Scientific Abstracts of UPDATE Congress – Latest news in dentistry, Bucharest, 18–20 february 2021

Pages: 178-210

U.N.A.S.

Table of Contents

Digital technologies applications in multidisciplinary treatment

Prof. Dr. Lucian Toma Ciocan, U.M.F. „Carol Davila” București

The development of digital technologies in dental medicine has gained a great development in recent years. Although the developers of these technologies have promoted revolutionary applications at the expense of classical technologies, its application and clinical efficacy is still limited in dental medicine to certain stages required in the development of the plan or in the treatment steps. This presentation, based on both scientific sources and personal experience, will show the advantages and limitations of digital technologies at this point in the multidisciplinary dental treatments.

Keywords: digital technologies, multidisciplinary, teamwork

Complex rehabilitation of a worn dentition

Conf. Dr. Dan Nicolae Pătroi, Universitatea „Titu Maiorescu”, București

The aesthetic rehabilitation of a worn dentition is challenging because the clinical crowns have become shorter and the tooth length needs to be increased. Increasing the coronal length is often associated with the increase of the VDO, even though this loss of tooth structure may not automatically indicate a loss of the VDO due to a possible compensatory phenomenon. To achieve the restorative, functional and aesthetic objectives, it is perhaps most important to ensure that the proposed increase in VDO will be the minimum amount necessary in either one or both arches.

Keywords: VDO, articulator, facebow, e.max, veneer, crown, table tops

Early detection of caries by transillumination (DiagnoCam) and its significance in daily clinical practice

Dr. Milan Uzelac, Practică privată, Belgrad, Serbia

Early detection of any medical problem is the most valuable action in its treatment. Treatment of carious lesions and its consequences represent vast majority of every day clinical practices all-around the world thus early detection of carious lesions could be one of most significant clinical findings.

Detection of carious lesions by transillumination is obtained by dedicated “light”-camera system (buccal and oral tooth surface positioned “light” source and tooth occlusal surface perpendicularly oriented intraoral camera).

The most important insight we are given from this diagnostic tool is condition of enamel structure at approximal tooth surfaces. Concerning that we are able to answer two important clinical issues, first if there is carious lesion in region which is suspicious by sole clinical inspection and second whether we can discover lesions which are not even noticeable at all during sole clinical examination.

Positive finding of carious lesion limited to enamel will necessitate some clinical action or individually dedicated patient instructions.

During presentation we will share our experience, impressions, treatment approach changes and overall impact of introduction of this diagnostic device to our clinical practice.

Keywords: transillumination, DiagnoCam

Biomimetic approach of direct restorations – the secret of super strong adhesion

Dr. Péter Farkas, private practice, Budapest, Hungary

Fortunately, scientific developments in the modern age also have a significant impact on dentistry. Cutting-edge modern dental materials do not only allow our fillings to be aesthetically pleasing, but they are also able to replace the properties of the missing tissues of the tooth. However, when it comes to adhesion, the past becomes more and more important and we return once again to the old, well-proven systems.

Because it is useless to use new modern dental materials properly if we do not have strong and durable adhesion!

Therefore, the main topic of my presentation will be focusing on how to increase the adhesion force, and I will give a little encouraging sneak peek into the increasingly popular biomimetic dental approach.

Within the framework of my hands-on course, I will go into details on the further tricks of scientifically based biomimetic restorations by scrutinizing the unsuccessful restorations and analyzing their faults.

Keywords: dental adhesion, biomimetic restorations

Registration and transfer of intermaxillary relations. Can the theory be applied in practice?

Dr. Şerban Augustin, Practică privată DentAllFine, București

In oral rehabilitation, whether simple or extremely complex, the transfer of occlusal relationships is a key element.

The recording of intermaxillary relations must be carefully planned, like any other step in the treatment plan, thought out in a personalized way and performed with precision, so that the technician has the correct occlusal landmarks even in the early stages of prosthetic works.

Most occlusion problems occur not so much from an erroneous determination as from a faulty transfer. Therefore, the method, technique and materials for recording and transferring occlusal relationships are essential in the success of a complex treatment.

Although the occlusion is recorded at the beginning, the possible transfer errors of the occlusal relations are seen only at the end of the treatment, which usually requires the repetition of a large number of clinical-technical steps or even a complete start-over of a prosthetic work.

Each case is different, so the transfer method must be individualized, sometimes it is necessary to innovate and adapt our usual techniques to effectively achieve our goal.

Keywords: occlusion, bite registration, intermaxillary relations, transfer, stability, centric relation, maximal intercuspation

Direct aesthetic restorations with the new simplified composite resin systems

Șef lucr. Dr. Iulian-Costin Lupu, Conf. Dr. Cristina Angela Gheorghe, UMF „Gr. T. Popa”, Iași

New tendency in dentistry regarding direct restorations determined the manufacturers of dental materials to adapt or to improve composite resin systems.

Thus, “one shade” alternative systems have emerged – which with a single shade can restore teeth with different close shades. Previous composite resin systems demanded from the chromatic point of view layering different color and opacity materials. Various studies on the chameleon effect in new materials concluded that the predictability and effectiveness of direct restoration treatments with composite resins are much often encountered.

Keywords: composite resin, “one shade”, simplified layering, efficiency, predictability, chromaticity

Predictable prosthetic on implants

Dr. Bogdan Liviu Mirodot, Dr. Teodora Ioana Carlaonț, Practică privată

Rehabilitation of the anterior area of the upper jaw is always a challenge for the doctor as the aesthetic requirements are high due to the visual impact that can contribute to the rapid social and professional reintegration of the patient, but also to his isolation with consequences on the psyche, when the results are unsatisfactory.

Prosthetic rehabilitation with implant support of this area (front of the jaw) requires even more knowledge and skill of the doctor who inserts the implants and manages the profile of bone and soft tissue remodeling, following the extraction of the front teeth.

The present case aims to reproduce the work stages in the situation in which the extraction of the 2 upper central incisors is required.

Keywords: predictable implant-prosthetic rehabilitation

Optimization of the supracrestal complex in prosthetic rehabilitation with implant support. Case report.

Dr. Bogdan Liviu Mirodot, Dr. Teodora Ioana Carlaonț, Practică privată

The term EMERGENCY PROFILE is defined as “the contour of a tooth or a restoration, be it on the natural tooth or on the implant, in relation to the soft tissues that surround it.”

Two main factors are incriminated in the accumulation of biofilm at the level of the peri-implant sulcus: poor oral hygiene and improper design of the cervical margins.

When the cervical margin of the crown corresponds to the cervical margin of the peri-implant sulcus, the biofilm can be effectively removed by rigorous oral hygiene.

This goal is easily achieved when we contribute to the modeling of soft tissues by making custom healing abutments or temporary crowns that perform a dynamic compression.

Keywords: Supra crestal complex

Perio Patients’ Rehabilitation – Interdisciplinary practice flow

Dr. Mădălina Trofin, Practică privată, Bucureşti

Aim: 2 clinical cases, very young adult patients, both diagnosed with periodontal disease.

Material and method: 28 years patients, females, come to dental clinique to complain about poor aesthetic. First one is diagnosed with severe perio disease, second with iatrogenic gingival recession in frontal area. Therapeutic management of both cases starts with patio treatment, followed by orthodontic treatment to regain functions, especially esthetic one. The last follow-up describes the prosthodontic rehabilitation.

Results: both cases were fully rehabilitated, with a significant improvement of both periods status and functions.

Conclusion: perio patients need specific treatment, not only to stop the disease from worsening, but also to improve the lost functions. the treatment most be an interdisciplinary one, with perfect coordination among the stages and disciplines.

Keywords: perio, interdisciplinary, orthodontics, iatrogenic

AAP/EFP New Diagnosis Classification: How do we integrate it in our treatment planning process?

Conf. Dr. Irina F. Drăgan, Tufts University School of Dental Medicine/ Brookline Periodontal Associates

The aim of this presentation is to allow the participants to review the following concepts: AAP/EFP New Diagnosis Classification; Understand how to integrate critical thinking and evidence-based-dentistry in the shared decision-making process; Identify different periodontal surgical techniques that can be used to allow for a favorable treatment outcome.

Keywords: diagnosis, treatment planning, osseous surgery

Minimally invasive fiber reinforcement of MOD cavities – how to deal with large restoration in the daily dental practice

Dr András Volom, Private practice, Budapest

The vast majority of the work of a general dentist is direct restoration. In most of the cases we face a technical and financial challenge: the large cavities with significant tooth material loss should be treated with indirect restorations while the financial possibilities of the patient tie the hands of the practitioner. The decision is very uncomfortable: by the rules of our profession, we have to make indirect, but the circumstances force us to do direct restoration. Is there a way -with the help of biomimetic dentistry and a better understanding of biomechanics acting in a large filling- to safely fill the large cavities? How to manage the extremely big MOD cavities? The lecture offers to learn novel methods to safely solve such situations.

Keywords: direct restorations, fiberglass, bio-mimetic dentistry

Bonding to zirconia

Asist. Dr. Dragoș Corneliu Smărăndescu, UMF „Carol Davila”, București

Zirconia structure and surface are different from most well-known and long used dental materials. Adhesion to zirconia has been well documented since 2000. Nevertheless, for many clinicians the use of this techniques, though much desired, are still a wish. Chemical similarity between organo-phosphates and silane primers, lack of knowledge on how chemical bonds are developed, wrong surface activation by sandblasting, have all led to reluctance in bonding to zirconia, luting being preferred instead. Bonding to zirconia is now possible, offering a wider range of use for zirconia restorations. The simplicity of the techniques and the wide availability of materials involved in the clinical process, make it a must for modern dentistry.

Keywords: zirconia, bonding, adhesive dentistry, organo-phosphates, surface cleaners

Teeth-simple tools in a complex masticatory system

Dr. Gheorghe Daniel Raț, Practică privată

In this lecture I will try to share a different way that you should look and evaluate a patient, or patient teeth because teeth have a story to tell, a story about the health, harmony and history of the entire masticatory system, they are the main players that affects or can be affected by any masticatory imbalance.

Keywords: masticatory system

Perspectives in digital dentistry

Șef lucr. Dr. Mihaela Pantea, Prof. Dr. Marina Imre, Conf. Dr. Ana Maria Cristina Țâncu, Prof. Dr. Eugen Alexandru Petre, UMF „Carol Davila”, Bucureşti

We are witnessing remarkable advances in digital dentistry: new technologies have emerged and are rapidly developing, along with equipment and materials dedicated to the digital workflow. The elements estimated to be “top trends” in the evolution of digital dentistry and in influencing the development directions of dental education and scientific research are, in summary, the following: rapid prototyping; augmented reality and virtual reality (AR/VR); artificial intelligence (AI) and machine learning (ML); personalized and precision medicine/dentistry and tele-medicine. In this network of “digitally oriented fields”, it is important not to neglect the aspects related to authentic human interaction, direct communication with our patients and their safety, ensuring the confidentiality of patient personal data, as well as aspects related to the context of health policies. Consequently, the dental team will have to control the digital instruments for the maximum benefit of the patient. In addition, for the successful implementation of innovative digital technologies, undergraduate and postgraduate education in the field of digital dentistry is indispensable.

Keywords: digital technology, education, dental

The importance of radiology in diagnosis of periapical lesions

Asist. Dr. Cristina Antohi, Asist. Dr. Radu Eduard Cernei, Conf. Dr. Anca Melian, Șef lucr. Dr. Cristian Levente Giuroiu, Șef lucr. Dr. Liana Aminov, UMF „Gr. T. Popa”, Iași

Introduction: The introduction of CBCT examination on endodontics problems it is asseverated from European Society of Endodontology. Our purpose was to evaluate the impact of using the CBCT examination performed in accordance with European Commission`s guidelines versus Periapical Radiographs when doing diagnoses in endodontics and treatment planning.

Material and methods: Our study included 57 patients with endodontically untreated teeth diagnosed with non-vital pulps and 30 patients with periapical lesions symptomatic or not. The examinator wrote down a preliminary diagnosis after a clinical examination (history, clinical findings, diagnostic test, periapical radiograph) for each tooth which was suspected to have one of the pathologies mentioned, before the CBCT were made.

Results: From 57 patients with pulp necrosis PA radiolucency was present in 80 roots when assessed with PA radiographs and in 92 roots assessed with CBCT. 30 patients with periapical lesions symptomatic or not – 35 roots have PA radiolucency assessed with PA radiograph in comparation with CBCT which reveal 54 roots with PA lesions.

Conclusions: The diagnoses and treatment plans were changed for the teeth where were discovered apical lesion assessed with CBCT examination.

Keywords: CBCT, periapical lesions, periapical radiograph

The role of endodontics in orthodontic treatment

Asist. Dr. Cristina Antohi, Asist. Dr. Radu Eduard Cernei, Conf. Dr. Mihaela Sălceanu, Asist. Dr. Yllka Decolli, Asist. Dr. Tudor Hamburda, UMF „Gr. T. Popa”, Iași

Clinical Presentation: We report a 27 years old girl who came with signs and symptoms of acute pulpitis at 3.6. She also has an open occlusion and she told us that in her medical history she has an orthodontic treatment for 3 years.

Material and methods: The three examinators indicated at first a OPG for making the treatment plan. OPG revealed resorption at apical root for: 1.1; 1.4; 1.5; 1.6; 2.4; 2.5; 2.6 between 3.3-4.3 and at 3.6, 4.6 especially at the distal roots. It is visible on OPG that the roots of 4.6 and 3.6 are shorter than 4.7 and 3.7. After a clinical exam we indicate to do a CBCT for 3.6 before endodontic treatment. CBCT reconstruction revealed apicolizis of the root of 3.6 and that will induce the shortening of roots.

Result & Conclusion: It is better to have a OPG before all the orthodontic treatments and after for comparing the roots and for knowing if the resorption were a secondary effect of the treatment. Also, for endodontic treatment we must know very well working length and the diameter of the apex – in such case increase, for not overcome with final obturation.

Keywords: endodontic treatment, orthodontics, apical resorption

The management of endodontic emergencies

Dr. Roberto Cristian Cristescu, Clinica endodonţie ENDO EN ZO, Amsterdam

This presentation will focus on endodontic emergencies types encountered in daily practice and the possible successful management of them. Endodontic pain is a main component of the total painful conditions in the oral cavity and its proper treatment should lead to a better quality of life of the patients suffering from this pathology.

Keywords: endodontic emergencies / management of endodontic pain

Regenerative dentistry – basic notions

Şef lucr. Dr. Mihnea-Ioan Nicolescu, UMF „Carol Davila”, Bucureşti, Institutul „Victor Babeş”

In a world of biomaterials and 3D printing, the translational concept of regenerative dentistry connects academia to scientific research and clinical utility. General features of regenerative medicine and specific aspects of its dental subdomains will be presented, along with distinct characteristic of stem cells and their microenvironment, together with their diversity in the oral cavity, all put into the context of research and clinical use.
Examples of regenerative studies regarding endodontic and periodontal compartments, as well as hard (alveolar bone) and soft (salivary glands) related tissues are intended to raise the awareness of this brand-new emerging topic in modern dentistry.

Keywords: stem cells, regenerative dentistry

Comparative study about dentists’ perception and opinion regarding magnification systems and the prevalence of their use for direct restorations in two European regions

Dr. Olah Renata*, Asist. Dr. Marius Gheorghe Bud**, *Spitalul Clinic Județean de Urgență Cluj-Napoca
** UMF „Iuliu Hațieganu”, Cluj-Napoca

Introduction: When one says “dentistry”, thinks about precision, small operating field, necessity of good vision, but also about professional health problems. Moreover, nowadays patients request more and more highly aesthetic and minimally invasive treatments what will make their teeth look like „the real ones” or even better. All these seem a long list of aspects to check when practicing modern dentistry, but luckily there exist such devices that can fulfil all the above characteristics, namely the loupes and the Dental Operating Microscope, which are worth it to take a closer look at.
Purpose: The aim of the study was to evaluate dentists’ perception and opinion regarding magnification systems and to establish their prevalence for direct restorations.
Materials and method: An e-questionnaire was made to evaluate different aspects of the magnification devices.
Results: Most dentists evaluated themselves as having medium level of theoretical knowledge about these devices. Although the majority encourages the use of magnification among general dentistry practitioners as well, the prevalence of their use was low. Direct restorations were amid the first three options the magnification is considered for. The participants from one of the regions were more willing the recommend these devices for direct restorations.
Conclusions: Although most of the participants have knowledge about magnification systems used in dentistry and are positive about introducing them to the daily practice, their application for direct restorations is reduced in both regions. 

Keywords: Magnification systems, loupes, Dental Operating Microscope, direct restorations, ergonomics

Could magnifying systems improve your working posture?

Asist. Dr. Marius Gheorghe Bud*, Stud. Răzvan Pricope*, Stud. Răzvan C. Pop*, Mrd. Răzvan Onaca**, MSc. Pieter-Jan Swerts***, Prof. Dr. Ondine Lucaciu*, Conf. Dr. Ada Delean*

*UMF „Iuliu Haţieganu”, Cluj-Napoca, ** Universitatea „Babeş-Boliay”, Cluj-Napoca, ***KU Leuven, Belgium

Dentists are susceptible to musculoskeletal disorders due to prolonged static postures during dental treatments. Using a magnification tool like dental operating microscope (DOM) or the dental loupes, may correct the operator’s posture. The aim of this study was to comparatively analyse the working posture of preclinical students during a dental restoration procedure, working with two different magnification methods. This study used a randomized cross-over design in which seventeen third year students were randomly divided into three groups. The exclusion criteria were previous contact with magnification systems and previous clinical working experience. Each student prepared 3 Black class 1 cavities on artificial lower molars: first with no magnification, following dental loupes and DOM. They were video-recorded throughout the preparation. Trunk, neck and upper-arm position was evaluated using the Posture Assessment Instrument. Students completed a questionnaire on their subjective perception of the two magnification systems.
The statistical analysis showed significant improvement of the working posture using magnification systems compared to direct vision. The biggest improvement was obtained through the use of DOM, followed by the dental loupes. Students perceived dental loupes as being the most comfortable and easy to adapt to. They reported being more focused when using DOM. Both magnification systems had a positive impact on the working posture, DOM having the best results. Loupes showed better adaptability while DOM showed better concentration.Keywords: posture, microscope, loupes, magnification, student, restorative dentistry

The impact of magnification on posterior composite restorations

Asist. Dr. Marius Gheorghe Bud*, Dr. Mircea Zlăvog*, Dr. Ștefan Jitaru*, Asist. Dr. Carina Culic*, Prof. Dr. Bora Korkut**, Prof. Dr. Ondine Lucaciu*, Conf. Dr. Ada Delean*

*UMF „Iuliu Hațieganu”, Cluj-Napoca
**Marmara University, Istanbul, Turkey

Purpose: The objective of the present study was to compare the outcome of direct composite restorations, with and without the use of additional magnification.
Materials and Methods: Twenty extracted molars were selected for the study. Class 1 Black cavities were prepared. All teeth were etched, and bonding agent was applied. Teeth were assigned randomly into two groups of ten each. Group I: restorations were done without the use of magnification, first by placing a layer of SDR® flow +Bulk Fill Flowable on the base of the cavity, and then restoring the morphology with Ceram.X SphereTEC® One. Group II: the same protocol was applied, but using the dental microscope. Teeth were then evaluated before and after the finishing protocol by 5 dental professionals using a series of established criteria. The results were documented and statistically analyzed using the non-parametric Mann-Whitney test.
Results: Statistically significant differences were found when using magnification, before the polishing protocol in “marginal adaptation integrity” and “excess material”, and after polishing in “marginal adaptation integrity”.
Conclusions: Magnification may be used to increase the quality of the final direct posterior restoration by improving the marginal adaptation integrity, reducing excess material, preventing marginal microleakage, and avoiding subsequent failure.

Keywords: magnification, microscope dentistry, composite, direct restorations

Management of destructed subgingival abutment with laser and dental dam isolation

Dr. Stefan Marian Mantale, Innovation Medical Center IMC, Bucureşti

Management of destructed subgingival abutment with dental dam isolation of teeth with laser gingivectomy and then the reconstruction of the abutment

Keywords: dental dam, subgingival abutment, laser gingivectomy

Surgical Endodontic Treatment

Dr. Sergiu Gabriel Nicola

Surgical Endodontic Treatment – limits and possibilities – I am presenting several techniques for surgical endodontic treatment, from diagnostic to surgical treatment, extraction and replantation or transplantation, guided surgical endodontics

Keywords: surgical, endodontic, treatment, outcome

The relationship between myofunctional disfunctions, posture problems and face development as well as occlusion in the aspect of general health. Is long-term successful orthodontics possible?

Dr. Mariann Volomne Varga, Practică privată, Budapesta (Ungaria)

The main problem of orthodontics is certainly the unsatisfactory extent of stability.

It is because malocclusions are still considered and also treated mainly as skeletal. However, what we’re actually seeing is that the etiology of malocclusions is a multifactorial equation.

Myofunctional bad habits such as thumb sucking, pacifier use, open mouth- and incorrect tongue- as well as body posture, mouth breathing, reverse swallowing, poor diet all contribute to the development of malocclusion and poor craniofacial growth.

As the development of malocclusion is multifactorial the treatment should be multifaceted and interdisciplinary as well.

Braces are effective in moving and aligning teeth, but the maintenance of this alignment requires permanent retainers for life, otherwise a relapse can happen, because braces aren’t able to treat the underlying causes.

 Frequency of orthodontic malformations (malocclusions) is as high as 70% to 90%. The majority of children now have crooked teeth, which is evident from 3 to 5 years of age. Identifying the causal risk factors that lead to orthodontic irregularities of face, jaws and teeth and intervening on time with a myofunctional therapy, we can treat the problems, prevent severe malformations and assist normal facial growth. The result is not only a normal occlusion, but also a more attractive face.  Treating causes and form simultaneously we can reach much better stability.

Keywords: orthodontic treatment, myofunctional therapy, malocclusion

Orthodontic Treatment – when it can be done without extraction

Dr. Antonius Valentin Claudiu Coca, Practică privată

After 20 years in the field of orthodontics I realized that I have more questions than answers. In this presentation I would like to express my current views on orthodontic extraction and raise a question on the postulates that we are educated to be captive to.
Through the Damon System, that offered me the opportunity to turn the orthodontic kaleidoscope, I discovered that certain information that I was considering as absolute truth – is in fact partially true or even false.
Mother Nature, Individual Response, Faith, God, Allah, Buddha or any other entity that defies known laws of science are present in daily medical activity and I feel that in orthodontics even more so than in other dentistry fields.
When is a good time to go from the didactical approach – based on postulates by definition – to a clinical approach based on tough realities? I hope you will find the subject at least interesting and maybe, some of you, even useful.

Keywords: orthodontic extraction; compromise in orthodontics

Orthodontic management of children with complex general conditions: possibilities and limitations

Dr. Andrada Mihaela Bratu*, Dr. Alexandru Stănculescu**, Şef lucr. Dr. Aneta Munteanu**,
Asist. Dr. Cătălina Farcașiu**, Şef lucr. Dr. Arina Vinereanu*
*Practică privată, **UMF „Carol Davila”, București

Orthodontic treatment comes with undoubted benefits and that applies to all patients needing orthodontic corrections, including those with special health care needs. However, orthodontic management of these patients may sometimes raise consistent challenges for the practitioner. Some general conditions may associate specific or non-specific orthodontic problems, whose management shall need, besides a rigorous diagnostic, a thorough analysis of the particularities of the general pathology, potential implications of specific diet and medication, as well as the patient’s actual possibilities to comply and to perform oral hygiene during and after treatment completion. A very realistic assessment of the possibilities to correct altered functions is to be made beforehand, as perpetuated malfunctions or habits can -and will- compromise treatment results. It is the practitioner’s responsibility to modulate expectations (own and parents’) and to conduct a beneficial and predictable – even though not always ideal – treatment plan.
Part of Erasmus + Project 2019-1-RO01-KA2020-063820 Oral Special Care Academic Resources (OSCAR), our work presents clinical examples of orthodontic management of children with special health care needs, treatment planning rationale, with challenges, drawbacks and results emphasizing the importance of interception, interdisciplinarity and careful individualization of treatment choices for each case.

Keywords: orthodontic management, special needs patients, interception, expectations

Dentists’ self-perception and availability to provide dental treatment to patients with special healthcare needs

Asist. Dr. Raluca Paula Vacaru*, Prof. Dr. Andreea Didilescu*, Prof. Dr. Betul Kargul**,Dr. Annelyse Garret-Bernardin***, Şef lucr. Dr. Arina Vinereanu****

*UMF „Carol Davila”, Bucureşti, **Universitatea Marmara, Istanbul – Turcia, ***Ospedale Pediatrico Bambino Gesu, Rome – Italy, ****Practică privată, Bucureşti

General pathology, medication and behavioral issues may impact management of patients in the dental office.

Aim. To assess dentists’ perception regarding provision of dental treatment to patients with special oral care needs (SOCN). Method. Pilot study on answers to a self-administered MCQ form by dentists from Romania, Turkey and Italy on their training, previous experience and self-perceived need for further training in SOC.

Results. Of the 88 respondents, 52.3% had 5 years or less of practice, 29.5% had more than 30 years, 35.2% had completed postgraduate studies. Most (81.8%) had seen SOCN patients in-office (95.85% Turkish vs 72.73% Romanians, p=0.03). Residents in pediatric dentistry (n=37) were more likely to have seen SOCN patients than other dentists (90.91% vs 63.64%); 40% of the subjects had referred/refused to treat SOCN patients; 60.2% felt confident in treating SOCN patients with non-pharmacological methods (Italians more than Turkish and Romanian dentists, p<0.01), 62.9% were confident/very confident using pharmacological means. 22.72% reported they had never received any training in SOC. Most respondents (95.2%) were open to working with SOCN patients and 97.7% wanted to improve their practical skills and knowledge.

Conclusions. Need is felt among dentists from different countries for more practical information regarding providing oral care to people with special conditions. Structured, easily accessible information could help improve dental addressability of this patients. This work is part of Erasmus+ Project 2019-1-RO01-KA202-063820 “Oral Special Care Academic Resources” (OSCAR).

Keywords: oral special care needs, dental management, behavior/perception

O.S.C.A.R. digital platform: prevention and dental treatment for children with special health care needs

Drd. Konstantina Kritikou*, Şef lucr. Dr. Aneta Munteanu*, Asist. Dr. Ioana Stanciu*, Prof. Dr. Marie-Cecile Maniere**, Prof. Dr. Rodica Luca*
*UMF „Carol Davila”, Bucureşti, **Hopitaux Universitaires de Strasbourg, Franța

Children with special healthcare needs often have dental and periodontal pathologies that sometimes can be very severe. These oral pathologies can be part of the general disease, can occur as side effects of the medication or they can be common oral conditions that reach extremely severe forms due to lack of effective prevention and limited addressability. Both dental practitioners and patients’ families agree that there is reluctance in treating this category of patients.
Erasmus + 2019-1-RO01-KA2020-063820 Oral Special Care Academic Resources (OSCAR) project aims, through its digital platform http://oscarpd.eu/, to enhance the knowledge and skills of practitioners in the field of Special Oral Care and thus improve the access of people with special healthcare needs to such treatments. On the other hand, the Parents’ Section of the platform provides practical information and personalized methods of home oral care, meant to enable families and caregivers to limit the need for complex, expensive treatments and ultimately improve the quality of life of children with special healthcare needs.
OSCAR is an international project (Romania-France-Italy-Turkey), promoting cooperation between various national societies of Paediatric Dentistry and recognition of professional qualification of paediatric dentists across different countries.

Keywords: special needs, digital platform, prevention

Capacitatea regenerativă endodontică și periradiculară în practica pedoodontică curentă

Şef lucr. Dr. Dan-Cristian Ionel, Dr. Anca Mantu, Universitatea „Dunărea de Jos”, Galați

The considerable potential for post-infection tissue regeneration of the endodontic-periradicular space has been indicated by numerous researches as well as by clinical experience in microendodontics. The young organism in particular responds quickly to the judiciously performed endodontic therapy.
Patient A.S.(15 years old) came to the office for treatment at teeth 35, 36, 37, 45, 46, 47. At the time of presentation, bilateral vestibular fistulous trajectories were present, with repeated exacerbations and moderate clinical symptoms.
Initially, taking into account the large size of the cystic lesions with pluriradicular-pluridental damage, the chemo-mechanical endodontic treatment was performed (rotary instrumentation, 30ml sodium hypochlorite solution 5.25%, 5ml chlorhexidine solution 2%, 5ml EDTA 17% solution), followed of intermediate application of calcium hydroxide paste (2 months), with monthly reassessment. Then vertical compaction of warm gutta-percha was used.
Healing of fistulous tracts resulted in about 4-5days, and bone healing ad integrum (quadrant 3) in about 6 months; in quadrant 4, a small area at the inter-radicular level (46) indicated a partial healing, the appearance of the reorganization of the bone geodes predicting a subsequent healing.
The lesion limits indicated by a good part of prior therapeutic guidelines become irrelevant in the context of performing a proper endodontic treatment(isolation, disinfection and firm sealing of the endodontic space) and especially respecting and stimulating the real healing potential of each body.

Keywords: regenerative dentistry, paediatric dentistry, endo-periodontal

Parents’ habits and attitude related to their own oral health vs. their children oral health

Asist. Dr. Mariana Cărămidă, Șef lucr. Dr. Ruxandra Sfeatcu, Asist. Dr. Dan Lambescu, Prof. Dr. Adina Mihaela Dumitrache, UMF „Carol Davila”, Bucureşti

Aim: the assessment of parents’ approach regarding their children oral health compared to their own oral health behaviors.
Material and method: the cross-sectional study took place in 2020, on a sample represented by 105 parents, 95,24% female, who were assessed using an on-line self-administered questionnaire regarding the oral health-related behaviors for them and their children.
Results: Twice daily toothbrushing is performed by 76.19% of parents vs. 56.19% of children; dental visits at least once a year were observed at 55.24% of parents vs. 51.43% of children, but 40.95% of parents vs. 34.29% of children choose to make an appointment only when symptoms are present. The main reason for dental visits were: preventive check-up for 28.57% of parents vs. 42.86% of children, dental emergencies for 13.33% of parents vs. 19.05% of children. Oral health status was perceived as good, very good or excellent by 80.95% of parents (self-assessment) and 85.71% of children (assessment by their parents).
Conclusion: parents tend to be more prevention-oriented with their children, compared to themselves, regarding the dental visits, but they pay more attention to daily tooth-bushing compared to their children.

Keywords: oral health, oral hygiene, oral health behaviors

Behavioral changes of adolescents included in the Erasmus+ program “Model of oral health education”

Prof. Dr. Mihaela Adina Dumitrache, Asist. Dr. Mariana Cărămidă, Şef lucr. Dr. Ruxandra Ionela Sfeatcu,  Asist. Dr. Dan Lambescu, Dr. Alexandra-Ștefania Ene, UMF „Carol Davila”, București

Aim: Our study was set to track the changes in knowledge and behavior regarding oral health habits of a group of adolescents aged between 14-18 years old.
Material and methods: There were 26 subjects included from DGASPC Galati. 53.8% male sex. Method used: survey. There were 3 stages as following: initially we applied a questionnaire in order to have a point zero, after that there were 3 educational lessons regarding oral health and we reapplied the questionnaire in order to establish the efficiency the lessons had. This model is based on Kolb’s cycle of experiential learning.
Results: The number of subjects that declared new sources of information grew up to 50% after the lesson, from 11.5% to 65.4% have now knowledge regarding risk factors – hygiene, also from 3.8% to 92.3% know the role of fluoride and up to 65.4% declared they brush twice or often after the lessons, 88.5% using the rolling technique. Also, up to 88.5% declared after the lessons they only consume plain water after brushing.
Conclusion:  The behavior of the adolescents included in the program was improved especially regarding brushing techniques and prevention methods. There was underlined the importance of diet changing habits.

Keywords: prevention, fluoride, diet, brushing, technique, frequency, habit, behavior, hygiene, factor, risk, knowledge

Smoking behaviors in a group of high school students – preliminary results

Şef lucr. Dr. Ruxandra Sfeatcu, Stud. Lavinia Ștefania Pădurescu, Asist. Dr. Dan Lambescu, Asist. Dr. Mariana Cărămidă, Prof. Dr. Mihaela Adina Dumitrache, UMF „Carol Davila”, Bucureşti

Purpose: The assessment of the behavior of a group of students aged between 14 and 19 years old regarding tobacco use.
Material and method: Cross-sectional study conducted between November and December 2020 on a group of 100 students aged between 14 and 19 years, using a questionnaire with 16 items, distributed on-line.
Results: Out of the total group of students, 18% smoke daily and 28% have tried or smoke occasionally. Most of them smoked their first cigarette between the ages of 15 and 18. They seem to smoke more at parties, during the time spent with friends and in stressful situations. The reasons why they claim to have adopted this habit are curiosity (12%) followed by the influence of the entourage (8%). Among them, 9% plan to quit in the future and 5% have tried in the past.
Conclusion: Students are very vulnerable to the habit of smoking, they are very easily influenced by their entourage, but they are also at an age predominated by curiosity and they want to experience as many things as possible. One way to prevent smoking among students could be open discussions about the curiosities they have about tobacco use.

Keywords: behavior, students, smoking

Condilographiated Veneers

Dr. Andi Dragus, Practică privată, Bucureşti

The concept combines the stomatognathic system functionality with the dental esthetics.
The Condilographiated Veneers concept is based on the mandibular dynamics and the masticatory reflex combined with the visual perception of the vestibular facets of the dental facets made by the dental technician team dental technician.
The condilographiated veneers are microprostheses that are part of a treatment plan that uses the condilography as a measurement of the mandibular dynamics.
Condilography is performed with the condylograph and is a digital method of recording the movements of the mandibular dynamics and diagnosing the status of the two ATMs.
By realizing the condylography we obtain the settings for the fully programmable articulator and exact data about the status of their ATM.
For the condylographiated veneers we need four SCI / Benett / ISS / SA parameters (obtained with the condylography) and the facial bow transfer of the correct position of the maxillary bone in the mathematical coordinate system that is the arcon type articulator.
In fact, the anatomy of the two ATMs is the one that, together with the neuro-muscular system, guide aesthetic dentistry.
When it comes to dentistry in general, we refer only to the vestibular facets of the teeth on the dental arches.
Keywords: veneers, personalization of the treatment plan, the uniqueness of each case, Condylography, face bow, sequential functional wax-up, sagittal inclination of the condyles.

Occlusal Clearance Problems related to Implant-Supported Superstructures in the Load-Bearing Area

Dr. Radu Baston, Dr. Ioana Neagu, Dr. Mihaela Gaşpar, Practică privată, Bucureşti

Purpose: The aim of this lecture is to statistically assess the number and subdivisions for load-bearing area implant cases featuring various degrees of occlusal clearance problems, analyze their extent and present appropriate treatment solutions.

Materials: 223 implant case reports.

Method: between January 2013 and August 2020 we inserted in all load-bearing areas a total of 281 fixtures which have been loaded with 223 non-removable superstructures. 116 (52%) were single crowns and 107 (48%) multiple crown units and bridges. Not a single case was treated with a removable implant-borne superstructure. For every implant case we took standardized snapshots (1) before beginning the treatment, (2) during relevant prosthetic procedures and (3) at treatment completion. The snapshots have been stored in individual PPT files and analyzed for occlusal clearance.  In order  to  overcome  the  deficient,  usually  insufficient  occlusal   clearance  we   have   to consider  the  following  procedures: (1) crown  lengthening  for: adjacent and/or opposite teeth, (2) coronoplasty   for:  adjacent  and / or  opposite  teeth, (3) root  canals,  crown  built-ups, post  and  cores, teeth-supported  crowns  and  bridgework  for adjacent  and/or  opposite  teeth, (4) alveoloplasty  for the opposite jaw edentulous areas or/and implantation sites preceding implant placement, (5) palatal  submucosal excision for implantation sites preceding implant placement or associated with the uncovering procedure, (6) giving  up the  ceramic  layer  in  the  second  molar  area for implant-borne superstructures, adjacent and/or opposite teeth-supported crowns, (7) using non-veneered, cad-cam manufactured mono-block ceramics for implant-borne superstructures, adjacent and/or opposite teeth-supported crowns, (8)reducing the increased occlusal clearance  by prosthetic means: gingiva-colored  acrylic, porcelain, composite, an inverted Spee’s  curvature.

Results: the retrospective analysis identified 168 cases featuring clear-cut occlusal clearance problems, thus representing an absolute majority of 75%.

Discution: occlusal clearance problems cases range from minor to close to the edge. Their identification and treatment are unfortunately not given in many textbooks the appropriate emphasis. Unapproached they lead to treatment failure. Beside an “on the problem focused” examination, pretreatment plaster/virtual 3D-casts and standardized snapshots are unbearable for proper diagnosis, thus achieving a rewarding treatment result.

Conclusion: every implant case in the load-bearing area visiting a dental office has an extremely high potential of featuring occlusal clearance problems.

Keywords:  occlusal clearance, dental implant, implant superstructure

Surgical aspects in immediate fixed total edentulous rehabilitation

Dr. Ovidiu Dumitru, Practică privată, Bucureşti

During the last years, the motto “Fixed teeth in 24 hours” became more and more popular in Romania. In reality, the edentulous patients or the ones with failing dentition present different stages of bone atrophy. In order to keep your promise and treat all of these patients, we must improve our surgical and prosthetic abilities and learn how to use special implants and techniques.

Keywords: immediate loading, fully edentulous, tilted implants

Managing complex pain and infection cases in a contemporary endodontic office

Jorge Vera DDS, MEndo, PhD (Honorary), Assistant clinical Professor, University of Missouri Kansas City, School of Dentistry

This lecture is designed to address common problems in diagnosis encountered when dealing with patients presenting with symptoms mimicking odontogenic pain.  Most of those patients have undergone multiple dental interventions, which have resulted in exacerbation of their symptoms rather than relief. Neurovascular orofacial, and neuropathic pain syndromes are some examples. The second part of the lecture will deal with common anesthetic problems and how to solve them, as well as a rationale for the use of analgesics and antibiotics in an Endodontists office.

Keywords: pain, endodontics, non-dental pain

Front teeth with calcified canals – how to use the CBCT efficiently

Miguel Vasco Seruca Marques, DDS, MSc, Practică privată Endo En Zo, Amsterdam, Olanda

Front teeth with obliterated canals are quite common in the endodontic clinical practice and they represent a challenge even for the experienced clinician.
In the last decades we have assisted to the development of microguided approaches like 3D printed guides, live guided systems and CBCT guided that can be invaluably helpful.
In this presentation we will discuss several clinical cases to illustrate a CBCT guided technique and demonstrate that most of these cases can be treated predictably.
After this presentation all attendees will:
• learn about obliterated canals etiology
• learn about pulp necrosis risk in obliterated canals
• learn how to approach obliterated canals predictably reducing risk of iatrogenesis

Keywords: Cone-Beam Computed Tomography, guided endodontics, dental pulp calcification, root canal therapy

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