One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study.

PURPOSE: The study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source. METHODS: A total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months. RESULTS: First group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed. CONCLUSION: Odontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.

Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain.

(1) Background and Objectives: The aim of this narrative review was to analyze the neuroanatomical and neurophysiological basis of cervicogenic pain in cervico-cranial pain syndromes, focusing particularly on cervico-orofacial syndromes as a background for the proper diagnosis and non-surgical treatment. Relevant literature on the topic from past 120 years has been surveyed. (2) Material and Methods: We surveyed all original papers, reviews, or short communications published in the English, Spanish, Czech or Slovak languages from 1900 to 2020 in major journals. (3) Results: The cervicogenic headache originates from the spinal trigeminal nucleus where axons from the C1-C3 cervical spinal nerves and three branches of the trigeminal nerve converge (trigeminocervical convergence) at the interneurons that mediate cranio-cervical nociceptive interactions. The role of the temporomandibular joint in the broad clinical picture is also important. Despite abundant available experimental and clinical data, cervicogenic orofacial pain may be challenging to diagnose and treat. Crucial non-surgical therapeutic approach is the orthopedic manual therapy focused on correction of body posture, proper alignment of cervical vertebra and restoration of normal function of temporomandibular joint and occlusion. In addition, two novel concepts for the functional synthesis of cervico-cranial interactions are the tricentric concept of mouth sensorimotor control and the concept of a cervicogenic origin of bruxism. (4) Conclusions: Understanding the basis of neuroanatomical and neurophysiological neuromuscular relations enables an effective therapeutic approach based principally on orthopedic manual and dental occlusal treatment.

Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor-A Case Report with 24-Month Follow-Up.

The complicated crown-root fracture of young permanent teeth is an uncommon traumatic dental injury that is usually treated in a complex way and is demanding not only for the dentist but even for the treated child. In this case report, we present the conservative treatment of a maxillary central incisor in a 10-year-old boy after a traumatic dental injury. Treatment included partial pulpotomy and adhesive fragment reattachment after reflection of the mucoperiosteal flap. The patient was fully asymptomatic at 24-month follow-up, with an aesthetically acceptable outcome. Vital pulp therapy and adhesive fragment reattachment can be a viable treatment option for complicated crown-root fractures, especially when treating immature permanent teeth.

Clinical and Radiographic Outcomes of Immature Teeth Treated with Different Treatment Protocols of Regenerative Endodontic Procedures: A Retrospective Cohort Study.

Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.

The influence of gingival phenotype on the morphology of the maxillary central papilla.

BACKGROUND: Preservation of the interdental papilla is an essential part of the functional and esthetic rehabilitation of dental treatment. It has been described that thicker gingival tissues are more resistant to recession. The main objective of this investigation was to analyze whether a thin gingival phenotype represents a potential risk indicator affecting interdental papilla fill, height, or width in an esthetic region between maxillary central incisors. The secondary goals were: (1) to analyze parameters describing the papilla-fill, height, width, and effect of papilla base width on the vertical papillary dimension; (2) to determine correlation between different non-invasive measurements of gingival thickness; (3) to compare both sexes. METHODS: A total of 54 periodontally healthy students (20-30 years old) were included in the study. Gingival thickness was measured using Pirop Ultrasonic Biometer. Gingival phenotype was also assessed by gingival probe transparency. Papilla height and width were measured, and the degree of papilla recession was classified. RESULTS: No significant relationship between papilla fill, height, width and gingival probe transparency or gingival thickness was found. Gingival thickness and gingival probe transparency showed a significant relationship (P < 0.001). There was a significant relationship between papilla height and papilla fill (P = 0.028). A papilla which filled the interdental space completely seemed to be shorter. A strong positive correlation between papilla height and papilla width was found (P < 0.0001). The papilla between maxillary central incisors was significantly higher in males (P = 0.01). CONCLUSION: The appearance of the interdental papilla may be influenced by various factors. Within the limitations of this study, the results showed that the thin gingival phenotype alone is no potential risk indicator affecting interdental papilla fill, height, or width. It seems that there may be some effect of papilla base width on its vertical dimension. Gingival probe transparency is a simple reliable method of assessment of gingival thickness with a threshold value of 1-mm gingival thickness between the thick and thin phenotypes.

Students´ preparedness, learning habits and the greatest difficulties in studying Histology in the digital era: A comparison between students of general and dental schools.

INTRODUCTION: There are only sporadic references in literature regarding general medicine and dentistry student´s preparedness for Histology, study resources and how students might use them in the era of virtual microscopy. METHODS: A structured questionnaire was used to evaluate students´ opinion, with 192 students of general medicine and 82 students of dentistry responding. RESULTS: The dentistry students evaluate their previous knowledge of basic high school disciplines as less helpful when compared to their general medicine colleagues, but this difference diminishes during the first year of medical school studies. Students of dentistry display a better orientation in the amount of study resources (electronic vs printed) and also the ways of their use (practical vs theoretical preparation). The main problems surfacing in the study of Histology have been: the lack of time due to the high demands of Anatomy, problems with correct identification of structures in specimens and correct orientation in a large number of available study resources. Students indicate that they would appreciate the introduction of interactive exercise tests to verify practical and theoretical knowledge. CONCLUSION: We revealed significant differences between students of general medicine and dentistry in terms of student´s preparedness and learning habits. According to our findings, it is still necessary to further develop teaching methods utilising virtual microscopy, taking into account the needs of both general medicine and dental school students.

The Fundamental Comparison of Zn-2Mg and Mg-4Y-3RE Alloys as a Perspective Biodegradable Materials.

Biodegradable materials are of interest for temporary medical implants like stents for restoring damaged blood vessels, plates, screws, nails for fixing fractured bones. In the present paper new biodegradable Zn-2Mg alloy prepared by conventional casting and hot extrusion was tested in in vitro and in vivo conditions. Structure characterization and mechanical properties in tension and compression have been evaluated. For in vivo tests, hemispherical implants were placed into a rat cranium. Visual observation of the living animals, an inspection of implant location and computed tomography CT imaging 12 weeks after implantation were performed. Extracted implants were studied using scanning electron microscopy (SEM) on perpendicular cuts through corrosion products. The behaviour of zinc alloy both in in vitro and in vivo conditions was compared with commercially used Mg-based alloy (Mg-4Y-3RE) prepared by conventional casting and hot extrusion. Both compressive and tensile yield strengths of Zn and Mg-based alloys were similar; however, the brittleness of Mg-4Y-3RE was lower. Zn and Mg-based implants have no adverse effects on the behaviour or physical condition of rats. Moreover, gas bubbles and the inflammatory reaction of the living tissue were not detected after the 12-week period.

Discoloration after Regenerative Endodontic Procedures: A Critical Review.

Discoloration remains an unfavourable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. This review presents a critical view on current knowledge of discoloration sources, its treatment and possible preventive modalities, dealing mainly with the use of antibiotics, ethylendiaminotetraacetic acid, calcium hydroxide, mineral trioxide aggregate, calcium silicate cements, sodium hypochlorite and chlorhexidin during regenerative treatment and their possible interactions. Bleaching as a discoloration treatment modality is discussed as well.

Retreatment of failed revascularization/revitalization of immature permanent tooth - A case report.

The aim of this article is to describe the clinical case of the non-surgical retreatment of a failed revascularization/revitalization treatment (RRT). The retreatment was preceded by two sessions including an interim medication with calcium hydroxide and a modified irrigation protocol containing a highly-concentrated sodium hypochlorite and prolonged usage of ethylenediaminetetraacetic acid (EDTA) to reverse unacceptable side effects of hypochlorite. During a 15- month follow-up, the healing of the periapical lesion, increased thickening of root canal walls and maturation of root was apparent. The repeated RRT represents a possible treatment modality for s failed RRT. Key words:Retreatment, revascularization, revitalization, maturogenesis, immature tooth.

In Vitro Mechanical Properties of Mineral Trioxide Aggregate in Moist and Dry Intracanal Environments.

INTRODUCTION: The purpose of this study was to examine the microhardness and modulus of elasticity (MOE) of White ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK) after setting in moist or dry intracanal conditions. METHODS AND MATERIALS: To simulate root canal system, 14 polyethylen molds with internal diameter of 1 mm and height of 12 mm were used. These molds were filled with 9-mm thick layers of White ProRoot Mineral Trioxide Aggregate (MTA; Dentsply Tulsa Dental, Tulsa, OK). The experimental group (n=7) had a damp cotton pellet with 1.5 mm height and a 1.5 mm layer of resin composite placed on it. In control group (n=7) the whole 3 mm above MTA were filled with resin composite. The specimens were kept in 37°C and relative humidity of 80% for 4 days in order to simulate physiological conditions. Specimens were longitudinally sectioned and nanoindentation tests were carried out using Berkovich indenter at loading rate of 2 mN/s at 4×5 matrices of indents which were located in the coronal, middle and apical thirds of the specimen's cross section, to evaluate the microhardness and modulus of elasticity of the specimen to appraise the progression of the setting process. Differences were assessed using nonparametric generalized Friedman rank sum and Wilcoxon Rank-Sum tests. RESULTS: Statistical analysis showed that there was a significant difference in microhardness and MOE between control and experimental groups at coronal (P<0.001), middle (P<0.001) and apical (P<0.001) thirds of the simulated rod from simulated apical foramen. Kruskal-Wallis test showed no significant effect of depth on microhardness of material in experimental or control groups. CONCLUSION: Within limitations of this in vitro study, it seems that moist intracanal environment improves setting of MTA in various depths.

Parathyroid Carcinoma in Patients that Have Undergone Surgery for Primary Hyperparathyroidism.

BACKGROUND/AIM: Parathyroid carcinoma is a rare clinical entity, which represents one of the main reasons, why surgery should be performed in specialized centres. Preoperatively, it is very difficult to distinguish between benign and malignant hyperparathyroidism. PATIENTS AND METHODS: During the years 1996-2016, we performed 2,220 operations in 2,075 patients with a diagnosis of primary hyperparathyroidism. RESULTS: Among these 2,220 operations, there were 16 operations for parathyroid carcinoma. These 16 operations, including reoperations, were performed in four patients. Two patients had no reoperation, but another 2 patients required 14 reoperations in total. Parathyroid carcinoma was described in 0.2% of all patients with a diagnosis of primary hyperparathyroidism. The number of operations was 0.73% of all operations of primary hyperparathyroidism in years 1996-2016. CONCLUSION: Prognosis of parathyroid carcinoma is quite favourable, patients evidence a long-term survival rate after the primary operation. However, every reoperation increases the number of possible complications, including recurrent laryngeal nerve injury.

Paradigm Shift from Stem Cells to Cell-Free Regenerative Endodontic Procedures: A Critical Review.

Regenerative endodontic procedures of immature teeth with necrotic pulp have become a part of therapeutic endodontic spectrum and are considered as an alternative to calcium hydroxide or mineral trioxide aggregate apexification. In last decade, numerous case reports and series with usage of cell-free approaches known as revascularization, revitalization, or maturogenesis have been published. This cell-free approach prevails in clinical regenerative endodontics because of its relative ease of performance, lower financial demands, and absence of complications such as tumorigenesis of used stem cells. In this article, the integral steps of cell-free treatment approaches such as source of stem cells, possible endogenous scaffolds, sources of growth factors, and width of apical foramen in the context of sufficient disinfection of root canal system and outcome of treatment are discussed. Despite not being a fully established treatment protocol, the achieved outcomes are promising regardless of it having a reparative character than a regenerative one.

Root Maturation in Teeth Treated by Unsuccessful Revitalization: 2 Case Reports.

This article deals with the unusual course of failed revascularization/revitalization cases. Up to this date the evidence of success and failure rates of revascularization/revitalization treatment is scarce. These case reports present "unsuccessful" revascularization/revitalization treatment of permanent immature teeth with apical periodontitis. Although the teeth were treated by protocol suggested by the American Association of Endodontists and the symptoms disappeared, maturation of teeth continued, and periapical lesion was reduced, the teeth went symptomatic during the follow-up. Subsequently, regular root canal treatment was performed. Despite chronic infection that was probably left inside the root canal after a disinfection protocol, the secondary aims of the treatment were achieved even when the primary ones were not. The possible causes of failures of revascularization/revitalization treatment and their prevention are discussed.

Pathogenetic Mechanisms of Neurogenic Pulmonary Edema.

Neurogenic pulmonary edema (NPE) is a life-threatening complication of central nervous system (CNS) injuries. This review summarizes current knowledge about NPE etiology and pathophysiology with an emphasis on its experimental models, including our spinal cord compression model. NPE may develop as a result of activation of specific CNS trigger zones located in the brainstem, leading to a rapid sympathetic discharge, rise in systemic blood pressure, baroreflex-induced bradycardia, and enhanced venous return resulting in pulmonary vascular congestion characterized by interstitial edema, intra-alveolar accumulation of transudate, and intra-alveolar hemorrhages. The potential etiological role of neurotransmitter changes in NPE trigger zones leading to enhanced sympathetic nerve activity is discussed. Degree of anesthesia is a crucial determinant for the extent of NPE development in experimental models because of its influence on sympathetic nervous system activity. Sympathetic hyperactivity is based on the major activation of either ascending spinal pathways by spinal cord injury or NPE trigger zones by increased intracranial pressure. Attenuation of sympathetic nerve activity or abolition of reflex bradycardia completely prevent NPE development in our experimental model. Suggestions for future research into NPE pathogenesis as well as therapeutic potential of particular drugs and interventions are discussed.

Movement of the patient and the cone beam computed tomography scanner: objectives and possible solutions.

OBJECTIVE: This study aimed (1) to determine whether scanner arm rotation causes significant movement of the head restraint and (2) to measure patient movement and its variation during the scan. STUDY DESIGN: The iCAT scanner and a high-speed camera were used. The 40 patients were divided into 2 groups: the open-eyed group and the blindfolded group. RESULTS: The mean level of head restraint movement was 0.130 mm, with a significantly higher level at the beginning, probably owing to the accelerating arm. Mean movement of patients was 1.135 mm and 1.119 mm in the open-eyed and blindfolded groups, respectively. Patient movement was also significantly higher at the beginning of the scan, when noise and vibrations are likely to surprise the patient. CONCLUSIONS: Patient instruction and a dry-run scan should be done by clinicians. Manufacturers should consider separating the seat and head restraint from the rest of the scanner to avoid vibration transfer.

The combination of mesenchymal stem cells and a bone scaffold in the treatment of vertebral body defects.

PURPOSE: Vertebral body defects represent one of the most common orthopedic challenges. In order to advance the transfer of stem cell therapies into orthopedic clinical practice, we performed this study to evaluate the safety and efficacy of a composite bioartificial graft based on a hydroxyapatite bone scaffold (CEM-OSTETIC(®)) combined with human mesenchymal stem cells (MSCs) in a rat model of vertebral body defects. METHODS: Under general isoflurane anesthesia, a defect in the body of the L2 vertebra was prepared and left to heal spontaneously (group 1), implanted with scaffold material alone (group 2), or implanted with a scaffold together with 0.5 million MSCs (group 3) or 5 million MSCs (group 4). The rats were killed 8 weeks after surgery. Histological and histomorphometrical evaluation of the implant as well as micro-CT imaging of the vertebrae were performed. RESULTS: We observed a significant effect on the formation of new bone tissue in the defect in group 4 when compared to the other groups and a reduced inflammatory reaction in both groups receiving a scaffold and MSCs. We did not detect any substantial pathological changes or tumor formation after graft implantation. CONCLUSIONS: MSCs in combination with a hydroxyapatite scaffold improved the repair of a model bone defect and might represent a safe and effective alternative in the treatment of vertebral bone defects.

The role of sympathetic nervous system in the development of neurogenic pulmonary edema in spinal cord-injured rats.

The pronounced activation of sympathetic nervous system is a necessary prerequisite for the development of neurogenic pulmonary edema (NPE) in rats with balloon compression of spinal cord. In this study we examined whether this is a consequence of rapid activation of spinal pathways leading to sympathetic venoconstriction, blood pressure rise, and reflex bradycardia. We found that NPE development can be prevented by epidural upper thoracic anesthesia or by transection of the upper spinal cord. This indicates an important role of spinal pathways activation. NPE development can also be prevented by moderate blood loss, supporting the role of blood redistribution to pulmonary circulation. In rats developing NPE the catecholamine surge following spinal cord compression involved not only a dramatic increase of circulating norepinephrine but also of epinephrine levels. The pretreatment of rats with α-1 adrenoceptor blocker prazosin, α-2 adrenoceptor blocker yohimbine, or calcium channel blocker nifedipine prevented NPE development, whereas the effect of ß-adrenoceptor blockade with propranolol was less convincing. In conclusion, considerable activation of thoracic spinal pathways, followed by marked catecholamine secretion, play a major role in the development of NPE in spinal cord-injured rats. Enhanced α-adrenergic nifedipine-sensitive vasoconstriction is responsible for observed blood pressure changes, subsequent baroreflex bradycardia, and blood volume redistribution, which represent major pathogenetic mechanisms of NPE development.