Koncept imedijatne implanto-protetske rehabilitacije bezube celjusti fiksnim mostom na cetri implantata (All on 4) osmislio je Paulo Malό. Bazira se na ugradnji anguliranih distalnih implantata dužine 15 mm u premolarnoj regiji i dva implantata u interkaninom sektoru koji su imedijatno optereceni fiksnom konstrukcijom. Ovim postupkom osigurava se stabilnost fiksnog nadomjestka bez kirurskih zahvata koji prethode konvencionalnoj implanto-protetskoj terapiji bezube celjusti, kao sto su augmentacija grebena ili podizanje dna maksilarnog sinusa. Mnogi implantoloski sustavi prilagodili su ovaj koncept dizajnu svojih implantata tako da ga susrecemo skoro kod svih implantoloskih sustava. Koncept je zbog jednostavnosti primjene i niže cijene kostanja nasao siroku primjenu u modernoj implantologiji, to je i uzrok sve vece incidencije ranih i kasnih komplikacija koje iziskuju dodatno kirursko ili konzervativno lijecenje. U ovom slucaju pokazati cemo mogucnost uspjesnog lijecenja periimplantitisa anguliranog implantata u regiji 15, distalnom nosa- cu fiksnog mosta na cetiri implantata. Pacijentici staroj 69 god. bez ozbiljnijih sistemskih bolesti, pusac sa pocetnim KOPB-om i progresivnom parodontopatijom u gornjoj celjusti koja je godinama lijecena flap kiretažama, GBR i GTR tehnikama ekstrahirani su preostali zubi i napravljena GTP. Nezadovoljna mobilnim nadomjestkom želi fiksni most. Klinicki i rtg nalaz (CBCT) pokažu reducirani alveolarni grebe s opsežnom pneumatizacijom oba alveolarna recesusa maksilarnog sinusa. Godine 2011. ugrađena su cetiri implantata po sistemu 4 on ICX (angulirani u reg. 15, 25 ᴓ 3, 5/15 i ravni u reg. 13, 23 ᴓ 3, 5/10) na koje je imedijatno postavljen privremeni akrilatni most ojacan metalom. Tri mjeseca nakon ugradnje dijagnosticiran je periimplantitis na anguliranom implantatu reg. 15. Ucini se eksplantacija implantata, odstrani se svo patoloski promjenjeno tkivo te antimikrobna fotodinamska terapija alveole niskoenergetskim laserom (Laser HF, Hager Werken, GmbH). U istom posjetu ucini se augmentacija kostanog defekta ksenogenim kostanim nadomjestkom (Cerabon 05-1mm, Botis dental GmbH, Germany) i ugradnja sireg ICX implantata ᴓ 4, 5/15. Postojeci most imedijatno se fiksira na preostala tri implantata, a ugrađeni implantat prepusti cijeljenju s odgođenim opterecenjem tijekom 8 mjeseci. Nakon razdoblja cijeljenja ucini se kontrolni CBCT koji pokaže urednu oseointegraciju implantata te se privremeni most zamijeni trajnim titan-zirkon mostom. Pracenje tijekom 4 godine pokaže odlicnu oseointegraciju svih implantata, a pacijentica je jako zadovoljna postojecim rjesenjem u estetskom i funkcijskom smislu.
Background: A human periodontal ligament fibroblast cell line showed a very promising growth reaction to the mineralized dentin. The mineral and organic matrix compositions of a tooth, dentin, and cementum are almost identical to membranous bone, although, compared to bone, teeth contain more mineral. This feature may be beneficial for volume maintenance since at the remodeling stage dentin graft is resorbed slowly. As a supplement of bone graft material, dentin particulate autograft could be beneficial. Aim/Hypothesis: The aim of this pilot clinical study was to assess efficacy and predictability of dentin particulate autograft as regenerative treatment for alveolar ridge augmentation and two stage implant placement using CBCT radiographic analysis. Materials and Methods: The sample of presented study consisted of 8 patients, with insufficient width of alveolar ridge in lateral lower jaw. After surgical removal of third molar or periodontally compromised tooth, a dentin autograft was prepared according to manufacturer recommendations. Clean extracted teeth were dried and ground in a sterile chamber of the Smart Dentin GrINDIAr® unit (KometaBio Inc., Cresskill, USA). The particulate teeth were immersed in a basic alcohol cleanser to dissolve all organic remnants and bacteria and dehydrated. The particles were rinsed twice with sterile phosphate-buffered saline solution. The platelet-rich fibrin (PRF) membranes were prepared. Graft material was used for ridge augmentation and covered with PRF membranes. After 5 months of healing CBCT scan were made. During implants placement homogeneous integration of dentin particulate was found. Dental implants (BEGO Semados® SC BEGO, Germany) were inserted and restored by titanium abutment and zirconia crown. Results: Clinical re-entry, prior to dental implants placement confirmed a homogeneous integration of dentin autograft and bone-like appearance in former grafted area. Six months after implants placement CBCT scans were obtained as part of the standard procedure. The radiographic images of the target areas revealed no grafted bone resorption around the implants. All patients were followed for 6 months after loading through clinical follow-ups and control CBCT scans. No resorption of the autograft around inserted implants were found. Conclusions and Clinical Implications: Within its limitation, the present pilot clinical study revealed that autologous dentin particulate autograft may serve as an alternative autologous bone substitute to support alveolar ridge augmentation and two-stage implant placement. Keywords: dentin graft, alveolar ridge augmentation, dental implants, bone substitutes, cbct analysis
The use of lasers for treatment of oral leukoplakia has gained a lot of interest in the past years, however, data on the use of Er:YAG laser are scarce. The aim of this study was to compare the efficacy of Er:YAG laser and 1% topical isotretinoin in the treatment of 27 oral leukoplakia patients. Er:YAG laser (LightWalker AT, Fotona, Slovenia) was used in 27 patients with 27 leukoplakia lesions. Postoperative pain was assessed by use of visual analog scale (VAS), and the impact of laser treatment on the quality of life was assessed by the OHIP-14 questionnaire (Croatian version). Control group consisted of the same 27 patients previously treated with 1% topical isotretionin three times a day during the period of one year. No improvement in the size of leukoplakia lesions was observed after treatment with topical isotretinoin. There were significant differences between men and women according to leukoplakia localization, number of laser sessions and VAS (p<0.05). At follow-up after six months and one year, there was no recurrence of lesions. Er:YAG laser is a successful treatment for oral leukoplakia. Topical isotretionin treatment is unsuccessful in patients with oral leukoplakia.
The presence of a microgap along an implant-abutment connection (IAC) is considered the main disadvantage of two-piece implant systems. Its existence may lead to mechanical and biological complications. Different IAC designs have been developed to minimise microleakage through the microgap and to increase the stability of prosthodontic abutments. Furthermore, different sealing materials have appeared on the market to seal the gap at the IAC. The purpose of this study was to evaluate the antimicrobial efficacy and permeability of different materials designed to seal the microgap, and their behaviour in conical and straight types of internal IACs. One hundred dental implants with original prosthodontic abutments were divided into two groups of fifty implants according to the type of IAC. Three different sealing materials (GapSeal, Flow.sil, and Oxysafe gel) were applied in the test subgroups. The contamination of implant-abutment assemblies was performed by a joint suspension containing Candida albicans and Staphylococcus aureus. It was concluded that the IAC type had no significant influence on microleakage regarding microbial infection. No significant difference was found between the various sealing agents. Only one sealing agent (GapSeal) was found to significantly prevent microleakage. A complete hermetic seal was not achieved with any of the sealing agents tested in this study.
Lokalni anestetici su sredstva koja reverzibilno prekidaju provođenje podražaja u perifernim osjetnim živcima na mjestu primjene. Lokalna anestezija je temelj kontrole boli u klinickoj stomatologiji te se pomocu nje mogu izvesti gotovo svi zahvati u usnoj supljini (1). Topikalni lokalni anestetici koriste se u mnogim medicinskim i stomatoloskim zahvatima, uglavnom za smanjenje boli prilikom primjene infiltracijske anestezije, a mogu se koristiti i za ublažavanje bolnih lezija na sluznici te tijekom postupka biopsije
Background: Fractures and cracks have been reported during conventional debonding procedures of ceramics brackets by removing plier. The aim of this study was to develop a method to reduce debonding force and enamel fracture during debonding process of self-ligating ceramic brackets by using laser irradiation with diode laser. Study: Ninety human premolars and molars extracted for orthodontic reasons were used in this study. Polycrystalline ceramic self-ligating brackets with metal clip were bonded using adhesive and dual cured composite. The samples were thermocycle in 1800 cycles at temperature up to 55 8C during 10 s. Thermocouple for temperature measurement was placed in the hole prepared on the oral tooth side. Tensile force for debonding was measured with custom made machine. All teeth were randomly divided in the three groups: control- plier debonding and laser debonding 5 seconds, 3 W (group 1) and 4 W (group 2) energy, CW, spot size 2 mm, 2 mm distance Results: Significantly (p ¼ 0.023) lower tensile force for brackets debonding using laser irradiation (15 J and 20 J) in premolar group compared with controls was found. There was no significant difference between two premolar laser groups nor between all three molar groups. There was significantly (p < 0.001) pulp temperature increase between all three premolars group. There was significantly (p <0.001) pulp temperature increase between control molar group and molar laser debonding groups Conclusion: Diode laser is safe clinical tool and significantly reduce tensile force for orthodontic brackets debonding from premolars. During laser debonding temperature increase in pulp chamber is below threshold of 55 8C.
Ameloblastoma is a benign odontogenic tumor of epithelial origin with locally aggressive behavior. It affects a broad age range of patients and it is most commonly found in the mandible, especially posterior area. The majority of ameloblastomas are conventional (multicystic), which are more difficult to eradicate than the unicystic or peripheral types. Although most of ameloblastoma cases can be treated predictably with radical surgical treatment, the management of recurrent and metastasizing ameloblastomas remains a major challenge. Surgical treatment is standard, but the extent of resection is controversial. Radical resection with segmental and marginal mandibulectomy or curettage and enucleation with better quality of life, but with higher recurrence rate. Besides the conventional surgical treatment, novel therapy options like neoadjuvant molecular targeted therapy and decompression in young patients could make a significant improvement in the management of the disease. The aim of this chapter was to determine the present and future concepts of treatment and discuss significant factors responsible for recurrence.
Background: Socket shield technique was introduced by Hurzeler and associates in year 2010., which is used at immediate implantation in order to preserve buccal wall bone. During tooth extraction, buccal root with periodontal ligament should be left in alveola and implant is inserted little bit towards palatal wall bone, in direct contact with buccal part of the root. As written above preservation of buccal bone and soft tissues has a huge influence on esthetic outcome of implant prosthetic work. Aim/Hypothesis: The aim of this clinical study was to investigate clinical success of the socket shield technique and to evaluate its outcome 6 years after surgical and prosthetic rehabilitation. Materials and Methods: This clinical study constituted of 30 patients with strong indication for tooth extraction in the frontal part of the maxilla. Patients were divided due to their clinical indications: Postendodontic horizontal tooth fracture where the fracture line is prosper enough to preserve buccal tooth root and immediate implant placement; Postendodontic submarginal fracture when patient rejects orthodontic tooth extrusion; Crown fracture of vital tooth beyond the marginal bone surface. In each group consisted of 10 patients. Partial resection of palatal root was performed in each patient with a view to preserve buccal root as well as buccal bone wall. Before implant was inserted a buccal root was smeared with Emdogain gel. Immediate crowns were made. After 4 months a permanent implant-prosthetic substitute was made, while x- ray analysis was made after 6 months, 4 years and after 6 years and esthetic (PES) evaluation has been made on clinical photo. Results: Patients did not have any kind of complications after surgery. Immediate crowns were replaced with permanent tooth crowns after 4 months. Soft tissue contours were preserved in all cases, also buccal bone wall was preserved after 6 months and after 4 and 6 years. In a period of following 6 years there were one biological complication regarding peri-implantitis after 5 years and that implant was lost. There were mechanical complications with 4 patients regarding screw loosening. All mechanical complications occured after 1 year in function and were resolved in one visit. The mean PES of evaluations after 6 years in function were 12.23 (±3.7 SD) regarding 12.78 after 6 months post implant and crown placement. Conclusions and Clinical Implications: With buccal bone wall preservation as well as a preservation of gingival tissue using technique of immediate implant placement, very good esthetic results were achieved. By deciding which patients are candidates for this surgery indications and guidelines written above need to be followed. Keywords: socket shield, PES, Emdogain, immediate implant placement