Implantoprosthetic Rehabilitation by Computer-guided Implant Surgery (M-Guide): Case report.

Correct implant positioning poses a major challenge in modern dentistry and mismatch between the planned and final implant position is one of the most common treatment complications. A surgical guide or a template is a ''transmission device'' which enables the implant placement in the intended position as accurate as possible. Case study: A woman aged 60 came into dental office to resolve a single tooth loss in regions 15 and 24. Radiographic analysis and clinical examination showed a lack of transversal space in the regions of implantation. Considering the fact of having a narrow area available for implantation, a computer-guided implant therapy using the M-Guide system was selected. The treatment plan was a prosthetic restoration involving the placement of two implants in areas 15 and 24 and the fabrication of zirconium oxide crowns. After digital planning, a fully guided surgical protocol was performed. Immediately after implantation, a temporary suprastructure and temporary crowns were placed. After a period of osseointegration, a definitive prosthetic restoration was made.

Symmetrical Fibrous Hyperplasia of the Palate.

Bilateral symmetrical fibrous palate hyperplasia is not a common case in the literature. The cause of this pathological change is not completely known. The development of hyperplasia may also be associated with a genetic mutation in the gingival soft tissue or gingival injury. We present a case of a 47-year-old patient who developed a formation that manifested bilaterally in the hard palate. After the excision, there were no histological elements in the material that indicated aggressive behavior of the formation. The clinical and histological diagnosis was the bilateral symmetrical palate hyperplasia, which is a very rare condition.

Mini Dental Implant-Retained Removable Partial Dentures: Treatment Effect Size and 6-Months Follow-up.

OBJECTIVE: The aim was to compare esthetic outcomes, masticatory performance and a comfort of removable partial denture (RPD) wearing after receiving: clasp-retained RPD (C-RPD) or mini dental implant-retained RPD (MDI-RPD) in the mandible. MATERIALS AND METHODS: A sample of 88 patients (Kennedy Class I) with all posterior teeth missing and a linear support for a RPD participated. A total of 52 patients (36 females, 16 males; 56 to 84 years old) participated in the C-RPD group and 36 patients (26 females, 10 males; 43 to 81 years old) in the MDI-RPD group. All MDIs were placed adjacent to the last remaining mandibular anterior tooth or one tooth length posteriorly. The new RPDs had Co-Cr frameworks with lingual plate major connectors; the MDI-RPDs were retained by O-ball matrices and the C-RPDs with clasps. Patients answered questions at pre-treatment and post-treatment stages and after 6-months follow-up: how satisfied they had been with esthetic appearance, how confident they were while chewing hard food, how satisfied they were with food comminution and they also evaluated a comfort of RPD wearing. The 0-10 visual-analogue scale was used. Statistics included descriptive methods, t-tests and the standardized effect-size calculation. RESULTS: The MDI-RPD wearers were more satisfied with their post-treatment esthetics, food comminution, a comfort with RPDs and had better confidence while chewing than the C-RPD wearers. The MDI-RPD wearers reported larger positive effect of the treatment. The results were consistent throughout the first 6-months period. CONCLUSION: The MDI-RPD patients showed superior outcomes than the C-RPD patients after the treatment and over the 6-month period.

The use of ozone in the prevention of osteoradionecrosis of the jaw.

Radiation therapy of the head and neck area has resulted in numerous and undesired effects on the oral cavity tissue. The most frequent and most dangerous complications of radiotherapy of the head and neck area is osteoradionecrosis (ORN). The purpose of this study is to demonstrate the possibility of using ozone in the prevention of ORN of the jaw, and show the recent therapeutic protocols for treatment in patients receiving radiation therapy for the head and neck. We used an ElektroMagneTron device during the therapy. The patient underwent postoperative follow-up examination when bio-oxygenation therapy and clinical evaluation of wound healing were performed. Wound healing evaluation showed no complications. Ozone therapy is given as an option in the therapeutic protocol for the prevention and treatment of ORN. 

Assessing Health-Related Quality of Life with Antimicrobial Photodynamic Therapy (APDT) and Low Level Laser Therapy (LLLT) after Third Molar Removal.

INTRODUCTION: The purpose of this study was to evaluate the antimicrobial photodynamic therapy (APDT) and low level laser therapy (LLLT) on wound healing, pain intensity, swelling problems, halitosis and the postoperative usage of analgesics after surgical removal of lower third molars. METHODS: One hundred and fifty patients, randomly divided into three groups were selected (50 per each group). The P1 group received the APDT after a third molar surgery, the P2 group received the LLLT and the C group (control group) was without any additional therapy after surgery. A photoactive substance was applied in the APDT study group before suturing. After 60 seconds the photosensitive substance was thoroughly washed with saline water and the laser light was applied in two intervals (30 seconds each). The irradiation power was 50 mW while the wavelength was 660 nm. The laser therapy in P2 group was performed before suturing and the laser light was applied also in two intervals (90 seconds each), the irradiation power was 90 mW while the wavelength was the same as in the first group - 660 nm. Postoperative follow-ups were scheduled on the third and the seventh day in patients who received laser therapy. RESULTS: The results of the postoperative evaluation showed that there was a statistically significant difference in the postoperative wound healing, pain intensity, swelling problems, halitosis and analgesics intake between patients in all three groups (p<0.001). The patients that were subjected to APDT (P1) had the least postoperative problems. After the laser therapy (P1 and P2) wound healing was without any complications, opposite from the patients from the C group (p<0.001). Postoperative application of a laser therapy significantly reduced patient's use of analgesics over the observed period of time (p<0.001). CONCLUSION: Both modalities of laser therapy significantly reduced postoperative problems after surgical removal of third lower molars with the best results in both laser groups.

A new approach for transversalis fascia reinforcement in Lichtenstein's inguinal hernia repair.

Operations undertaken for inguinal hernia repair are the most common elective surgical procedures. According to the current guidelines, Lichtenstein's tension-free method is the gold standard for elective hernia operations. The most common types of implanted mesh are polypropylene and composite mesh. We herein present Lichtenstein's operation using a biological hemostatic mesh (Tachosil) used for transversalis fascia reinforcement, and our results after a 3-year follow-up period for 52 patients implanted with Tachosil mesh are reported. According to our results, the biological mesh can be safely implanted during hernia repair with the same recurrence rate and lower postoperative pain and complications compared to hernia repair with polypropylene mesh implantation.

The frequency and malignant transformation rate of oral lichen planus and leukoplakia--a retrospective study.

The aim of this retrospective study was to determine the frequency and malignant transformation rate of oral lichen planus and leukoplakia in a large group of oral medicine patients. Study included 12 508 patients who were referred between 1998 and 2007 to the Department of Oral Medicine. The frequency of OLP was 4.30%, leukoplakia 1.11%, and combined diagnoses 0.14%. In primary biopsies dysplasia was found in 12.96% of patients with leukoplakia and not in one with OLP and combined lesions. The highest frequency of leukoplakia was found in smokers. Women were found as predominant sufferers of both diseases and their combination. During the observed period often years malignant transformation of OLP was not detected, unlike leukoplakia where it was 0.64%. The frequency of OLP and leukoplakia in our study are comparable to other similar studies. The highest frequency of malignant transformation was observed in those patients who did not respond to our invitation to regular check-up. It is therefore neccessary to perform a detailed examination of the oral cavity in these patients and to raise patients awareness of the disease and the importance of regular follow-up.

Changes of the dental service delivered to patients with intellectual disability under general anaesthesia in Dental Polyclinic Split, Croatia, during the years 1985-2009.

People with intellectual disability (ID) usually have a poor quality of oral health, which include poor oral hygiene, untreated caries and high proportion of missing teeth. Due to their fear and repulsive attitude towards medical staff general anesthesia is often a useful method for dental treatment. One thousand and fifty four intellectual disability patients for the period of 1985-2009 who received dental treatment under general anesthesia in Dental Polyclinic Split, were included in the study. Patients were divided into five groups based upon the period when a specific dental treatment had been received. Each period was analyzed for the number of ID patients treated and the type of dental treatment. The results showed that the most services provided were 4006 fillings, followed by 3225 extracted teeth and finally 274 endodontic treatments. Significantly the lowest number of fillings and endodontic treatments were found among patients in group II (1990-1994), with significantly the highest number of extracted teeth. In Conclusion, the types of dental treatment have changed during twenty five years. Number of extracted teeth decreased while the number of fillings and endodontic treatment increased. However, dental status of people with intellectual disability should be improved with more restorative treatments and with better oral health prevention program.

Multivariate analysis of different factors affecting the patient general satisfaction with complete dentures.

The aim of the study was to investigate different factors that affect the level of patient's general satisfaction with maxillary and mandibular complete dentures (CDs) using a multivariate analysis. A total of 100 CD wearers participated in this study. There were 46 men (37-77 years old; mean age 62.6 +/- 9.2) and 54 women (34-77 years old; mean age 60.9 +/- 9.3). In the questionnaire the patients answered the questions regarding gender, age, number of previous CDs worn, the present dentures' age and denture-wearing habits. Participants rated the level of their satisfaction with the esthetics, retention, speech, mastication, sense of taste, comfort and general satisfaction with their CDs. More than 70% of the examined patients claimed all the examined variables to be the best-score category. Of the 9 factors examined, satisfaction with the mastication and esthetics, denture-wearing habits and satisfaction with retention in the maxilla explained the variability of the patients's general satisfaction with their CDs by 72%. Satisfaction with the mastication, denture-wearing habits and satisfaction with speech and comfort in mandible explained the variability of the patients's general satisfaction with their CDs by 79%. These findings suggest that the general patient satisfaction with maxillary CDs is related more to the mastication and retention abilities, as well as with esthetics and denture-wearing habits, while in the mandible CDs is related to mastication and speaking abilities, denture-wearing habits and comfort of wearing.

The impact of human epidermal growth factor receptor-2 status of invasive breast tumors on thermography findings.

OBJECTIVE: To analyze the impact of prognostic human epidermal growth factor receptor-2 (HER-2) in invasive breast cancers on the findings of thermography tests. METHODS: The study was carried out at the Department of Surgical Oncology and the Department of Pathology, University Clinical Hospital Center, Sisters of Mercy, Zagreb, Croatia, in collaboration with licensed infrared (IR) thermography experts. The study involved 75 female patients diagnosed with invasive breast cancer from May to July 2011. Thermography findings were compared between different immune-histochemical (IHC) findings (HER-2 status: positive or negative). RESULTS: Significantly higher temperatures were recorded in invasive cancer breasts than in healthy breasts. The cancer sites and the entire cancer breasts were significantly warmer (p less than 0.001) than the healthy breasts and opposite tumors mirror sites. Considering the HER-2 status, HER-2 positive invasive cancers were significantly warmer in comparison with the HER-2 negative cancers (p=0.035). CONCLUSION: The trend of increased temperature in HER-2+ tumors was noted. The findings clearly indicate that HER-2+ status has a higher impact on the increased thermographic temperature findings.

Application of tomographic methods in the diagnosis of pathological changes of the jaw.

The aim of this study was to evaluate the frequency of specific diagnostic methods used for diagnosis of oral pathologies. The sample consisted of 198 patients (98 man and 100 women) with formulated diagnosis, confirmed postoperatively by histopathological verification. In 74.7% of subjects only X-ray diagnostic examination was used. Both X-ray and computed tomography (CT) examinations were used in 18.7% of subjects. Magnetic resonance imaging (MRI) wasn't performed in any subject. In 6.6% of subjects neither X-ray nor CT was performed. The study reported on statistically significant differences in the distribution of specific diagnostic methods according to age groups (p = 0.026). Also, there was statistically significant differences in the distribution of diagnostic methods according to diagnostic groups (p = 0.053). In the group of 37 subjects, in whom both X-ray and computed tomography were used, the majority had carcinomas, followed by fractures and inflammatory cysts.

Follicular jaw cysts.

The aim of this study was to examine the occurrence, localization, size, ways of diagnosing and treatment of a foIlicular jaw cyst. Assessment of the patients' motives and their earlier health status was recorded, as well as their postoperative clinical course. Most of the patients were admitted because of pain, swelling, trismus, or other difficulties associated with cyst formation. Follicular cysts with persisting primary predecessor had an asymptomatic development, and were discovered after orthodontic examination or by chance. In most cases pathohistological finding and description of the formation have coincided with each other (p < 0.05). Cysts of different sizes were treated by different surgical approaches, most commonly alveolotomy and cystectomy in small cysts, while alveolotomy and cystectomy with suction or iodine tampon in large cysts. Cooperation of a dentist, an oral surgeon, a pathologist, and other specialists can lead to early diagnose and prevention of further growth of a follicular jaw cyst, thus preventing substantial bone damage.

Analysis of impacted and retained teeth operated at Department of Oral Surgery, School of Dental Medicine, Zagreb.

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8- (38.64%), -8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses -8 and 8- are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000.

Surgical treatment of pathologic fractures in patients with metastatic tumors.

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with significant improvement of physical activity and rehabilitation in the investigated group.

The treatment options of dens invaginatus complications in children: report of 3 cases.

PURPOSE: The authors described 3 cases of dens invaginatus accompanied by different periapical complications in children, as well as the therapy methods they used. METHODS: The 3 children were between the ages of 12 and 16 years. The type of dens invaginatus was classified according to Schulze and Brand. RESULTS: All 3 cases had dens invaginatus on their permanent teeth in the maxilla. The complications occurred while the teeth were growing, and they were accompanied by swelling in the region of the dens invaginatus. CONCLUSIONS: The periapical complications required early diagnostic and endodontic treatment to prevent further difficulties at a later stage.