Publications by authors named "Dragana Gabrić"

38 Publications

Implant Prosthodontic Rehabilitation after Surgical Treatment for an Oropharyngeal Malignant Tumour Using Tantalum Dental Implants.

Case Rep Dent 2021 22;2021:5585181. Epub 2021 Apr 22.

Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.

Oropharyngeal cancer (OPC) represents a significant portion of head and neck cancers. In most cases, it is localised in the soft palate, lingual and palatine tonsils, base of the tongue, and the surrounding tissues. Alcohol and tobacco exposure are well-known evidence-based risk factors for developing OPC; however, over the last decade, there has been a rapid increase in OPC linked to human papillomavirus (HPV). Dental implant therapy faces many challenges related to immediate and long-term success, and patients who are rehabilitated with implant prosthodontic therapy often have numerous comorbidities. Tantalum is a rare transitional metal element which has high corrosion resistance and is extremely inert. Porous tantalum trabecular metal (PTTM) has high volumetric porosity, a low modulus of elasticity, and very high friction. PTTM implant surface enhancement allows "osseoincorporation," which means the neovascularisation and formation of new bone directly onto the implant. A 65-year-old patient presented to the Department of Oral Surgery of Clinical Hospital Centre Zagreb after resection of the mandible due to OPC had oral rehabilitation. Three Zimmer Biomet Trabecular Metal™ implants (4.1 × 10 mm) were inserted in the area of lower left first incisor, lower left second premolar, and lower right second premolar, and after four months, a new upper partial denture and the bar-retained mandibular overdenture were made. Implant prosthodontic rehabilitation of head and neck cancer patients is usually challenging in terms of achieving an improvement in its main aim, quality of life; however, today it is a safe and reliable therapy. Although radiation therapy may negatively affect the patient's oral condition and influence the short- and long-term success of the implant, the presented case report showed that the excellent properties of PTTM-enhanced dental implants may give great basis for future comparative researches of using these implants in the treatment of oncologic patients.
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http://dx.doi.org/10.1155/2021/5585181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084688PMC
April 2021

Evaluation of Antimicrobial Efficacy and Permeability of Various Sealing Materials at the Implant-Abutment Interface-A Pilot In Vitro Study.

Materials (Basel) 2021 Jan 14;14(2). Epub 2021 Jan 14.

DDM, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia.

The microenvironment of the oral cavity is altered when an implant, a biocompatible foreign body, is inserted into the mouth. Bacteria settle in the tissues in and around the implant due to the passage of microorganisms through the microgap at the connection of the implant and prosthetic abutment. To prevent colonization of the implant by microorganisms, one idea is to use sealing and antimicrobial materials to decontaminate the implant-abutment interface and close the microgap. The purpose of this study is to evaluate the antimicrobial efficacy and permeability of different types of sealing materials at the implant-abutment interface, under static conditions. Three different sealing material (GapSeal gel, Oxysafe gel and Flow.sil) were used for sealing the implant-abutment interfaces in 60 titanium dental implants, which were first contaminated with a solution containing and for 14 days under an aerobic condition. Results showed that a complete seal against bacterial infection was not formed at the implant-abutment interface, while for fungal infections, only GapSeal material helped to prevent microleakage. Findings of this in vitro study reported that application of sealing material before abutment connection may reduce peri-implant bacterial and fungal population compared with the interface without sealing material.
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http://dx.doi.org/10.3390/ma14020385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830056PMC
January 2021

Multidisciplinary Approach to Rehabilitation after Tumor Resective Jaw Surgery: A 9-Year Follow-Up.

Case Rep Dent 2020 10;2020:8867320. Epub 2020 Dec 10.

Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia.

A 36-year-old male patient presented at the Department of Maxillofacial Surgery, University Hospital Clinic Zagreb in December 2010 due to a swelling of the left body of the mandible that was noticed 4 months earlier. The patient was referred regarding an atypical clinical and radiological finding in the form of a multicystic appearance in the corpus of the left mandible and teeth mobility in the same region. A probatory biopsy was performed under local anesthesia and sent for histopathologic examination which reported odontogenic myxoma. The tumor was removed with a marginal resection of the mandible from the left first incisor to the left second molar. Two years after surgery, in January 2013, the patient was referred to the oral surgeons for implant-prosthodontic rehabilitation. Two narrow implants were placed at positions 32 and 36, and three months afterwards, implant-retained denture was made using locator connections to compensate lost teeth and to correct the ratio of soft tissues and facial contours. The patient was followed-up for 9 years without any functional and aesthetic problems. Loosing function and aesthetic morbidity, after radical surgical treatment, often have compromised the quality of life of this group of patients. It is important to highlight the need for multidisciplinary collaboration for the complete rehabilitation of the patient after surgical oncology of the maxillofacial region.
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http://dx.doi.org/10.1155/2020/8867320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748915PMC
December 2020

Salivary Hormones and Quality of Life in Female Postmenopausal Burning Mouth Patients-A Pilot Case-Control Study.

Dent J (Basel) 2020 Oct 1;8(4). Epub 2020 Oct 1.

Department of Oral Medicine, University Clinical Hospital Zagreb, 10000 Zagreb, Croatia.

The objective of our study was to investigate salivary levels of estradiol, progesterone and dehydroepiandrosterone (DHEA), and quality of life, in female postmenopausal women with burning mouth syndrome. The study included new patients diagnosed with burning mouth syndrome and excluded local and systemic causes. Unstimulated saliva samples were taken in the morning from 9 AM and 11 AM and immediately frozen for hormone analysis. The patients filled out a self-perceived quality of life questionnaire Oral Health Impact Profile-14 and determined the intensity of mucosal symptoms according to the visual-analog scale grading 0 to 10. A total of 40 patients were included. The study group had significantly lower levels of salivary estradiol. No difference was observed in levels of progesterone and DHEA between the groups. The levels of salivary hormones did not exhibit a significant correlation according to the Spearman correlation test with a self-perceived quality of life questionnaire (OHIP-14) in the study group or in the control group. Further research on a larger number of patients is needed to verify these results. This information might help to enable more precise and efficient treatment.
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http://dx.doi.org/10.3390/dj8040111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711961PMC
October 2020

EVALUATION OF INNOVATIVE DIGITALLY CONTROLLED ER:YAG LASER IN SURGICAL TREATMENT OF ORAL LEUKOPLAKIA - A PRELIMINARY STUDY.

Acta Clin Croat 2019 Dec;58(4):615-620

1Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb University Hospital Centre, Zagreb, Croatia; 3student, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4PhD student, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 5University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.

The use of lasers for treatment of oral leukoplakia has gained a lot of interest in the past years, however, data on the use of Er:YAG laser are scarce. The aim of this study was to compare the efficacy of Er:YAG laser and 1% topical isotretinoin in the treatment of 27 oral leukoplakia patients. Er:YAG laser (LightWalker AT, Fotona, Slovenia) was used in 27 patients with 27 leukoplakia lesions. Postoperative pain was assessed by use of visual analog scale (VAS), and the impact of laser treatment on the quality of life was assessed by the OHIP-14 questionnaire (Croatian version). Control group consisted of the same 27 patients previously treated with 1% topical isotretionin three times a day during the period of one year. No improvement in the size of leukoplakia lesions was observed after treatment with topical isotretinoin. There were significant differences between men and women according to leukoplakia localization, number of laser sessions and VAS (p<0.05). At follow-up after six months and one year, there was no recurrence of lesions. Er:YAG laser is a successful treatment for oral leukoplakia. Topical isotretionin treatment is unsuccessful in patients with oral leukoplakia.
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http://dx.doi.org/10.20471/acc.2019.58.04.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314310PMC
December 2019

Assessment of the Impact of the Addition of Nanoparticles on the Properties of Glass-Ionomer Cements.

Materials (Basel) 2020 Jan 8;13(2). Epub 2020 Jan 8.

School of Science, University of Greenwich, Central Ave, Gillingham, Chatham ME4 4TB, UK.

The aim of the study was to evaluate the effects of incorporation of AlO, ZrO and TiO nanoparticles into glass-ionomer cements (GICs). Two different GICs were used in the study. Four groups were prepared for each material: the control group (without nanoparticles) and three groups modified by the incorporation of nanoparticles at 2, 5 or 10 wt %, respectively. Cements were mixed and placed in moulds (4 mm × 6 mm); after setting, the samples were stored in saline (one day and one week). Compressive strengths were measured and the morphology of the fractured surfaces was analyzed by scanning electron microscopy. The elements released into the storage solutions were determined by Inductively coupled plasma-optical emission spectrometry (ICP-OES). Addition of nanoparticles was found to alter the appearance of cements as examined by scanning electron microscopy. Compressive strength increased with the addition of ZrO and especially TiO nanoparticles, whereas the addition of AlO nanoparticles generally weakened the cements. The ion release profile of the modified cements was the same in all cases. The addition of AlO, ZrO and TiO nanoparticles into GICs is beneficial, since it leads to reduction of the microscopic voids in the set cement. Of these, the use of ZrO and TiO nanoparticles also led to increased compressive strength. Nanoparticles did not release detectable levels of ions (Al, Zr or Ti), which makes them suitable for clinical use.
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http://dx.doi.org/10.3390/ma13020276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014475PMC
January 2020

Corrigendum to "Oral Adverse Reactions Caused by Over-the-Counter Oral Agents".

Case Rep Dent 2019;2019:2816785. Epub 2019 Nov 21.

Clinic for Tumours, Clinical Hospital Centre Sisters of Mercy, Zagreb, Croatia.

[This corrects the article DOI: 10.1155/2015/196292.].
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http://dx.doi.org/10.1155/2019/2816785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906826PMC
November 2019

Oral Mucormycosis and Aspergillosis in the Patient with Acute Leukemia.

Acta Stomatol Croat 2019 Sep;53(3):274-277

Department of Oral Surgery School of Dental Medicine University of Zagreb and Department of Oral Surgery University Hospital Centre Zagreb, Zagreb, Croatia.

A 54-year-old male patient with acute lymphoblastic leukemia was referred to the Department of Oral Medicine. He had a primary refractory disease and was treated according to HOVON71 and HAM protocol. Sixteen days after the start of the HAM protocol the patient developed palatal dark red/brownish lesion and maxillary vestibular exophytic lesion. Biopsy specimens from oral lesions were taken and microbiologic evaluation confirmed the presence of and . The treatment of the patient consisted of the inferior maxillectomy and intravenous posaconazole and amphotericine B for the following 28 days. Since the coinfection with and is extremely rarely seen in the oral cavity, a diagnostic and therapeutic dilemma easily presents itself.
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http://dx.doi.org/10.15644/asc53/3/9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820447PMC
September 2019

Effects of Addition of Quaternary Ammonium Antimicrobial Compounds into Root Canal Sealers.

Eur J Dent 2019 May 3;13(2):243-247. Epub 2019 Sep 3.

Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, SS. Cyril and Methodius University, Skopje, Republic of North Macedonia.

Objective: The aim of this study is to determine the effect of the addition of benzalkonium chloride and cetylpyridinium chloride in three commercial root canal sealers.

Materials And Methods: Three different root canal sealers were used: EndoRez, N2, and Apexit Plus. The samples were prepared by mixing the components according to the manufacturers' guidelines and adding 2% in weight of the antimicrobials to the newly mixed cement. The paste was placed in molds and stored in an incubator (37°C, 24 h). The samples were then stored in 5-mL distilled water. Samples without antimicrobials served as a control. All samples were tested at 3 time intervals: 1 day, 1 week, and 1 month following their storage in distilled water. The impact of the antimicrobials on the solubility of the sealers, the release of chloride ions (Cl), and the pH value were examined.

Statistical Analysis: Analysis was done using one-way analysis of variance and the post hoc Tukey's honestly significant difference test.

Results: Chloride ions are present in storage media with EndoRez, N2, and Apexit Plus samples (without antimicrobials) following all tested storage intervals. The addition of the antimicrobials increased the release of chloride ions. Endodontic cements without addition of antimicrobials show an increase in weight after 1 month. The highest pH value is measured in Apexit Plus samples. The solutions in which N2 samples (with and without addition of antimicrobials) were stored did not have a significant change in their pH, while in the EndoRez solutions, a significant decrease in the pH value after the first week was measured.

Conclusions: The addition of antimicrobials might lead to improved characteristics of the root canal sealers.
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http://dx.doi.org/10.1055/s-0039-1688524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777158PMC
May 2019

Influence of different laser-assisted retrograde cavity preparation techniques on bond strength of bioceramic-based material to root dentine.

Lasers Med Sci 2020 Feb 4;35(1):173-179. Epub 2019 Jul 4.

Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Clinical Hospital Center Zagreb, Zagreb, Croatia.

The purposes of the study were to evaluate the bond strength of bioceramic TotalFill root repair material (RRM) in retrograde cavities prepared using Er:YAG and Er,Cr:YSGG laser and steel bur, and to analyze failure modes. The root canals of 30 single-rooted teeth were endodontically treated, their root-ends were resected using a diamond bur, and the teeth were randomly divided into three groups (N = 10) according to the retrograde cavity preparation technique: (1) Er:YAG laser, (2) Er,Cr:YSGG laser, and (3) steel bur. All retrograde cavities were filled with the TotalFill RRM which was prepared according to the manufacturers' instructions. Push-out test was performed using universal testing machine, and failure mode was analyzed using a scanning electron microscope. The data were analyzed using one-way ANOVA, post hoc analysis with Bonferroni correction, and Fisher-Freeman-Halton exact test (p < 0.05). In the Er:YAG-, Er,Cr:YSGG-, and steel bur-prepared cavities, mean bond strengths (MPa) were 12.76, 8.44, and 6.01, respectively. The bond strength of the TotalFill RRM to dentin was significantly higher in the Er:YAG laser compared with the steel bur-prepared cavities (p = 0.004). The bond strength was not significantly different between the Er:YAG and Er,Cr:YSGG cavities (p = 0.074) and between the Er,Cr:YSGG and bur cavities (p = 0.648). In the cavities prepared by the Er,Cr:YSGG laser and bur, the failure mode of the TotalFill RRM was predominantly mixed, then adhesive and cohesive. In the Er:YAG laser-prepared cavities, the most common failure mode was adhesive, followed by mixed type and no cohesive failure. The bond strength of the TotalFill RRM to dentin was highest in the group of retrograde cavities prepared by the Er:YAG laser.
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http://dx.doi.org/10.1007/s10103-019-02835-zDOI Listing
February 2020

Idiopathic Exposed Bone Lesions of the Jaw.

Dent J (Basel) 2019 06 1;7(2). Epub 2019 Jun 1.

Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb 10 0000, Croatia.

Introduction: Osteonecrosis of the jaw is defined as exposed bone in the oral cavity that does not heal longer than eight weeks after identification. The two most common predisposing factors for osteonecrosis of the jaw are medication-related and radiotherapy. Rarely, exposed bone in the maxillofacial region can occur due to other causes and represents a clinical and therapeutic challenge for the dentist because there is no universally accepted treatment protocol.

Case Presentation: We report a case of a patient with two idiopathic lesions of exposed bone which have healed after systemic antibiotic therapy, seven weeks after the first examination.

Conclusion: Exposed bone lesions of the jaw are a rare entity and are poorly documented in the literature. It is necessary to exclude possible local or systemic contributing factors. Surgical and conservative therapy (antibiotics) are the treatment of choice.
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http://dx.doi.org/10.3390/dj7020055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630877PMC
June 2019

Dental Treatment Under General Anesthesia in a Day Care Surgery Setting.

Acta Stomatol Croat 2019 Mar;53(1):64-71

Department of Pediatric Dentistry, Dental Clinic, University Clinical Hospital Zagreb/University of Zagreb, School of Dental Medicine, Zagreb, Croatia.

Objective: To analyze data on full-mouth rehabilitation under general anesthesia (GA) performed at the University Clinical Hospital Zagreb with emphasis on patient characteristics, type of procedure and postoperative complications.

Materials And Methods: Retrospective chart review of 100 patients treated under GA at the Dental clinic's day care surgery. Patient's demographic (sex, age) and clinical data (diagnosis, GA technique, intubation type, procedure duration, number of carious teeth, presence of visible calculus, number of sealed teeth, fillings, extractions and endodontic treatments, discharge time, postoperative complications) were registered.

Results: Eighty patients were treated under GA because of noncompliance due to different reasons and twenty patients because of either their poor physical condition or extensive dental procedure. Median DMFT per patient was 9(0-21). Eighty nine patients underwent full-mouth dental restoration and 11 patients underwent other types of procedures. Ninety-six patients were safely discharged the same day. Four patients experienced postoperative complications and three of them were hospitalized for another 24-48 hours for postoperative follow-up.

Conclusion: Patients with physical and/or intellectual disabilities have higher caries activity and increased dental treatment needs compared to the general population. Dental treatment under GA in day care service is a safe and effective way of providing dental care for noncompliant patients.
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http://dx.doi.org/10.15644/asc53/1/7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508932PMC
March 2019

Comparison of Er:YAG and Er,Cr:YSGG Laser in the Treatment of Oral Leukoplakia Lesions Refractory to the Local Retinoid Therapy.

Photobiomodul Photomed Laser Surg 2019 Jun 13;37(6):362-368. Epub 2019 May 13.

3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.

The aim of this study was to compare the efficacy of Er:YAG and Er,Cr:YSGG laser in the treatment of oral leukoplakia refractory to conventional retinoid therapy. The study sample consisted of 54 patients (16 men and 38 women) who were histopathologically diagnosed with oral leukoplakia that was refractory to conventional retinoid therapy. Patients were randomly allocated into two groups according to the type of the laser used for treatment of oral leukoplakia: Group 1. Er:YAG laser; Group 2. Er,Cr:YSGG laser. Patients were recalled at 6 months and 1 year after treatment to evaluate possible recurrence and assess the patients' postoperative quality of life. After initial ablation, the degree of residual lesion was significantly greater in the Er:YAG laser group (74.1%), compared with the Er,Cr:YSGG group (18.5%) ( = 0.0001). Six months and 1 year after the second ablation, there was no lesion recurrence in either laser group. Fourteen days after the initial ablation, the visual analog scale (VAS) pain rating and the total oral health impact profile score fell significantly in both groups ( < 0.0001). However, in the Er,Cr:YSGG laser group, the average value of the VAS rating was significantly lower than in the Er:YAG laser group ( = 0.039). The Er:YAG and Er,Cr:YSGG lasers showed similar efficacy in the treatment of oral leukoplakia and resulted in full postoperative recovery without recurrence after 1 year of follow-up.
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http://dx.doi.org/10.1089/photob.2018.4560DOI Listing
June 2019

Shear Bond Strength of Orthodontic Brackets Luted with RMGIC After Er:YAG Laser Etching with Two Pulse Modes Using a Digitally Controlled "X-Runner" Handpiece.

Photomed Laser Surg 2018 Nov 18;36(11):608-613. Epub 2018 Sep 18.

1 Department of Orthodontics, School of Dental Medicine, University of Zagreb , Zagreb, Croatia .

Objective: To compare the shear bond strength (SBS) values of orthodontic brackets luted using a resin-modified glass ionomer cement (RMGIC) on enamel surfaces etched using either an Er:YAG laser in two different working modes, or a conventional etching protocol, including phosphoric acid.

Materials And Methods: Sixty healthy human premolars were randomly allocated to three experimental groups (n = 20) and etched with: Group 1: Er:YAG laser in super-short pulse (SSP) mode (100 mJ, 20 Hz, 2 W); Group 2: Er:YAG laser in quantum square pulse mode (120 mJ, 10 Hz, 1.2 W) using a digitally controlled handpiece ("X-Runner"); Group 3 (control): 5.25% sodium hypochlorite pretreatment, then 37% phosphoric acid for 15 sec. Stainless steel brackets were bonded using light-curing RMGIC for orthodontic bonding. After term cycling (1800 cycles), SBS testing was performed using a universal testing machine. After debonding, both enamel and bracket surfaces were examined to determine the amount of RMGIC still present on the surfaces.

Results: Group 3 surfaces gave the lowest mean SBS (10.6104 ± 2.66196 MPa), whereas Group 1 provided the highest 1 (13.1795 ± 3.37904 MPa), which was significantly different from the control (Group 3, p = 0.0226). Group 2 provided intermediate values (11.8486 ± 0.59832 MPa) nonsignificantly different from the control or from SSP (p = 0.4215 and p = 0.3082, respectively).

Conclusions: Er:YAG laser treatment in SSP mode of enamel surfaces for orthodontic bonding provided higher SBS and a shear behavior of the luting material similar to the conventional acid-etching procedures, making it a viable alternative to acid etching.
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http://dx.doi.org/10.1089/pho.2018.4461DOI Listing
November 2018

Antimicrobial Efficacy of Photodynamic Therapy and Light-Activated Disinfection Against Bacterial Species on Titanium Dental Implants.

Int J Oral Maxillofac Implants 2018 Jul/Aug;33(4):831-837

Purpose: The aim of this study was to evaluate the efficacy of photodynamic therapy (PDT) and light-activated disinfection (LAD) against a 3-day-old bacterial suspension prepared from three different bacterial species present on titanium dental implants, and to analyze the possible alterations of the implant surfaces as a result of the PDT and LAD.

Materials And Methods: The study was conducted on 72 titanium dental implants contaminated with a bacterial suspension prepared from three bacterial species: Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis. The contaminated implants were incubated under anaerobic conditions for 72 hours and then were randomly divided into four experimental groups and two control groups (n = 12 each), according to the following treatment protocols: group 1 (PDT1): PDT (660 nm, 100 mW, 60 seconds) with toluidine blue; group 2 (PDT2): PDT (660 nm, 100 mW, 60 seconds) with phenothiazine chloride dye; group 3 (LAD): light-emitting diode (LED) with toluidine blue; group 4 (toluidine blue): treatment with only toluidine blue for 60 seconds. In the positive control group, the implants were treated with a 0.2% chlorhexidine-based solution for 60 seconds, and in the negative control group, no treatment was used.

Results: The highest bacterial reduction was recorded in the PDT1 (98.3%) and PDT2 (97.8%) groups. The results of this study showed that there was a statistically significant reduction of bacteria in the PDT1 and PDT2 groups compared with the negative control group (P < .05), individually for each bacterial species as well as for all three species together. LAD was less effective than PDT1 and PDT2, and did not show a statistically significant difference compared with the negative control or any other treatment group. Toluidine blue was the least effective treatment in terms of both the total bacterial count and the individual count for each bacterial species.

Conclusion: Both PDT1 and PDT2 protocols showed a high efficacy against a 3-day-old bacterial biofilm on dental implants and were more effective compared with LAD.
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http://dx.doi.org/10.11607/jomi.6423DOI Listing
October 2018

Tuberculosis of the Oral Cavity Misdiagnosed as Precancerous Lesion.

Acta Stomatol Croat 2017 Dec;51(4):326-331

Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.

Introduction: The aim of this case report was to discuss an extremely rare oral lesion as a result of primary pulmonary tuberculosis.

Case Report: In this case report, the patient with refractory painless ulceration at ventral surface of the tongue was described. Detailed medical history was taken followed by clinical examination of the oral mucosa and palpation of regional lymph nodes. Clinical examination revealed ulceration on the patient's ventro-lateral surface of the tongue, approximately two centimeters in diameter. Palpation of regional lymph nodes has not revealed enlargement. The toluidine blue test of the suspected lesion was performed at each control examination. Biopsy samples for histopathologic diagnosis were taken three times. The analysis of the first biopsy sample for histopathology revealed a non-specific inflammation, the second biopsy revealed a caseous necrosis without positive Ziehl-Neelsen staining and the third biopsy revealed a granulomatous inflammation which was highly suspicious of sarcoidosis. During hospitalization, the patient underwent a complete physical examination, and laboratory and radiological diagnostics. Physical chest examination revealed bilaterally coarse crepitations and laboratory findings of his complete blood count revealed normocytic anemia of chronic disease. Radiographic examination of lungs showed multiple small nodules bilaterally and positive direct sputum smear.

Conclusion: Although oral tuberculosis is a rare condition, it must be taken into account in differential diagnosis of refractory painless oral ulcers.
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http://dx.doi.org/10.15644/asc51/4/7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5975450PMC
December 2017

Antimicrobial efficacy of photodynamic therapy and light-activated disinfection on contaminated zirconia implants: An in vitro study.

Photodiagnosis Photodyn Ther 2018 Mar 2;21:328-333. Epub 2018 Feb 2.

Department of Oral Surgery, University Hospital Center Zagreb, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000, Zagreb, Croatia. Electronic address:

Background: We aimed to evaluate the antimicrobial efficacy of photodynamic therapy (PDT) and light-activated disinfection (LAD) on zirconia dental implants contaminated with three bacterial species and investigate if the PDT and LAD cause implant surface alterations.

Methods: Seventy-two zirconia dental implants were contaminated with a bacterial suspension of Prevotella intermedia, Actinomyces actinomycetemcomitans, and Porphyromonas gingivalis. The implants were subsequently randomly divided into four groups (n = 12 dental implants/each) according to the decontamination protocol: Group 1 (PDT1) - PDT (660 nm, 100 mW) with toluidine blue; Group 2 (PDT2) - PDT (660 nm, 100 mW) with phenothiazine chloride dye; Group 3 (LAD) - light emitting diode (LED) with toluidine blue; and Group 4 (TB) - toluidine blue without the application of light. Implants in the positive control (PC) group were treated with a 0.2% chlorhexidine-based solution, and implants assigned to the negative control (NC) group did not undergo any treatment. Each implant was then placed in tubes containing phosphate buffered saline (PBS) and vortexed for 60 s to remove the remaining bacteria from the implant surface. After 10-fold serial dilutions, 30 μl of the suspension was plated on Brucella agar plates. After 72 h, the colony forming units (CFU) were counted. Distinctive colonies were confirmed with MALDI Biotyper. The implants were analyzed using scanning electron microscope (SEM) to evaluate the possible surface alterations due to PDT or LAD.

Results: All study groups had significant reductions in the number of CFUs compared with the NC (p < 0.05). PDT1, the PDT2, and the LAD groups had the largest bacterial reduction with respect to each bacterial species separately and the total bacterial count, and they were more efficient compared with the TB group (p < 0.05). SEM analysis did not reveal any alterations of the implant surface after the treatment procedures.

Conclusion: Both PDT protocols and LAD showed high and equal effectiveness in decontamination of zirconia dental implants.
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http://dx.doi.org/10.1016/j.pdpdt.2018.01.017DOI Listing
March 2018

Effect of Different Laser Treatments on the Bond Strength of Intracanal Fiber Posts Cemented with a Self-Adhesive Resin Cement.

J Prosthodont 2019 Jan 29;28(1):e290-e296. Epub 2018 Jan 29.

Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia.

Purpose: To evaluate the influence of laser-activated irrigation by Er:YAG and Er:YSGG (LAI) protocols and Nd:YAG laser irradiation on the bond strength of self-adhesively cemented fiber posts to root canal dentine.

Materials And Methods: The study sample consisted of 84 human single-rooted permanent teeth instrumented with ProTaper Next technique. After obturation, post space preparations were created for fiber-reinforced composite posts. The prepared specimens were divided according to the laser treatment of the post space preparations: group 1: LAI (Er:YAG) + saline solution (pulse energy: 20 mJ, repetition rate: 15 Hz); group 2: LAI (Er:YAG) + QMiX solution (pulse energy: 20 mJ, repetition rate: 15 Hz); group 3: LAI (Er,Cr:YSGG) + saline solution (pulse energy: 62.5 mJ, 20 Hz); group 4: LAI (Er,Cr:YSGG) + QMiX (pulse energy: 62.5 mJ, 20 Hz); Nd:YAG laser (pulse energy: 100 mJ, 10 Hz). Fiber-reinforced posts were cemented with a self-adhesive cement. The bond strength was evaluated by the push-out bond strength test, and the mode of failure was determined under a stereomicroscope. Kruskal-Wallis test was used for the intergroup comparative analysis with 5% level of significance.

Results: The highest bond strength was recorded in the Er:YAG + QMiX group (mean 3.401 MPa) (p < 0.05), followed by the Er,Cr:YSGG and the Er:YAG + saline solution (mean 1.111 MPa and 1.094 MPa, respectively), which did not differ significantly (p = 0.232). The irradiation with the Nd:YAG laser caused similar bond strength as the Er,Cr:YSGG + QMiX (p = 0.942).

Conclusion: All laser protocols enhanced the bond strength of the self-adhesive cement in root canals compared to only saline irrigation. The bond strength of the self-adhesive cement depended on the laser parameters and irrigant used for the LAI.
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http://dx.doi.org/10.1111/jopr.12738DOI Listing
January 2019

Push-out bond strength of three different calcium silicate-based root-end filling materials after ultrasonic retrograde cavity preparation.

Clin Oral Investig 2018 Apr 23;22(3):1559-1565. Epub 2017 Oct 23.

Department of Oral Surgery, School of Dental Medicine, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.

Objective: The aim of this study was to evaluate the bond strength of three calcium silicate-based root-end filling materials.

Materials And Methods: The root canals of 30 single-rooted teeth were endodontically treated; their root ends were resected and root-end cavities were prepared using ultrasonic tip. The teeth were randomly divided into three groups according to the material: (1) Micro-Mega mineral trioxide aggregate (MM-MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using Kruskal-Wallis and Man-Whitney post hoc tests. All p values < 0.05 were considered significant.

Results: TotalFill RRM exhibited significantly higher bond strength (12.69 MPa) than Biodentine (9.34 MPa, p = 0.023) and MM-MTA (7.89 MPa, p = 0.002). The difference between Biodentine and MM-MTA was not significant (p = 0.447). Mixed failures were the most noted in all three groups. MM-MTA had more adhesive failures than Biodentine and TotalFill, and no cohesive failures, but without statistical significance (p = 0.591).

Conclusion: The bond strength was the highest for TotalFill RRM.

Clinical Relevance: In order to provide a persistent apical seal, root-end filling materials should resist dislodgement under static conditions, during function and operative procedures. TotalFill RRM exhibited higher bond strength to dentin than MM-MTA and Biodentine.
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http://dx.doi.org/10.1007/s00784-017-2244-6DOI Listing
April 2018

Significance of stroma in biology of oral squamous cell carcinoma.

Tumori 2018 Jan-Feb;104(1):9-14

11 Department for Oncoplastic and Reconstructive Surgery, Clinic for Tumours, Clinical Hospital Centre "Sisters of Mercy", Zagreb - Croatia.

The worldwide annual incidence of oral squamous cell carcinoma (OSCC) is over 300,000 cases with a mortality rate of 48%. This cancer type accounts for 90% of all oral cancers, with the highest incidence in men over 50 years of age. A significantly increased risk of developing OSCC exists among smokers and people who consume alcohol daily. OSCC is an aggressive cancer that metastasizes rapidly. Despite the development of new therapies in the treatment of OSCC, no significant increase in 5-year survival has been recorded in the past decades. The latest research suggests focus should be put on examining tumor stroma activation within OSCC, as the stroma may contain cells that can produce signal molecules and a microenvironment crucial for the development of metastases. The aim of this review is to provide an insight into the factors that activate OSCC stroma and hence faciliate neoplastic progression. It is based on the currently available data on the role and interaction between metalloproteinases, cytokines, growth factors, hypoxia factor and extracellular adhesion proteins in the stroma of OSCC and neoplastic cells. Their interplay is additionally presented using the Systems Biology Graphical Notation in order to sublimate the collected knowledge and enable the more efficient recognition of possible new biomarkers in the diagnostics and follow-up of OSCC or in finding new therapeutic targets.
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http://dx.doi.org/10.5301/tj.5000673DOI Listing
May 2018

Mandibular Osteonecrosis due to the Pulpal-Periodontal Syndrome: a Case Report and Review of the Literature.

Acta Stomatol Croat 2017 Mar;51(1):65-71

Department of Oral Medicine, School of Dental Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia.

Objective: Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw.

Case Report: We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and bethamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and sutures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of microorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely.

Conclusion: This case highlights the fact that in some patients bone exposure might develop due to the pulpal-periodontal syndrome i.e. pulp necrosis.
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http://dx.doi.org/10.15644/asc51/1/9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506249PMC
March 2017

The Significance of Brain Transcranial Sonography in Burning Mouth Syndrome: a Pilot Study.

Acta Stomatol Croat 2017 Mar;51(1):48-59

Department of Oral Surgery, School of Dental Medicine, University of Zagreb, University Dental Clinic, University Hospital Center, Croatia.

Objective: Burning mouth syndrome (BMS) is a chronic disorder which is affecting mostly postmenopausal women and is characterized by burning symptoms in the oral cavity on the clinically healthy oral mucosa. Also, the results of previous studies suggested a possible role of peripheral and/or central neurological disturbances in these patients. The aim of this study was to analyze patients with burning mouth syndrome using transcranial sonography.

Methods: By use of transcranial sonography of the brain parenchyma, , midbrain raphe and brain nucleus were evaluated in 20 patients with BMS (64.7±12.3 years) and 20 controls with chronic pain in the lumbosacral region (61.5±15). Statistical analysis was performed by use of Student t test with significance set at p<0.05.

Results: The results of this study have shown hypoechogenicity of the and as well as hyperechogenicity of the in BMS patients (p<0,05) as compared to controls.

Conclusions: Altered transcranial sonography findings of the , and eus in patients with burning mouth syndrome might reflect central disturbances within this syndrome.

Key Words: Burning Mouth Syndrome; Transcranial Sonography; substantia nigra; Midbrain Raphe Nuclei; Red Nucleus.
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http://dx.doi.org/10.15644/asc51/1/6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506256PMC
March 2017

Efficacy of Three Different Lasers on Eradication of Enterococcus faecalis and Candida albicans Biofilms in Root Canal System.

Photomed Laser Surg 2017 Jul 20;35(7):372-377. Epub 2017 Apr 20.

5 Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb , Zagreb, Croatia .

Objective: The objective was to compare the efficacy of three different lasers in disinfection of root canals inoculated with Enterococcus faecalis and Candida albicans biofilms.

Background: Endodontic space disinfection depends on the type of root canal irrigant used and the way it is delivered and agitated because irrigants have limited ability to reach all parts of root canal system.

Materials And Methods: Thirty single-rooted human teeth were selected. Root canals were instrumented and root surfaces were sealed using adhesive and the apical openings with adhesive and composite resin. Roots were fixed in Eppendorf tubes and sterilized in autoclave. The specimens were randomly divided into three experimental groups (n = 10) and inoculated with E. faecalis and C. albicans. After 7 days of incubation period, the number of E. faecalis and C. albicans colony-forming units (CFUs) was determined for each root canal. In the first experimental group, Er:YAG laser (0.3 W) with photon-induced photoacoustic streaming technique was used for root canal disinfection, in the second, Nd:YAG laser (1.5 W), and in the third, Er,Cr:YSGG (1.25 W) laser was used. After different root canal disinfection protocols, the number of E. faecalis and C. albicans CFUs was determined again for each root canal.

Results: Er:YAG and Er,Cr:YSGG lasers eradicated significant number of E. faecalis and C. albicans CFUs (p < 0.05), while Nd:YAG laser irradiation did not result in statistically significant reduction (p > 0.05). Er,Cr:YSGG laser eradicated significantly more microorganisms in comparison with Er:YAG laser (p < 0.05).

Conclusions: Er,Cr:YSGG laser was the most efficient tool in eradication of E. faecalis and C. albicans biofilms.
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http://dx.doi.org/10.1089/pho.2016.4258DOI Listing
July 2017

Influence of Laser Activated Irrigation with two Erbium Lasers on Bond Strength of Inidividually Formed Fiber Reinforced Composite Posts to Root Canal Dentin.

Acta Stomatol Croat 2016 12;50(4):321-328

- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.

Objective: The aim of this study was to investigate the effect of laser activated irrigation (LAI) using two erbium lasers on bond strength of individually formed fiber-reinforced composite (FRC) posts to root canal dentin.

Materials And Methods: Twenty-seven single-rooted human teeth were endodontically treated and after post space preparation divided into three groups (n=9 per group), according to the pre-treatment of post space preparation: 1) Conventional syringe irrigation (CSI) and saline; 2) Er.YAG photon-induced photoacoustic streaming (PIPS) technique and saline; 3) Er,Cr:YSGG activated irrigation with RFT2 tip. Two specimens from each group were used for SEM analysis. The remaining specimens (n=7 per group) received individually formed FRC post, everStick POST, luted with self-adhesive cement, G-CEM LinkAce. After cementation, the roots were perpendicularly sectioned into 1 mm thin sections and a push-out test was carried out (0.5 mm/min). The data were calculated as megapascals and were log transformed and statistically analysed using one-way ANOVA at the level of significance set at 5%.

Results: In the control group, the smear layer was still present. In the Er:YAG group, the smear layer was removed. In the Er,Cr:YSGG group, the smear layer was partially removed. The Er,Cr:YSGG group achieved the highest bond strength values, followed by the control group and then the Er:YAG group, but no statistically significant difference was found in bond strength values in the tested group of post space pretreatment (p=0.564).

Conclusions: LAI using two erbium lasers, with PIPS or RFT2 tip, did not affect the bond strength of individually formed FRC posts to root canal dentin.
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http://dx.doi.org/10.15644/asc50/4/5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328648PMC
December 2016

Bone Healing Following Different Types of Osteotomy: Scanning Electron Microscopy (SEM) and Three-Dimensional SEM Analyses.

Microsc Microanal 2016 12;22(6):1170-1178

4Faculty of Dentistry,University "Ss Cyril and Methodius" Skopje,Vodnjanska 17, 1000 Skopje,Republic of Macedonia.

The aim of the present study was to compare dynamics of the bone healing process after different types of osteotomies. In total, 24 Wistar rats were subjected to different types of osteotomy performed with standard steel bur, piezosurgery, contact, and non-contact Erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation. The animals were randomly divided into four groups, to be euthanized immediately after the procedure, or at 1, 2, or 3 weeks after surgery. The obtained bone samples were analyzed by scanning electron microscopy (SEM). Immediately after surgery, there were significant differences in the appearance of the bone defects, with presence of bone fragments and debris after standard steel bur preparation, compared with the clean smooth walls and relatively sharp edges in all other groups. The initial bone formation in defects prepared by piezosurgery was observed to be the most rapid. After 3 weeks, all bone defects were completely restored; although, differences in the healing pattern were noted, with a modest initial delay in healing after laser preparation. The first stage of the bone healing process was delayed when contact and non-contact Er:YAG laser modes were used and accelerated by piezosurgery; however, the results after 3 weeks demonstrated similar restitution of defects in all tested groups.
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http://dx.doi.org/10.1017/S1431927616011971DOI Listing
December 2016

The Effectiveness of Low-Level Laser Therapy in Patients with Drug-Induced Hyposalivation: A Pilot Study.

Photomed Laser Surg 2016 Sep 14;34(9):389-93. Epub 2016 Jul 14.

6 National Cancer Institute, Clinical Hospital Center Sisters of Mercy , Zagreb, Croatia .

Objective: The aim of this study was to compare switched on and switched off (sham) low-level laser therapy (LLLT) in the treatment of drug-induced hyposalivation.

Background Data: Hyposalivation is decreased salivary flow rate most frequently present in patients who take a lot of medication, suffer from Sjögren's syndrome, or were irradiated. Available therapies provide only short-term relief.

Materials And Methods: Forty-three participants (40 females and 3 males, average age 72.3 ± 8.9) participated in the study. Before therapy or after therapy, every participant fulfilled quality-of-life assessment scale (OHIP-CRO14). Unstimulated and stimulated salivary flow rates were measured before and after treatment. The LLLT was performed by the use of gallium-aluminum-arsenide (GaAlAs) laser (830 nm) on parotid, submandibular, and sublingual glands every day except during weekends for 14 days.

Results: Significant difference in unstimulated salivary flow rate after the treatment was found in the study group (p = 0.002) compared with the sham group. No significant difference in stimulated salivary flow rate after treatment was found in the laser group (p = 0.626) nor in the sham laser group (p = 0.233). No significant difference in patient's quality-of-life score was found after both treatments.

Conclusions: The results of this study showed that the LLLT increased unstimulated salivary flow rate significantly. However, stimulated salivary flow rate did not increase significantly after the LLLT. In patients who underwent sham laser therapy, neither unstimulated nor stimulated salivary flow rate increased significantly.
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http://dx.doi.org/10.1089/pho.2016.4109DOI Listing
September 2016

Enamel alteration following tooth bleaching and remineralization.

J Microsc 2016 06 21;262(3):232-44. Epub 2015 Dec 21.

St. Mary's University, Twickenham, London, UK.

The purpose of this study was to compare the effects of professional tooth whitening agents containing highly concentrated hydrogen peroxide (with and without laser activation), on the enamel surface; and the potential of four different toothpastes to remineralize any alterations. The study was performed on 50 human molars, divided in two groups: treated with Opalescence(®) Boost and Mirawhite(®) Laser Bleaching. Furthermore, each group was divided into five subgroups, a control one and 4 subgroups remineralized with: Mirasensitive(®) hap+, Mirawhite(®) Gelleѐ, GC Tooth Mousse™ and Mirafluor(®) C. The samples were analysed by SEM/3D-SEM-micrographs, SEM/EDX-qualitative analysis and SEM/EDX-semiquantitative analysis. The microphotographs show that both types of bleaching cause alterations: emphasized perikymata, erosions, loss of interprizmatic substance; the laser treatment is more aggressive and loss of integrity of the enamel is determined by shearing off the enamel rods. In all samples undergoing remineralization deposits were observed, those of toothpastes based on calcium phosphate technologies seem to merge with each other and cover almost the entire surface of the enamel. Loss of integrity and minerals were detected only in the line-scans of the sample remineralized with GC Tooth Mousse™. The semiquantitative EDX analysis of individual elements in the surface layer of the enamel indicates that during tooth-bleaching with HP statistically significant loss of Na and Mg occurs, whereas the bleaching in combination with a laser leads to statistically significant loss of Ca and P. The results undoubtedly confirm that teeth whitening procedures lead to enamel alterations. In this context, it must be noted that laser bleaching is more aggressive for dental substances. However, these changes are reversible and can be repaired by application of remineralization toothpastes.
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http://dx.doi.org/10.1111/jmi.12357DOI Listing
June 2016

Response to letter Re: Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent.

Br J Oral Maxillofac Surg 2016 07 26;54(6):711-2. Epub 2016 Apr 26.

Head of the Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Dentistry Clinic, Clinical Hospital Center Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia. Electronic address:

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http://dx.doi.org/10.1016/j.bjoms.2016.04.012DOI Listing
July 2016

Ablative Potential of Er:YAG Laser in Dentin: Quantum Versus Variable Square Pulse.

Photomed Laser Surg 2016 May 8;34(5):215-20. Epub 2016 Apr 8.

1 Department of Endodontics and Restorative Dentistry, School of Dental Medicine , Zagreb, Croatia .

Objective: The primary objective of this study was to compare the dentin ablation volume and ablation rate of quantum square pulse (QSP), using two different pulse energy settings plus a new digitally controlled dental laser handpiece (X-Runner), with those of variable square pulse (VSP), using three different pulse durations. The secondary objective was to examine, by scanning electron microscopy (SEM), the surface effects of ablation with the different Er:YAG laser modes on the dentin surfaces.

Background Data: The available literature has limited data on the efficiency of different operating modes, pulse durations, and the new digitally controlled handpiece of the Er:YAG laser on human dentin.

Materials And Methods: Freshly extracted human molars (n = 72) were divided into two experimental groups (n = 36 each): (1) QSP group, and (2) VSP group. Each group was randomly divided into three subgroups (n = 12 each). In the QSP group, preparations in dentin were performed using 250 and 500 mJ of pulse energy with the conventional handpiece, and with the X-Runner handpiece set at 250 mJ pulse energy. In the VSP group, cavity preparations were performed using three pulse variables: super short pulse (SSP), micro short pulse (MSP), and short pulse (SP). Cavity preparations were made in dentin at time intervals of 1, 2, and 5 sec. A laser triangulation profilometer was used to determine cavity volumes. Surface analysis of the ablated dentin specimens was performed by SEM.

Results: For time intervals of 1 and 2 sec, ablated volume and ablation rate for QSP-500 mJ were significantly higher than for all other groups (p < 0.0001). For the 5-sec time interval, X-Runner and QSP-500 mJ were the most efficient in dentin ablation (p < 0.0001). Dentin surfaces were free of smear layer in all groups.

Conclusions: The most efficient modes of dentin ablation in the study were the QSP-500 mJ and X-Runner groups. Dentin surfaces were free of smear layer in all groups.
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http://dx.doi.org/10.1089/pho.2015.4078DOI Listing
May 2016

[INFLUENCE OF NECK DISSECTION ON THE CORRESPONDING MOTOR AND SENSORY NERVES].

Lijec Vjesn 2015 Jul-Aug;137(7-8):219-23

Objective: Radical neck dissection (RND), utilized for treatment of lymph node metastases in patients with head and neck cancers, can result in clinically significant functional disturbance secondary to the corresponding nerve damage. However, there is only limited data relative to post-operative analysis of impact of RND on the cranial and cervical nerves after neck dissection especially regarding the technique used such as electroknife or scalpel.

Study Design: 48 patients (42 men and 6 women) with intraoral cancer were enrolled. A total of 55 dissections were performed, including 7 patients who received bilateral dissections. Analysis of motor and sensory nerves was conducted seven days and three months later with regard whether electroknife or scalpel was used.

Results: The most frequent post-operative loss of motor function was seen in accessory and hypoglossal nerves; within sensory nerves the lingual nerve was most frequently dysfunctional. Permanent diaphragm dysfunction was seen in 15% of investigated patients.

Conclusion: We might conclude that routine evaluation of sensoneural and motor nerve function of all potentially damaged nerves should be performed after RND, especially regarding diaphragm paralysis. There were no differences in postoperative nerve function of the examined nerves with regard to the technique used (electroknife/scalpel).
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November 2015