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Journal of IMAB
Annual Proceeding
(Scientific Papers)
ISSN: 1312-773X (Online)
Issue: 2008, Book 2, part Dentistry
P: 3 - 60
CONTENTS:
Emergency Treatment of Irreversible Pulpitis
Elka Radeva
Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University - Sofia , Bulgaria
Summary : Irreversible pulpitis is characterized by acute and intense pain that is difficult to control with painkillers; hence the patient needs urgent endodontic help
The aim of this study has been to determine the minimum set of interventions needed in order to reduce the pain and prevent further complications when treating emergency cases of irreversible pulpitis.
The study encompassed 102 endodontic cases. After being diagnosed as advanced irreversible pulpitis, the cases were divided into 3 groups depending on the manipulations.
The results show that the minimum set of interventions leading to a satisfactory clinical result, to a lower percentage of bleeding in the root canal and pain at percussion, was the one in Group 2.
The best clinical results were achieved by Group 3, but frequently, due to the lack of time within a single appointment, it is impossible to implement all manipulations in this group.
Key words : emergency treatment, intracanal medicaments, irreversible pulpitis
< back > Received - May 12, 2008; Published online - May 30, 2008, /Page 3-4/
EXAMINATION OF PALATAL MUCOSAL RELIEF IN NORMAL OCCLUSION PATIENTS
Vera Krumova
Department of
Orthodontics, Faculty of Dental Medicine, Medical University - Sofia , Bulgaria
Summary :
Although its discussional stability, the position of primary rugae distal edges was examined for two reasons: on one hand, it was provoked by Van der Linden’s clinical study on the stable and constant position of the first rugae in relation to canines and on the other, by the lack of published research results on this issue in Bulgarian medical literature. From anatomo-topographic point of view, the first rugae are disposed just behind sutura incisiva with its onset between the lateral incisives and canines. Most frequently, the first ruga is fastened to the palatal suture on a quite large basis. Having in mind that the palatal mucosa and teeth have common ectodermal origin and the genetic determination of relief reveals yet in embryonic development, the elucidation of the relationship between them is of special interest. Our study on first ruga position determining the commencement of rugal zone aimed at establishing the stability of rugal position in orthodontically non-treated Class I intact dentitions and at its possible use as a reference for comparisons. Our study used the classical anthropologic method of Martin-Saller and the method of Jordanov. The study group included 80 Bulgarian students at the Faculty of Dental Medicine, Medical University – Sofia, from both sexes (42 males and 38 females) with intact dentition and normal occlusal proportions – Class ² (orthognatic occlusion) and non-treated orthodontically. The analysis of mucosal relief components showed that three shapes of papilla incisiva were most commonly observed: oval (31.3%), pear-shaped (23.8%) and flame-shaped (17.5%). This corresponded with the shape types and respective frequencies found by the population study among Bulgarians. The analysis of the type of rugal zone relief showed that in normal occlusion subjects, type A (three primary rugae) was mainly observed. These data were similar to those obtained for adult Bulgarians. The distal border in normal occlusions was rather symmetric than asymmetric. Our research data for the medial rugae disposition in relation to canines revealed that almost 1/2 of the cases (38) (47.5%) displayed bilaterally symmetric disposition of medial (primary) ruga against the canine tooth. The medial (primary) rugae were projected in right in 92.6% of the cases and in left in 87.8% of the cases, within the limits of the canine mesiodistal diameter as the significant frequency of this position give grounds for its acceptance as a norm/reference. .
Key words:
first rugae, palatal mucosa, canines, rugal zone
< back > Received - Jun 03, 2008; Published online - Jun 18, 2008, /Page 5-7/
Diagnostic imaging of dentigerous cysts of the mandible
Hristina Mihailova, Vl. Nikolov*, Sv. Slavkov**
Department of imaging and oral diagnostic, Faculty of Dental Medicine, Medical University - Sofia, *Department of diagnostic imaging, Military Medical Academy - Sofia, **Hospital of maxillo-facial surgery, Medical University - Sofia, Bulgaria.
Summary: The authors submit a theme concerning X-ray methods for examination of mandibular dentigerous cysts and the role of CT examination in the diagnostic process.
Key words: dentigerous cyst, mandible, diagnostic imaging
< back > Received - May 12, 2008; Published online - June 30, 2008, /Page 8-10/
Imaging modalities and algorithm in cases of mandibular trauma
Hristina Mihailova
Department of imaging and oral diagnostic, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
ABSTRACT: There are a lot of reports in the literature concerning a wide variety of imaging modalities used for the diagnostic process of mandibular fractures. They include plain radiography, CT, MRI, radionuclide imaging. Because all of these examinations cannot be used simultaneously imaging algorithms should be developed. That will allow early diagnosis of the mandibular fracture to be made.
This issue focus on which imaging modalities to use and when to use them in the diagnostic process of mandibular trauma.
Key words: mandibular fracture, radiograms, algorithm
< back > Received - May 12, 2008; Published online - June 30, 2008, /Page 11-12/
CONNECTIVE TISSUE GRAFT IN THE TREATMENT OF MULTIPLE ADJACENT GINGIVAL RECESSIONS
Christina Popova, K. Kotsilkov
Department of Periodontology, Faculty of Dental Medicine, Medical University - Sofia, Bulgaria
ABSTRACT: Marginal tissue recession is a displacement of the soft tissue margin apical to the cement-enamel junction with exposure of the root surface. The etiology of the gingival recessions is associated with the gingival inflammation, mechanical factors like improper toothbrushing in the circumstances of tooth malposition, bone dehiscence, thin periodontal tissue, and aberrant frenulum. The treatment of the gingival recession in the last years includes gingival grafting procedures. The most generally used procedure is the free gingival graft. Recent studies have demonstrated that connective tissue grafting is an effective treatment of gingival recession. The graft used may either be an epithelialized graft or a subepithelial connective tissue graft of palatal masticatory mucosa.
The presentation demonstrates an connective tissue graft procedures for root coverage in a 23 years old patient with Miller class II recessions on teeth #14, #15, #24, and Miller class I recessions on teeth #16, #25, #26 and the results.
In the limitations of this case the connective tissue graft procedure led to clinical improvement which is a premise for better maintenance of the achieved root coverage
Key words:marginal tissue recession, soft tissue graft procedures, epithelial collar, root coverage
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 13-15/
THE APPLICATION OF A MINIMAL INVASIVE CONNECTIVE
TISSUE GRAFT TECHNIQUE (ENVELOPE TECHNIQUE) IN A TREATMENT OF A GINGIVAL
RECESSION
Kamen Kotsilkov, Christina
Popova
Department of Periodontology, Faculty of Dental Medicine, Medical University
- Sofia, Bulgaria
ABSTRACT: Marginal tissue recession is a displacement
of the soft tissue margin apical to the cement-enamel junction with exposure
of the root surface. The main indications for root coverage procedures
are esthetic /cosmetic demands, root hypersensitivity and management of
shallow root caries lesions and cervical abrasions.
The presentation demonstrates an envelope technique connective tissue
graft procedure for root coverage in a 30 years old patient with Miller
class I recession on teeth #14.
The connective tissue graft procedure led to achievement of satisfying
clinical results in the presented case.
Key words: marginal tissue recession, root coverage procedures,
connective tissue graft, envelope technique
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 16-18/
FREE GINGIVAL AUTOGRAFT FOR AUGMENTATION OF KERATINIZED
TISSUE AND STABILIZATION OF GINGIVAL RECESSIONS
Christina
Popova, Tsv. Boyarova
Department of Periodontology, Faculty of Dental Medicine, Medical University
- Sofia, Bulgaria
ABSTRACT: Background: The presence of gingival recession
associated with an insufficient amount of keratinized tissue may indicate
gingival augmentation procedure. The most common technique for gingival
augmentation procedure is the free gingival autograft.
The aim of this study was to evaluate the changes in the amount of keratinized
tissue and in the position of gingival margin in sites treated with free
gingival autograft apical to the area of Miller’s class I, class II and
class III gingival recessions.
Methods: Twenty three subjects with 56 gingival recessions
associated with an insufficient amount of keratinized gingiva were treated
with gingival augmentation procedure (free gingival graft). The grafts
were positioned apical to the area of recession at the level of mucogingival
junction. Clinical variables, including recession depth (Rec), amount
of keratinized tissue (KT) and probing depth (PD) were measured at baseline
and six months to one year after surgery and analyzed using statistics
model of variation analysis.
Results: From baseline to one year after free gingival
grafting KT increased with 4.28±1.10 (P<0.001) and recessions reduced
with 0.90±0.56 (P<0.001). There was no significant change in probing
depth after gingival augmentation procedure (P>0.05).
Conclusion: In the limits of this study it may be concluded
that free gingival graft augmentation procedure apical to the area of
recession lead to predictable results providing an increased amount of
keratinized tissue and may reduce the recession depth.
Key words: Gingival recession; free gingival graft; gingival
augmentation procedure.
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 19-25/
INTERRADICILAR BONE LOSS IN CONJUCTION WITH PROBING
DEPTH
Christina
Popova, A. Mlachkova, D. Emilov
Department of Periodontology, Faculty of Dental Medicine, Medical University
- Sofia, Bulgaria
Background: Diagnosis, treatment and long-term retention
of the furcation involved molars in chronic periodontitis patients always
have been challenge to the periodontal specialist. Continued periodontal
breakdown in the furcation area may lead to total loss of the tooth unless
these defects can be predicted, diagnosed and appropriate treated to preserve
as long as possible the entire dentition. Two important risk factors for
progression of periodontal disease – furcation involvement and pocket
depth – are implicated in multi-step process of the calculation of the
risk (PRC) (2).
The demonstration of the association between actual pocket depth in molar
sites and interradicular deterioration would be of great importance in
suggesting treatment options for minimizing future risk for progression
of the bone loss in furcation involved teeth (3, 4) .
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 26-29/
EFFECTIVENESS OF NSAIDs AULIN AND IBUPROFEN ON
THE POSTOPERATIVE PAIN AT GINGIVAL GRAFT PROCEDURES – A PRELIMINARY STUDY
Christina
Popova, A. Mlachkova, D. Emilov
Department of Periodontology, Faculty of Dental Medicine, Medical University
- Sofia, Bulgaria
ABSTRACT: Background: Gingival reconstruction has recently
become a routine part of the periodontal treatment. Gingival grafting
is considered as predictable procedure for root coverage with a high degree
of cosmetic enhancement for attached tissue augmentation and for preprosthetic
treatment. Mucogingival surgery includes pedicle flaps and free gingival
grafts or connective tissue grafts. These procedures are accompanied by
donor site pain. NSAIDs are successfully used to affect this pain. Aulin
and Ibuprofen have good analgesic and anti-inflammatory activities. Their
main pharmacological action includes inhibition of prostaglandin synthesis
via COX-2, reduction of cytokine-induced hyperalgesia by suppressing TNF-±
and the synthesis of proteinase enzymes (MMPs). Postoperative administration
of the drugs after gingival graft procedures and its pharmacological effect
might contribute to inhibit the pain and decrease the morbidity in the
postoperative period.
Methods: Fifteen subjects participated in this study from 18 to 62 years
of age. They received Aulin and Ibuprofen twice daily x 100 and 200 mg
respectively for 4 days – in the early postoperative period. The surgical
interventions were performed under local anaesthesia (4% Ubistesin with
epinephrine 0,006 mg/ml). A four-point verbal rating scale (VRS-4) was
used to measure the level of pain. Patients were instructed to complete
a pain diary every hour for the first 8 hours after the surgical procedure
and three times a day on the following 3 days. Each of them received Aulin
or Ibuprofen initially by the end of the first hour after intervention
and 12 hours after the first dose, and then for the next 3 days twice
daily x 100 and 200 mg, respectively. Patients evaluated an independent
rate of their pain intensity as follows: high expression, moderate, discomfort
or missing.
Results: In the following hours after the grafting procedure the pain
in the recipient and donor sites show scores of successful inhibition
from 0.33 to 1.25. This represents discomfort to missing pain. In the
first day after the surgery Aulin® shows higher scores than Ibuprofen®
but both of them are lower than 1, which represents discomfort to missing
pain. In the second day, the pain shows a little bit higher scores. In
the third day, the pain is successfully inhibited and the pain syndrome
is still between discomfort and missing pain.
Conclusions: Aulin® and Ibuprofen® are effective analgesics in the early
postoperative healing – there was no need for additionally analgesic drug
to be taken .
Key words: cosmetic gingival reconstruction, gingival
graft procedures, NSAIDs.
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 30-34/
CORRELATION OF INTERDENTAL AND INTERRADICULAR
BONE LOSS – RADIOGRAPHIC ASSESSMENT
Christina
Popova, A. Mlachkova, D. Emilov
Department of Periodontology, Faculty of Dental Medicine, Medical University
- Sofia, Bulgaria
Background: Furcation areas present some of the greatest
challenges to the success of periodontal therapy. Higher mortality and
compromised prognosis for molars with furcal involvement have been reported
in several retrospective studies of tooth loss. Additionally, reduced
efficacy of periodontal therapy has been consistently found in multirooted
teeth with furcation involvement, regardless of the treatment modality
employed (1). It is known that with progression of periodontal destruction
and the involvement of furcal areas the severity of periodontitis increases
and treatment is less effective because of limited access for mechanical
control. Therefore it is of great importance that chronic periodontitis
treatment happens before involving the furcal areas. The threshold of
alveolar bone loss associated with progression of periodontal destruction
and involvement of interradicular areas is not clearly defined in the
literature.
This study was undertaken to investigate the connection between interradicular
bone destruction and interdental bone loss in patient with chronic periodontitis
.
<
back > Received - June 15, 2008; Published online - Aug 6, 2008,
/Page 35-37/
HEPATITIS B AND C IN DENTISTRY
Asya Krasteva*, Vl. Panov**, M. Garova*, R. Velikova*, A. Kisselova*,
Z. Krastev***
*Faculty of Dental Medicine, Sofia; **Bulgarian Academy of Science,
Sofia; *** Medical University, Sofia, Bulgaria
ABSTRACT: Viral hepatitis is a major public health problem,
occurring endemically in all areas of the world. The prevalence of the
disease is influenced by numerous factors which may be able to modulate
its onset. The presence of HCV-RNA in saliva provides a biological basis
for saliva as a possible source of HCV infection, although it does not
necessarily imply transmission. Lock and coworkers (2006) demonstrates
a contamination with HCV-RNA of a considerable portion of toothbrushes
used by hepatitis C patients. Dentists were in a high risk of contracting
this disease due to the procedures and instruments of dental treatment.
Key words: dentistry, hepatitis B and C, oral cavity.
<
back > Received - July 28, 2008; Published online - Aug 8, 2008,
/Page 38-40/
SALIVARY COMPONENTS OF TREATED CANCER PATIENTS
AND PATIENTS WITH PRECANCEROUS LESIONS
Asya Krasteva1, E. Aleksiev2, A. Ivanova3, I. Altankova4, T. Bocheva4,
P. Stanimirov2, A. Bobeva2, N. Janev2, A. Kisselova1
1 Department of Oral Diagnostic and Maxillofacial Radiology, Faculty
of Dental Medicine, Medical University, Sofia; 2 Specialized University
Hospital for Active Treatment in Maxillofacial Surgery, Sofia; 3 Clinic
of Gastroenterology, “St. Ivan Rilski” University Hospital, Medical University,
Sofia; 4 Laboratory of Immunology, “St. Ivan Rilski” University Hospital,
Medical University, Sofia, Bulgaria
ABSTRACT: Oral squamous cell carcinoma (OSCC) accounts
for nearly 50 % of all newly diagnosed cancers in India. In Bulgaria OSCC
reaches nearly 75% of malignant tumours in the oral cavity (Ugrinov, 2006).
The prognosis of this cancer remains relatively unchanged for the past
30 years, despite advances in diagnosis and management.
Salivary analysis holds promise as a non-invasive approach to identify
biomarkers for human oral cancer. Salivary levels of immunoglobulins and
acute phase proteins may have significant prognostic value in early cancer
diagnostics.
Key words: saliva, oral cancer patients, proteins.
<
back > Received - July 28, 2008; Published online - Aug 8, 2008,
/Page 41-44/
ALLERGIC CONTACT STOMATITIS FROM BISPHENOL-A-GLYCIDYLDIMETHACRYLATE
DURING APPLICATION OF COMPOSITE RESTORATIONS. A CASE REPORT
Iliyana Stoeva, A. Kisselova, M. Zekova
Departement of Oral Diagnostic and Maxillofacial Radiology, Faculty of Dental Medicine, Medical
University – Sofia, Bulgaria
ABSTRACT: Bisphenol-A-glycidyldimethacrylate (BIS-GMA)
is a frequently used monomer in dental composite resins.
We report one case of allergic contact stomatitis from BIS-GMA, which
has been rarely reported in dental patients.
Key words: allergy, bisphenol-A-aglycidyldimethacrylate,
dental resins.
<
back > Received - July 28, 2008; Published online - Aug 8, 2008,
/Page 45-46/
REACTION OF 5 AND 6 YEAR OLD CHILDREN TO LOCAL ANESTHESIA DURING DENTAL TREATMENT
Kremena Nikolova-Varlinkova, R. Kabaktchieva
Departement of
Pediatric Dentistry, Faculty of Dental Medicine, Medical University – Sofia, Bulgaria
SUMMARY: One of the most delicate and difficult procedure in pediatric dental treatment is the administration of local injection anesthesia. There are literary data showing that dental anxiety in children might be due to maternal anxiety, family influences, personality and psychological development of the children, and previous painful medical and dental experience.
The aim of this study was to compare children’s reaction to two techniques of local anesthesia administration - the one in which the dentist shows the needle prior to local anesthetic administration to the child and the other in which the dentist does not show the needle. It aims also at investigating if there is a connection between mother’s and child’s attitude to dental treatment and reaction of the child during anesthetic administration.
24 children aged 5 - 6 (12 girls and 12 boys) took place in this study. All participants needed local injection anesthesia as part of their treatment plan.
The collected data give us the reason to accept that there is no difference in the reaction of the children when we applied both different techniques for anesthesia (with or without showing the needle), because the results are identical. The study shows that local injection anesthesia can be successfully applied even at 5 and 6 years old children.
Key words: local anesthesia, dental treatment, children, fear.
< back > Received - June 12, 2008; Published online - Aug 14, 2008, /Page 47-51/
CLINICAL AND GENETIC PECULIARITIES OF ISOLATED
CLEFT PALATES
Vera Krumova
Departement of Orthodontics, Faculty of Dental Medicine,
Medical University – Sofia, Bulgaria
SUMMARY: The systematic investigations
on genealogical data of children with clefts have revealed that there
is clinical-genetic heterogeneity between cleft lips and/or palates (CL/P)
and isolated cleft palates (CP). Isolated cleft palates are often a constituent
part of syndromes. These clefts are most frequently found in Pierre Robin
syndrome, as this syndrome is more typical for the girls than the boys.
The following micro-symptoms were observed among the relatives of children
with CP: bifid uvula (BU), palatal defect, submucous cleft, intrauterine
healed harelip and cleft nose. The results have shown that 43.4% of the
children of our sample manifested accompanying malformations and syndromes,
which means that almost every second child with CP has additional congenital
diseases. Among the examined relatives, 18.81% demonstrated various types
of micro-symptoms. The genetic-mathematical data processing has revealed
that only isolated CP demonstrated polygenic type of inheritance, while
CP with accompanying malformations approached mostly the autosomal-dominant
type of inheritance.
Key words: cleft palate, micro-symptoms, heredity, syndromes.
<
back > Received - Sept. 10, 2008; Published online - Sept. 22,
2008, /Page 52-54/
HYPODONTIA OF THE UPPER LATERAL INCISORS – A THERAPEUTIC APPROACH AND FACTORS, WHICH HAVE DETERMINED IT (A CLINICAL CASE)
Vera Krumova, I. Yoncheva*
Departement of Orthodontics, *Department of Prosthetic Dentistry, Faculty of Dental Medicine,
Medical University – Sofia, Bulgaria
SUMMARY: A clinical case of hypodontia of the upper lateral incisors, wedge-shaped canines, microdontia of premolars, diastemata and tremata in the maxilla and mandible is presented. Complex orthodontic-prosthetic treatment has been performed.
Key words: Hypodontia, orthodontic-prosthetic treatment.
<
back > Received - Sept. 10, 2008; Published online - Sept. 25,
2008, /Page 55-57/
A STUDY ON CONGRUITY BETWEEN CLINICAL AND METRIC NORMS IN HUMAN DENTITION
Vera Krumova
Departement of Orthodontics, Faculty of Dental Medicine,
Medical University – Sofia, Bulgaria
SUMMARY: The relationship between dental-jaw system morphologic deviations and functional and esthetic disturbances, which may lead to aggravation of both general organism disorders and local periodontal pathologic alterations and early tooth loss, has focused the increasing attention of orthodontists. Our study aimed at examining the congruity between normal occlusion-articulation relations in permanent dentition of a patient sample defined as normal on prophylactic examinations and some metric methods used in orthodontics and anthropology, in order to establish if there were any metric changes in the dental arch, although the availability of normal occlusion relations. Our examinations in a sample of 60 subjects (aged between 14 and 30 years) found that for the norm of occlusion-articulation relations defined by Gerlach’s method, congruity was observed in 75% of the cases; for the norm of transversal relations defined by Korkhaus’ method, congruity was observed in 53.3% and for the norm of sagittal relations defined by Korkhaus’ method – in 71.2% of the cases.
The anthropometric examinations showed that concerning palatal indices, the examined palates were most frequently brachystaphylic (85.6%) and mesostaphylic (14.4%), in conformity with the previously observed results for the Bulgarian population (2).
Palatal expansion was predominant in males and palatal compression – in females, a fact that could be related to general individual development.
The results showed that from a clinical point of view, the differentiation of a “normal group” including children with normal occlusion-articulation relations, is justifiable, although the availability of some metric deviations.
Key words: norms, human dentition, anthropometric examinations.
<
back > Received - Sept. 10, 2008; Published online - Sept. 25,
2008, /Page 58-60/
Last edition: September 25, 2008
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