An experience with colistin applied in treatment of imunocompromised patients with peritonitis on peritoneal dialysis.

INTRODUCTION: Immunocompromised patients, such as those with multiple myeloma on peritoneal dialysis, are particularly susceptible to the occurrence of peritonitis. CASE REPORT: We presented a 56-year-old female patient with a 10-year history of multiple myeloma. The patient was on peritoneal dialysis since 2010. During 2012 the patient had the first episode of peritonitis that was successfully managed, but in 2013 the second episode of peritonitis occured. Analysis of dialysate culture and exit site swab revealed the presence of multiresistant Acinetobacter spp., which was susceptible only to colistin. Prompt colistin therapy was administered at the doses of 100,000 units/day during six days, which resulted in complete recovery of the patient, as well as improvement of local abdominal findings. Gram-negative bacteria (genus Acinetobacter) are common causative agents in hospital-acquired infections. Studies confirmed susceptibility of Acinetobacter to colistin, which was also the case with the presented patient. Intravenous administration of colistin resulted in a complete remission of this severe, life-threatening peritonitis. CONCLUSION: Patients with multiple myeloma and renal failure are highly prone to severe life-threatening infections.

Application of modern computer-aided technologies in the production of individual bone graft: A case report.

INTRODUCTION: An autologous bone (bone derived from the patient himself) is considered to be a "golden standard" in the treatment of bone defects and partial atrophic alveolar ridge. However, large defects and bone losses are difficult to restore in this manner, because extraction of large amounts of autologous tissue can cause donor-site problems. Alternatively, data from computed tomographic (CT) scan can be used to shape a precise 3D homologous bone block using a computer-aided design-computer-aided manufacturing (CAD-CAM) system. CASE REPORT: A 63-year old male patient referred to the Clinic of Dentistry of Vojvodina in Novi Sad, because of teeth loss in the right lateral region of the lower jaw. Clinical examination revealed a pronounced resorption of the residual ridge of the lower jaw in the aforementioned region, both horizontal and vertical. After clinical examination, the patient was referred for 3D cone beam (CB)CT scan that enables visualization of bony structures and accurate measurement of dimensions of the residual alveolar ridge. Considering the large extent of bone resorption, the required ridge augmentation was more than 3 mm in height and 2 mm in width along the length of some 2 cm, thus the use of granular material was excluded. After consulting prosthodontists and engineers from the Faculty of Technical Sciences in Novi Sad we decided to fabricate an individual (custom) bovine-derived bone graft designed according to the obtained-3D CBCT scan. CONCLUSION: Application of 3D CBCT images, computer-aided systems and software in manufacturing custom bone grafts represents the most recent method of guided bone regeneration. This method substantially reduces time of recovery and carries minimum risk of postoperative complications, yet the results fully satisfy the requirements of both the patient and the therapist.

Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions.

BACKGROUND/AIM: Patients receiving long-term oral anticoagulant therapy pose a clinical challenge during invasive dental procedures. The goal of this study was to compare different local hemostatic modalities after tooth extraction in patients receiving chronic Vitamin-K antagonist therapy. METHODS: Totally 90 patients with International Normalized Ratio (INR) ≤ 3.0 requiring simple extraction of one or two teeth were randomized into three groups, 30 patients in each group. The patients with the mean INR value of 2.35 ± 0.37, in whom extraction wound was sutured comprised the group A. In the group B with the mean INR of 2.43 ± 0.4, local hemostasis was achieved by placing absorbable gelatin sponges into the wound without suturing. The group C consisted of the patients with the mean INR of 2.36 ± 0.34 in whom neither gelatin sponge nor suturing were used for providing local hemostasis. Bleeding was registered as an event if other than initial hemostatic measure was needed or additional oral surgeon intervention required. RESULTS: The obtainded results show that 1 (3.3%) patient in the group A, 2 (6.7%) patients in the groups B and C manifested post-extraction bleeding. All cases of hemorrhage were easily solved with local hemostatic measures and all, except one case, were registered in the first two hours after the procedure until the dismissal. A difference between the groups was not statistically significant (χ2 = .42, p > 0.05). CONCLUSION: In therapeutically anticoagulated patients tooth extractions can be safely performed without altering the dose of anticoagulant medication if efficient local hemostasis is provided. In most cases; in patients with INR ≤ 3.0 after extraction of one or two teeth postoperative bleeding can be controlled with local pressure, without any additional local hemostatic measures.

Improving mechanical properties of flowable dental composite resin by adding silica nanoparticles.

BACKGROUND/AIM: The main drawback of flowable dental composite resin is low strength compared to conventional composite resin, due to a low amount of filler, neccessary for achieving low viscosity and ease of handling. The aim of this study was to improve mechanical properties of flowable dental composite resin by adding small amount of nanoparticles, which would not compromise handling properties. METHODS: A commercially available flowable dental composite resin material was mixed with 7 nm aftertreated hydrophobic fumed silica and cured by an UV lamp. Four sets of samples were made: control sample (unmodified), the sample containing 0.05%, 0.2% and 1% nanosilica. Flexural modulus, flexural strength and microhardness were tested. One-way ANOVA followed by Tukey's test with the significance value of p < 0.05 was performed to statistically analyze the obtained results. Furthermore, differential scanning calorimetry (DSC) and SEM analysis were performed. To asses handling properties, slumping resistance was determined. RESULTS: It was found that 0.05% is the most effective nanosilica content. All the tested mechanical properties were improved by a significant margin. On the other hand, when 0.2% and 1% nanosilica content was tested, different results were obtained, some of the mechanical properties even dropped, while some were insignificantly improved. The difference between slumping resistance of unmodified and modified samples was found to be statistically insignificant. CONCLUSIONS: Low nanosilica addition proved more effective in improving mechanical properties compared to higher additions. Furthermore, handling properties are unaffected by nanosilica addition.

[Stabilisation of lower denture using mini dental implants].

UNLABELLED: INTRODUCTION. The role of the total lower denture is not only to replace the missing teeth but also to provide the substitute for a range of supporting tissues which have diminished due to the process of resorption, to re-establish the original relations in the region ofjaw complex, to support the surrounding soft tissues which have lost their natural support, and, moreover, to be unobtrusive and discrete substitution of lost functions. Application of Mini-dental Implants. If anatomical conditions are unfavorable, there is a wide range of oral-surgical pre-prosthetic procedures which can be performed on both soft tissues and bone structures (vestibuloplasty, alveolar ridge augmentation...) in order to enable proper fabrication of the total lower denture to some extent. Having in mind the old age of the patients, the majority of who suffer from chronic diseases such as diabetes mellitus, cardiovascular problems, systemic diseases etc., these procedures should be avoided because of the extent of the procedure, possible systemic complications and prolonged therapy period. CONCLUSION: Most recently, the application of titanium endosteal mini implants have proved to be one of good solutions in overcoming unfavorable anatomical conditions resulting in stability and retention of total lower dentures.

Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination.

INTRODUCTION: The preliminary diagnosis of chronic periapical lesions is made on the basis of clinical symptoms and radiographs, which is a reliable diagnostic tool, but it has only a subsidiary role since histopathological verification is essential for the definitive diagnosis. This study was aimed at diagnosing removed chronic periapical lesions and classifying them by size as well as at comparing the clinical diagnoses with histipathological results. MATERIAL AND METHODS: The study included 34 patients diagnosed with chronic periapical process by applying clinical examination and radiography. The removed chronic periapical lesions were processed according to classical histological technique and analyzed by hematoxylin and eosin staining protocol. RESULTS: According to histopathological analysis 53% of chronic periapical lesions were periapical granulomas and 47% were radicular cysts. The size of the lesions ranged from <9 mm (70% of lesions), 9 to 20 mm (18% of lesions) and >20 mm (12% of lesions).The histopathological examination revealed that clinical diagnosis was wrong in 26% of cases. CONCLUSION: A statistically significant difference between clinical and histopathological diagnosis has been found. The histopathological findings strongly suggest the necessity of complete curettage of lesions sizing >20 mm in order to prevent recurrences.

[Orthodontic-surgical therapy of retained upper canine].

INTRODUCTION: Therapy of impacted teeth is undoubtedly one of the most intriguing issues for the experts in the field of dentistry. General dental practitioners, as well as specialists in the field of pediatric dentistry, periodontology, orthodontics and particularly oral and maxillofacial surgery have been facing this challenge throughout past several years. Each of these experts can contribute to solving this problem; however, each of them alone can solve only a limited number of cases. DISCUSSION AND CONCLUSION: Since recently, the fate of impacted tooth has been determined mainly by the competence, experience and skill of the orthodontist to apply light traction in an appropriate direction once the tooth has been made surgically exposed. Oral surgeon and orthodontist should share the responsibility for a patient with impaction as they together have the necessary skill and competence required for an effective therapy. In addition, dental age of the child is to be taken into consideration, as well as his/her overall health status and potential interference with other anomalies of dental arch.

[Influence of different types of surgical suture materials on mechanical damage of oral mucosa].

INTRODUCTION: Throughout history many kinds of different suture materials have been used for closing and suturing surgical wounds. Medical literature describes four basic characteristics of suture material: knot safety, tensile strength, tissue reaction and wound safety. The tissue reaction is reflected in an inflammatory response, which, though minimal, occurs during first two to seven days after implanting suture into the tissue. The aim of this research was to investigate whether different suture materials affect the development of decubital damage of oral mucosa, which to a great extent can compromise the process of wound healing. MATERIAL AND METHODS The investigation was designed as a prospective clinical study including 150 patients of both genders, aged between 25 and 60. The patients were distributed into three groups of 50 persons. The suture Black Silk was used in the first group, designated as a control group. Nylon and Vicril were used in the second and third group, i.e. experimental groups, respectively. Decubital damage of the surrounding soft tissues was the main parameter for monitoring the effects of selected suture materials on the oral mucosa. CONCLUSION: The comparison of results obtained for the investigated suture materials after suturing oral mucosa revealed that certain advantage could be given to synthetic monofilament suture materials.

[Complications after placement of peritoneal catheter].

INTRODUCTION: Peritoneal dialysis is one of the modalities used for treatment of end-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis and renal transplantation. Owing to the rich vascularization of the peritoneum, it is used in the processes of osmosis and diffusion, enabling the removal of uremic material from the body. The procedure includes introduction of peritoneal fluid via the peritoneal catheter. COMPLICATIONS: The catheter is placed through the anterior abdominal wall with its tip positioned in the small pelvis. There are several techniques for catheter placement considered minimally invasive, which, however, may be associated with various complications. These complications can be divided into mechanical (catheter dysfunction, cuff protrusion, hernia, dialysate leaks, visceral perforation) and infectious (early peritonitis, exit site or tunnel infection, surgical wounds). In most cases, such complications are rare and can be successfully managed using conservative therapy; however, in some situations severe complications can endanger the life of the patient. On-time recognition of complications, particularly in patients at risk, is of paramount importance for an effective treatment. The development of complications can increase the morbidity and the chance of treatment failure, and therefore transfer to haemodialysis. CONCLUSION: The preoperative evaluation and determination of the risk factors as well as the early recognition and adequate management of complications are essential in their prevention.

Influence of surgical sutures on wound healing.

Historical data on closing and suturing of surgical wounds describe a wide range of various suture materials. The choice of the surgical catgut, i.e. the type and diameter, depends on the locality, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of outstanding importance with respect to the selection of suture material: accumulation of soft deposits on the sutures, score of the adjacent soft tissues and dehiscence of the operative wound. Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (apicotomy) of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: Black Silc 5-0, Nylon 5-0 and Vicryl 5-0. The effects of the selected sutures were evaluated according to the wound dehiscence. The effects of the applied sutures were recorded on Days 2, 5 and 7 after the surgery. The comparison of cited parameters of the investigated materials after suturing the oral mucosa revealed that none of the used material was ideal; however, a certain advantage might be given to the synthetic monofilament suture materials.

[Choice of surgical suture material used in oral cavity-clinical study].

INTRODUCTION: Historical data on closing and suturing of surgical wound describe a wide range of various suture materials. The choice of the surgical catgut, i.e. type and diameter, depends on the localization, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of the outstanding importance regarding the choice of suture material: accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. AIM: The aim of this research was to determine the correlation between different types of suture materials and accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. MATERIAL AND METHODS: Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (aplicoectomy) of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: BLACK SILK 5-0, NYLON 5-0 and VICRYL 5-0. The effects of the selected sutures were evaluated by using several parameters: accumulation of soft deposits, wound dehiscence and decubitus of the adjacent soft tissues. The effects of the applied sutures were recorded on days 2, 5 and 7 after the surgery. CONCLUSION: The comparison of cited parameters of the investigated materials of ter suture of oral cavity mucosa revealed that none of the used material was ideal; however a certain preference might be given to the synthetic monofilament suture materials.

[Effects of smoking on edentulous alveolar ridge mucosa].

INTRODUCTION: Tobacco use is an important risk factor for advanced histopathological findings on edentulous alveolar ridge mucosa. The aim of this study was to examine the effects of smoking on histopathological findings on edentulous alveolar ridge mucosa. MATERIAL AND METHODS: The experimental group consisted of 48 patients (29 smokers and 19 nonsmokers). The mean age of smokers was 42.6 and of nonsmokers 48.7 years. The anamnesis included the following data: age, sex, diseases and toxic habits--cigarette smoking. Biopsy samples were taken from the edentulous alveolar ridge mucosa without gross signs of symptoms. RESULTS: The mean number of cigarettes smoked per day was 11.5 +/- 7. The results of chi2 test proved that there were no statistically significant differences (p > 0.05) in histopathological findings on the alveolar ridge mucosa. The mean duration of smoking was 12.7 +/- 5 years. Hyperkeratosis was established in 76.92% of smokers who smoked longer than 15 years. The mean age at which smokers began smoking was 27.3 +/- 8 years and there were no statistically significant differences in histopathological findings on the alveolar ridge mucosa correlated with the beginning of smoking. CONCLUSION: On the basis of our research we conclude that smokers who have been smoking for 15 years are at risk for developing histopathological changes of the alveolar ridge mucosa, but there were no statistically significant differences in histopathological findings on the alveolar ridge mucosa correlated with the number of cigarettes per day and the beginning of smoking.