EFFICIENCY OF CHELATING IRRIGATION AGENTS FOR REMOVING A LUBRICATED DENTIN LAYER OF ROOT CANAL.

The study is aimed at investigating the smear layer, formed on the walls of dental root canals as a result of endodontic treatment, by using scanning electron microscope (SEM) and determining its removal and/or modification quality after applying water solution of 18% ethylenediaminetetraacetic acid (EDTA) and gel. 50 extracted teeth preliminary prepared using Step-Back technique has been studied. Experimental teeth were randomly divided into the following 3 groups: control group (20 teeth), study group I (15 teeth) and study group II (15 teeth), respectively, irrigated by water solution of 18% ethylenediaminetetraacetic acid (EDTA). SEM examination was carried out for 3 different areas of preliminary prepared separated dental roots: coronal, middle and apical portions. The entire study was based on the analysis of 900 electron microscope photo- images. SEM study revealed formation of the thick smear layer on the surface of root canal dentin, practically covering the openings of canal tubules. Both the water solution and/or gel of 18% ethylenediaminetetraacetic acid provided partial or complete removal of the mentioned smear layer; among them, EDTA 18% water solution appeared to be more effective for coronal and middle thirds of dental root (P<0.05). Removal of the smear layer from root canals by using the chelating agents was less effective in the apical third. Having studied these areas, the portions covered with the smear layer and blocked dentinal tubules on canal surfaces were revealed.

TEETH IMPACTION: CHALLENGES AND SOLUTIONS.

The aim of the study was investigation of statistics of impaction and semi-impaction in permanent dentition in the population of Georgia, revealing the correlation and feedback of expressed adentia and retention in different groups of teeth. Study was also aimed to determine any regularity in reduction of tooth number of the skeleto-dental system. To comply with this goal, 1000 panoramic images of patients, from 12 to 35 years of age 651 women and 349 men have been examined. In our study cases 1 and 3 were similar. In both situations possible cause of impaction was dental crowding and space deficiency. Similarities were found in facial features as well. Case 1 (N. J.) - NLA (nasolabial angle) was obtuse and patient had prominent chin. E-Line to lower lip was (-5) mm. Therefore tooth extraction could cause adverse esthetic outcome. Case 2 (N.G.) - patient had class I dental and skeletal malocclusion and tendency towards vertical growth (Sn-GoGn- 34°, FMA- 31°). Maxillary right canine was horizontally impacted and was located close to the nasal cavity. Technically it was very difficult to expose canine surgically and put it orthodontically into the dental arch. Deciduous canine was extracted, space was closed and missing canine was substituted with first bicuspid. We ended treatment with right side in functional class II malocclusion and left side in class I molar and canine relationship. Case 3 (N.S.) - Sn-GoGn angle was 28° and FMA -22° -patient had Low Mandibular Plane angle, square Gonial angle and tendency towards "horizontal facial growth". In both cases treatment was without tooth extraction. Spaces were created for retained teeth and facial esthetics was improved. In some cases, the restorative approach can be considered as an alternative to orthodontic treatment. Improvement of facial aesthetics, taking into consideration individual cases and approaches, can be achieved by aesthetic restoration. Despite the considerable number of cases reported in the literature, to find guideline of proper outcome of treatment therapy of abovementioned abnormalities is difficult. That's why, the aesthetic rehabilitation has been suggested, to depend upon the patient's desires, but at the same time, avoid treatment plans with aggressive management.

ANATOMO-MORPHOLOGICAL FEUTURES OF THE ROOT CANAL SYSTEM IN GEORGIAN POPULATION - CONE-BEAM COMPUTED TOMOGRAPHY STUDY.

Incomplete and superficial knowledge of morphological types and anatomical variations of the root canal system will become the reason leading to the failure of endodontic treatment. cone-beam computed tomography (CBCT) - it is a technologically more sophisticated, interesting, reliable, non-invasive imaging technique with high degree of visualization, considered as a particularly important and useful tool to study complexity and variability of canal system. 2753 teeth of 228 patients have been studied by CT. Ages of the patients varied within 25-55 years. Among them 122 men and 106 women. Maxillary teeth - 1394 and mandibular - 1359, respectively. The aim of our study was investigation and evaluation of: tooth length, number of roots and canals, type of configuration, root canal curvature and degree of curvature in Georgian population. The results of the study revealed interesting data and anatomical characteristics, those replicating the racial signs and differs from the data recorded by the other researchers, became evident. In studying of dental form variations were interested anatomists (description and comparison) anthropologists, biologists, palaeontologists and stomatologists. The field of human dental anatomy has not been completely explored so, the modern human teeth still remain a matter of continual curiosity and research. The knowledge of anatomical characteristics of dental root canals will help clinicians to optimize the algorithm of endodontic treatment. Thus, statistic data are not the universal criterias, however, basing on these indicators anthropometrical data of roots and canals vary according to the geographic zones and nationalities. The study of variations in tooth form has interested anatomists (description and comparison), anthropologists, biologists, palaeontologists and dentists. The field of human dental anatomy has not been completely explored and the dentition of modern man still remains a matter of continual curiosity and research. Thus, statistic data are not the universal criterias, however, basing on these indicators anthropometrical data of roots and canals vary according to the geographic zones and nationalities. The study of variations in tooth form has interested anatomists (description and comparison), anthropologists, biologists, palaeontologists and dentists. The field of human dental anatomy has not been completely explored and the dentition of modern man still remains a matter of continual curiosity and research.

The maxillary second molar - anatomical variations (case report).

To be acquainted with dental anatomical specificity is of great importance for dental endodontic treatment algorithm. The subject of present publication is 2 clinical cases of upper second molars, detailed characterization of, which is considered very important for enrichment of anatomical knowledge about dental anatomical variations. In one case, the reason for admission to the clinic of a 38-year-old woman was complains as of esthetic character as well as functional misbalance (disturbance of chewing function due to the damage of orthopedic construction). The patient indicated to the existence of coronary defects of large size aesthetic discomforts, damage and discolouration of old orthopedic construction (denture) in maxillary right molar area. According to the data obtained after clinical and visiographical examinations, chronic periodontitis of 17 teeth was identified as a result of incomplete endodontic treatment. According to the data obtained after clinical and visiographical examinations, the diagnosis of chronic periodontitis of 17 teeth was identified, tooth 17 with 2 roots and 2 canals. In the second clinical case, the reason for admission to the clinic of a 39-year-old woman was severe pain in the upper right molar area. The patient indicated to the caries on the tooth 17. After completion of proper survey clinical and visiographical examinations, acute pulpitis (K04.00) - with three roots and 4 canals was diagnosed. In both cases after the proper examinations and agreement with the patients a treatment plan envisaging: 17 teeth endodontic treatment, filling of caries defects and their preparation on one hand for orthopedic construction (denture) and on the other hand for restoration of anatomical integrity by light-cured composite, was scheduled. The present study is designed to prevent complications of endodontic treatment of the second molar, to optimize diagnosis and treatment algorithm, once again proving reliable information indicating to the individuality of treatment tactics.

[Root and canal morphology of maxillary first premolar in Georgian population].

Almost each stage of endodontic treatment is connected with structural peculiarities of teeth. One of the biggest challenges facing clinicians is profound knowledge of root canal systems which is different in various races and ethnic groups. This study is devoted to the investigation of anatomo-morphological peculiarities of maxillary first premolar in Georgian population. The purpose of our work is to study anatomo-morphological and anthropological data of permanent teeth among Georgian population, establish average statistical indices of tooth length, peculiarities of "canals system", make correlation of the obtained results with international statistical indices. The data obtained as a result of clinical and laboratory studies must be assumed as a basis for making new tables of anatomo-morphological statistical indices of teeth roots and canals for Georgian population. Statistical index by itself is not a universal criterion because anthropometric data of roots and canals according to nationality and geographical zones are subjected to variations. The investigation done by us is a visible example of this.

Gemination or fusion? - challenge for dental practitioners (case study).

Gemination and fusion are anomalies in size, shape and structure of teeth. Gemination more frequently affects the primary teeth, but it may occur in permanent dentitions, usually in the incisor region. Geminated teeth are typically disfigured in appearance due to irregularities of the enamel. Fused teeth can have separated pulpal space, one pulp chamber and two canals or take the form of a large bifid crown with one pulpal space. It is hard to differentiate between fusion and gemination, especially if the supernumerary tooth bud is fused with the adjacent one. Usually, fusion may be differentiated from germination by a reduced number of teeth. An exception is in the unusual case in which the fusion is between a supernumerary tooth and normal tooth. A 20-year-old male referred to us at - "UniDent" - Dental Clinic, Training and Research Center. The patient complained about the large, unusual maxillary central incisors, lip irritation and aesthetic problems. According clinical examination and radiological findings, clinical diagnose was - bilateral germination of central incisors. Several treatment methods have been described in the literature with respect to the different types and morphological variations of fused and geminated teeth, including endodontic, direct\indirect restorative, surgical, periodontal and/or orthodontic treatment. Our patient has demanded for better aesthetics and he choose the treatment option to make two separate PFM crowns. In the beginning of treatment, the length of tooth 11 was 9.5mm, after prosthodontic treatment it has become 11.5mm. For tooth 21, it was 9.9 millimeter and became - 10.8 mm, while the primary width of right central incisor appeared 13.2 millimeter and was narrowed until 10.8 mm. 12.8 mm was the - width of left central incisor, which finally became - 10.4 mm. Despite the considerable number of cases reported in the literature, the differential diagnosis between these abnormalities is very difficult, as well as, to find guideline of proper outcome of treatment therapy of abovementioned abnormalities. That's why, the aesthetic rehabilitation of doubled teeth, has been suggested, to depend upon the patient's desires, but at the same time, avoid treatment plans with aggressive management.

Peculiarities of the anatomo-morphological parameters of teeth and root canals in permanent dentition in Georgian population.

One of the main reasons that cause the failure of endodontic treatment is the lack of knowledge of complex anatomy of the tooth cavity. Numerous studies over the years have established a complex structure of the tooth root system, a particular configuration of which determines the uniqueness of each tooth.Numerous researches have laid the foundation for anatomical and morphological peculiarities of root system of the tooth, their classification and nomenclature indices. The anatomical picture of the tooth, its shape, root length - the "norms" have been established in the course of years. Statistical indices do not represent universal criteria due to the fact that anthropometric data are subjected to variations in accordance with national and geographic zones. The aim of our study is to establish anatomo-morphological peculiarities of the groups of teeth, roots and canals in Georgian population and to develop statistically reliable indicators on the basis of anthropological and clinical data. The obtained data will help to improve the effective endodontic treatment and avoid complications after obturation.

Articaine - the best choice of local anesthetic in contemporary dentistry.

Local anesthesia forms the foundation of pain control techniques in clinical dentistry. Within the rich local anesthetic drugs available in dentistry for the prevention and management of pain 4% articaine solutions achieve highest level of anesthetic potency and lowest systemic toxicity in all clinical situations, prior to its superlative physicochemical characteristics and the pharmacological profile. These are - low lipid solubility, high plasma protein binding rate, fast metabolization, fast elimination half time; low blood level. Articaine inactivates in both ways: in the liver and the blood serum. It has good spreading through tissues. Thus, articaine seems to be the local anesthetic of first choice in tissues with suppurative inflammation, for adults, children (over 4), elderly, pregnant women, breastfeeding women, patients suffering from hepatic disorders and renal function impairment. In Articaine solutions (1: 200,000) epinephrine is in low concentration, thus in patients at high risk adverse responses are maximally decreased. In these patients articaine should be used with careful consideration of risk/benefit ratio. Articaine solutions must not be used in persons who are allergic or hypersensitive to sulphite, due to content of Sodium metabisulfite as vasoconstrictor's antioxidant in it. Incidence of serious adverse effects related to dental anesthesia with articaine is very low. Toxic reactions are usually due to an inadvertent intravascular injection or use of excessive dose. To avoid overdoses maximum recommendation dose (MRD) must not be exceeded and aspiration test always performed prior all LA injections. In these article we introduce new graphs providing a quick and effect way to determine maximum LA dose. If the overdose reactions develop, adherence to the basic step of emergency management with end to a successful outcome in virtually all cases.

[Polymer films of antiviral preparation Rodopes for dental practice].

There was created new medical form of antiviral reparation Rodopes that surpassed previous forms - Rodopes adhesive ointment and Rodopes ointment - and also traditional preparations Zovirax and Interferon with its increased therapeutic effectiveness. Rodopes polymer films are much more comfortable way of clinical usage and can be successfully and widely used in stomatological practice.

[Functional morphology of adrenal cortex in aging rat under the influence of barocameral hypoxia].

The aim of the study was the assessment of adrenocorticocytes morphology in aging rat under the influence of hypobaric hypoxia. Adrenocorticocytes samples were collected from 11-18 months age 15 albino males under chronic hypobaric hypoxia of 60 days duration. The exposure time was 2 hours, pO2 was decreasing till 364-372 mm Hg. Histology, histochemistry and electronmicroscopic techniques were used to assess the weight and thickness of adrenal cortex. Remarkable fibrosis, decreasing of weight (14%) and thickness of zone glomerulosa (37%) and z. fasciculata (24%) were detected. Involution of cells and cellular organelles (lipid droplets), activation of scavenger cells and secondary lysosomes play a crucial role in secretory function depletion of glandular cells. There were revealed the giant mitochondria in Z. glomerulosa glandular cells. Morphological analysis have shown the involutive influence of hypoxia on the adrenal cortex conditioned by age.

[Changes of adrenal cortex structure in young rats under the single influence of hypobaric hypoxia].

Histo- and ultrastructure investigation of adrenal cortex in young animals after the single administration of hypobaric hypoxia has been carried out. Hypobaric hypoxia was modeled in ventilated barocamera with pO(2) decreasing till 364-372 mm Hg on the 15 albino male rats 51-120 days of age and 90-120 gr of body mass. Duration of the experiment was 4+/-1 hours. The animals of the control group were placed in normobaric conditions for the same time. Adrenocorticocytes of z. fasciculate are more sensible to oxygen insufficiency. Hyperchromocitous and shrinking of nucle-decrease of lipids, mitochondrion swelling and diffuse cells edema are presented. Myelin like transformation of lipids drops are remarkable. Hypobaric hypoxia is a severe stress-factor, which induces remarkable structure failure in adrenal cortex, especially in z. facsiculata.