Mihai Juncar

Evolution assessment of head and neck infections in diabetic patients – A case control study

This research aimed to assess the occurrence and progression of head and neck infections in diabetic compared to non-diabetic patients. A retrospective study was carried out over a period of 10 years in 899 patients with head and neck infections. The patients who met the inclusion criteria were divided into cases and controls according to the presence/absence of diabetes. Seventy-three patients (8%, 95% CI [6.45%-10.12%]) were included in the case group and 826 (92%, 95% CI [89.87%-93.55%]) were assigned to the control group. The extension of the infection proved to be significantly (p < 0.001) higher in diabetic patients compared to non-diabetic patients. The difference between the two groups was statistically significant (Mann-Whitney U statistics = 18205.500, p < 1.56 · 10(-8)). A more than 10 year history of diabetes was statistically related to a wider extent of head and neck infections (p < 0.001). Diabetes proved to be associated with large necrotic areas and the spread of head and neck infections to more than two cavities.

SUBANTRAL AUGMENTATION WITH A 1/1 ALLOPLASTIC AND AUTOLOGOUS MATERIAL MIXTURE. HISTOLOGICAL CHARACTERISTICS AND DIMENSIONAL STABILITY OF THE NEWLY FORMED BONE

Background and aim. The maxillary sinus augmentation procedure is the most frequent method used to prepare the posterior maxillary area, with bone deficit, for the placement of dental implants. For this purpose, several types of materials have been used as bone grafts, each of these materials having a number of advantages and disadvantages. The present study is aimed at evaluating the histological and volumetric properties of an alloplastic and autologous material mixture. Patients and methods. The study included 7 selected patients who underwent subantral bone augmentation with a 1/1 autologous and alloplastic material mixture. Subsequently, at the time of dental implant placement, biological samples were taken from the bone augmentation area and were histologically analyzed. The subantral bone resorption rate was also evaluated in parallel. Results. Histological examination evidenced the presence of residual amorphous material in the bone augmentation area. The mean bone resorption rate was 15.15%. The presence of a high bone resorption rate was correlated with the presence of a smaller residual amorphous material amount in the subantral bone augmentation area. Conclusions. The association of autologous and alloplastic material for subantral bone augmentation improves the characteristics of the two material types.

Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review

Necrotizing fasciitis (NF) is a severe infection involving the superficial fascial layers, subcutaneous cellular tissue, and possibly skin. It usually has a fulminant evolution, rapidly leading to death in the absence of early diagnosis and aggressive surgical treatment. We herein report a rare case of NF secondary to a traumatized occipital psoriatic plaque in an alcoholic 47-year-old woman and compare this case with the published literature. The NF extended to the entire scalp, right face, and posterior and lateral cervical region. Despite the initially guarded prognosis, the patient’s survival emphasizes the importance of aggressive surgical treatment with wide excision of all necrotic structures without any aesthetic compromise.

Oral Disease in Diabetic Patients – A Pilot Study

Abstract Background and Aims. Diabetes mellitus is one of the most frequent systemic diseases found in the human adult population. However, the impact of diabetes mellitus, particularly type 2, on oral health is a controversial subject that is far from being clarified. The aim of this study was to prospectively assess the oral health of patients with type 2 diabetes mellitus (T2DM) in order to detect the main oral pathological changes occurring in these patients. Material and method. For this study, 328 patients who presented for dental treatments in the period May 2015 – May 2016 were available. Of these, 33 patients with T2DM, who made up the diabetes group, and 79 patients who formed the control group were selected. Diabetes group was selected from patients that presented no other systemic disorders that could determine the appearance of oral lesions except for T2DM. The control group was selected in order to have general characteristics similar to the diabetes group. Results. Patients in the diabetes group had a mean tooth loss value of 12.69±7.47 compared to patients in the non-diabetic group, who had a mean value of 6.29±4.62. Non-odontogenic oral pathology such as chronic candidiasis, salivary disorders and lichen planus was present in 51.52% of all patients with T2DM, while in the control group this was absent. Conclusions. The presence of diabetes mellitus favors tooth loss and the development of non-diabetic oral lesions.

Effect of Masticatory Forces Transmitted by Dental Implants on the Mandibular Bone of Patients with Type 2 Diabetes Mellitus

Abstract Background and Aims: Diabetes mellitus is considered to be one of the most important diseases of our society, affecting a considerable proportion of the adult population. Currently, dental implant treatment of diabetic patients is controversial, the main controversy being related to changes that occur in the jaw bones of the diabetic patient and the ensuing side effects. This preliminary study aims to evaluate the response of mandibular bone to masticatory forces transmitted by dental implants in diabetic patients. Material and Method: 11 dental implants placed in the mandible were selected, and mandibular bone resorption as a result of masticatory forces transmitted by them was evaluated. Results: The mean bone resorption rates were the following: 2.72% at the time of dental implant exposure, 10% at 3 months from dental implant exposure, and 13.63% at 6 months from exposure. Conclusions: No significant changes in mandibular bone response to the action of dental implants were found in diabetic patients compared to standard response reported in non-diabetic patients.

Efficiency of empirically administered antibiotics in patients with cervical infections of odontogenic origin

Background and aims. Odontogenic infections are among the main types of disorders located in the cephalic extremity. The aim of this study was to determine the efficiency of empirically administered antibiotics on the bacterial strains identified at the infection sites. Patients and method. The study included 10 randomly selected patients with odontogenic cervical soft tissue infections, who received antibiotic treatment prescribed by the family doctor or the dentist. The bacterial flora involved in the development of the septic process, the type of antibiotic administered to the patient and the sensitivity of the identified bacterial flora to the administered antibiotic were determined. Results. In the 10 selected patients, 14 bacterial strains were detected; 7 patients had a single bacterial strain, and 3 patients had two or three types of bacteria. Of the administered antibiotics, amoxicillin was the most widely used (33.3% of the cases), followed by amoxicillin with beta-lactamase inhibitors (25% of the cases). In half of the patients, there was no sensitivity of the bacteria detected in the septic focus to the empirically administered antibiotic, and in 10% of the cases, partial sensitivity was evidenced. Conclusions. Empirical administration of antibiotics without the association of surgery did not prove to be effective in the treatment of cervical infections of odontogenic origin.

Mandibular reconstruction using free vascularized iliac crest grafts and dental implants

Background and aim The mandible is frequently affected by tumor masses present in the oral cavity and is included in the tumor ablation procedure, with major functional and esthetic consequences for the patient. A method of high current interest in mandibular reconstruction is based on the use of free vascularized iliac crest grafts, followed by reconstruction using dental implants. Methods This study presents the case of four patients benefiting from this treatment method, and monitors the treatment stages and their clinical evolution after mandibular reconstruction and dental implant placement. Results The postoperative evolution of the patients was favorable, with the integration of the iliac crest grafts and dental implants. After prosthetic loading, the masticatory as well as the esthetic function of the patients was restored to a standard close to the initial one. Conclusions This mandibular reconstruction method proved to be effective, with a high degree of reliability and a significant improvement of the patients’ quality of life.