygiene and fluoride use was performed because orthodontic treatment carries a high caries risk and risk for periodontal disease. Skeletal and dental changes were observed after treatment (correction [Max+Mand]: molar relation 7 mm, overjet 8 mm, skeletal relation 5 mm, molars 2 mm, incisors 3 mm). Combination of Herbst and fixed appliances was effective in the treatment of dental and skeletal irregularities for a short period of time. Conclusion . In the retention period, 14 months after treatment, occlusal stability exists. Follow-up care in oral prevention is based on regular recalls at the dental office and supervision at home by the parents

Size of the lower third molar space in relation to age in Serbian population

Background/Aim. It is considered that the shortage of space is the major cause of the third molar impaction. The aim of this study was to establish the frequency of insufficient lower third molar eruption space in Serbian population, to question the differences in this frequency in the subjects of different age, to determine the influence of the lower third molar space (retromolar space) size on third molar eruption, and to investigate a possible correlation between the size of gonial angle and the space/third molar width ratio. Methods. Digital orthopantomograms were taken from 93 patients divided into two groups: early adult (16-18 years of age) and adult (18-26) patients. Retromolar space, mesiodistal third molar crown width, gonial angle and eruption levels were measured. Results. The space/third molar width in early adult subjects was smaller (p < 0.0001) and insufficient space was significantly more frequent (p = 0.0003) than in adult patients. Considerably more third molars erupted in case of enough space in both age groups (p < 0.0001). There was no difference between the means of gonial angle size in relations to the available space. Conclusions. The retromolar space/third molar width ratio is more favorable in adult subjects. Gonial angle is not in correlation with the retromolar space/third molar width ratio. [Projekat Ministarstva nauke Republike Srbije, br. 45005

Abnormalities in enamel structure and their association with systemic diseases and syndromes

Etiology of abnormalities in tooth structure has been subject of numerous studies but still has not been fully understood. Heredity is an established etiological factor for many types of structural anomalies of the teeth. Factors that cause changes in enamel structure may be genetic, immunologic and teratogenic or systemic diseases. Genetic changes may include individual genes, micro deletions or chromosomal defects. Systemic diseases can be associated with anomalies of tooth structure and diversity of clinical picture requires a multidisciplinary approach to the therapy. Amelogenesis imperfecta (AI) represents a large group of structural abnormalities of the teeth. AI can exist independently or as a part of large number of syndromes and systemic diseases. Knowledge of clinical presentation, etiology, pathogenesis of structural anomalies of the teeth and their association with certain systemic diseases is of great importance to everyday dental practice in terms of prevention, prognosis and therapy. Also, it is necessary to expand basic knowledge of pediatricians in regards to the clinical picture of anomalies in tooth structure and their possible association with a wide range of systemic diseases and syndromes, in order to provide comprehensive clinical treatment. Therefore, the aim of this study was to present etiopathogenesis and classification and to describe the most important abnormalities of enamel structure and their association with systemic diseases and syndromes

Porcelain veneers - preparation design: A retrospective review

This paper discusses the preparation of tooth design for porcelain veneers. It follows the literature more than three decades back in the past. From the very beginning, porcelain veneers were placed to no/minimally prepared tooth substance, showing different problems in clinical use. Later, the technique of etching the porcelain and controlling the reduction of tooth structure, presented the great steps forward in porcelain veneers accepting. A special accent concerning the preparative design was placed on variations of incisal edge preparation - the problem, which is still present in current practice. Additionally, the paper emphasizes the extremely demanding protocols in making the porcelain veneers as well as their expanded clinical indications

Fracture toughness of zirconia ceramic crowns made by feather-edge tooth preparation design

Background/Aim. Fracture toughness determines functional crown strenght and prevents damages on ceramics during mastication. There is a lack of relevant literature data about fracture toughness of crowns made by feather-edge preparation. Mechanical testing of ceramic samples is supposed to show if feather-edge tooth preparation is a successful method for making ceramic crowns without any risk of reduction of their mechanical properties. This research was done to establish effects of feather-edge tooth preparation on fracture toughness of single zirconia ceramic crowns. Methods. The research was performed as an experimental study. Sixty (60) ceramic crowns were made on non-carious extracted human premolars. Thirty (30) crowns were made on the basis of feather-edge preparation (experimental group I). The group II included 30 crowns made on 1 mm rounded shoulder. Crowns fabrication was executed on a copy mill production system “Zirkonzahn” (Zirkonzahn GMBH, Gais, Germany). The spherical compression test was used to determine fracture toughness, using 6 mm diameter ceramic ball. Fracture load for damaging ceramic crown was recorded on a universal testing machine - Zwick, type 1464, with the speed of 0.05 mm/min. Results. The results of this research introduced significant differences between fracture toughness of ceramic samples in every examined group. However, fracture toughness of crowns from both group was above 2 000 N, what was double beyond a recommended value. The mean value of fracture toughness in the feather-edge group was 2 090 N, and in shoulder group it was 2 214 N. Conclusion. This research showed a high fracture toughness of zirconia crowns made on feather-edge preparation. The examined crowns showed a fracture resistance at a sufficient distance in relation to the minimum values of functional loads. Further research of functional loads of these crown is necessary, as well as research of marginal adaptation of cemented crowns and gingival inflammatory response

Dental status of institutionalized persons with special needs who live in Special institution “Srce u jabuci” in Pancevo

Introduction. Dental status of most people with special needs is not satisfactory. Many of them are edentulous or toothless, with acute extensive caries lesions present, high DMFT index and severe periodontal disease. The objective of this study was to examine the dental status of mentally impaired persons who live in the special institution “Srce u jabuci” in Pancevo. Material and Methods. Clinical examination was performed on 114 institutionalized patients (68 male and 46 female), age 22 to 71 years. Patients were divided in two groups; the first group consisted of 71 persons who had a moderate mental disorder (F71), while the second group included 43 respondents with severe mental retardation (F72). Oral examination revealed: the number of present teeth, caries lesions, the presence of restorations, the number of extracted teeth, the presence of residual roots, fractures and the presence and number of fixed restorations. Results. The mean DMFT of total examined teeth was 20.33±7.63. The greatest percentage found for extracted teeth (63.76%): in the first group 63.23%, and in the second 64.06%. The percentage of teeth that had caries lesions of all examined teeth was 33.48%, while the lowest percentage was for restored teeth (2.76%). In majority of examined people, initial caries, deep caries, or tooth with the exposed pulp (K1 - 51.74% K2 - 40.35%, K3 - 51.75%) were not found. A high percentage of examined people had more than 10 extracted teeth (52.63%). Most of them did not have any restoration in the mouth (81%) and only three persons had fixed denture. Conclusion. Dental status of institutionalized mentally impaired persons showed high prevalence of extracted teeth, significant presence of carious lesions and small percentage of restored teeth with inadequate oral hygiene

Effects of the platelet rich plasma on apexogenesis in young monkeys: Radiological and hystologycal evaluation

Platelet-reach plasma (PRP) is an attractive tool in regenerative medicine due to its ability to stimulate proliferation and differentiation of stem cells. Since dental pulp derived stem cells are recognized as central in apexogenesis, the aim of the study was to evaluate radiologically and histologically effects of PRP on apexogenesis in teeth with immature roots. The study included eight monkeys (Cercopithecus Aethiops) divided in two equal groups for evaluation 3 and 12 months after treatment. All participants obtained the same treatment including pulpotomy and after-treatment with: hydroxiapatite (HA)-incisor and HA+canine PRP. Radiological evaluation was performed using the long cone paralleling technique for recording of defined parameters and histological evaluation was performed using tissue removed en block for the observation of parameters related to apexogenesis. The results obtained radiologically and histologically have shown increase in bridge formation in HA+PRP (75%) group after 3 months comparing to HA group (50%). Contrary to that, after 12 months there were no significant differences between groups. The root delay was not registered in the HA+PRP group contrary to HA group where it was registered in 25% after 12 months. Results of the study suggest that PRP is a powerful tool for intensive and rapid apexogenesis since it offers clear and comprehensive results (mostly in the first three months) which are early radiologically visible without any failure in the proposed requests

Bleeding gastroduodenal ulcers in patients without Helicobacter pylori infection and without exposure to non-steroidal anti-inflammatory drugs

Background/Aim. A high risk of bleeding in Helicobacter pylori (H.pylori)-negative, non-steroidal anti-inflammatory drugs (NSAID)-negative ulcers highlights the clinical importance of analysis of the changing trends of peptic ulcer disease. The aim of the study was to investigate the risk factors for ulcer bleeding in patients with non-H. pylori infection, and with no NSAIDs use. Methods. A prospective study included patients with endoscopically diagnosed ulcer disease. The patients were without H. pylori infection (verified by pathohistology and serology) and without exposure to NSAIDs and proton pump inhibitors (PPI) within 4 weeks before endoscopy. After endoscopy the patients were divided into 2 groups: the study group of 48 patients with bleeding ulcer and the control group of 47 patients with ulcer, but with no bleeding. Prior to endoscopy they had completed a questionnaire about demographics, risk factors and habits. The platelet function, von Willebrand factor (vWF) and blood groups were determined. Histopathological analysis of biopsy samples were performed with a modified Sydney system. The influence of bile reflux was analyzed by Bile reflux index (BRI). Results. Age, gender, tobacco and alcohol use did not affect the bleeding rate. The risk of bleeding did not depend on concomitant diseases (p = 0.509) and exposure to stress (p = 0.944). Aspirin was used by 16/48 (33.3%) patients with bleeding ulcer, as opposed to 7/47 (14.9%) patients who did not bleed (p = 0.036). Abnormal platelet function had 12/48 (25.0%) patients who bled, as opposed to 2/47 (4.3%) patients who did not bleed (p = 0.004). Patients with BRI < 14 bled in 79.2%, and did not bleed in 57.4% of the cases (p = 0.023). There was no statistical difference between groups in regards to blood groups and range of vWF. Antrum atrophy was found in 14/48 (29.2%) patients with bleeding ulcer and in only 5/47 (10.6%) patients who had ulcer without bleeding (p = 0.024). Conclusion. Abnormal platelet function, aspirin use and antrum atrophy were the risk factors for ulcer bleeding in non-H. pylori, non- NSAIDs ulcer disease

Radiographic cephalometry assessment of the linear and angular parameters on cranial base in children with skeletal class III

Background/Aim. In malocclusion of skeletal class III, mandible is located in front of maxilla in sagital plain, which is manifested by a lower value of the sagital inter-jaw angle than in skeletal class I, where the jaw sagital relation is normal. Apart from the deformities on mandible and/or maxilla, in skeletal class III deformities are also frequent on the cranial base. The aim of this research was to find the differences in the parameter values on the cranial base among the children with skeletal class III and the children with skeletal class I in the period of mixed dentition. Methods. After clinical examination and orthopan-tomography, profile radiography of the head was analyzed in 60 examinees, aged from 6−12 years. The examinees were divided into two groups: group 1 - the children with skeletal class III; group 2 - the children with skeletal class I. Both linear and angular parameters on the cranial base were measured, as well as the angles of maxillary and mandible prognatism and the angle of sagital inter-jaw relation. The level of difference in the parameter values between the groups was estimated and the degree of correlation of the main angle of the cranial base with the angles of sagital position of the jaws in each of the two groups was established. Results. A significant difference between the groups was found only in the average values of the angles of maxillary prognatism and sagital interjaw relation. In the group 1, the main angle of the cranial base was in a significant correlation with the angles of sagital positions of the jaws, while in the group 2, such significance was not found. Conclusion. There were no significant differences in the parameter values on the cranial base between the groups. There was a significant correlation of the main angle of the cranial base with the angles of sagital position of the jaws in the group 1 only.