Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

Assessment of Cytotoxic and Genotoxic Effect of Modern Dental Materials in vivo.

Objectives: The aim of the study was to assess the biocompatibility of modern composite and amalgam dental fillings. Material and Methods: The research was conducted on 150 healthy patients between the ages of 10 and 20 who had amalgam and composite fillings between 6 and 12 months. Under in vivo conditions, a swab of buccal cells near the fillings was taken, and the cytotoxic and genotoxic impact of composite and amalgam fillings on these cells was analyzed using the extended micronucleus test (cytomeassay). Results: The results showed statistically significant differences between the groups of subjects with amalgam and composite fillings and subjects without fillings for the following parameters: number of micronuclei (p=0.006), number of buds (p<0.001), number of binuclear cells (p<0.001), number of nucleoplasmic bridges (p<0.001).The number of micronuclei was statistically significantly higher in the group of subjects with amalgam and composite fillings compared to the group without fillings. The results for nuclear buds, for the number of binuclear cells and the number of nucleoplasmic bridges showed that the group with amalgam fillings had a statistically significantly higher number of these changes compared to other groups.The results of the analysis of the relationship between the parameters of the micronucleus test and the number of amalgam and composite surfaces did not show statistically significant values. Parameters indicating cell cytotoxicity were not statistically significantly elevated in subjects with fillings. The results of the analysis of the influence of the patients' lifestyle on the results of the micronucleus test showed statistically significant results for certain predictors (diagnostic X-ray radiation, coffee consumption, consumption of cooked, dried meat and baked food). Conclusion: Based on the results, it can be concluded that the buccal cells of subjects with amalgam fillings showed the highest degree of genotoxic changes, followed by those with composite fillings and the least buccal cells of patients without fillings.

Antibiotic Administration Along with Endodontic Therapy in the Republic of Croatia: a Pilot Study.

OBJECTIVE: To evaluate the type and the frequency of antibiotic prescribing along with endodontic therapy in Croatia. The aim is, also, to assess the attitudes of Croatian doctors towards endodontic treatment of patients at risk of developing bacterial endocarditis. MATERIAL AND METHODS: Data were collected by a survey questionnaire. RESULTS: 8.4% of the examined practitioners stated that they prescribe antibiotics often, and 91.6% of them stated that they prescribed them never/ very rarely/rarely. Most of them (41%) prescribe antibiotics once or twice a month, 32.5% once or twice in several months and 20.5% once or twice a week. The most commonly used antibiotic was penicillin with clavulanic acid. Also, 26.2% of examined practitioners prescribed antibiotics for gangrene pulp, 51.2% of them for localized acute apical periodontitis without swelling, 85% of them for cellulitis, 75% of them for fever and enlarged lymph nodes, 16.9% of them for tooth with fistula and 94.1% of them for prophylaxis of infectious endocarditis. According to the results of study, 54.4% of dental practitioners did not prescribe antibiotics without intervention on susceptible tooth; 76% of participants often/almost always/ always accepted endodontic treatment of patients requiring antibiotic prophylaxis to prevent infectious endocarditis, and 96.7% of participants indicated they were familiar with recent instructions for antibiotic prophylaxis. CONCLUSION: These findings point to inappropriate use of antibiotics in the practice of 83 dental practitioners questioned regarding the frequency of administration and indications. The most commonly used antibiotic was penicillin with clavulanic acid. A high percentage of surveyed practitioners stated that they were familiar with recent instructions for antibiotic prophylaxis. They also stated that they performed endodontic procedures on patients who were at risk of bacterial endocarditis. There is a noticeable need for targeted continuing education of dental practitioners in the Republic of Croatia.

Cold atmospheric plasma for bleaching endodontically treated tooth: a new clinical approach.

The most commonly used bleaching agents contain different concentrations of hydrogen peroxide and carbamide peroxide. In the present case, the bleaching procedure was performed using an induced field of cold atmospheric plasma, obtained from dielectric barrier discharge. The therapeutic effect of the device used in the clinical procedure is based on floating electrode dielectric barrier discharge, in which the glass electrode functions as the primary electrode, while the therapeutic area, which in this case is the tooth, represents the secondary electrode. A periodontal (PA) probe is a glass tube filled with a noble gas, which generates an electrical discharge in the gap between the tip of the electrode surface and the therapeutic area, thus producing reactive oxygen species. Bleaching with only the cold atmospheric plasma bleaching technique, without any conventional bleaching agents, was performed successfully for an endodontically treated tooth. The cold atmospheric plasma bleaching technique, which could be a novel approach for the bleaching of non-vital teeth, provides good clinical results and is safe for clinical use.

Antimicrobial Effect of Ozone Made by KP Syringe of High-Frequency Ozone Generator.

AIM: The aim of this study was to evaluate in vitro the antibacterial effect of ozone on suspension of three different bacteria inoculated in prepared canals of extracted human teeth. MATERIAL AND METHODS: Ozone was produced by special KP syringe of high frequency ozone generator Ozonytron (Biozonix, München, Germany) from aspirated atmospheric air by dielectric barrier discharge and applied through the tip of the syringe to the prepared root canal. The microorganisms used were Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis. RESULTS: However, none of the methods was 100% effective against the three bacterial types in suspension. Application of ozone significantly decreased the absolute count of microorganisms (89.3%), as well as the count of each type of bacteria separately (Staphylococcus aureus 94.0%; Staphylococcus epidermidis 88.6% and Enterococcus faecalis 79.7%). Ozone generated by KP syringe was statistically more effective compared to NaOCl as positive control, for Staphylococcus aureus and Staphylococcus epidermidis. CONCLUSION: The absolute count of Enterococcus faecalis was statistically decreased without a statistically significant difference between the tested group and positive control, respectively. Among the three types of bacteria in suspension, KP probe had the lowest antimicrobial effect against Enterococcus faecalis.

Dental caries experience and tobacco use in 19-year-old Croatian army recruits.

The aim of this study is to investigate caries prevalence and smoking habit in the population of 19-year-old Croatian male recruits. Dental examination of 505 male recruits was conducted in 2001 in the military centre in Koprivnica. Caries status was described by the FS-T (Filled and Sound Teeth) index and DMFT (Decayed, Missing and Filled Teeth) index. Mean DMFT scores were 7.32 and FST 23.56. There was a significant statistical difference in comparison of smoking habits depending on the reason to visit the dentist (p = 0.001). The subjects who do not smoke tobacco have less decayed teeth (DT index with p < 0.001), and more teeth with fillings and/or sound teeth (FT with p = 0.005 and FST with p = 0.004). There is no statistically significant difference for the DMFT (p = 0.657) and MT (p = 0.703). In conclusion, it showed that FS-T is a more appropriate index for describing variation in the population with higher caries experience. In the population of Croatian recruits, there were an astonishing 58.6% of smokers.

The incidence of satellite cysts in keratocystic odontogenic tumors.

Renaming of the Odontogenic Keratocyst as the Keratocystic Odontogenic Tumor by the World Health Organization (WHO) is based on the aggressive nature of this lesion. Satellite cysts founded in the walls of the original cysts may give rise to a new lesion formation. The aim of this retrospecitve study was to identify the existence of specific features according incidence of satellite cysts and the pallisading of the basal layer of the epithelium and to establish their mutual correlation. The histopathologic data of Keratocystic Odontogenic Tumor on the basis of new WHO's classification (2005) were analized. Prominent palisade basal cell layer was found in 415 (94.75%) and partially absent palisade basal cell layer in 23 (5.25%) cases. Satellite cysts were presented in prominent palisade basal cell layer in 85 specimens (20.5%) and in cases with partial absent of the palisade basal layer in 3 spicemens (13%). The higher the frequency of pallisading was the higher the frequency of satellite cysts was (p > 0.05).

Comparison of vertical forces during root canal filling with three different obturation techniques.

The aim of this study was to examine and compare vertical forces exerted during root canal obturation with the cold lateral condensation technique, Thermafil technique and ProTaper guttapercha. Fourty-five single-rooted permanent teeth were used in the study. All specimens were instrumented using the ProTaper rotating technique and were randomly divided into three experimental groups (n = 15 per group). In the first group, root canals were obturated using the cold lateral condensation technique. In the second group, the Thermafil technique was used to obturate root canals. In the last group, a ProTaper gutta-percha of the same taper as the instrumented root canals was used for root canal obturation. Vertical forces were measured using the device developed for simulation of endodontic treatment. The results showed a statistically significant difference (p = 0.0001) for vertical forces when cold lateral condensation obturation technique was used in comparison to other techniques. No statistically significant difference was found for vertical forces during obturation with Thermafil and ProTaper gutta-percha (p = 0.16). The cold lateral condensation technique exerted higher vertical forces in comparison to the Thermafil and ProTaper obturation techniques.

Microleakage along glass-fibre posts cemented with three different materials after cyclic loading: a pilot study.

The purpose of this in vitro study was to evaluate microleakage along glass-fibre posts cemented with three different cements after cyclic loading. After post-space preparation, fifty obturated root canals were randomly divided into three experimental groups and two control groups. In group 1, Glassix posts were cemented using Harvard cement, in group 2, Fuji PLUS cement was used and in group 3, Variolink II was used for post cementation. The specimens were artificially aged by loading in a special testing machine. Coronal leakage was evaluated using a fluid transport system. Posts cemented with Variolink II, showed significantly higher failure rate after loading, compared to group 1 and 2 (p = 0.009). Comparing microleakage in samples that have not failed, specimens cemented with Variolink II showed significantly less fluid transport than specimens cemented with zinc phosphate and glass ionomer cements (p = 0.04 and p = 0.006, respectively). Variolink II cement exibited significantly less fluid movement compared with Harvard and Fuji PLUS cement.

An in vitro morphological investigation of the endodontic spaces of third molars.

Aim of this paper was to investigate the particular anatomic features of the endodontic space of third molars in the general population of Croatia. A total of 106 fully developed third molars (56 maxillar and 50 mandibular) has been analyzed. The respective number of roots and of root canals, the structure of the roots, and the curvature and absolute length of the root-canals were analyzed. In most cases, upper third molars had three roots (83.9%), while most of the lower molars were single rooted (56.0%). Upper third molars had mostly three root canals (75.1%), lower third molars two (90.0%). In both jaws, most third molars had curved canals (60.7% in the upper and 84.0% in the lower jaw). 12.5% of upper third molars had lateral and accessory canals, whereas only 4.0% of the lower third molars were found to have them. The Student t-test showed statistically significant differences (p < 0.05) in the length of the root-canals, mesiobuccal and distobuccal canals being significantly shorter than palatinal canals. The same test showed that in the lower third molars the mesial root canals were significantly longer that the distal ones, although slightly. The results obtained are in compliance with similar results by other authors; however, they tend to show some specific population-related features.

Erosive lesions in patients with alcoholism.

BACKGROUND: The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance. METHODS: The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants' salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva. RESULTS: The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05). CONCLUSIONS: The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates. CLINICAL IMPLICATIONS: Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.

Coronal microleakage of two root-end filling materials using a polymicrobial marker.

The purpose of this study was to evaluate polymicrobial coronal leakage of mineral trioxide aggregate (MTA) and amalgam. There were 108 single-rooted teeth randomly divided into 3 groups of 32 teeth each and positive and negative control groups of 6 teeth and obturated with gutta percha and either Diaket (3M/ESPE, Seefeld, Germany), AH Plus (Dentsply, De Trey, Konstanz, Germany), or Ketac Endo (3M/ESPE). These groups were further divided into 2 subgroups of 16 teeth in which root ends were resected and obturated with either MTA or zinc-free amalgam. The samples have been incorporated in a dual-chamber leakage model with a polymicrobial marker of five facultative anaerobes on the coronal part. Leakage was observing during a period of 90 days. The least leakage was found in a combination of Diaket and MTA (76.9 +/-14.8 days) followed by AH Plus and MTA (66.1 +/- 18.7), Diaket and amalgam (60.0 +/- 23.1), AH Plus and amalgam (56.9 +/- 22.1), and Ketac Endo and MTA (42.1 +/- 17.8), whereas the greatest leakage was observed in the Ketac Endo and amalgam group (40.0 +/- 17.24). Samples filled with MTA showed significantly better sealing than samples filled with amalgam (p < 0.05).

[Caries in Croatian Army recruits in 2000]. / Karijes novaka Hrvatske vojske u 2000. Godini.

AIM: The aim of this study was to evaluate oral health of Croatian army recruits, and subsequently, by DMFT index and FST index, to point to dental status of each recruit and to make the diagnosis and treatment plan accordingly. PATIENTS AND METHODS: A total of 248 randomly chosen Croatian Army recruits aged 19-29 underwent examination at a dental office in Koprivnica barracks. Their oral health status was clinically observed and evaluated by use of DMFT and FST indexes. The quality of dental treatment and number of restorations were estimated according to the formula: FTx100/DFT. The study included recruits who had no decayed teeth (DMFT=0), and all teeth, apart from wisdom teeth, were examined. The subjects were divided according to age and place of residence (urban, rural), all of them living in central Croatian counties. They were also interviewed about their dietary habits, and personal oral and dental care. The methods of nonparameter statistics were used due to abnormal data distribution. RESULTS: Healthy teeth were found in 4% of study subjects. The median value of DMFT was 6, and of FST index 25. There were no statistically significant differences in the indices according to either residence or age of recruits. A statistically significant difference was recorded between DT and FST index (p<0.05) according to educational level and understanding of the dietary role of carbohydrates reflected in caries development. Restorations were present in 18.6% of the recruits, i. e. their teeth were well treated, without any further carious lesions. DISCUSSION: The results of epidemiological studies, carried out in many countries, have revealed a decreased number of caries resulting from overall preventive measures that were taken from early childhood. Specific socioeconomic factors play an important role in Croatia as well as in other transition countries. CONCLUSION: The values of DMFT indexes recorded in recruits from other countries tend to be considerably lower than those in Croatian Army recruits. In populations with a high caries incidence it is more appropriate to use FST index. The study of caries in heterogeneous populations such as recruits points to the need of taking more effective preventive measures in childhood and adolescence.

Estrogen receptors in human pulp tissue.

OBJECTIVE: The aim of this study was to evaluate the expression of estrogen receptor (ER)-alpha in human pulp tissue. STUDY DESIGN: Tissue samples were collected from 51 teeth extracted for orthodontic reasons or from endodontically treated teeth. Immunohistochemical staining was performed with mouse antihuman ER-alpha 1D5 by using the alkaline phosphatase antialkaline phosphatase technique. Immunohistochemical reactivity was semiquantitatively assessed and graded on an intensity scale of 0 to 3. RESULTS: ERs were found in odontoblasts, endothelial cells, and Schwann cells. By means of statistical analysis, ERs were found to be common in odontoblasts (1.3-1.6) and in endothelial cells (1.0-1.4), whereas in Schwann cells they were somewhat rare (0.7-1.1). Difference in expression of ERs was not found among patients in different age groups. With respect to sex, a difference in reactivity was observed in Schwann cells, which showed higher reactivity in female pulps. CONCLUSION: The results of this study confirm the expression of ER-alpha in the human dental pulp.

Changes in dentin after insertion of self-threading titanium pins with 3 methods: a scanning electron microscope pilot study.

STATEMENT OF PROBLEM: Inserting a self-threading pin can cause dentinal cracks, but it is not known whether dentin bonding agents can penetrate these cracks. PURPOSE: Part I of this in vitro pilot study was conducted to document the presence of dentinal cracks after the placement of self-threading pins with 3 methods. Part II was conducted to observe changes in dentin when a dentin bonding agent was applied before insertion of the self-threading pins. MATERIAL AND METHODS: The crowns of 14 noncarious third molars were sectioned horizontally 2 mm above the cemento-enamel junction, and the occlusal portions were discarded. The teeth were put into a nontransparent bag and divided randomly into 2 groups. Group 1 consisted of 12 teeth. In each tooth, 4 pinholes were prepared with a handpiece at normal rotation speed (30,000 rpm). Self-threading pins were placed into 3 of the pinholes in each tooth: 1 manually, 1 by handpiece at 7000 rpm, and 1 by handpiece at 30,000 rpm. The fourth pinhole was left empty and served as the control. All group 1 teeth were sectioned vertically through the pins, dental hard tissue, and control pin holes. The examination surface of each specimen in group 1 was polished, and the smear layer was removed with Calcinase and NaOCl solutions. After dehydration in ascending grades of alcohol, specimens were coated with a 10- to 15-nm-thick layer of gold and examined with a scanning electron microscope. In the remaining 2 teeth (group 2), a dentin bonding agent was introduced into the pinholes prior to pin placement. Two pins were placed manually and 2 by handpiece at 30,000 rpm. After pin placement, sectioning, cleaning, and dehydration, the specimens were examined with a scanning electron microscope, and x-ray mapping was performed to determine the presence of titanium, silicon, and calcium. RESULTS: Craze lines in dentin were associated with 54.5% of pins placed manually and 54.5% of pins placed with a handpiece at reduced speed (7000 rpm). Dentinal cracks were associated with 50% of pins placed with a handpiece at standard speed and with 16.7% of the control pinholes. X-ray mapping analysis revealed the presence of the dentin bonding agent between the pin and dentin wall. The dentin bonding agent was not found in the dentinal cracks except at the crack orifice. SUMMARY: Within the limitations of this pilot study, the method of pin insertion had no direct bearing on the presence of dentinal cracks. The dentin bonding agent tested did not fill the entire space of dentinal cracks but did occlude their orifices and fill the spaces between pin surface and dentin walls in the pin preparation.