Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: a 6-week split-mouth clinical study.

BACKGROUND/AIM: Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. METHODS: Following the split-mouth design, self-tapping implants n = 44) were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group), while the other side was placebo (control group). For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs) laser (Medicolaser 637, Technoline, Belgrade, Serbia) with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm2 per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP) activity and early implant success rate. The follow-up took 6 weeks. RESULTS: Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030). The difference in ALP activity between the groups was insignificant in any observation point (paired t-test, p > 0.05). The early implant success rate was 100%, regardless of LLLT usage. CONCLUSION: LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of self-tapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.

[Juvenile Sjögren's syndrome: case report].

INTRODUCTION: Sjögren's syndrome (SS) is an autoimmune disease of unknown etiology, clinically manifested by dry eyes (xerophthalmia) and dry mouth (xerostomia). In childhood SS is a rare disease, clinically atypically or asymptomatic and is often unrecognized. We report a girl with asymptomatic, juvenile form of primary Sjögren's syndrome (JSS). CASE OUTLINE: A 13-year-old girl was initially observed for several months due to elevated sedimentation rate (ESR 75-90 mm/h) without signs of inflammation or other symptoms and disease signs. Subjective symptoms of dryness of the eyes and mouth were absent at the beginning. Ophthalmologic examination demonstrated hypolacrimia although the patients had no subjective signs of xerophthalmia. Ultrasonography (US) revealed mild enlargement and heterogeneity of large salivary glands parenchyma. Increased rheumatoid factor (RF), anti SS-A/Ro, anti SS-B/La antibodies were found in serum. Ophthalmologic examination demonstrated decreased lacrimation.JSS was confirmed on the basis of ophthalmologic examination, immunological tests, histological findings of biopsy of small and US of major salivary glands. During a 12-years follow-up period systemic or extraglandular manifestations of JSS and other autoimmune diseases were not observed. CONCLUSION: Our experience suggests that in the differential diagnosis of unexplained elevated ESR the primary form of JSS should be also taken into consideration. Ultrasonographic changes of major salivary glands in the absence of symptoms of xerostomia point out that this noninvasive method has an important role in the diagnosis and management of patients with JSS.

[Oral lesions in patients with psychiatric disorders].

INTRODUCTION: Oral diseases in psychiatric patients are usually a result of bad oral hygiene and psychopharmaceutical side-effects. OBJECTIVE: The aim of this study was to detect oral lesions in patients hospitalized in psychiatric institutions with the confirmed diagnosis of psychiatric illness and mood disorder with psychotic characteristics, as well as to discover the factors that can influence these oral lesions. METHODS: Cross-section study consisted of 186 hospitalized patients with psychiatric disorders in the experimental group, out of whom 87 were males and 99 females. Patients were aged from 18 to 59 years, mean age 46.0 +/- 8.0 years. The control group consisted of 186 healthy persons matched for age and gender. Data on oral lesions were obtained within history and clinical examination of the oral cavity. Other medical data were collected from medical documentation. Statistical analysis was performed by Student's t-test, chi-square test and logistic regression. RESULTS: Dry mouth was registered in 78.5% of patients. The difference in tongue and lip lesions, burning and stinging symptoms, bruxism, facial pain, low saliva rates, halitosis, taste changes and swallowing difficulties between the patients and healthy persons was highly statistically significant (p < 0.001). Age and gender, as well as the factors of main disease, influence burning and stinging, bruxism, low saliva rates, swallowing difficulties, taste changes and facial pain of the psychiatric patients. CONCLUSION: Results imply that psychiatric patients are more frequently involved with oral lesions than healthy persons. It is necessary to organize specific preventive and educational oral health programmes with these patients, as well as with doctors who treat the basic illness.

[Health habits, attitudes and behaviour towards oral health of psychiatric patients].

INTRODUCTION: People with psychiatric disorders are at high risk of oral diseases due to the impact of their primary psychiatric condition and the side-effects of antipsychotic medications. OBJECTIVE: The aim of this study was to identify habits, attitudes and behaviour towards oral health of hospitalized psychiatric patients with psychotic disorders, including mood disorders with psychotic characteristics, as well as to identify factors that could influence those habits, attitudes and behaviour. METHODS: The experimental group consisted of 186 hospitalized patients with psychiatric disorders (87 males and 99 females), aged from 18 to 59 years (mean age 46.0-8.0 years). The control group consisted of 186 healthy persons matched for age and gender. Data were obtained by using specially designed questionnaires with questions about the subjects' social, economic and demographic characteristics, as well as their habits, attitudes and behaviour concerning their oral health, in a form of a standardized interview. Other medical data were collected from medical documentation of disease history. Statistical analysis was performed by Student's t-test, Chi-square test, ANOVA, Logistic Regression and simultaneous multiple regression. RESULTS: Psychiatric patients have worse habits, attitudes and behaviour concerning their oral health in comparison with healthy persons (p < 0.001): they wash their teeth more rarely and in a shorter time, have less knowledge of oral diseases and their effect on general health, and visit their dentist more rarely. The obtained results depend on social, economic and demographic characteristics and on the underlying illness of patients. CONCLUSION: Health educational work concerning oral health of patients should be included in psychiatric treatment, as a part of an existing therapy with the aim of improving the general quality of their life.