Legal approach regarding dental malpractice in Romania.

In Romania, the term dental malpractice is relatively new compared to medical malpractice. The common premises that underlie these iatrogenics have made doctors more vigilant about treatment and achieving the desired results. At the same time, the conditions of medical liability are consistent with those of civil liability, namely: damage, wrongdoing, guilt, and causation. To counteract these effects, public attention has been focused in recent years on patients' rights (involving, causes, effects, informed consent of the patient regarding the collection of personal data, informing the patient about the work itself, and possible complications which may occur postoperatively). As a result, the number of reported cases of malpractice has increased markedly in recent years.

Retrospective study regarding the appearance of osteonecrosis related to bisphosphonate therapy.

Bisphosphonates are analogues of the natural compound pyrophosphate and one consequence of the mechanism of action of bisphosphonates on bone metabolism is the reduction of bone turnover, replenish the resorption spaces and to mineralize the extracellular matrix. Osteonecrosis of the jaw is the most common side effect of bisphosphonates and most often occurs after an invasive dental procedure, such as dental extraction. The existence of a maxillary bone infection leads to a delayed healing reaction manifested by the presence of areas necrotic bone, exposed in the oral cavity, which persists for more than eight weeks and has no tendency to heal. In most cases, the dentist is the first one who can detect the onset of osteonecrosis even in the early stages, thus being able to direct the patient to a hospital unit where he/she receives the treatment of necessity. The aim of this retrospective study is to determine the link between bisphosphonate therapy and the occurrence of necrosis of maxillary and mandibular bone. This study was conducted on 22 patients hospitalized for different stages of bone necrosis for a period of two years. The prevalence of osteonecrosis is higher in menopausal women and also after a certain period after the bisphosphonate therapy is closed.

Principles of biomechanics in oral implantology.

BACKGROUND AND AIMS: The principles of biomechanics comprise all the interactions between the body (tissues) and the forces acting upon it (directly or via different medical devices). Besides the mechanical aspects, the tissues response is also studied. Understanding and applying these principles is vital for the researchers in the field of oral implantology, but they must be equally known by the practitioners. From the planning stages to the final prosthetic restoration, they are involved in each and every aspect. Ignoring them inevitably leads to failure. METHODS: The first part of this paper includes a review of our current research in oral implantology (mechanical, digital and biological testing), while the second part includes a review of the available literature on certain biomechanical aspects and their implications in everyday practice. RESULTS: Our research opens new study directions and provides increased chances of success for dental implant therapy. The practical aspects of our findings, combined with the available literature (from the basic principles described more than 40 years ago to the most recent studies and technologies) can serve as a guide to practitioners for increasing their success rate. CONCLUSION: While no therapy is without failure risk, a good understanding of the biomechanics involved in oral implantology can lead to higher success rates in implant supported prosthetic restorations.

Oral surgery for combined haemophilia A and B. The dos and don'ts presented in a clinical scenario.

BACKGROUND: Haemophilia A (factor VIII deficiency), B (factor IX deficiency) and C (factor XI deficiency) are common genetic bleeding disorders. Most often they are caused by the absence or defective function of coagulation factors, causing inefficient blood clots. CASE REPORT: The present manuscript describes a rare case of a combined haemophilia A and B patient, who underwent several extractions. The therapy and clinical management is presented, in the view of surgeon as well as haematologist. CONCLUSION: These patients are a serious challenge for the oral surgeons due to an increased number of accidents and complications. Scarce literature covering this topic contributes, as well, to the difficult management. Thus, several principles must be considered when diagnosing and treating haemophilia patients. KEY WORDS: Haemophilia, Oral surgery.

Head and neck cancer, treatment, evolution and post therapeutic survival - Part 2: a decade's results 1993-2002.

INTRODUCTION AND OBJECTIVES: In the second part of an analysis of a 10-year period of treating oral cancer patients, the focus was the efficiency of treatment, recurrence rates and survival. PATIENTS AND METHODS: From 1485 patients with oral and maxillofacial malignant tumours, 1072 cases could be evaluated. The following data were analyzed statistically: patients' charts and medical records including the follow-up reports. RESULTS: From all patients studied, 811 underwent surgical treatment alone, the mean recurrence rate was 23%. The recurrence rate after surgery plus radiotherapy was 38%; after surgical treatment alone it was 23%; the survival rate at 3 and 5 years post-therapeutically was 49% and 31%, respectively. CONCLUSIONS: The first choice therapy for carcinomas is surgical. The recurrence rate increased with lymph node involvement and tumour size.

Head and neck cancer, epidemiology and histological aspects - Part 1: a decade's results 1993-2002.

INTRODUCTION AND OBJECTIVES: Studies prior to 1990 showed an incidence of 5% for oral and maxillofacial cancer in Romania. In this paper (Part 1) an evaluation of malignant tumour cases, covering a 10-year period is made regarding histological forms, the relationships of malignant tumours to patients' geographic origin, environment, age, gender of patients and lymph node involvement. PATIENTS AND METHODS: From 1485 patients with malignant oral and maxillofacial tumours, 1072 cases fulfilled the criteria for inclusion in this study. The following data were examined: patients' charts and medical records as well as pathology reports. RESULTS: From 16,315 patients admitted to this hospital between 1993 and 2002, 9% presented with primary ('de novo') malignant tumours; 2/3 were male patients; average age at presentation was 61 years for males and 59 years for females; 47% presented with stage IV tumours; out of the 'de novo' tumours, 93% were carcinomas and 4% sarcomas; 56% of patients had positive lymph nodes at presentation. CONCLUSIONS: The number of head and neck cancer cases increased in the last 15 years; almost half of the patients presented with tumours in stage IV.