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Computer - assisted mandibular reconstruction with free fibula flap. Accuracy, efficiency, success. Systematic literature review.
No full textAim and relevance of the problem: Head and neck deformations may negatively impact appearance and function of the a patient. Thus, it makes a person to isolate himself from the others and his quality of life starts to decrease. Surgeons have to cope with a hard task – reconstruction of mandibula after its resection. This operation requires precision, consistency and, of course, human resources. Thankfully, as the technologies are improving rapidly, the use of them in hard operations may give positive results. Using a three dimensional planning system in a reconstruction of mandibula already gave its first results. Thus, this system literature review will evaluate the accuracy, effectiveness and success of computer – assisted reconstruction of mandibula with free fibula flap. Material and the methods: PubMed (Medline) and Cochrane Library data resources are used as search engines of scientific literature with these keywords: ((mandibular reconstruction" OR ("mandibular" AND "reconstruction") OR "mandibular reconstruction") AND ("fibula" OR "fibula"))) Scientific articles last time were searched on 2020m. May 23th. Publications are no older than 10 years. Results: After research on both of databases, 1073 articles were found. 13 publications were included in this literature review after activating the filters and including/rejecting criterias were taken into account. In 9 of found articles accuracy was tested between virtual surgery and post operation evaluation. The landmarks to determine the accuracy in every article were different. The largest mean difference was 3,9mm ± 3.8, when measuring two segments of bone flap per patient. The smallest mean difference was 0,9 mm, when segment of fibula flap was measured before and after the surgery. In 7 researches the mean time of ischemia of the bone flap was measured and compared. Shorter time of ischemia was measured on computer – assisted reconstruction compared to the standart reconstruction. It fluctuates between 10,3 min and 50 min in favor to computer – assisted reconstruction p = <0,001. However, the overall time of surgery is similar between the types of operations. Even, the time consumed on computer – assisted surgery was longer in one research. The mean difference of overall time of the surgeries fluctuates from 102min to –52min p = 0,73. The bone flap necrosis was examined in 4 researches. Out of 72 patients, who had their mandibula reconstructed the computer – assisted way, 4 had total bone flap necrosis, while 122 patients, who underwent standart reconstruction, 4 had total bone flap necrosis. Conclusions: The difference between virtually planned surgery and the outcome of the actual surgery is insignificant - 4mm. This means that the accuracy of computer – assisted reconstruction is high. Also, the ischemia time is shorter compared to standart reconstruction p = <0.001. However the overall time of operation is suchlike. After comparing the data of the researches, the necrosis of fibula bone flap occurs more often in computer guided reconstruction. Even so, the conclusions of the articles says, that the difference is not observed. More researches are needed to properly evaluate the success of the computer guided reconstruction
Sedation methods used for third molar extractions
No full textAim of the work and relevance of the problem. Third molar extraction is a common procedure in dentistry and it is usually performed under sedation. The aim of this work is to do a systemic analysis based on reviewed articles related to the selected topic. Moreover, to find out the main methods of sedation used during extractions, indications, medications and its dosage, possible side effects. Material and methods. Systematic review was performed based on PRISMA guidelines. PubMed/ Medline, Willey Online Library databases were used for the search of articles. All selected studies were published between January 1, 2015 and January 1, 2020. Results. There were found 33 articles related to the selected topic. After applying inclusion/exclusion criteria 17 publications enrolled in this systematic review. Intravenous sedation is performed if patients suffer from serious anxiety and dental phobia or bilateral or more than two ipsilateral third molars are being removed. Midazolam has anxiolytic, sedative and amnesic properties and can be used in combination with opioids. Midazolam can also induce oral and general sedation. Conclusions. Intravenous sedation was the main method used during extraction of third molars. This sedation method is indicated if bilateral or more than two ipsilateral third molars are being removed or patients suffer from serious anxiety and dental phobia. The smaller dose of medication is needed to induce intravenous sedation. It also provides better effect of sedatives. Midazolam was the most often used drug to perform a sedation. The most effective dosage of midazolam intravenous administration- 4.1mg. Nausea and vomiting were the side effects that most frequently appeared after sedation
Effect of lithium disilicate on gingival tissues. Systematic review of the literature
No full textRelevance of the problem: following tooth preparation instructions for full crowns, lithium disilicate can have direct contact with gingival sulcus, also implant abutments can have direct contact with epithelium tissue. It is important to analyse human epithelium biological response and human epithelium cells adhesion and proliferation to lithium disiliacte restaurations. Aim of the work: The aim of this study is to systematize the data obtained on the effect of lithium disilicate on gingival tissues by analyzing the latest scientific literature. Materials and methods: : an electronic literature search was performed with the methodology of PRISMA. Search was performed in LSMU subscribed databases PubMed/Medline, Cochrane Library, ScienceDirect, Willey Online Library. Search was performed from October 1st 2019 till December 15th 2019 including articles not older than 5 years written in English. Results: A total of 1110 articles were identified by searching for scientific articles according to the established selection criteria, from which 9 studies examining the biocompatibility of lithium disilicate with human epithelial cells, lithium disilicate restorations on natural human teeth and prosthetics on implants were obtained after reading the full text. 8 of included articles were in vitro studies and 1 in vivo study. Conclusions: It can be concluded that the lithium disilicate restaurations used in combination with standardized clinical procedures do not lead to a measurable inflammatory response of the gingiva. Lithium disilicate is biological acceptable material because it has positive epithelium tissue response. Surface roughness affects cell attachment and proliferation, polished surface leads to improved cellular performance
Evaluation of hard tissue debris removal using different irrigation solutions: an in vitro SEM study
No full textThe relevance of the problem and aim of the work: Root canals instrumentation produce debris which consists of dentinal shavings, residual pulp, microorganisms. For positive treatment debris must be removed from root canals using irrigation. The aim of the study was to evaluate the efficacy of different irrigation solutions on debris removal created after instrumentation. Materials and methods: 40 single-rooted mandibular incisors without endodontic treatment, root caries were included. Teeth checked radiologically. After preparation of the access cavity 10, 15 K-files were used to create glide path. Root canals were prepared with XP-endo Shaper. Teeth were decoronated at the CEJ, leaving a root length of 9 mm, sectioned longitudinally into two parts using daimond disc and a chisel. The specimens were divided into 4 groups (n = 10): 1gr. - 2,5% NaOCl, 2gr. – 2,5% NaOCl + 17% EDTA, 3gr. – 2,5% NaOCl + 18% HEDP solution, 4gr. (control) – irrigation with saline water. SEM photographs were taken at apical, middle, coronal canal thirds. Statistical analysis of data was conducted using SPSS program. Results: significant less debris was found in groups irrigated with 2,5% NaOCl + 17% EDTA and 2,5% NaOCl + 18% HEDP with no statistically significant difference between them in all canal thirds. Also there was no statistically significant difference between 2,5% NaOCl group and control group in all canal thirds. Conclusions: A chelators used together with NaOCl can reduce but not completely remove debris from root canal dentin during rotary root canal instrumentation
The Connection between Stress, Anxiety, Depression and Periodontal Diseases: A Systematic Review
No full textRELEVANCE OF THE PROBLEM: Stress, anxiety, and depression are closely related. It is estimated that 350 million people worldwide suffer from depression, the World Health Organization predicts that by 2020 depression will be the second most common disease in the world. Researchers are still trying to find out what the link is between recent psychological disorders and periodontal diseases, but the findings are mixed. AIM OF THE WORK: To review and systematize the scientific literature, which reviews the relationship between stress, anxiety and depression and the pathology of periodontal tissue and to determine which of the latter risk factors have the greatest negative impact. MATERIALS AND METHODS: A systematic review of the scientific literature was performed in the PubMed (Medline) and Embase databases, using keywords that are validated in the MeSH Browser dictionary, in search of articles no older than 10 years. A descriptive qualitative data analysis was performed. RESULTS: After a thorough search of scientific publications and using exclusion/inclusion criteria, seven studies corresponding to the chosen topic were selected for systematic analysis of articles. All authors used different periodontal indexes and psychological tests to assess periodontal and psychological conditions. The results of laboratory tests for stress and psychological assessment tests for anxiety were similar, but the results of tests for the assessment of depression were nevertheless CONCLUSIONS: Laboratory studies have shown that stress has a negative effect on the condition of periodontal tissue. Due to the unreliable psychological tests used, the lack of research and the non-participation of a psychology expert in the study, the association of depression and anxiety with periodontal disease cannot be ruled out
Stress coping, diabetes anxiety and diabetes management in middle-aged people with type 2 diabetes mellitus
No full textStudy problem: In 2019, there were about 463 million adults with diabetes in the world, and that number is growing every year (IFD, 2020). Diabetes mellitus (DM) is a disease from which recovery is not possible, so it constantly poses challenges that the patient has to cope through lifetime. Disease control and other aspects of DM can cause a number of challenges that affect both the physical and psychological wellbeing, and much of the disease control depends on individual abilities to cope with challenges. Research methods: The study involved 95 individuals with type 2 diabetes (48 men and 47 women) aged 42-65 years (mean 56.7 ± 5.8 years). The study used a standardized “Improved Four-Factor Stress Management Coping Questionnaire”, as well as questions compiled by the study author on anxiety about disease and disease control: questions about self-control behavior and objective control indicators. Results: Among the subjects, 75.5% had obesity. The minority of the participants lost weight and increased their physical activity after diagnosis. More than 2/3 of participants had bad control of DM (HbA1c >7 %). Those who rated their disease control better had better HbA1c scores. Only 13.7% of respondents said they did not have enough information on how to maintain good diabetes management. 54.9% of those who stated that they had enough information on how to maintain good diabetes management did not change their physical activity habits, 45.1% of participants gained weight, 75% had >7% HbA1c index. High levels of anxiety were observed among participants with type 2 diabetes. The main concern was how to maintain good diabetes control. Women anxiety level in non-diabetes-related scale was higher than men. Those who wished but did not payed enough attention to control experienced more anxiety about it. Anxiety about diabetes was associated with higher pre- and post-meal glucose levels. Individuals with HbA1c >7% reported experiencing more non-diabetes-related anxiety. Patients with type 2 diabetes used problem solving coping strategy most often. Social support was more often sought by men and married participants. Problem solving - younger and higher educated people. Emotional discharge and avoidance were independent of sociodemographic characteristics. Patients who used emotional discharge more often were likely to worry more about disease, possible complications, and felt more non-diabetes-related anxiety. Other coping strategies were not related to anxiety. Emotional discharge strategy were related to pre-meal glucose (ρ=0.24; p-0,033) and lack of information about diabetes control (U=363; p=0,064). Problem solving - with changes in physical activity (χ2=6.38; p-0.041). Avoidance was associated with post-diagnosis weight change (χ2=6.13; p-0.047) and HbA1c index (HbA1c≤7% mean 18,5±4,55; HbA1c>7% mean 21,2±3,73; p-0,005). Avoidant strategy predicted bad disease control (HbA1c >7%) regardless of gender, insulin use, BMI, age, and disease duration. Social support was not related to the objective and other indicators of disease control. Conclusions: The stress coping strategies are related to the anxiety about disease, self-control behavior, objective control indicators and can predict poorer disease control
Retrospective study of patients with mandibular fractures: analysis of a epidemiology, demographic situation, treatment methods, and complications. Experience at LSMUL KK Department of Maxillofacial Surgery of 2010-2019
No full textStatistically mandibular fractures are the most common ones among all injuries of facial bones. As evidenced by the data of different researchers, demographic situation of mandibular fractures, anatomic localizations, causes of an injury and therapeutic approaches often vary by countries and they are strongly related to socioeconomic, cultural and other peculiarities of patients or that country. There is no available objective data on a retrospective research covering mandibular fractures that would have been carried out in Lithuania in the recent decade. The aim of this work is to carry out a retrospective analysis of patients who suffered mandibular fractures and were treated in the Department of Maxillofacial Surgery of LSMUL KK in 2010-2019. The obtained findings would provide a basis for assessing the situation of mandibular fractures in Lithuania, and the data received would be available for use in further research
Children Physeal Distal Tibial Fractures Treatment Analysis
No full textA retrospective case control study was held in which treatment methods used for distal physeal tibia fractures in children, hospitalized in LSMU KK 2018-2019 was analyzed
Naujagimių sepsįo (ankstyvo ir vėlyo) diagnostikoje naudojami nauji biomarkeriai, jų naudos įvertinimas.
No full textThis literature review aims to identify biomarkers that are effective in diagnosing neonatal sepsis based on available literature. Comparing acute phase reactants with chemokines /cytokines and summarising the collected information on biomarkers of neonatal sepsis for future consideration. The literature was identified by searching PubMed by using a combination of terms, forming a summary table with the collected sensitivity, specificity, negative predictive value (NPV) and Positive predictive value (PPV). Concluding that, each biomarker has a different cut-off value along with sensitivity and specificity, due to varying sample sizes, detection methods used and the type of analysis. Therefore a combination of several sepsis biomarkers may be more effective
The evaluation of dentin microhardness after chemomechanical root canal preparation using different irrigating solutions.
No full textThe relevance of the problem and aim of the work. The tooth root canal irrigation is one of the most important steps in endodontic treatment. There are different solutions, that can be used for final irrigation before hermetic root canal filling and can alter the chemical and physical properties of dentin. Solutions reduce the microhardness of dentin, that can increase the possibility of occurrence of root canal deviation, can affect the sealing ability and adhesion of root canal sealers [1]. The aim of this study to compare solutions of EDTA and HEDP used together with sodium hypochlorite regarding their ability to affect on dentin microhardness. Material and methods. 30 extracted human single-rooted mandibular incisors were selected according to the selection criteria. Root canals were cleaned and shaped using „XP-endo Shaper“ endodontic instruments through the access cavity in the tooth crown by following the manufacturer’s recommendations. According to the final irrigation protocol, the specimens were divided into 3 experimental groups as follows: 1 gr. – 2,5% NaOCl, 2 gr. – 2,5% NaOCl + 17% EDTA, 3 gr. – ,,Dual Rinse HEDP” (2,5% NaOCl + 18% HEDP). After chemomechanical preparation, teeth were decoronated leaving 9mm of the root length. Roots were sectioned vertically into two parts. Dentin microhardness was measured with a Vickers indenter at coronal, middle and apical thirds of the root canal. Data were statistically analyzed using the SPSS program. Results when p < 0,05 were considered statistically significant. Results. The biggest dentin microhardness reduction was found in the root canals of the teeth, irrigated with 2,5% NaOCl/17% EDTA, however, the intragroup comparison showed statistically insignificant results. In the middle and apical thirds irrigation with 2,5% NaOCl and 2,5% NaOCl/17% EDTA reduced dentin microhardness significantly more than irrigation with 2,5% NaOCl/18% HEDP. In the coronal third all experimental groups reduced dentin microhardness the most in comparison with the middle ant apical thirds. Conclusions. 1. All irrigation solutions – 2,5% NaOCl, 2,5% NaOCl/17% EDTA and 2,5% NaOCl/18% HEDP reduced dentin microhardness. 2. The dentin microhardness is the most affected by irrigating solutions in the coronal third. 3. NaOCl together with etidronic acid reduced dentin microhardness the least in the middle and apical thirds