Milos Tijanic

Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis

BACKGROUND/AIM Alveolar osteitis (AO) is the extraction wound healing disorder with a presence of severe pain. Low level laser therapy stimulates cell metabolism and microcirculation, have has pronounced analgesic, antiedematous and anti-inflammatory effect and speeds up wound healing process. The aim of this study was to present results of clinical research that examined the effectiveness of low level laser in pain relief and healing of extraction wounds with alveolar osteitis in the lower jaw which was formed on the second day after tooth extraction. METHODS The study was conducted on 60 subjects divided into the study and the control group. In both groups extraction wounds were processed in similar way, except that in the study group was applied daily treatment of low level laser with a total of eight sessions of radiation, while in the control group extraction wounds were dressed with zinc oxide eugenol paste, which was changed every 48 hours up to the pain cessation. Measurement of pain intensity was done with a visual analogue scale (VAS) 10 min prior to processing of extraction wounds and daily for the next eight days. Assessment of the effectiveness of low level laser on healing of extraction wounds was performed on the day eight of the treatment. RESULTS On the day five after beginning of the treatment of extraction wounds with alveolar osteitis in the patients of the study group a lower average value of pain as compared to the control group was registered. This difference was increased within the following days. Extraction wounds healing in the study group was more successful and faster than in the control group. CONCLUSION This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.

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.

Endosteal (central) osteochondroma of the mandibular body.

Cartilaginous pathology of the jaws is relatively uncommon, owing the fact that the osteochondroma of the mandibular body are extremely rare. This paper elaborates on the rare case of endosteal (central) osteochondroma created 6 months after exodontia in the left body of the mandibula in tooth region #36. After obtaining a histologic diagnosis of an osteochondroma, a tumor was locally resected. One year later, panoramic radiographs showed bone regeneration at the site of the previously resected osteochondroma. However, extreme caution should be maintained, because an osteochondroma could be the first feature of osteosarcoma or chondrosarcoma. Therefore, regular clinical examinations and radiographic evaluations are mandatory every 6 and 12 months, respectively.

Usefulness of cone-beam CT for presurgical assessment of keratoma (cholesteatoma) of the maxillary sinus

Evaluating the presurgical usefulness of cone‐beam CT (CBCT) in the diagnosis and subsequent surgery of keratoma (cholesteatoma) of the maxillary sinus.

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.

Preparation of patients with hemophilia A for oral surgery

Hemophilia A is an inherited disease characterized by deficiency of coagulation factor VIII and bleeding tendency. It is transmitted through the X chromosome. Hemophilia A is characterized by excessive bleeding in various tissues of the body, including soft tissue hematomas and hemarthrosis. In formulating the diagnosis of hemophilia A, in addition to a well-taken medical history and physical examination, laboratory tests should also be carried out and analyzed. Tooth extraction is the most common surgical procedures in patients with hemophilia. Hematological preparation implies the application of a concentrated factor VIH for one to two days prior to the intervention to achieve a desired level of factor VIII needed for the operation. In tooth extraction, this level has to be 50% before and after the tooth extraction for 5 days, with the application of antifibrinolytic agents. In oral surgical interventions the desired level of factor VIII is 50-80% preoperatively, 30-80% for 5 days after surgery, and 30% up to 14 days, also with the use of antifibrinolytic therapy. Patients with hemophilia and inhibitors are prepared for intervention through the application of recombinant FVIIa at the dose of 120mcg/kg, repeated every 2 hours for the period of 7-10 days after the intervention. It is necessary to apply antifibrinolytic agents and local hemostatic measures. Measures of local hemostasis are unavoidable in the case of oral surgical interventions in patients with hemophilia A. Implementation of these procedures in oral surgery has the role of minimizing the possibility of intra- and postoperative bleeding in patients with hemophilia A. For this purpose, the following are mostly used: absorbable suture thread, preparations of collagen, oxycellulose, gelatin, fibrin glue, with topical application of tranexamic or epsilon aminocaproic acid. Conclusion: Close cooperation between hematologists and oral surgeons is essential in order to minimize unwanted complications in patients with hemophilia A.

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.