Varna Medical University Press: Journals
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Methods for diagnosis of third molar eruption disturbances on orthopantomography
Get PDFIntroduction: Third molars are the last teeth to form in the permanent dentition. In some individuals, jaw growth completion precedes the time of eruption of third molars, which creates conditions for their complete or partial retention in the bone. In order to predict the risk of wisdom tooth retention, methods have been developed that provide the possibility for early diagnosis of the deviations in their eruption.Aim: The aim of this review article is to present different methods for diagnosis of third permanent molar impaction on orthopantomography.Materials and Methods: Online research of 30 articles in different databases—PubMed, ResearchGate, Thieme, and Elsevier.Results: In this article are described different methods: a method for predicting the impaction of maxillary third molars, Haavikko’s method, Ganns’ ratio for predicting the available space for eruption of mandibular molars, Olive-Basford’s method, Olmos’ method, and Cryer’s method.Discussion: The reduction of space available for third molar eruption, leading to partial or complete retention, is an evolutionary process, determined by the reduction in the size of the lower and, to a lesser extent, the upper jaw in relation to the modern eating habits of the population. This increases the need for early diagnosis of possible deviations in eruption and control over any impact on the developing of the occlusion and function.Conclusion: The presented methods give the opportunity for early diagnosis of the deviations in the eruption of third molars. Their application allows the clinician to increase the accuracy of the prognosis and the risk assessment regarding the stability of the orthodontic treatment results
Antimicrobial resistance as a public health challenge seen through a cultural lens
Get PDFIntroduction: Antibiotics (ABs) are among the most significant scientific discoveries. Their unreasonable use, however, is a leading cause of the development of antimicrobial resistance (AMR) – one of the three most serious health threats for Europe in the 21st century. The aim of this publication is to present the AMR public health challenge through the prism of the cultural specifics of Bulgaria. Materials and Methods: A study was made of the current state of publications in keywords: “health”, “culture”, “Hofstede”, “Bulgaria”, “antibiotics use”, “self-medication”, “patients”, “public health” in PubMed and Google Scholar in August 2024. The up-to-date content of publicly available information related to the consumption of ABs in Bulgaria and the European policies regarding AMR in the period 2022–2024 was studied. Results of studies carried out so far on the consumption of ABs on a national scale are systematized, making a comparative analysis with other European countries. The review presents Hofstede’s model of five cultural dimensions, which was used as an analytical framework for the irrational use of ABs specific to the Bulgarian patient.Results and Discussion: Antibiotic consumption among Bulgarians is more than twice as high as in other European countries, increasing significantly in recent years. The reasons for this are many, but answers are sought here through Hofstede’s model of five cultural dimensions.Conclusion: The cross-cultural approach to the public health challenge of AMR is essential for successful changes in behavioral patterns that lead to irrational use of ABs. The holistic approaches of One Health for humans, animals, and plants remain very important for the sustainable management of AMR
Surgical closure of oronasal communications
Get PDFBackground: An oronasal communication (ONC) is a pathological opening between the oral and nasal cavities, normally separated by the hard and soft palate. The integrity of the palate is essential for the physiological acts of respiration, mastication, digestion, and phonetics. The persistence of ONC or its unsuccessful closure leads to a permanent communication between the cavities, called an oronasal fistula (ONF). The most common reason for a congenital ONC/ONF is cleft defects, while for acquired ONC/ONF are trauma, tumors, and iatrogenic causes. The main symptoms of ONC/ONF include liquid regurgitation and leakage through the nose, rhinitis, speech disorders, halitosis, and persistent and recurrent respiratory and ear infections.Aim: This review aims to summarize and compare the treatment methods for surgical closure of ONC/ONF, define and point out their advantages and limitations, and give recommendations for further research.Material and methods: An electronic search was performed via four electronic databases: Pubmed, Scopus, Web of Science, and Google Scholar and using the following keywords: (((oronasal) OR (oro-nasal)) AND ((communication) OR (fistula)) AND ((cleft) AND (palate))). After analysis of the obtained data, 28 articles were included in this review.Results and discussion: Different soft-tissue flaps and their modifications have been proposed to provide secure closure with minimum post-operative complications and bone deformities. Local flaps, if available, are preferred over distant soft tissue flaps. Some novel techniques utilize various grafts and tissue regeneration materials, such as acellular dermal matrix, bone morphogenic proteins, collagen, human amniotic membrane, etc.Conclusion: Various methods for ONC/ONF closure have been suggested over the years. The surgical management aims to provide a soft-tissue barrier between the oral and nasal cavities and, thus, restore their anatomical integrity and functions. The factors that should be considered before the surgery are etiology, location, size of the communication, quality and quantity of the surrounding soft tissues in the area, age of the patient, and comorbidities
Propofol: a clinical discussion of its role in neonatal MRI anesthesia and sedation
Get PDFPropofol is a widely used anesthetic known for its rapid induction and rapid recovery. However, the safety and efficacy of propofol in children younger than 6 months remain areas that require further investigation due to limited data in this age group. The present retrospective study aimed to investigate the safety of propofol as an anesthetic in 100 children aged 2 weeks to 6 months undergoing diagnostic procedures (MRI or CTA)
Alternative method for surgical treatment of a semi-impacted lower third molar – a case report
Get PDFINTRODUCTION: Injuries to nerves associated with third molar surgery can pose a challenging complication, resulting in sensory disruptions, chronic pain, and adverse psychological effects for the affected individual. It is crucial to prioritize the preservation of the nerve from injuries during third molar surgery. Coronectomy, serving as an alternative surgical approach in cases with a high damage risk to the inferior alveolar nerve (IAN), has demonstrated long-term effectiveness and safety.AIM: This study aims to present the application of an alternative method for surgical treatment of high-risk semi-impacted lower third molar with an eight-month follow-up.MATERIALS AND METHODS: The following case is presented: a 35-year-old patient, with periodic complaints of pain, discomfort and swelling in the area of tooth 38. Objective clinical criteria referred to pericoronaritis due to semi-impacted left wisdom tooth. Preoperative cone-beam computed tomography (CBCT) scan revealed passage of the IAN between the roots of tooth 38. Extraction of this tooth carried a risk of nerve damage, and a coronectomy was decided upon.RESULTS: Eight-month follow-up showed new bone formation above the remnant roots, without any periapical lesions around them. Results show that performing a coronectomy on wisdom teeth is a suitable and secure method, especially when radiographic evidence reveals a close proximity between the IAN and the tooth roots.CONCLUSION: Coronectomy is a third-molar surgical strategy that involves removing only the crown of the wisdom tooth, while preserving the roots intact. It has been demonstrated that coronectomy effectively prevents IAN injury, making it a safe long-term approach
A case report: axillary nerve block in a patient with Myasthenia Gravis
Get PDFTo date, there is a lack of abundant information about the usage of brachial plexus nerve blocks in patients with Myasthenia Gravis.The choice of the regional anesthesia technique depends on the region and the surgical technique, the necessity for tourniquet placement to produce a “bloodless” field, the skills of the anesthesia team, and the individual anatomical characteristics and comorbidities of the patient.Myasthenia Gravis is a chronic, progressive autoimmune disorder characterized by the autoimmune destruction or inactivation of postsynaptic acetylcholine receptors at the neuromuscular junction, leading to a reduced number of receptors, muscle weakness, and easy fatigability of skeletal muscles
Classifications of defects affecting furcation
Get PDFФуркационните пародонтални лезии се дефинират като загуба на клинично ниво на прикрепване и алвеоларна кост в интеррадикуларната област. Срещат се много често в клиничната практика и обикновено са резултат от плак-асоциирано пародонтално заболяване. Тези дефекти са от изключителна важност, тъй като наличието им променя драстично прогнозата на съответния зъб, както и диагнозата и лечението му.Добре описаната класификация на дефектите, засягащи фуркацията е важна, тъй като тя би помогнала да се постави точна диагноза на съответния зъб и по този начин да се определи неговата прогноза и лечението, което ще се планира.В исторически аспект са публикувани не малко класификационни системи на дефектите, засягащи фуркацията. Днес най-често използваните са тези на Hamp (1975), Ramfjord и Ash (1979г.), Tarnow и Fletcher (1984г.). Те обаче се свързват с не малко недостатъци.Последните две публикувани класификации (Pilloni и Rojas, 2018г. и Kolte и Pajnigara, 2018г.) са първите опити за създаване на класификационна система, която свързва степента на хоризонтална и вертикална загуба на прикрепване и костна резорбция в областта на фуркацията с дължината на кореновия трункус и позицията на гингивалния ръб.Furcation periodontal lesions are defined as clinical loss of attachment and alveolar bone in the interradicular region. They are very common in clinical practice and usually result from plaque-associated periodontal disease. These defects are of utmost importance as their presence dramatically alters the prognosis of the tooth in question as well as its diagnosis and treatment.A well-described classification of defects affecting the furcation is important, as it helps to make an accurate diagnosis of the tooth concerned and thus determine its prognosis and the treatment to be planned.Historically, several classification systems of defects affecting the furcation have been published. The most commonly used today are those of Hamp (1975), Ramfjord and Ash (1979), and Tarnow and Fletcher (1984). However, they have several drawbacks.The most recent classifications, published by Pilloni and Rojas (2018) and Kolte and Pajnigara (2018), are the first attempts to establish a system that relates the degree of horizontal and vertical attachment loss and bone resorption in the furcation area to the length of the root trunk and the position of the margo gingivalis
Health consequences of obesity – a review
Get PDFIntroduction: Currently, obesity is a global concern that impacts individuals of all ages, including young people. Its association with metabolic syndrome and related health issues is particularly noteworthy. Surprisingly, one-third of obese adults are considered metabolically healthy; however, they still face a heightened risk of developing diseases.Aim: This review aimed to provide an overview of the literature on the mechanisms underlying organ damage brought on by obesity.Materials and Methods: The review was conducted using a variety of web-based databases, including PubMed, Google Scholar, and ScienceDirect.Results: Adipocytes release a variety of substances that affect homeostasis. Eating a diet high in calories causes activation of the renin-angiotensin-aldosterone system, which raises blood pressure. Increased renal flow, glomerular capillary pressure, and glomerular filtration rate are among the hemodynamic changes it induces in the kidneys, which are linked to the development of microalbuminuria and renal injury. The exact mechanism causing these changes is unknown. One factor contributing to hypertension is the elevated sympathetic tone. Among the pathways that have been proposed as responsible for the development of endothelial dysfunction in obesity are oxidative stress, vascular proinflammatory agents, decreased antioxidant defense, and oxidized low-density lipoproteins. Vascular events occur as a consequence of these changes. Low-grade inflammation also plays a role in the development of steatofibrosis and simple steatosis in the liver. Obesity affects the heart by raising systolic and diastolic blood pressure, as well as the volume of blood and heart rate. The heart geometry is impacted by this modification.Conclusion: Obesity negatively affects health. Reducing adiposity can lead to improvements in obesity-induced organ damage
