Regeneration of Buccal Wall Defects after Tooth Extraction with Biphasic Calcium Phosphate in Injectable Form vs. Bovine Xenograft: A Randomized Controlled Clinical Trial.

Bone healing after tooth extraction may be affected by defects of the alveolus buccal wall, such as fenestrations and dehiscences. Therefore, to minimize dimensional changes it is advisable to perform alveolar ridge preservation after tooth extractions. Different biomaterials are used for this purpose. The aim of this study was to investigate the qualitative and quantitative histological changes in human biopsies taken after 6 months of healing of extraction sockets with buccal wall defects. For this purpose, the defects of 36 patients (18 per group) were treated with injectable biphasic calcium phosphate (I-BCP) or bovine xenograft (BX) after extraction. After six months of healing, biopsies were taken and proceeded to the histology laboratory. No evidence of an inflammatory response of the tissue was observed in the biopsies of either group, and the newly formed bone (NB) was in close contact with the remaining biomaterial (BM). The histomorphometric results showed that there was no statistically significant difference between the groups in the mean percentage of NB (p = 0.854), BM (p = 0.129), and soft tissue (p = 0.094). To conclude, both biomaterials exhibited osteoconductivity and biocompatibility and achieved satisfactory bone regeneration of buccal wall defects after tooth extraction.

A Histologic, Histomorphometric, and Immunohistochemical Evaluation of Anorganic Bovine Bone and Injectable Biphasic Calcium Phosphate in Humans: A Randomized Clinical Trial.

Following trauma, chronic periapical process, or tooth extraction, a large loss of bone volume is noticed during the healing process. To facilitate the placement of dental implants, various surgical procedures are used for an optimal alveolar ridge profile, while maintaining adequate bone dimensions. The main aim of this study was to determine the healing ability (histologically and immunohistologically) of alveolar bone defects during augmentation with two different biomaterials: injectable biphasic calcium phosphate (BCP) and anorganic bovine bone (ABB). Thirty-eight subjects were randomly divided into two groups. The first group received the tested bone substitute biomaterial (BSB), i.e., BCP (maxresorb inject®), and the second group received an alternative to the gold standard, i.e., ABB (Bio-Oss®). The histopathological, histomorphometric, and immunohistochemical analyses gave comparable results for these bone substitute materials in terms of newly formed bone: (BCP: 39.91 ± 8.49%, ABB: 41.73 ± 13.99%), residual biomaterial (BCP: 28.61 ± 11.38%, ABB: 31.72 ± 15.52%), and soft tissue (BCP: 31.49 ± 11.09%, ABB: 26.54 ± 7.25%), with no significant difference found between the groups (p < 0.05, t-test), proving that BCP is equally suitable and successful for alveolar bone regeneration.

Lateral orbital wall reconstruction after basal cell carcinoma penetration-Case report.

Advanced periorbital basal cell carcinomas may necessitate orbital exenteration and consequent vision loss, which significantly reduces patients' life quality. Orbital reconstruction is a demanding surgical procedure due to the complex orbital anatomy and vital structures located in the orbit. In this report, we presented an 83-year-old patient with advanced basal cell carcinoma that had expanded into the orbit. An orbitotomy was performed to remove the tumor completely while preserving the eye function. Orbital reconstruction was performed by a standard surgical method using a titanium mesh modeled according to a natural phantom skull. This maintained the eye function and achieved satisfactory facial esthetics.

Comparison of Injectable Biphasic Calcium Phosphate and a Bovine Xenograft in Socket Preservation: Qualitative and Quantitative Histologic Study in Humans.

This study is the first histologic evaluation of an injectable biphasic calcium phosphate (IBCP) in humans six months after socket preservation according to the principles of guided bone regeneration. After tooth extraction, the alveolar ridge of 21 patients was augmented with IBCP (maxresorb® inject) in the test group, while 20 patients in the control group received a bovine xenograft (BX) (cerabone®). Six months after augmentation, a reentry procedure was performed to collect biopsies of regenerated bone for qualitative and quantitative histologic analysis. A total of 20 biopsies were taken for analysis. Qualitative histologic analysis showed complete integration of the biomaterial and no inflammatory tissue reaction, indicating the biocompatibility of the bone grafts and the surrounding tissue in both groups. Histomorphometric analysis showed comparable results in terms of newly formed bone (IBCP: 26.47 ± 14.71%, BX: 30.47 ± 16.39%) and residual biomaterial (IBCP: 13.1 ± 14.07%, BX: 17.89 ± 11.81%), with no significant difference found across groups (p > 0.05, Mann­Whitney U test). Statistical significance between groups was found in the result of soft tissue percentage (IBCP: 60.43 ± 12.73%, BX: 51.64 ± 14.63%, p = 0.046, Mann­Whitney U test). To conclude, IBCP and BX showed good osteoconductivity and biocompatibility with comparable new bone formation six months after alveolar ridge preservation.

Orthodontic treatment demand in young adolescents - Are parents familiar with their children's desires and reasons?

AIM: To assess the levels of agreement between parents and adolescents about young adolescents' orthodontic treatment demand and to what extent is treatment demand conditioned by family and psychosocial impacts and oral function. DESIGN: This cross-sectional study included 221 adolescents (11-14 years, 54% female) and their parents. A 5-point scale was used to assess orthodontic treatment demand. Adolescents self-administered the Child Perceptions Questionnaire, and parents self-administered the Parental-Caregivers Perceptions Questionnaire and Family Impact Scale. The Index of Orthodontic Treatment Need Dental Health Component (IOTN DHC) was used for determining malocclusion severity. Intraclass correlation coefficient and Cohen's kappa coefficient were used for the assessment of agreement between two informants. RESULTS: The parent-child agreement on children's orthodontic treatment demand was weak, concording in 67.4% of cases. The most common reasons for seeking orthodontic treatment derive from the emotional (EW) and social well-being domains for both informants. In linear regression, the adolescent's reporting of impaired EW and IOTN DHC was the only significant linear predictor of orthodontic treatment demand. CONCLUSION: Parents cannot correctly assess the orthodontic treatment demand of their children. Impaired EW is the most significant self-reported determinant of adolescents' demand for orthodontic treatment. Family relationships and parental perspective have a low influence.

Synthetic Injectable Biomaterials for Alveolar Bone Regeneration in Animal and Human Studies.

After tooth extraction, the alveolar ridge undergoes dimensional changes. Different bone regeneration biomaterials are used to reduce bone loss. The aim of this article was to systematically review the literature on the effect of injectable synthetic biomaterials and their advantages and disadvantages for new bone formation in the maxilla and mandible in animals and humans. A literature search was conducted in November 2020 via MEDLINE PubMed, Cochrane, and Embase. Of the 501 records screened, abstract analysis was performed on 49 articles, resulting in 21 studies that met the inclusion criteria. Animal studies have shown heterogeneity in terms of animal models, follow-up time, composition of the injectable biomaterial, and different outcome variables such as bone-implant contact, newly formed bone, and peri-implant bone density. Heterogeneity has also been demonstrated by human studies. The following outcomes were observed: newly formed bone, connective tissue, residual injectable bone graft substitute, radiographic density, residual bone height, and different follow-up periods. Further studies, especially in humans, based on the histological and biomechanical properties of the injectable delivery form, are needed to draw more concrete conclusions that will contribute to a better understanding of the benefits of this type of biomaterials and their role in bone regeneration.

Oral Health of Children from the SOS Children's Village in Croatia.

The aim of this study was to determine the values of DMFT/DMFS and dft/dfs in the examined groups of children and the assessment of the mothers of the examined groups of children related to the oral health of their children. The research included children from the SOS Children's Village in Croatia as well as children from biological families from rural and urban areas. The children were examined by the visual-tactile method according to the standardized World Health Organization criteria. dft/DMFT and dfs/DMFS indices were calculated. An analysis of completed questionnaires was made. The children from the SOS Children's Village demonstrated the lowest mean values of the dft/dfs (2.42/3.31) and DMFT/DMFS (1.61/2.23) indices compared to children from rural and urban areas. The Kruskal-Wallis test showed a significant difference (p = 0.01) in SiC index values between the examined children. In the groups of children from the SOS Children's Village and from the rural area compared to the children from the urban area, oral hygiene was singled out as the most important factor in the analysis of the main components. An equally significant factor for all the respondents is the assessment of oral health and eating habits. The least significant factor for the group of children from the SOS Children's Village is socio-economic status, which is the most significant for the children from the urban area. The children from the SOS Children's village have the lowest dft/DMFT, dfs/DMFS, and SiC indices. The most important factor influencing oral health in the group of children from the SOS Children's Village that stands out is oral hygiene, and the least important is the socio-economic status. The assessment of oral health by the SOS mothers does not differ from the assessment of biological mothers of children from rural and urban areas.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education.

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The "I do not know" answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

Prevalence of Molar-Incisor Hypomineralization and Caries in Eight-Year-Old Children in Croatia.

The aim of this study was to detect molar-incisor hypomineralization (MIH) and caries prevalence in eight-year-old children with early mixed dentition in Eastern Croatia. There is a lack of data on MIH in Croatia. There were 729 children examined in total: 356 (48.83%) were female and 373 (51.16%) were male. The presence of MIH was found in 95 children, the prevalence of MIH was 13%, and the remaining 634 (87%) did not have any changes associated with MIH. The prevalence of caries overall in the population of examined children was 11.48%. In the group of children with MIH, the prevalence of caries was 24.14%, while in the group of children with no MIH, the prevalence of caries was 11.18%. Teeth had a Decayed, Missing, and Filled Teeth (DMFT) index of 1.2, the value of the SiC index was 1.4, and the decayed, missing, and filled teeth (dmft) index for deciduous teeth was 5.8. Children with MIH had a caries index of DMFT 2.1, and the value of the SiC index was 2.6. The index of caries for non-MIH children was DMFT 1.1 and the SiC index was 1.2. MIH prevalence in Croatia is more common in girls than in boys. MIH has a significant impact on children's development and is a major factor in the occurrence of caries.

Histological and Radiological Features of a Four-Phase Injectable Synthetic Bone Graft in Guided Bone Regeneration: A Case Report.

BACKGROUND AND OBJECTIVE: Injectable synthetic bone grafts (ISBG) are widely used biomaterials for regeneration purposes. The aim of this case report was to examine the efficacy of ISBG in the management of buccal fenestration in the case of a 25-year-old female. CASE REPORT: After a traumatic tooth extraction, the defect was filled with ISBG and covered with a resorbable membrane. The ISBG showed easy handling and the patient had no complications during healing. Six months after augmentation, a bone biopsy was taken during implant bed preparation. The histological results showed good integration of ISBG into the newly formed bone and no signs of tissue inflammation. Additionally, a CBCT (cone beam computed tomography) analysis was performed to support the histological results. CONCLUSION: The use of the examined ISBG led to successful treatment of the buccal fenestration defect.

The Efficacy of Low-Level Laser Therapy in Burning Mouth Syndrome - A Pilot Study.

The aim of this clinical study was to compare low-level laser therapy (LLLT) switched on and switched off in the treatment of burning mouth syndrome (BMS). BMS is a debilitating condition for patients and highly demanding for physicians, characterized by burning symptoms in the oral cavity. Despite extensive research, so far only cognitive behavioral therapy and clonazepam have been proven successful for its treatment in randomized controlled trials. Forty-four patients with BMS were randomly assigned to the study laser group (LLLT) or the sham laser group. LLLT was performed with the GaAlAs laser (830 nm) used in non-contact mode on the site in the mouth where burning symptoms were present; study patients received 10 sessions (10 days). Each participant filled out the visual analog scale (VAS) and oral health impact on the quality of life scale (OHIP-CRO 14) before and after either therapy protocol. There were no significant differences between the groups before and after LLLT (switched on and off) in the quality of life (OHIP CRO 14 scores) (p>0.05). There was significant decrease in pain symptoms (VAS) in both LLLT switched on and LLLT switched off groups (p <0.05). Both LLLT switched on and switched off decreased pain symptoms (VAS) in patients with BMS; however, neither LLLT switched off or switched on im-proved the OHIP-CRO 14 scores.

Anxiety and Depression Scores in Patients with Burning Mouth Syndrome.

BACKGROUND: Burning mouth syndrome is a condition of unknown etiology, characterized by burning symptoms on the otherwise clinically healthy oral mucosa. Central and/or peripheral neuropathy is one of the proposed causes for this condition. Psychological component in these patients is also very present, as it is known that BMS patients exhibit high levels of pain, anxiety, and depression. The aim of this study was to evaluate anxiety and depression among patients with burning mouth syndrome and a control group. We also further review and discuss the literature available on this subject. SUBJECTS AND METHODS: A total of 93 subjects, divided into two groups, participated in this study. The group of patients with BMS included 43 participants, while the control group consisted of 50 participants. Self-reported STAI (State anxiety and Trait anxiety) and BDI questionnaires were used to evaluate anxiety and depression in subjects in both groups. RESULTS: BMS group had higher average total scores of state anxiety, trait anxiety and depression. The difference between the BMS group and control group was statistically significant for state anxiety scores and BDI scores. CONCLUSION: We might conclude that BMS patients are more anxious (state) and depressed when compared with the control group. However, they do not differ from the control group regarding anxiety as a trait. Thus we might conclude that feeling of anxiety in general starts after the BMS symptoms first occur and last for a longer period of time.

Assessment of Oro-Maxillofacial Trauma According to Gender, Age, Cause and Type of the Injury.

OBJECTIVES: The occurrence and causes of maxillofacial trauma varies in different regions of the world. The aim of this study was to identify the occurrence, types and causes of maxillofacial injuries according to the age and gender differences in patients treated at the Department of Maxillofacial Surgery, University Hospital Center Osijek, between January 2011 and December 2013. MATERIALS AND METHODS: A total of 64 patients, 41 males (64.1%) and 23 females (35.9%), aged from 18 to 86 years (mean age 42) participated in the study. Data collected and analyzed included gender, age, cause of injury and the type of maxillofacial injuries. RESULTS: The most common cause of injuries in both gender groups was falling down (39% males; 65% females). The second leading cause of injuries in males was interpersonal violence (29%) and in females traffic accident (26%) (p<0.05). The most common type of injury in both gender groups was bone injury (50%; in males zygomatic bones 55%, in females mandible 40%) (p>0.05). The most common causes of injuries in the youngest patients was violence (43%), and in others fall (50-70%; p<0.05). The most common reported type of injury in all age groups was bone injury (more than 50%; p>0.05). The majority of the falls and violence caused bone tissue injuries, and soft tissue and dentalveolar injuries were detected in traffic and sports accidents (p>0.05). CONCLUSION: Falling down was the most common cause of oro-maxillofacial injuries in both men and women and in all three age groups. The leading type of injury was bone injury. The data obtained from this study provide important information for future prevention from injuries.

Determining the quality of life after removing of impacted lower wisdom tooth using the principal component analysis method.

The main objective of this study was to determine to what extent a detailed oral instruction about treatment after surgical removal of a lower wisdom tooth affects postoperative quality of life (QoL). The research on QoL after removal of a lower wisdom tooth was conducted with 108 patients. Depending on the type of information given to each respondent individually, the examinees were divided into two groups: a test group which was given detailed written and oral instructions, and a control group which received only written instructions about treatment after the surgery. In this research the QoL was examined using modified Oral Health Impact Profile-14 (OHIP-14) criterion four, seven and thirty days after the operation depending on the type of information previously provided to the respondents. In order to reduce the dimensionality of the obtained data sets, as well as in order to explain the relationship between the examined variables that are interrelated the principal component analysis (PCA) was applied. Both groups expressed satisfaction with the postoperative period for the individual variables investigated in modified OHIP-14 questionnaire, with the intensity and the order of the major components of satisfaction determined by the PCA differing between the two groups of the patients. On the fourth postoperative day, the test group expressed the highest level of satisfaction with sleep, physical appearance and the ability to eat. In the later postoperative period the test group (on the seventh and thirtieth day) had the highest level of satisfaction with the absence of discomfort during removal of sutures, satisfaction with performed treatment, and the ability to eat. Detailed preoperative oral instructions to patients can significantly improve the quality of life after operative removal of a lower wisdom tooth.

The influence of surgical experience, type of instructions given to patients and patient sex on postoperative pain intensity following lower wisdom tooth surgery.

The aim of this study was to determine the extent to which the intensity of postoperative pain in the first seven days after lower wisdom tooth extraction is affected by operator experience, patient level of information and patient sex. Postoperative pain intensity after lower wisdom tooth extraction was assessed in 108 patients. Depending on the type of information given to each patient individually, the patients were divided into two groups: test group in which patients were provided with detailed standard written and verbal instructions and control group where patients only received detailed standard written instructions about treatment after surgery. Each of these two groups was divided into three subgroups depending on operator experience. Results of this study showed that the type of information irrespective of being given verbally or not had no effects on postoperative pain intensity, whereas operator experience and patient sex influenced postoperative pain intensity.

The effectiveness of the therapeutic ultrasound on the psycho-physiological functioning in patients who presented with neck pain.

The aim of this study was to investigate the effectiveness of the therapeutic ultrasound on the psycho-physiological functioning in patients who presented with neck pain. There is a limited number of scientific studies which provide information on clinical effectiveness of the therapeutic ultrasound and its effect on the psycho-physiological functions. The present study investigated 100 patients (average age 55), 69 females and 31 males, who presented with neck pain. Treatment protocol consisted of 15 treatments spread over three weeks (five treatments per week). Patients were separated into the two groups (test and control). Both groups of patients undertook programed isometric exercises specific for the cervical spine as well as transcutaneous electrical stimulation. The test group received continuous therapeutic ultrasound on the neck five times a day with the intensity of 0.5 w/cm2, while in the control group ultrasound machine was switched off during the therapy. It has been found that programed isometric exercises specific for the cervical spine in combination with transcutaneous electrical nerve stimulation (TENS) had the same therapeutic effect on the psycho-physiological functioning as the combination of these two therapies with the therapeutic ultrasound.

Does body mass index and position of impacted lower third molar affect the postoperative pain intensity?

The main objective of this study was to determine to which extent body mass index and position of impacted lower third molar was affecting the pain intensity in the first seven postoperative days. The study was conducted following the extraction of the lower third molar in 108 patients. Depending on the type of information given to each particular patient, the patients were divided in two groups: the test group where patients were given detailed standard written and verbal instructions and the control group which received only standard written instructions about treatment after surgery. Using canonical discriminant analysis we investigated the influence of body mass index and the position of impacted lower third molar on postoperative pain intensity in two groups of patients. Results of this study showed that the body mass index or the tooth position did not have influence on intensity of postoperative pain. The body mass index and the position of impacted lower third molar do not affect the postoperative pain intensity.

Posttraumatic subperiosteal orbital hematoma.

BACKGROUND: Subperiosteal orbital hematoma (SOH) is a rare finding after midface trauma, causing compartment syndrome within the orbit. It should be consideration in the differential diagnosis of any case of proptosis and vertical globe displacement. PATIENTS: We present two patients with SOH treated by surgical evacuation and drainage. RESULTS: In both the hematomas resolved completely and uneventfully. CONCLUSION: Being a safe and simple method, surgical decompression combined with drainage enables complete evacuation of the blood clot and prevents possible sequelae. This method should be considered even in cases without significant visual impairment.

The importance of thorough preoperative diagnostics of maxillary ameloblastoma: report of three cases.

Ameloblastoma, especially maxillary, is a rare benign neoplasm of odontogenic origin. Diagnosis of significant number of lesions is usually established postoperatively, because ameloblastoma, especially the unicystic form, mimics wide range of more frequent jaw lesions. From January 1993 to December 2005, three cases of the maxillary ameloblastoma were surgically treated at our Department. The authors present clinical, radiological and pathohistological features of the ameloblastomas in this rare localization with special attention to need of accurate preoperative diagnostics.

An overview of coagulation disorders in cancer patients.

A diversity of coagulation disorders in cancer patients arise from tumor-specific growth characteristics, neoangiogenesis with impaired endothelial lining, defective myelopoiesis, hypoproteinemia or metastatic lesions growth with organ dysfunction. Recent investigations have found a clinically relevant correlation of coagulation disorders and tumor growth. These prompted new therapeutic strategies focused on growth factors with the aim to control tumor metastasis, particularly if used for the treatment of micrometastatic disease. However, such treatment may lead to the life threatening coagulation imbalance. A coagulation homeostasis may become further impaired after nonsurgical cancer therapy, especially after preoperative irradiation, which produces lesions precipitating both bleeding and thrombosis. Anticancer chemotherapy may affect liver function and decrease the synthesis of both procoagulation and anticoagulation factors. The most of chemotherapeutic protocols affect platelet synthesis, which arises as a principal dose-limiting side effect. It was observed both during combined systemic chemotherapy and local antitumor therapy. Although the side effects produced by chemotherapy are reversible, endothelial lesions may persist for many years after the anticancer treatment. Instead of cancer patients, there's a growing cohort of patients with nonmalignant diseases who use cytostatics in the perioperative period, and are candidates for surgical procedures not related to their malignant disease, i.e. hernia repair. In this patient population a special attention must be paid to the preoperative evaluation of coagulation status and thromboprophylaxis. This overview reminds the most common coagulation disorders in cancer patients in the perioperative period. It emphasizes the need for proper patient monitoring which may facilitate the diagnostics and treatment of cancer-related coagulation disorders in the perioperative setting.