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Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue:2007, Volume 13, book 2,
DOI: 10.5272/jimab.2007132
Subject Collection: Oral and Dental Medicine
Page: 3 - 63
Date of close: December 12, 2007


J of IMAB 2007, 13(2):3-7;
Elka Radeva, B. Indjov, R. Vacheva*
Department of Conservative Dentistry, Faculty of Dental medicine, Medical University, Sofia; *Department of Microbiology and Virology, Military Medical Academy, Sofia.
Introduction. Frequently isolated pathogens from teeth with necrotic pulp include various enteric bacteria (Klebsiella, Enterobacter), fungi (especially Candida spp.) and enterococci (Enterococcus faecalis). Candida albicans is the most often isolated species. Fungi can be found both in primarily infected teeth and in teeth where the endodontic treatment has failed.
The aim of the current study has been to evaluate the in vitro effectiveness of some of the intracanal irrigants used in eliminating Candida albicans.
Materials and Methods. The study used clinical isolates of Candida albicans from infected root canals.
The effectiveness of the following endodontic irrigants were studied: 17% EDTA, 2% CHX (chlorhexidine), 6% NaOCl (sodium hypochlorite), 3% NaOCl 8 3% H2O2 (hydrogen peroxide).
The study used an agar-diffusion method: cavities were made in the agar and then filled with the studied medicaments.
The data were input and processed using the statistical package SPSS 15.0.1. The level of significance for rejecting the null hypothesis was fixed at p<0,05.
Results. The largest observed zone of inhibition of bacterial growth was achieved with 6% NaOCl – 25.88mm and 17% EDTA – 24.50mm.
The 2% chlorhexidine solution came third in effectiveness compared to the other solutions – the zone of inhibition of the bacterial growth was 17.75mm.
3% NaOCl was less effective than 6%NaOCl, with an inhibition zone of 14.00mm.
The lowest effectiveness was registered in the case of 3% H2O2 – 5.38mm.
Conclusions. In infected root canals there are some microorganisms (Candida albicans, E. Faecalis) that are more resistant to chemical and mechanical procedures and this must be taken into account when using various endodontic irrigants and intracanal medicaments. With the reduction of concentration, the effectiveness of NaOCl against Candida albicans is reduced significantly. The 2% chlorhexidine solution is more effective than 3% NaOCl in eliminating Candida albicans.
Keywords: Candida albicans, intracanal irrigants, infected root canal.

, / PDF 1194 KB /< back > Published online - July 12, 2007

J of IMAB 2007, 13(2):8-11;
Christina Popova, Antoaneta Mlachkova
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
BACKGROUND: The surgical treatment is the definitive therapy of the drug-induced gingival overgrowth, although the recurrence is frequent even with well conducted periodontal maintenance. There are many surgical approaches, but the common surgical technique is the simple excision of the excessive gingival tissue with secondary healing. The apically displaced flaps may posses the advantage to preserve the attached gingiva.
CASE PRESENTATION: It is describe a case of a surgical approach with apically displaced flap in the renal transplant patient with severe drug-induced gingival overgrowth (DIGO).
CONCLUSION: Surgical treatment is often the most reliable option and scalpel gingivectomy remains the treatment of choice, but the apically displaced flap may be more suitable surgical approach to the treatment of drug-induced gingival enlargement. Further investigations are required to develop appropriate management strategies to prevent recurrence of DIGO.

, / PDF 851 KB /< back > Published online - July 24, 2007

J of IMAB 2007, 13(2):12-15;
Christina Popova, Antoaneta Mlachkova
Department of Periodontology, Faculty of Dental Medicine, Medical University – Sofia, Bulgaria
BECKGROUND: Pain is a common feature of the early postsurgical stage. Numerous studies have been conducted to investigate the effect of non-steroidal anti-inflammatory drugs (NSAID) to control postoperative pain after periodontal surgery.
AIM: The aim of this preliminary study is to assess the effectiveness of Aulin (Nimesulide) on the postoperative pain in different surgical procedures of patients with periodontitis treatment and/or mucogingival deformities corrections.
RESULTS AND CONCLUSION : In the limitations of the present study and on the base of the receive results it may to conclude that Aulin is an effective analgesic agent and it’s use in the postoperative period in the surgical treatment of periodontal diseases can control the postsurgery pain.
Key words: anti-inflammatory agents, pain measurement, Nimesulide, postoperative pain, periodontal surgery.

, / PDF 710 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):16-18;
Christina Popova, Velitchka Dosseva
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
When discussing mucogingival surgery and surgical methods, problems related to the lack of attached gingiva, the presence of an osseous defect and/or periodontal pocket must be taken into account. If there is an osseous defect or periodontal pocket that extends beyond the mucogingival junction, it is recommendable as a pretreatment for managing the intrabony defect, to increase the attached gingiva by mucogingival surgery to facilitate periodontal flap surgery. If the width of the keratinized gingiva is inadequate in conjunction with bone defect area, it is necessary to preserve and increase the tissues with free autogenous gingival graft.
The gingival marginal region, in which the inflammatory processes of periodontal disease exist, needs to be protected by a sufficient height and thickness of attached gingival tissues (7,8). Presented case consider one point of the contemporary classification of periodontal diseases (Armitage, AAP, 1999) – the incidental attachment loss. It is recommendable to take into consideration the presence of osseous defect with localized attachment loss and lack of sufficient band of keratinized gingiva. In these cases we must apply an approach to assure adequate attached gingiva before the periodontal regenerative procedure. The free gingival graft is a simple, predictable technique for increasing the zone of attached gingival tissues (1,2,3,4) The autogenous free gingival graft introduced by Nabers in 1966 is designed to increase the width of keratinized gingival. This procedure takes epithelium and connective tissue of the palate and locates it in to a recipient bed. This graft retains none of its own blood supply and depends upon the recipient blood vessels. For that reason it was not recommendable originally to cover denuded roots but to change the alveolar mucosa into keratinized gingival (5).

, / PDF 779 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):19-20;
Evaluation of the pulp vitality in patients with periodontitis
Velitchka Dosseva, Antoaneta Mlachkova, Angela Gusiyska*
Department of Periodontology; *Department of Operative Dentistry and Endodontics; Faculty of Dental Medicine, Medical University - Sofia
Background: Periodontitis and pulpitis are caused by bacterial infections and its interactions are well documented in the literature. It has been reported that the pulp of teeth with persisting periodontal disease develops fibrosis and some forms of mineralization. Lesions of the periodontium may reflect the pulpal conditions and lead to pulp inflammation and necrosis. Bacterial infection from the periodontal pocket may spread trough accessory canals to the pulp and cause pulp injury. In the advanced periodontal disease infection may spread trough the apical foramen. However many periodontally affected teeth show no evidence of pulpal involvement.
Aim: Evaluation of the pulp vitality in patients with moderate or advanced periodontitis. Material and method: We examinated pulp vitality of 156 teeth in 18 patients who received periodontal treatment. Teeth were assessed for oral hygiene status, gingival status and periodontal status.
Results: Received results didn’t show that periodontal disease affects seriously the vital function of the pulp in the examinated teeth.
Conclusion: Other authors suggest that persisting moderate or advanced periodontitis is obviously related with pulp injury as reversible and irreversible pulpitis, and pulp necrosis.

, / PDF 948 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):21-24;
Christina Popova, Tsveta Boyarova
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
Background: Gingival recessions require treatment for many reasons – impaired aesthetic appearance, root sensitivity, cervical caries or abrasion. Two surgical techniques have been described that use free gingival graft for root coverage. The technique proposed by Bernimoullin et al. involves two surgical steps. The first step consists of creating attached gingiva by means of free gingival graft and second – coronally positioning of grafted tissue to cover the gingival recession. This indirect technique has advantages over other techniques because ensures development of an adequate band of attached gingiva. The minimal recommended healing period before second surgery is 8 weeks.
Case report: This case presents a 50-years old man with gingival recessions up to 6 mm on #34 and #44 (class II according to Miller classification). Before surgery full- mouth scaling and polishing were performed and oral hygiene instructions were given. Recession height, width, probing depth, clinical attachment level, keratinized and attached gingiva were measured at baseline and six months post surgery.
Results: Eight months after treatment there were significant increasing in keratinized and attached gingival tissues and reduction of height and width of recession (mean gain of root coverage was 91,67% and 90.91%) and great improvement in attachment level.
Conclusion: These results suggest that two-stage surgical procedure is highly predictable for root coverage in case of deep recession and lack of attached gingiva.
Key words : free gingival graft, gingival recession, periodontal plastic surgery, root coverage.

, / PDF 751 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):25-30;
Christina Popova, Kamen Kotsilkov, Velitchka Doseva
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
BACKGROUND: The treatment of the mucogingival problems is one of the main objectives of the periodontal therapy. The insufficient or absent attached gingiva increases the risk of development of gingival recessions. The classical grafting procedures cannot offer a solution for coverage of a larger than 3 teeth recipient area. The strip technique for free gingival graft avoids the limitations of the palatal donor area and decreases the number of surgical procedures required for augmentation of the attached gingival tissues. METHOD: Three patients with Miller class II, III and IV gingival recessions and small vestibuledepth in the frontal mandibular region were selected for treatment. On each patient a strip free gingival graft technique, which included a longitudinal division of the donor palatal tissue, was performed. RESULTS: The initial healing completed in two weeks without complications except the discomfort from the donor area. The augmentation of the attached gingival tissues using the strip free gingival graft technique led to significant gain (4,33 mm mean gain) of attached gingival in the treated regions. CONCLUSION: The limitations of the apical mucosal lap displacement for preparation of recipient site in situations with inadequate vestibule depth and small alveolar bone height require a graft with small width. The results from the presented case reportswith application of the strip technique for free gingival graft indicate that it could be applied when augmentation of the attached gingival tissues on larger area (more than 3 teeth).
Key words: attached gingival tissues, muco­gingival problem, free gingival graft, strip technique.

, / PDF 974 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):31-33;
Christina Popova, Velitchka Doseva, Kamen Kotsilkov,
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
Desquamative gingivitis is a descriptive term of nonspecific clinical expression in the gingiva (redness, burning, erosion, pain) of several dermato-mucous disorders - cicatricial and bullous pemphigoid, pemphigus vulgaris, erosive lichen planus, erythema multiforme, psoriasis, and allergy. These diseases often present with common and similar clinical manifestations in oral cavity and diagnosis based on histological changes of the tissues after biopsy and immunofluorescence is necessary.

, / PDF 919 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):34-37;
Repair of periapical structures in apical periodontitis using two step method
Angela Gusiyska
Department of Operative Dentistry and Endodontics, Faculty of Dental medicine, Medical University, Sofia
INTRODUCTION: Apical periodontitis is a result of infection in root canal system and manifestation of the host defense response. The aim of this study is to compare radiographically regeneration of periapical lesions in roots with infected root canals obturated with calcium hydroxide Ca(OH) 2 / ApexCal - IvoclareVivadent/ as intracanal medication in two steps. Phenols and aldehydes, chlo­ro­phenol camphor thymol and iodoform paste, formocresol and tricresol formalin are sometimes also recommended for this indication. Calcium hydroxide is an effective, biocompatible substance that has been widely studied in scientific research. It is regarded as the material of choice for temporary disinfectant dressings. METHODOLOGY: Standardized preoperative periapical radiographs were taken of 22 tooth of 22 patients / 9 fimale and 13 male /. All roots were then aseptically instrumented to ISO. 12 roots were aseptically instrumented to ISO size 45 , 6 roots were aseptically instrumented to ISO size 50 and the remaining roots were instrumented to ISO size 60 in apical control zone. Roots were irrigated with 10 cc NaOCl 5,25% and 17 % EDTA solution , and then irrigated with 10 cc saline. After saline irrigation ApexCal was placed with a lentulo in the canal for 10 days.Then roots were definitely obturated with Apexit Plus RESULTS: Antibacterial properties of temporary dressings in treatment of apical periodontitis have been the subject of much controversy. Radiographically and clinically treatment would be statistically superior to one-step treatment.Regeneration of periapical structures after 3, 6 and 12 months is significant for healing process. DISCUSSION: Accurate knowledge of root anatomy is an importantally to radiographic resources, tactile sense and operator’s clinical experience, thus contributing to the success of endodontic treatment. Incomplete disinfection of the root canal system is frequently a cause of failure of endodontic treatment. CONCLUSIONS: Clinical study of this 22 cases with periapical lesions appears to be related with use of ApexCal ,Ca(OH)2 antibacterial dressing in root canal system. The antibacterial effect of calcium hydroxide is based on the material’s capacity to release hydroxide ions in an aqueous environment. The bactericidal effect arises from the destruction of cell membranes and the denaturalization of structural proteins and enzymes.
Key words. Apical periodontitis, periapical structures, regeneration, Ca(OH)2.

, / PDF 1036 KB / < back > Published online - July 24, 2007

J of IMAB 2007, 13(2):38-40;
Platelet-rich Plasma - an Accelerator of the Secondary Stability of Immediate Loaded Implants.
Stefan Peev, Dimitar Atanasov*
Private Practice, Kazanlak; *Department of Oral Surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
Aim: To represent the results of one-year research on an original protocol for immediate functional loading of intraoseal implants. Patients and Methods: Totally 86 implants were placed on 21 patients- 7 male and 14 female patients at age of 26 to 64 years.44 of the implants were treated with PRP.The implants were inserted in bone type D2 by Misch, class A. Endure impants with diameter 4.3 have been used in the study. Implant stability was evaluated by Resonance-Frequency analysis. Results: The dynamic changes in the implant stability after the immediate loading have demonstrated improved stability of PRP-treated implants compared with the implants from control group. Conclusion: The established by us protocol for immediate functional loading of intraoseal implants has demonstrated higher success rate compared to the already known protocols and could be recommended for clinical use.

, / PDF 529 KB / < back > Published online - October 6, 2007

J of IMAB 2007, 13(2):41-42;
The diagnostic value of osteo­densito­metry in the treatment of patients with generalized periodontitis of II – III degree
Tihomir Georgiev
Stomatological Center Nr.1, Varna, Bulgaria
The results of osteodensitometric examination of patients with generalized periodontitis are described in this article. The author has shown that the course of this disease in patients older than 40 is often accompanied by a reduction of mineral density in osseous tissue of different degree of expressiveness in the whole skeleton. The osteodensitometric diagnostics carried out give grounds for the necessity to use complex therapy– surgical methods and general osteotropic preparations.
Key words: Generalized periodontitis, surgical treatment, osteodensitometry, mineral density of osseous tissue.

, / PDF 518 KB / < back > Published online - Nov. 13, 2007

J of IMAB 2007, 13(2):43-45;
Method for professional whitening of fluor-coloured teeth
Ivan Filipov, Stoian Vladimirov
Department of Operative Dentistry and Endodontics, Faculty of Dental Medicine, Medical University – Plovdiv
Introduction – The change of teeth color comes as a result of external discoloration due to bad oral hygiene, excessive ingestion of coloring foods and drinks, the activity of chromatogen bacteria and fungi, etc., as well as of internal reasons the most common of wich is the excessive intake of fluoride and antibiotics in the early years of childhood. >Although in the past years a clear tendency to increased tooth fluorosis has been observed dentist are not well informed about the methods of its treatment.
Aim – The purpose of the present study is to introduce a methods of professional whitening of fluorosis-affected teeth by means of light-activated hydrogen peroxide.
Material and methods – An object of this study are fluorosis – coloured teeth. A 35% gel “Lase peroxide sensy” (DMC-Equipamentos, Brasil) activated by “Bluedent 12 BL” curing light (D&A Electronics, Bulgaria) was used by their whitening. The treatment was carried out in four consecuitive visits and every time the whitening gel was applied three times and lighted for seven minutes. Before the last whitening the enamel surfaces were microabraded with the help of abrasive discs DF 12.7 G ( Axis , Switzerland ) and Clean Polish paste (Kerr Hawe SA). Finally, the teeth were polished with rubber covered with desensitizer – Lase Peroxide Sensy II, containing 2% Sodium Fluoride and 5% Potassum Nitrate.
Results - By all teeth, cured by this way, the fluor stains got discolered and we got a high aesthetic effect.
Conclusion – Fluorosis-affected teeth whitening by means of light-activated hydrogen peroxide is a fast and efficient method which preserves teeth vitality and their anatomic shape.
Key words: tooth fluorosis, professional whitening.

, / PDF 639 KB / < back > Published online - Nov. 20, 2007

J of IMAB 2007, 13(2):46-48;
Amyloid Arthropathy in haemodialysis patients – radiological findings
Silvia B. Tsvetkova, B. Blagov *, A. Batalov **
Department of Radiology, *Nephrology, Haemodialysis clinic, **Department of Rheumatology, Medical University, Plovdiv, Bulgaria
Dialysis-related amyliod arthropathy is an osteoarticular condition, that is due to amyloid beta-2-microglobulin deposits in the bones and joints of patients on long-term haemodialysis treatment. The radiological findings of amyloid arthropathy have been studied in 32 patients receiving haemodialysis for more than 5 years. Plain radiographs of hands, knees, shoulder, pelvis and spine revealed cystic lesions in 11 patients ( 34,38%) , the distribution being: 72,73 % shoulder, 54,55% carpal bones, 27,27% pelvis, 18,18% femur and 18,18% knees.Discitis was found in 12 patients (36,36%). The study focuses on the radiographic appearance and the high incidence of these lesions as a complication of long-term haemodialysis and discusses the differential diagnosis of the lesions in other pathological conditions.
Key words: amyliod arthropathy, haemodialysis, dialysis-related amyloidosis.

, / PDF 736 KB / < back > Published online - Nov. 30, 2007

J of IMAB 2007, 13(2):49-53;
The results of surgical orthodontic treatment of 70 patients with maxillary compression
Kh. Fakih
Department of Oral and Maxillofacial surgery, Faculty of Dental Medicine, Sofia, Bulgaria
The report shares the results of the surgical and orthodontic treatment of 70 patients at the age of 13 to 37 with compression of maxilla, combined with different orthodontic deformities. The features of the surgical, as well of the orthodontic treatment separately of these patients are described.
Key words: maxillary expansion, surgical-orthodontic treatment.

, / PDF 550 KB / < back > Published online - Dec. 12, 2007

J of IMAB 2007, 13(2):54-55;
Kh. Fakih
Department of Oral and Maxillofacial surgery, Faculty of Dental Medicine, Sofia, Bulgaria
The orthodontic treatment of the inborn lip and palatal clefts has a leading part in their complex treatment, both preoperatively and postoperatively, for the achievement of optimal results. Based on the literature review, the report considers the stages of preoperative orthodontic treatment using an obturator and the results of treatment of a case.
Key words: palate cleft and lip, orthodontic treatment - obturator.

, / PDF 510 KB / < back > Published online - Dec. 12, 2007

J of IMAB 2007, 13(2):56-57;
Kh. Fakih
Department of oral and maxillo-facial surgery, Faculty in Dental Medicine, Sofia, Bulgaria
The author shares his experience from the use of vertical ostheotomy on the (ramus) of the lower jaw (mandible) for the treatment (third class deformity) of progenia.
The work done covers 10 patients for the period 2003 till 2008. The level of expression of deformity in the separate patients varies. Good early and late results for all patients are reported. This is explained with the correct orthodontic preparation following oclusoarticulation relations, the broad contact between the fragments of the ostheotomy combined with stable fixation and appropriate pre-operation medication. The lack of relapses in all patients is based on the combination of the above mentioned elements of the treatmen.
Key words: progenia, surgery, vertical ostheotomy

, / PDF 569 KB / < back > Published online - Dec. 12, 2007

J of IMAB 2007; 13(2):58-60. DOI:
Milena Peneva, Maya Rashkova, Liliya Doychinova,
Department of Pediatric Dentistry, Faculty in Dental Medicine, Medical University - Sofia, Bulgaria

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J of IMAB 2007, 13(2):61-63;
Milena Peneva
Department of Pediatric Dentistry, Faculty in Dental Medicine, Medical University - Sofia, Bulgaria
Dental caries is a process developing as a result of the disturbed balance between the factors comprising the oral environment.It is the aim of thisresearch to determine the correlation between the risk and protective factors in the dental caries in children in our country. Based on the model of Featherstone, the creator of the concept of balanced caries, a diagram was built by us showing the balance between the active factors in the oral environment of the examined children. The protective factors that were found to affect a decrease in the risk of development of dental caries were not strongly manifested and were only active in a very small, sometimes even insignificant, part of the children. The risk factors found to be active in the group proved to be much more powerful. The occurrence of risk factors was proven in a major part of the children. These factors represent a serious risk provoking the development of a caries process. The combined action of the two types of factors tips the balance towards a development of the caries process.
Carbohydrate nutrition, the intermediate intake of carbohydrates, sweetened beverages and bad oral hygiene are the strongest risk factors for the children.

, / PDF 600 KB / < back > Published online - Dec. 12, 2007

Date of close: December 12, 2007

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