Jelena Stanisic

Aim: Through the use of CBCT images, many unidentified features of impacted canines can be easily resolved. The potential collision of impacted maxillary canines and adjacent teeth could lead to root resorption (RR). The aim of this study is to examine the prevalence, location and severity of RR on adjacent teeth caused by impacted maxillary canines and the association between the adjacent teeth and the features of maxillary impacted canines on CBCT. Methods: This study examined 89 subjects with 108 maxillary impacted canines, having had no previous orthodontic treatment (mean age: 18.3 ± 4.1 years). The following impacted-canine-related parameters were analyzed on the CBCT images: location; RR levels on adjacent teeth; occlusal line and midline distances of impacted canines; and the angulations of impacted canines to the midline, lateral incisor and occlusal line. Logistic regression was used to evaluate the association between RR and the measured parameters on CBCT. Results: In this study, we found that the majority of our patients with impacted maxillary canines were female (62.5%). Of the total 108 maxillary impacted canines, 60.2% resorbed the adjacent teeth of the affected quadrants. Lateral incisors were the most affected (34.3%). The mean age of subjects with RR was 16.7 ± 3.5 years. The frequency of RR was statistically significantly higher in female subjects (40.4%). Slight RR was the most frequent (30.5%) and the highest incidence noted at the apical third of the root (29.6%). Regarding the impacted maxillary canine angulation to the midline and adjacent tooth, higher values of angulation caused severe forms of RR (p < 0.05). Conclusion: The sensitivity of CBCT allows for the accurate diagnosis of the location and the degree of RR, alongside the angulation and distance of impacted canines to adjacent teeth. The association between the linear and angular features of the impacted maxillary canines and RR was confirmed.

Background/Aim. Chronic microbial infections of the root canal are a common issue. This process very often causes an immune reaction in the root canal system that results in forming of chronic periapical lesions (PLs). The aim of this study was to determine the quantitative expression of the bacterial heat shock protein (HSP), chaperonin 60 (cpn60), and the pro-inflammatory and anti-inflammatory cytokines in periapical tissue obtained from individuals with chronic PLs and to determine if there is a correlation between the expression of the bacterial HSP and the expression of these cytokines. Methods. The study was performed on 18 PLs and 6 control samples of healthy periapical tissue, taken at the Department of Dentistry, Faculty of Medicine, University of Pristina/Kosovska Mitrovica. The levels of messenger ribonucleic acid (mRNA) expression of pro- and anti-inflammatory cytokines and bacterial HSP were determined by quantitative real-time polymerase chain reaction (RT-PCR) and quantified by comparing to the internal control gene for glyceraldehyde 3-phosphate dehydrogenase (GAPDH). Results. Analysis revealed significantly higher mRNA levels of tumor necrosis factor-alpha (TNF-a) and cpn60 in the tissue of PLs compared with normal periapical tissue (p < 0.05). Contrary to these results, the mRNA expression of anti-inflammatory interleukin-10 (IL-10) was significantly higher in the samples of normal periapical tissue compared with the mRNA levels of this cytokine in the tissue of PLs (p < 0.001). Expression of cpn60 is in strong correlation with TNF-a expression in PLs. Conclusion. cpn60 released from bacteria in periapical tissue could be a strong stimulator of inflammatory response and one of the important players in the pathogenesis of PLs.

Background/Aim: The aim of this study was a CBCT radiographic bone density analysis of bicortical defects healing when treated with guided bone regeneration and two bone substitutes - bovine xenograft and alloplastic bone substitute. Methods. Research was performed on domestic pigs in two phases. In the first phase, extraction of all teeth in the inter-canine sector was performed in the lower jaw and post-extraction wounds were sutured. In the second phase, after the period required for healing, bi-cortical defects were formed - following elevation of mucoperiosteal flaps from the vestibular and lingual side in the area of the previously extracted teeth, surgical removal of the cambium layer of periosteum was performed in the area of future defects with sharp surgical scissors and curette. Two defects, 10 mm in diameter, on the left and right side of the medial line were formed and filled with alloplastic bone substitute on left and xenograft on right side, afterwards. After augmentation, the defects were covered by collagen resorptive membrane on both sides and flap was repositioned and sutured. After the 12 weeks, experimental animals were sacrificed. Results. Analysis of bone tissue showed a statistically significant difference between the examined substitutes (p<0.01). After applying Bonfferoni correction, the difference was still statistically significant. Conclusion: Both bone substitutes used in the study showed good osteoconductive properties in the treatment of bi-cortical defects. Bone tissue density in defects filled with alloplastic bone graft was statistically significantly higher than that in the defects filled with xenograft.

Background/Aim: Implant treatment expands extensively the possibilities of prosthetic treatment, which provide benefits, bigger comfort as well as general improvement of the patient’s life quality. In cases with no possibility of implantation, it is possible to improve conditions by using modern methods for bone tissue repair. One of factors important for the long-term success is proper oral hygiene, as well as raising awareness of its importance to patients. The aim of the paper is to present a patient rehabilitated with multiple implants and followed-up for a five-year period, and to point out the importance of raising patient’s awareness and motivation in order to preserve the results of the treatment. Case Report: A 31-year-old patient was admitted to the oral surgery clinic for rehabilitation of a poor oral health status. After taking history, clinical examination and additional analysis, the following treatment plan was suggested: to remove impacted upper canines and to put an implant supported by fixed prosthesis in the upper jaw, to make two implants supported by bridges laterally and one dental supported by bridge in the inter-canine sector in the lower jaw. The treatment was carried out in several stages that involved extraction of residual roots and impacted teeth, augmentation of bone defects with bone substitutes and bio-absorbable membranes, placing implant, and prosthetic rehabilitation. By verbal communication with the patient, we pointed out the importance of proper oral hygiene and regular check-ups. The five year follow-up showed the absence of factors that could adversely affect the success of the treatment, and the patient was still highly motivated to maintain proper oral hygiene. Conclusions: It is possible to achieve predictable results in complex cases by using a multiphase prosthetic treatment supported by implants. Concerning a long-term success, motivation, proper information and patient’s willingness to cooperate play an important role.

Background/Aim. The injury of inferior alveolar nerve during surgical extraction of impacted lower third molars, followed by sensory disturbance, is, for the patient, an extremely unpleasant complication. The aim of this study was to determine the frequency of this complication after the third molar surgery in patients of northern part of Kosovo and Metohia, and its frequency depending on tooth position and tooth relation to the mandibular canal. Methods. In this study, 800 surgical extractions of the impacted lower third molar were performed. The position of the impacted tooth was recorded according to the Winter classification, as well as the ratio of their root tips to the mandibular canal using the Tanaka and al. and Rood and Shebab classifications. Results. The frequency of the recorded post extraction sensory disturbance was 2.25%, most frequently when teeth were in mesioangular position. Concerning Tanaka and al. classification, the incidence of injuries was inversely proportional to the increase of the distance between roots and mandibular canal with the statistical significance in cases where mandibular canal overlaps more than half of the root of the tooth (p=0.001). Considering radiological signs recommended by Rood and Shehab, higher frequency of the inferior alveolar nerve injury was recorded when illumination in the area of the root tips was present and when the loss of linear overshadowing characterized by the "roof" and the "bottom" of the mandibular canal were observed, or diversion of the canal and root deflection, but without statistical significance. Conclusion. The superposition of the mandibular canal with the lower third molar roots at the panoramic radiographies may increase possibility of the inferior alveolar nerve injury. Angulations of the impacted lower third molar, as well as vicinity of the tips of its roots to the content of the mandibular canal, do not significantly affect the frequency of the nerve injury.

The panoramic radiography is the most used diagnostic imaging method in planning impacted lower third molar extractions. However, often panoramic radiography does not provide enough information in treatment planning for performing safely surgical extraction of impacted third molars. CBCT (Cone beam computed tomography) provides more precise information in diagnostic analysis especially for planning surgical procedures where complications can be expected due to close relationship between mandibular canal and lower impacted third molars. The aim of this study is comparative analysis of panoramic radiography and CBCT in evaluating the topographic relationship between mandibular canal and impacted third molars. The study included 50 patients with close relationship between mandibular canal and impacted third molars detected using panoramic radiography. After panoramic radiography analysis CBCT was performed in order to diagnose, plan and prevent complications during the surgical tooth extraction. CBCT examination considered comparative analysis with panoramic radiography, marking, volume rendering and assessment of mandibular canal in buccolingual direction. Out of total patients where suprimposition of mandibular canal and impacted third molar on panoramic radiography was detected, in 32 patients mandibular chanal was localised on lingual side. Mandibular canal was positioned at bucal side in 18 of 50 patients. Results of this research indicate that panoramic radiography can be useful in everyday practice for diagnosis, planning and preparing lower third molar extractions, but in cases where close relationship between mandibular canal and lower third molars is detected CBCT is recommended as more precise radiographic imaging method in order to prevent complications.

Patient fear from dental intervention is the most common cause of permanent disposal of the visits to the dentist by the patient , and there arise some magic circle in which symptoms of disease becomes more intensive , which proportionally increase the already present fear and further delay the visits to the dentist . The ultimate outcome is compromised oral health with early loss of teeth and chewing function , speech , etc. The aim of work is to determine the frequency of fear from dental intervention , occurrence of pain during certain phases of tooth extraction , its intensity , and justified fear of the patient from the most common oral surgery . The study includes 96 patients , aged 16-45 years , of whom 55 were male and 41 were female . For the assessment of fear of dental intervention was used Korah modified anxiety scale consisted of four questions ,in which every question has an answer and they are scored on a five point Likert scale . To determine the prevalence of pain in various stages of extraction there was used interview about the pain made up of three questions , and the sample consisted of patients divided by Kore scale into high and very high anxiety person. People who have positively responded to the questionnaire, the pain was further determined with visual analogue scale. For statistical analysis we used hi square test at a significance of level p5,92) . Five patients (22,74%) felt the pain during anesthesia where was found statistically significant differences in responses (X ²=7.34> 5.91) . Two patients (8.7%) registered the pain during tooth extraction and all the pain was characterized as mild to moderate. There was no statistically significant difference using the Hi square in the responses (x²=15,69>5,91 za p<0,05). The frequency of dental anxiety in our sample was very high in comparison with similar studies in the west of Europe, and the possible cause among other things, can be considered as a lower level of education of the population on which we must work. The emergence of real pain in high and very high anxiety patients during tooth extraction is very small, which indicate the unjustified fear of this type of intervention .