Ljubomir Todorovic

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis.

OBJECTIVE The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF). STUDY DESIGN Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans. RESULTS All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case. CONCLUSION These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.

The closure of oroantral communications with resorbable PLGA-coated β-TCP root analogs, hemostatic gauze, or buccal flaps: A prospective study

OBJECTIVE The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique. STUDY DESIGN In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored. RESULTS The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group. CONCLUSION Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.

Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial?

The aim of this study was to investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. A total of 352 patients were given a total of 560 injections of local anaesthetic (119 IANB and 441 others). The study group comprised 279 patients with therapeutic international normalised ratios (INRs), and the control group 73 patients who were taking oral anticoagulants but had subtherapeutic INR on the day of operation. Blood was aspirated 7 times (7.3%) during the IANB in the study group. However, there were no clinical signs of prolonged haemorrhage into the medial pterygoid muscle or pterygomandibular space after 96 IANB, including those from whom blood had been aspirated. Only two minor haematomas developed after multiple infiltrations in the lingual sulci. The results suggest that bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly.

Oral tissue engineering of complex tooth structures on biodegradable DLPLG/β-TCP scaffolds

Research for new technologies and biomaterials improving orofacial implantation and regeneration has evolved at a fast-pace1,2,4,13–16. Teeth are essential for survival in many vertebrates, and missing or misplaced teeth can have fatal consequences, causing some species to be unable to make use of available food supplies. Tooth loss due to periodontal disease, dental caries, trauma, or a variety of genetic disorders is one of the most severe human health problems. It is critical, therefore, that the dentition develops correctly, with the required number and type of teeth developing in specific positions in the jaws. A biological tooth substitute that could replace lost teeth would provide a vital alternative to currently available clinical treatments5. The purpose of this study leads to new composite constructs to be shapable, resorbable, and biocompatible multifunctional bone equivalent for applications in periodontology, oral surgery and trauma of the teeth and periodontal tissues, including bone. The goal of our compiled projects is tooth organ engineering. In order to organize such a complex project, work has been divided in three phases. Starting phase deals with experimental tools for in vitro and in vivo tooth engineering. Second phase would be selection, collection and preservation of high number of healthy teeth extracted for orthodontic reasons, and the final phase will be to treat organizational aspects of a bank for tooth tissue.

Efficacy of fentanyl transdermal patch in pain control after lower third molar surgery: A preliminary study.

Background Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. Material and Methods Seventeen patients with bilateral impacted lower third molars were included in this preliminary study. For postoperative pain control, patients randomly received a fentanyl patch plus placebo tablet after the first operation and regular (placebo) patch and an analgesic, after the second operation. Analgesia was evaluated during first 24 hours postoperatively according to patients’ reports about time of first pain appearance and additional analgesic consumption. Pain severity was rated using a 10 cm long visual analogue scale (VAS). Results Intensity of postoperative pain and postoperative analgesic consumption were significantly lower after the Fentanyl Transdermal System (FTS) was applied (p<0.05). Duration of postoperative analgesia was significantly higher with FTS when compared to control treatment (p<0.05). Conclusions Based on the results of this preliminary study, transdermal system with fentanyl significantly reduced postoperative pain after third molar surgery. Key words:Analgesia, fentanyl, transdermal administration, third molar surgery, acute pain, postoperative care.