Milan Spasić

The use of absorbable polyglactin/polydioxanon implant (Ethisorb(®)) in non-surgical closure of oro-antral communication.

Oro-antral communications (OAC) greater than 4-5 mm in diameter can seldom be counted on to heal spontaneously without the necessity for surgical closure. The initial experience in applying an absorbable polyglactin/polydioxanon implant (Ethisorb(®)), in non-surgical closure of OAC ranging from 5 to 7 mm in diameter, is presented. Twelve patients of varying ages with OAC up to 72 h in duration, have been treated with Ethisorb(®). Failures were not demonstrated in the form of the creation of an oro-antral fistula (OAF), and in all patients, OAC-s were closed with the epithelization of post-extraction wounds up to 21 days after implantation of Ethisorb(®). Based on these initial encouraging results, we propose that an Ethisorb(®) biopolymeric absorbable implant can be used in selected clinical cases for non-surgical closure of OAC.

Immunohistochemical and karyometric similarities and differences of salivary gland tumors between pleomorphic adenoma, basal cell adenoma and polymorphous low grade adenocarcinoma

Uvod: Tumori pljuvačnih žlezda su veoma retke neoplazme. S obzirom na njihovu patohistološku sliku, ovi tumori predstavljaju veoma veliki dijagnostički izazov. Cilj: istaživanja je diferencijacija ova tri tipa tumora primenom imunohistohemijske i morfometrijske analize, kao i određivanje visine Ki67 proliferativnog indeksa. Materijal i metode: Istraživanje je obuhvatilo 44 tumora, 20 pleomorfnih adenoma, 12 adenoma bazalnih ćelija i 12 polimorfnih adenokarcinoma niskog gradusa. Analizirana je ekspresija Ki67, p53 i HER-2 antigena, kao markera proliferacije. U sklopu diferencijalne dijagnostike, analizirana je ekspresija CEA, EMA, GFAP, p63, vimentina, CK14, α-SMA, S-100 protein i WT1 antigena. Morfometrijska analiza vršena je u softverskom paketu „ImageJ” verzija 1.43u. Rezultati: Neoplastične ćelije u pleomorfnom adenomu su pokazale jaku ekspresiju GFAP, p63, WT1, vimentin i S100. U grupi od dvanaest polimorfnih adenokarcinoma niskog gradusa prisutna je difuzna ekspresija CK14, S100, vimentin i EMA su bili apsolutno eksprimirani, dok je αSMA bio negativan. Adenom bazalnih ćelija pokazuje pozitivnost na S-100, CEA, p63 i vimentin. Analizom vrednosti proliferativnog Ki67 indeksa ustanovljena je statistički značajna razlika u grupi pleomorfnog adenoma, što se dovodi u vezu sa čestim recidiviranjem. Morfometrijskom analizom se uočavaju veće vrednosti u grupi polimorfnog adenokarcinoma niskog gradusa, ali su statistički značajne razlike nađene samo za Feretov dijametar i integrisanu optičku gustinu u odnosu na pleomorfni adenom (p<0,05). U grupi adenoma bazalnih ćelija tumorske ćelije su pokazale statistički veće vrednosti za integrisanu optičku gustinu u odnosu na pleomorfni adenom (p<0,001). Zaključak: Za diferencijalnu dijagnozu tumora pljuvačnih žlezda, pored osnovne mikromorfološke, neophodna je i imunohistohemijska i morfometrijska analiza.

Necrotizing Fasciitis of the Cheek: A Case Report

Summary The term necrotizing fasciitis (NF) was first used by Wilson in 1952, who described this rare, however, progressive infection that primarily affects the fascia and subcutaneous tissues. Necrotizing fasciitis may affect any part of the body; however, it usually appears on the extremities. The most common microorganisms isolated in NF are Staphylococcus aureus, group A Streptococci, and Escherichia Coli. We are presenting the case of a sixty-seven-year old woman, who was admitted for the perforation of painful edema of the left cheek. Clinical examination of the anterior two-thirds of the left cheek revealed a defect of the full thickness of the skin, 3×4 cm in size. During the patient’s hospitalization she was treated by parenterally administered broad-spectrum antibiotics, necrotomy, fasciotomy of the cheek and the extraction of the remaining roots in the 3rd and 4th quadrant. Necrotic fasciitis is a rare, rapidly progressive infection of soft tissues, which, if untimely diagnosed and treated, may be life-threatening. The prognosis of treatment depends on the early recognition of the disease. It is treated with aggressive surgical debridement followed by antibiotic therapy.

Central mucoepidermoid carcinoma of the mandible: A case report

Introduction Mucoepidermoid carcinoma, compared to other tumors of salivary glands, occurs in 5–10% of cases. Histopathologically, it is divided into a well differentiated tumor that is of low-grade of malignancy, and a medium and poorly differentiated tumor of high grade of malignancy. Central mucoepidermoid carcinoma (CMEC) of the mandible was firstly described by Lepp in 1936, on a 66-year-old female patient. CMEC is characterized by atypical clinical image and radiological manifestation. Case Outline A 55-year-old female patient was examined at the Clinic of Dentistry in Niš, Serbia, with anamnestic data regarding the presence of painless swelling in the right side of the mandible. Considering the histopathological results and presence of enlarged lymph nodes, right hemimandibulectomy and tumour excision from pterygomandibular space followed by supraomohyoid neck dissection was done. In due course, postoperative radiotherapy was applied (60 Gy) Conclusion CMEC represents a rare tumor, characterized by local tissue destruction and ability to metastasize. Initial biopsy represented the key in preoperative planing. Radical excision with neck lymph node dissection followed by postoperative radiotherapy in our case represent a successful method of treating CMEC of the mandible.

Ameloblastoma of the Lower Jaw: A Case Report

Summary Ameloblastoma, a semi-benign odontogenic tumor, is divided into four subtypes based on the clinical presentation, radiological manifestations and histological characteristics. Radiologically, it manifests itself in the form of uni- or multicystic intrabony expansive lesions, with destruction of the medullary zone of the existing bone, resorption and possible perforation of the buccal and lingual cortex. The patient, a 62-year-old woman, came to the Clinic for Maxillofacial Surgery in Niš with an anamnestically present painless tumefaction in the anterior segment of the mandible present for the past three years. In the course of an intraoral examination in the region of symphysis and parasymphysis of the lower jaw on the left side, an oval-shaped tumor was spotted, 5x3 cm in size; palpation showed that it was hard, painless and motionless. Multislice computed tomography (MSCT) of the oro - and hypopharynx and neck showed an extensive tumor formation of the soft tissue density in the anterior segments of the lower jaw, with the signs of destruction of bone tissue of the buccal and lingual cortex of the lower jaw. The frequency of recurrence depends on the histological type of ameloblastoma and the degree of radicalism of the performed surgical intervention. Ameloblastoma in most cases is definitely diagnosed in the advanced stage of the disease due to the absence of symptoms and very slow tumor progression.

The role of growth factors in extraction wound healing

Zarastanje rane je složeni proces koji uključuje hemostazu, inflamaciju, proliferaciju i remodelaciju tkiva. Faktori rasta su prirodni biološki posrednici koji regulišu najznačajnije ćelijske procese uključene u regeneraciju tkiva, kao što su DNA sinteza, angiogeneza, metabolička aktivnost, migracija, hemotaksa, proliferacija, diferencijacija i sinteza matriksa. Najznačajniji faktori rasta koji učestvuju u zarastanju ekstrakcione rane i regeneraciji koštanog tkiva su: trombocitni faktor rasta-PDGF, transformacioni faktor rasta-TGF β ,faktor rasta sličan insulinuIGF, koštani morfogenetski proteini-BMP-2, BMP – 7 , vaskularni endotelijalni faktor rasta, VEGF, ,fibroblastni faktor rasta-FGF. Faktori rasta pojavljuju se u različitim koncentracijama u različito vreme, pa se na osnovu njihovog prisustva može proceniti starost rane. Osim zarastanja rane faktori rasta mogu se primeniti za bolju oseointegraciju implanata,augmentaciju alveolarnog grebena, alveolita itd. Studije fizioloških procesa u kojima faktori rasta imaju regulatornu ulogu ukazuju da ovi molekuli retko kada svoje aktivnosti vrše u biološkoj izolaciji. Proučavanje interakcije između faktora rasta u alveolarnoj kosti može pružiti objašnjenje o sposobnosti tkiva da zaraste i pod nepovoljnim uslovima, kao što suinfekcija i zračenje

Perioral and sublingual hematoma: Oral anticoagulation therapy complication: Case study

Introduction. Anticoagulation therapy includes drugs which prevent intravascular formation and spreading of a thrombus. Heparin and dicoumarin preparation are in use. Heparin preparations are commonly used when a rapid anticoagulant effect is required, they are administered intravenously, act immediately performing the inhibition of thromboplastin activation, prothrombin to thrombin conversion, and the effect of thrombin to fibrinogen. Oral anticoagulation therapy (OAT) includes drugs - antagonists of vitamin K, which is responsible for the synthesis of prothrombin complex factors - II, VII, IX and X. They are derived from coumarin and indandione. One of the most frequently used drugs from the OAT group is warfarin. It is a competitive inhibitor of vitamin K required for the carboxylation of the residues of PK factor glutamic acid. The results of this inhibition lead to the unsuccessful formation of gama carboxyglutamic acid and the production of functionally inert coagulation proteins. The aim of this study was to show a rare but dangerous complication of an inadequate application of oral anticoagulation therapy. Case study. Patient S.S., male, aged 79, was admitted to the Oral Surgery Department, Clinic of Dentistry of the Faculty of Medicine in Nis on October 5, 2012 due to a severe general condition with massive hematoma in the facial area. Anamnestic data showed that during the previous couple of days, the patient was voluntarily taking a whole tablet of Farin instead of the prescribed dose. The patient started receiving intravenous low-molecular-weight heparin therapy (Fraxarin 0.3/12h) along with the antibiotic therapy. In the following period, the patient reported daily at the Oral Surgery Department for regular check-ups. The hematoma was absorbed and the swelling was completely gone within the next 7 to 10 days.

Extraction and non-extraction therapy in class II/1 patients

Introduction: Class II malocclusion is characterized by distoclusion and is divided into two divisions depending on the inclination of the upper front teeth. The first division is characterized by protrusion of the upper front teeth. Treatment possibilities of class II/1 malocclusion depend on the skeletal form. Therapy of dentoalveolar types of class II/1 malocclusion is exclusively orthodontic. More emphasized skeletal forms of class II/1 malocclusion may require surgery apart from orthodontic therapy. Casse raport: In this paper, the extraction and nonextraction treatment of 13 years old patients - M.P.(boy) and I.T. (girl) was shown, respectively. The diagnosis was based on clinical and functional intraoral findings, analysis of dental casts, face photos, orthopatomogram and profile x-ray. Nonextraction therapy was suggested for a boy and extraction therapy for a girl, combined with the use of upper and lower fixed appliances. In the treatment, technique of straight arch, Dentaurum brackets, root prescriptions, slot 22 were used. In the male patient, there was a slight maxillary prognathism, mandibular retrognathism, anterior type of growth, protrusion of the upper incisors and retrusion of the lower ones. The body of maxilla was shorter by 4 mm with regard to the cranial base. In the female patient the extraction of the upper first premolars was performed because of maxillary prognathism, mandibular retrognathism, increased length of the body of maxilla, decreased length of the body of maxilla and severe protrusion of the upper frontal teeth. After the treatment, functional occlusion and improvement in facial aesthetics was achieved in both patients. Facial changes were more apparent in the patient who underwent the extraction treatment. After completion of treatment, it is necessary to maintain the obtained results.

Healing of extraction wounds in an experimental model of rat

Introduction: The process of wound healing after tooth extraction has been studied in several animal species under normal and experimental conditions that might interfere with the healing. Chronology of wound healing after tooth extraction (molars and incisors), which consists in several phases, has been examined by histological, radiological, immunohistochemistry, stereology (bone volumetry), and densitometry methods and by using of micro-camera to determine the volume fraction of histological components. The aim of this study is to analyse the process of healing of normal extraction wound and to determine the period of time it takes for the postextraction wound to completely heal. Material and method: The research is based on the literature available in electronic databases Pubmed/Medline, Kobson, Googlescholar. The total of 22 papers which follow the normal course of healing were found; 7 papers met the criteria regarding the complete description of the healing process in the socket after tooth extraction in rats. Results: On the second day after the extraction wound starts with forming epithelium. The first sign of bone tissue has appeared four days after the extraction as subperiostal osteogenesis. On fourth and fifth day, in some fibroblasts differentiation in osteoblasts has already begun. On the fifth day the delicate trabecules of young bone attached to the walls of the socket in its basal part can be seen, and the signs of ossification are clearly indicated by a darker shadow in the central part of the apical third of the socket present in the x ray. The end of the epitelization is on the eighth day, when the lamina dura was slightly less pronounced, while the lower parts of the socket have a pronounced X-ray shadow. In most of the specimens, the socket has been completely filled with reticular bone on day 14. The socket has been filled with young bone after 20 days. Presence of lamelar bone can be seen 60th day after extraction. Remodelation of aveolar ridges lasts until 112th day. Conclusion: The healing of normal extraction wounds in rats begins with the appearance of the epithelium of the second postoperative day, and the end of the epitelization is on the eighth day . Formation of bone begins on the fourth day after the exodontia. The intense bone formation lasts until the twentieth postoperative day when the young r bone fills the socket. Lamellar bone is present on 60th days after extraction. Application of bone morfogenetic protein, low power laser and polarized light had no expected effect on the healing of the extraction wound in experimental rats.