THE MULTIDISCIPLINARY APPROACH TO TEMPOROMANDIBULAR JOINT DYSFUNCTIONS

Cristina Brăileanu*, Georgeta Zegan**

*Spitalul Clinic de Urgență pentru Copii “Sf. Maria” Iași, România

**U.M.F. “Grigore T. Popa” Iași, România

This paper presents an overview of the etiological factors involved in temporomandibular joint dysfunctions, emphasizing the importance of a multidisciplinary approach. The etiology of temporomandibular joint (TMJ) dysfunctions is still a controversial topic. In the scientific debates regarding the etiology, psychological factors, occlusion disorders or postural changes, skeletal asymmetries are mentioned, but last but not least, genetic factors, which are more difficult to track and diagnose. Orthopedic instability due to dental occlusion is by far the leading cause of temporomandibular joint pain in both children and adults. TMJ dysfunction refers to any problem that limits the normal functions of the complex system of muscles, ligaments, discs, and bones that perform the functions of the TMJ. Pain caused by temporomandibular disorders is caused by either muscle or joint conditions, or both. Temporomandibular joint pathology requires a multidisciplinary approach, including a rehabilitation plan to limit functional sequelae and improve patients’ quality of life.

Disorders of the oral mucosa of children

Conf. Dr. Lelia Mihai, Dr. Adrian Răzvan Mihai

Catedra de Patologie Orală, Universitatea Titu Maiorescu

Oral mucosal affections to children are a special pathology in dentistry. Some diseases, sometimes rare in adulthood may occur, which can cause both diagnostic problems and serious concerns for parents. These disorders can be divided into: the pathology of the oral mucosa to the new-born; viral and bacterial infections of the oral mucosa; oral manifestations in immune affections such as recurrent chronic aphthous, oral lichen plan, erythema polymorph. Viral infections of the oral mucosa are frequently encountered in usual dental practice. There are acute infections, chronic infections and viral tumors. The difference between them refers to the time of evolution and the degree of intensity.

The main causes of acute oral infections are herpes simplex virus type I, Varicella-zoster virus, Coxackie virus. Latent viral infections as form of chronic infection are caused by herpes virus type I and various types of Papilloma virus, Barr Epstein virus. Some viral tumors occur in immunocompetent persons (HPV). Other viral tumors (Kaposi’s sarcoma, non-Hodking lymphoma) are more frequent in immunosuppression and lately, they are considered an indicator of the main disease progression or response to treatment. In general, acute infections are symptomatic with typical lesions, single or multiple, with modifications of the general state. Diagnosis of viral infections of oral mucosa is based on a careful case history, a thorough clinical examination and specific laboratory tests (viral or histology). Treatment is etiology-specific and it covers local and general conditions.

Burning mouth syndrome. Clinical approach algorithm.

Șef lucr. Dr. Ioanina Părlătescu

Disciplina Patologie Orală, Facultatea Medicină Dentară, Universitatea de Medicină și Farmacie Carol Davila

Burning mouth syndrome (glossodynia or stomatodynia) is a multifactorial condition characterized by chronic orofacial pain with no visible clinical lesions but the presence of persistent burning sensation for more than 2 hours a day, evolving for at least 3 months. The diagnosis is based on clinical and paraclinical criteria after the elimination of general or local conditions that have similar symptoms. Depending on the evolution of the painful symptoms, 3 clinical types of pain are known: type 1 – the symptoms do not appear in the morning but during the day and intensify towards evening, type 2 -symptoms are present on waking and persist continuously during the day, type 3- symptoms do not occur every day and are variable in location. Etiologically, BMS is classified into 2 groups: BMS secondary to systemic or local causes and group 2 primary or idiopathic BMS. The inclusion of patients in these groups can be difficult. Hematological investigations such as complete blood count, sideremia, glycemia, dosing of vitamins B1, B2, B6, B12, assessment of thyroid function are of primary concern in patients who report BMS symptoms. Allergic tests are also included in the evaluation of these patients.  Gastroenterological, endocrinological, psychiatric, hematological disorders may associate identical symptoms with ABN. Local factors such as recurrent candidiasis infections, premature occlusal contact or dental interference, or benign variants of the oral mucosa may mimic the BMS symptoms. For this reason, a multidisciplinary approach is needed for these patients. The treatment is different depending on the etiology and the response to treatment is variable. This work was supported by a grant of the Romanian Ministry of Education and Research, CCCDI – UEFISCDI, project number PN-III-P2-2.1-PED-2019- 1339 within PNCDI III. (Contract number 564PED/ 2021)

Alveolar Ridge Preservation: Clinical and Radiological Findings From a Case Report

Misăiloaie Alexandru, Misăiloaie  Denisa, Budacu Cristian. Prof. Dr. Sava Anca

University of Medicine and Pharmacy “Grigore T. Popa” Iasi,Romania

Tooth extraction is a common procedure in dentistry and is the first step in the oral implantology field. After dental extraction, alveolar bone remodeling has been estimated to cause 50 % reduction in the bucco-lingual width of alveolar bone. The dimensional changes that occur following dental extractions remain inevitable even if regeneration techniques are used. The management of tooth extraction is more complex if an implant procedure will be apply.

Over the past, a lot of research has focused to minimize the alveolar bone loss. It is certain that, in implant dentistry, the first step is the atraumatic extraction preferably without raising a muco-periosteal flap. The overall alveolar changes following tooth extraction may compromise the ideal prosthodontic rehabilitation. To limit bone loss after extractions dentist or surgeon can use the ALVEOLAR RIDGE PRESERVATION (ARP) that involves filling the alveolar socket with differently grafting materials and leaving it to heal for several months. The alveolar socket after extraction can be filled with human, animal or artificial bone. It can be with or without the use of barrier membrane (collagen, PTFE membranes, growth factors such PRF, autogenous tissue graft).

The socket preservation technique can be favorable for preserving the alveolar ridge and height. The purpose of ARP is to maintain a favorable alveolar ridge architecture for future dental implant placement. [1-5]

Keywords: ARP-ALVEOLAR RIDGE PRESERVATION, PTFE –POLYTETRAFLUOROETHYLENE, PRF-Platelet Rich Fibrin

APPLICATIONS OF Platelet Rich Plasma IN THE MEDICAL AREA

Ion Hurjui, Irina Grădinaru, Claudia Cristina Tărniceriu, Carina Balcoș, Adina Oana Armencia, Loredana Liliana Hurjui

PRF (platelet-rich fibrin) is a product considered an autologous healing material. The fibrin matrix contains leukocytes, platelets and most of the cells that act in the healing process of tissues. This study will analyze the clinical and biological features of the PRF action registered in bone regeneration in the field of dentistry and the multiple possibilities of application in this field. PRP is a promising biological treatment with a wide range of applications in dentistry, orthopedics and sportive medicine. Multiple studies have shown efficacy in a wide variety of challenging conditions, of a systemic nature having applicability in dentistry. Understanding the factors that contribute to this variability will allow clinicians and researchers to make it proper in the treatment of various clinical conditions.

Keywords: disease, platelet, dental medicine.

CLINICAL-HISTOLOGICAL ASPECTS OF ACUTE AND CHRONIC PULP INFLAMMATIONS

Prof. Dr. Mihaela Țuculina, Conf. Dr. Oana Andreea Diaconu, Șef lucr. Dr. Lelia Gheorghiță

Acute inflammations of the dental pulp are classified histopathologically into serous pulpitis and purulent pulpitis, with limited lesions (coronal pulpitis) or with extensive lesions (corono-radicular pulpitis).

The mentioned morphological varieties actually represent the evolutionary phases of the same inflammatory process, the aspects of which are due to the structural particularities of the dental pulp (well-vascularized and innervated loose connective tissue contained in a cavity with rigid walls and the presence of an extremely important number of pro-inflammatory cells).

Chronic pulp inflammation most frequently follows a purulent pulpitis but also a serous pulpitis or a pulp hyperemia, when the general and/or local reactivity is constitutionally low or when the body’s defense potential is diminished.

A similar situation occurs when the etiological agent is non-aggressive, but acts slowly, for a long time, and on a large surface of the pulp.

Any form of pulp aging characterized by a fibrous degeneration of the connective structure is assimilated to chronic pulpitis.

Aligners Biomechanics – principles and facts

Cristina Vasilache, Georgeta Zegan

U.M.F. „Grigore T. Popa” Iași

In the past two decades, aligner treatment has received remarkable attention from orthodontists. There have been various companies that have emerged using heavy advertising to promote their products specifically to patients but also to clinicians through social media. A variety of concepts, methods and adjuvants have been introduced to enhance the effectiveness of these aligners. However, it has been shown that the accuracy of tooth movement with aligners is still unclear and there are many difficulties in performing orthodontic treatments with them. Performing orthodontic treatments with polyaggregate appliances are much more useful in terms of treatment accuracy and predictability. Why is there a discrepancy between expected and actual results in aligner treatments? This presentation will clarify the “first principles” and existing evidence to demonstrate some of the key drawbacks of alignment-based therapy. Some biomechanical deficiencies are discussed and the importance of material properties of aligners (thermoplastics) affecting clinical performance. Based on the first principles of aligner biomechanics, this presentation provides clinical insights for improving the predictability and effectiveness of aligner therapy.

CHARACTERISTICS OF THE NEW DENTAL MATERIALS BASED ON ZIRCONIA

Ioana Madalina Ciornei, Georgeta Zegan

U.M.F. “Grigore T. Popa” Iași, România

Zirconium or “Steel Ceramic” has become, in recent years, an extremely popular restorative material due to the special characteristics of zirconium, as a material used in dentistry, which has led to an extremely wide use in dental medical practice. The properties that make it extremely attractive for use in dental practice are: increased mechanical strength, wear resistance, high hardness and density, biocompatibility (inert material), low thermal conductivity and good aesthetics (opaque white material). Along with this trend, researches focused on Zirconia have become more and more frequent. In recent years, several variants of this material have been developed, which were particularly oriented towards improving the characteristics of monolithic zirconia. Thus arose the need to study in depth the different variants of zirconium, primarily for a thorough understanding of the limits of this material, in all its variants, as well as to improve its properties for the benefit of practitioners and patients. The studies from the last years in the specialized literature were analyzed, through PubMed, which have Monolithic Zirconium as their subject. The most relevant articles were selected and analyzed. The properties of zirconium depend on many factors that appear throughout the entire technological process of production of zirconium structures: the method of synthesis and the content of nano-zirconium powder, sintering of zirconium, coloring of zirconium, etc. It has been found that an increased concentration of yttrium oxide (stabilizing oxide) causes increased translucency, which provides excellent aesthetics, but this compromises the mechanical strength of the material. The accelerated development of new materials based on Zirconia is accompanied by both advantages and disadvantages. This requires a thorough knowledge of the characteristics of these materials by practitioners to ensure a rational use, adapted to each individual clinical situation.

Challenges in the Management of Oral Erosive Lichen Planus

Mihaela Paula Toader*, Cristina Popa*, Ana Maria Sciuca*, Victor Vlad Costan**, Ștefan Toader***, Mădălina Mocanu*

*University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Oral Medicine, Oral Dermatology

**University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Oral and Maxillo-facial surgery

***University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Physiopathology

Oral lichen planus is a chronic inflammatory condition with partially known etiology, which occurs in approximately 1-2% of the general population and mainly affects middle-aged women. The erosive clinical form of oral lichen planus carries a risk of progression to carcinoma of about 1-4%. This aspect, together with the chronic, recurrent character of the disease, the multifactorial etiology, as well as the distressing symptomatology that hinders food and liquid intake, turns the therapeutic conduct of the oral erosive lichen planus into a real challenge.

The treatment aims to reduce the symptoms and to resolve oral mucosal lesions. The classic first-line treatment is topical corticosteroids (moderately potent or potent corticosteroids in Orabase / Mouthwashes / Sprays or intralesional – Triamcinolone 0.1%, Dexamethasone 0.1%) with notable anti-inflammatory effects. Short-term systemic corticosteroids may be associated with topical therapy in case of exacerbation of lesions or resistance to local treatment. Calcineurin inhibitors (Tacrolimus 0.1% and Pimecrolimus 1%) administered topically, 1-4 applications / day in various pharmaceutical forms (gel, cream, Orabase, spray) are a viable therapeutic alternative for cases without response to classical corticosteroids. There was a low rate of adverse reactions and favorable local therapeutic effects on the sensation of pain, stinging, as well as a reduction in the size of oral erosions or their complete resolution. Other therapeutic alternatives suitable for selected cases, refractory to conventional local therapies are systemic retinoids, intravenous immunoglobulins, immunosuppressants (mycophenolate mofetil, cyclosporine, azathioprine) and systemic immunomodulators (Levamisole, Dapsone). Studies have shown the efficacy and safety of Apremilast, a phosphodiesterase-4 inhibitor, in patients with oral erosive lichen planus. Photodynamic therapy is another therapeutic option for oral erosive lichen, as monotherapy or in combination with topical treatment.

Treatment should be individualized and involves constant monitoring to assess the amount of risk-benefit balance given the high potential of these therapies to induce significant side effects.

Classic vs. digital in non-surgical and surgical preprosthetic planning and treatment in extended partial edentulous

Cosmin Crețu, Roxana Vasluianu, Răzvan Curcă, Bianca Toader, Doriana Agop-Forna, Norina Forna

The transition from traditional to digital is still a challenge for doctors who want to keep up with the professional evolution. This technology is evolving rapidly. But without the principles of prosthetics and a deep understanding of the science behind the digital design aspect, the success of the case will be compromised. For years, the removable dentures department has been pushed to the bottom of technology. Although we have an advantage in terms of dental materials from which artificial teeth are made (anatomical morphology with increased resistance) and removable prostheses (acrylates with increased resistance to impact and bending), only in recent years has the image and focus in the field of partial removable dentures began to change thanks to CAD-CAM technologies. But on the other hand, when we look at the traditional techniques of making removable dentures, the correct protocol with case planning, quality materials lead to a successful removable denture case. Once all the software design applications and technologies of digital prostheses are learned, it will be possible to produce a prosthesis much faster with high precision. We must also take into account the fact that the success of the removable prosthesis depends on the correctness of the digital scan of the edentulous patient. Classic and digital go together. There are features and benefits to both technologies. However, with the evolution of digital techniques, the comfort level of the dentist is much higher and the adaptation of the prosthesis is much improved. Also, in case of accidents such as the fracture of the prosthesis or its loss, based on the records made, a new one can be printed or milled very quickly.

CLASSICAL VERSUS DIGITAL APPROACHES TO BIOMATERIALS AND TECHNOLOGIES INVOLVED IN PROSTHETIC RESTORATIONS

Irina Grădinaru, Magda Ecaterina Antohe, Loredana Liliana Hurjui

„Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania 

Contemporary dental practice is governed by the contribution of new digital technologies in the realization of prosthetic restorations with a high degree of precision and achieving optimal biomechanical and aesthetic parameters. In full agreement with the new technologies, the biomaterials used are anchored in the register of non-metallic materials, but the most used are represented by integral zirconium-supported ceramics. The particularity of the clinical case with all the facets it involves, coupled with paraclinical investigations, is also the basis for choosing a solution selected from the classical or digital register.

The combination of local, loco-regional and general clinical-biological indicators, biological, biomechanical, and aesthetic criteria, as well as socio-economic criteria, lead to the therapeutic decision of choice. The planning and design of the prosthetic design by means of current digital techniques, the use of virtual models, optical impressions and various CAD-CAM systems lead to therapeutic solutions impeccably integrated into the harmony of the dental system. On the other hand, the classical techniques for the production of ceramic restorations on metal support are also being improved by the contribution of contemporary technologies so that their adaptation can be grafted onto the demands of today’s rehabilitations.

Keywords: CAD CAM, classical, digital, optic impression

comorbidities THAT INCREASE THE BLEEDING RISK IN HEPATIC DISEASE

Ion Hurjui, Irina Grădinaru, Claudia Cristina Tărniceriu, Mihaela Mitrea, Ion Andrei Hurjui, Ruxandra Maria Hârțan, Carina Balcoș, Adina Oana Armencia, Loredana Liliana Hurjui

Despite the presence of coagulopathies, the hemostatic system may be balanced in stable liver diseases. In patients with liver diseases routine coagulation tests are not predictive for the periprocedural bleeding. Pre-procedural correction of abnormal coagulation tests by using blood products does not reduce the risk of perioperative bleeding. To patients with liver disease routine perioperative administration, prophylactic or therapeutic, recombinant activated factor VII is not recommended. Up to now there are insufficient data to recommend routine, prophylactic or therapeutic administration of antifibrinolytics. Patients with liver disease often have a complex hemostasis disorder. The hemostatic profile of a patient with hepatic impairment includes thrombocytopenia and abnormal platelet function, low levels of coagulation factors agents and their inhibitors, low levels of plasminogen and of antifibrinolytic proteins, dysfibrinogemia, decreased ADAMTS 13 levels and elevated plasma levels of coagulation factors VIII (FVIII) and von Willebrand factor (FvW). Depending on the etiology of liver disease, the hemostatic changes can prevent different intensities. A definite association exists between hepatic disease and abnormalities of the coagulation system. These abnormalities can be detected by both routine and specialized coagulation tests. Extrahepatic causes of coagulation defects must first be ruled out by anamnesis, physical findings, and clinical laboratory tests before attributing the coagulopathies to hepatic disease.

Keywords: liver disease, coagulation system, clinical laboratory tests.

PROFESSIONAL COMMUNICATION IN DENTISTRY IN THE CONTEXT OF THE PANDEMIC COVID 19

Prof. Hab. Dr. Elena Mihaela Cărăușu

U.M.F. „Grigore T. Popa“ Iași, Facultatea de Medicină Dentară, Disciplina de Sănătate Publică și Management

The COVID-19 pandemic has brought about a change in the way the dental team works by redesigning the internal work as a result of the implementation of the new strategy, the introduction of new legislative regulations, together with a new set of principles and standards of professional communication in dentistry together with the set corresponding to communication relations and implicitly with the construction of a new organizational culture.

Professional communication courses are taught in all developed countries of the world, becoming part of the curriculum of undergraduate dental schools and also of postgraduate dental education.

Keywords: professional communication in dentistry, standards of professional communication in dentistry, the COVID-19 pandemic.

CONSIDERATIONS ON VERTICAL DISCREPANCIES IN ORTHODONTICS

Conf. Dr. Daniela Anistoroaei

Disciplina de Ortodonție și Ortopedie Dento-facială, Facultatea de Medicină Dentară, UMF “Grigore T. Popa”, Iași, Romania

Vertical dimension refers specifically to the vertical relationship of the mandible to the maxilla, and any deviation from normal in this relationship is referred to as a vertical discrepancy. Orthodontic studies abound in information regarding the diagnosis and treatment of the sagittal and transverse sense and discuss less about the treatment of vertical problems. The work addresses, through some clinical cases, different ways of managing vertical problems, depending on age. For each patient, the complete orthodontic file allowed the diagnosis, as well as the establishment and planning of the treatment. The results show that the treatment of vertical discrepancies is difficult and their insufficient vertical control leads to the prolongation of the treatment and even to the compromise of its results. From the point of view of orthodontic biomechanics, control of vertical dento-alveolar development is difficult to achieve because orthodontic mechanotherapy tends to produce vertical tooth movement and is most often dependent on patient compliance.

CONTRIBUTIONS OF HYALURONIC ACID IN FACIAL AESTHETICS

Loredana Liliana Hurjui, Adina Oana Armencia, Ion Hurjui, Carina Balcoș, Mihaela Mitrea, Claudia Cristina Tărniceriu, Irina Grădinaru

The name of hyaluronic acid (HA), derives from the Greek word hyalos (glass) and contained two saccharide molecules, one being uronic acid. HA exists in the form of various molecular sizes in biological tissues and fluids. HA is involved in many biological pathways both physiologically and pathologically. Shows biocompatibility, non-antigenicity effect anti-inflammatory and antioxidant. It has multiple indications in various medical fields. Due to its positive effect on tissue repair and wound healing, topical administration of HA could play a role not only in postoperative dental surgery but also in the treatment of patients with gingivitis and periodontitis, with a significant improvement in their quality of life.

Keywords: hyaluronic acid, periodontitis, dental surgery.

QUANTIFICATION OF PARACLINICAL ASSESSMENTS OF EXTENDED PARTIAL EDENTATION

Cosmin Crețu, Dimitrios Bardis, Walid Edlibi Al Hage, Doriana Agop-Forna, Raluca Biciușcă, Norina Forna

In the context of the evolution of digital techniques in the field of dental prosthetics, there will be a mechanism of care of the medical reasoning it will go through to reach a certain therapeutic decision and this can be summarized as follows: collection of essential data through anamnesis, objective and subjective clinical examination, and paraclinical exams. In order to support the making of the best decision from a therapeutic point of view, expert systems have been developed, with the help of artificial intelligence, which removes the possibility that a non-specialist does not have access to all the information and references of specialists in the field. In the medical field, decision support systems were first introduced to stabilize a treatment plan, then they focused on stabilizing a diagnosis, and currently they have futuristic valences, being able to specify a prognosis and predict the therapeutic evolution of the patient, within certain limits, based on the patient’s condition indicators and by quantifying the interventions to create the clinical situation, when they are practiced, as well as the chosen therapeutic solution. By evaluating the initial status and the one after the corrective interventions, a therapeutic solution for rejection is recommended, a solution that is the ideal solution to the existing clinical case, associated with the most favorable evolution prognosis. Thus, the application of a therapeutic solution of choice will lead to a final result with a favorable evolution prognosis. However, the solution of choice does not always correspond to the one applied, due to the context or the patient’s decision, and no clinical situation is always perfect. Therefore, a choice or intermediate therapeutic solution, applied to an unfavorable clinical situation, or an intermediate therapeutic solution, applied to a favorable or average clinical case, will generate a final result with an average evolution prognosis. And an unfavorable therapeutic solution, applied in any type of clinical situation (favorable, neutral or unfavorable to the treatment) will generate a final result with an unfavorable prognosis. This algorithm is used by expert systems to obtain a therapeutic solution applied to the case, taking into account the variables that can modify the prognosis and the final evolution. In this way, the success of a clinical decision can be accurately predicted, failure can be eliminated and the ill-advised patient will be motivated to choose an optimal solution and make an informed decision.

Current aspects of treatment methods in class III malocclusions

Eduard Radu Cernei, Cristina Antohi, Alina Sodor, Georgeta Zegan

U.M.F. „Grigore T. Popa” Iași 

Class III malocclusion affects between 5% and 15% of our population. The 2 most common dilemmas surrounding Class III treatment are the timing of treatment and the type of appliance. A number of appliances have been used to correct a Class III skeletal discrepancy, but there is little evidence available on their effectiveness in the long term. Concern regarding early treatment and the need for interceptive care in the case of Class III malocclusion has always been a dilemma, knowing that not all problems will be solved in these cases until maxillomandibular growth is further completed, and the long-term outcome of various treatment approaches may depend on the growth tendency of an individual. Interceptive treatment of Class III malocclusions should be undertaken if it prevents damage to the oral tissues and/or significantly reduces the amount or severity of future orthodontic and surgical interventions. Curative treatment involves the use of fixed appliances in combination with orthodontic camouflage techniques as well as orthodontic surgical treatment. This presentation is an overview regarding the treatment possibilities of class III malocclusions with the exemplification from my own casuistry.

MICRO-SURGERY DECOMPRESION OF A LARGE RADICULAR CYST IN A 9 YEARS OLD PACIENT: A CASE REPORT

C. A. (Concită )Brînză*, A. Melian**, S. Andrian**, B. C. Concită***, C. L. Giuroiu**

*Universitatea de Medicină și Farmacie ,,Grigore T. Popa” –Iași, Romania, Facultatea de Medicină Dentară, student doctorand și medic rezident, Departamentul de Odontologie, Periodontologie și Proteze Fixe.

**Universitatea de Medicină și Farmacie ,,Grigore T. Popa” –Iași, Romania, Facultatea de Medicină Dentară, Departmentul de Odontologie, Periodontologie și Proteze Fixe.

***Universitatea de Medicină și Farmacie ,,Grigore T. Popa” –Iași, Romania, Facultatea de Medicină Dentară, student

The radicular cyst (RC) is the most common odontogenic cyst of inflammatory origin affecting the jaws, but its development is relatively rare in deciduous teeth. We present a case report ofa 9-year-old male child which came in the clinic presenting the following symptoms: localized pain along with localized swelling at the level of 7.4 and 7.5 deciduous molars and the orthopantomography radiographic examination confirmed the presence of a large radicular cyst, based on a large radiolucency. Micro-surgical decompression was performed minimally invasive by means of a minimal access along with the irrigation using normal saline and calcium hydroxyl solutions that was done through the cannula simultaneously with an orthograde root canal treatment. After 4 weeks the cannula was removed. The radiographic examination after one year revealed a healthy periapical periodontal tissue. We confirmed a technique for conservative treatment of radicular cyst in deciduous teeth with endodontic origin by using conventional and micro-surgery therapy.

Keywords: radicular cyst, decompression, deciduous teeth

Dermoscopic Features of Oral Lichen Planus

Mihaela Paula Toader*, Cristina Popa*, Ana Maria Sciuca*, Victor Vlad Costan**, Ștefan Toader***, Mădălina Mocanu*

*University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Faculty of Dental Medicine, Discipline of Oral Medicine, Oral Dermatology

**University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Faculty of Dental Medicine, Discipline of Oral and Maxillo-facial surgery

***University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Faculty of Dental Medicine, Discipline of Physiopathology

Dermoscopy is a non-invasive tool for in vivo assessment of surface and color changes of the epithelium as well as structures, colors and micro-vascular changes in the superficial dermis that is commonly used for improving the accuracy of clinical diagnosis in dermatology. Lichen planus is a chronic inflammatory condition with unclear etiology, that affects the skin, mucous membranes (particularly oral and genital mucosae) and/or nails and hair. Oral lesions may accompany cutaneous manifestations or they may be solitary and are considered the result of an autoimmune response mediated by CD8+ cytotoxic lymphocytes to antigens that may be unmasked by contact allergens such as those in dental restorative materials, drugs, mechanical trauma, viral infection, or other unidentified agents, resulting in apoptosis of the basal cells of the oral epithelium. It affects 1-3% of the population, with a higher prevalence in women (women to men ratio 1.4:1). There is a risk of malignant transformation of 1-4% reported in the literature, therefore patients require periodic follow-up at least every 6 months, with repeated biopsies in case of suspicious changes of the lesions. Dermoscopic features of cutaneous lichen planus include reticular white streaks on a dull-red background and linear or dotted blood vessels. However, dermoscopy for the evaluation of mucosal lesions is not yet widely utilized and patterns for the diagnosis of oral lichen planus are not yet well established. We present a descriptive study of dermoscopic features of erosive and plaque-like lichen planus on the oral mucosa. We used polarized dermoscopy (DermLite DL4 handheld device) for the visualization of the dorsal lingual mucosa and the vermilion border of the lips in 23 patients diagnosed clinically and histologically with lichen planus involving the oral mucosa. Dermoscopy of plaque-like and erosive mucosal lichen planus on the dorsum of the tongue was characterized by the presence of white veil-like areas, speckled white and red structures, white parallel streaks on a pink background and linear blood vessels. On the vermilion there was a more discreet aspect of a white veil and polymorphic blood vessels (linear, dotted and hair-pin), or multiple erosions surrounded by white raised structures sketching a striped appearance. Dermoscopy may be a non-invasive solution for the diagnosis, treatment efficacy assessment and early recognition of malignant transformation of oral lesions of lichen planus.

DETERMINATION OF THE PERCEPTION THRESHOLD OF FACIAL ASYMMETRY – LITERATURE REVIEW

Alexandra-Nina Stan, Georgeta Zegan

UMF „Grigore T. Popa”, Iași, România

There is little data regarding the threshold at which both specialists and the general population can differentiate facial asymmetry from symmetry. This paper is a literature review and aims to find the threshold or thresholds at which the general population and specialists perceive facial asymmetry. Articles were searched in the following databases – Web of Science ISI and PubMed, including prospective studies. The general population detects facial asymmetry at a deviation of at least 4 mm of a facial element from normal. Dentists detect facial asymmetry at a deviation of 2-4 mm, and orthodontists and oral-maxillofacial surgeons detect asymmetry at a deviation of 2 mm. Also, deviation of the tip of the nose is more easily noticed than deviation of the chin. The perfectly symmetrical face does not exist, all people have a greater or lesser degree of asymmetry. Not all facial imperfections and asymmetric elements need to be corrected. The data obtained are especially important in borderline orthodontic-surgical cases, when patients may want surgical intervention, but receive negative feedback from relatives and doctors. Knowing the limits to which the asymmetry is accepted by the patient is an important factor in establishing the treatment plan.

PRESUMATIVE DIAGNOSIS AND MANAGEMENT OF ORAL MUCOSA ULCERATIONS: A CHALLENGE FOR THE DENTIST

Conf. Dr. Cristina Popa, Șef lucr. Dr. Ana Maria Sciuca, Șef lucr. Dr. Mihaela Paula Toader

Disciplina Medicina Orală. Dermatologie Orală, UMF GRIGORE T POPA, IAȘI

Ulcerations of the oral mucosa are among the most common lesions encountered in dental practice, in the field of oral pathology. Patients often present themselves in dental offices with various pathologies of an ulcerative nature, most of them painful, affecting masticatory and swallowing functions. They involve an extremely varied etiology and their recognition can pose problems even to an experienced eye.

This paper assists the dental practitioner by describing different types of oral ulcerations, their etiology, how dentists can differentiate between their variety of causes, specific clinical features, and primary treatment options for the most common oral ulcerative conditions.

THE EFFECTS OF PHOTOBIOMODULATION WITH THE 940NM DIODE LASER ON HUMAN GINGIVAL FIBROBLASTS

Asist. Dr. Carmen Amititeloaie, Prof. Dr. Marcel Costuleanu

Diode lasers with a wavelength of 940 nm are surgical and therapeutic devices at the forefront of technology. Their cellular phototherapy effects are a topic that paves the way for new research topics. Growth and proliferation of gingival fibroblasts are important elements in the healing process of oral lesions, and laser photobiomodulation (PBM) could modify this process. The mechanism of action of laser PBM at the cellular level is based on the simultaneous activation of several reactions. The structure and function of biological membranes are changed, endorphins are released and an increase in the activity of the immune system of cells and enzymes is observed. A signaling cascade is triggered by the transfer of electrons between five protein complexes identified in the mitochondrial membrane, including NADH dehydrogenase, succinate dehydrogenase, cytochrome c reductase, cytochrome c oxidase and adenosine triphosphate (ATP) synthase, as well as free molecules such as ubiquinone and cytochrome c. The intensification of cellular respiration contributes to the growth, migration, differentiation and proliferation of cells within the wound, including fibroblasts. Bioactive mediators released by fibroblasts, such as growth factors, affect cell metabolism by synthesizing extracellular matrix components such as type I collagen. In addition to playing an important role in wound healing or tissue regeneration, PBMs influence angiogenesis by generating the growth factor vascular endothelial growth factor (VEGF). The changes recorded at the cellular and biochemical level support the therapeutic effects of stimulating wound healing, as well as the anti-inflammatory and analgesic effects.

THE EFFECTS OF THE NEW CODE OF ETHICS ON DENTAL MEDICAL PRACTICE

Iulian Costin Lupu, Constatin Bogdan Mihăilă, Răzvan Constantin Brânzan, Cătălin Silviu Tibeică, Lucian Burlea, Laura Checherita, Elena Mihaela Cărăușu

UMF ”Gr. T. POPA” Iași, Facultatea de Medicină Dentară

The rules of professional ethics that guide the dentist and the entities under which he can practice are contained in the code of ethics. This deontological code is designed by the College of Dentists in Romania and to gain validity it is published in the Official Gazette. The last ethical code dates from 2010 and was issued under the auspices of the old College of Dentists. In the meantime, new regulations of professional associations have appeared at the level of the European Union, to which dentists in Romania must also align. Thus arose the need to design and issue a new and updated form of the Code of Ethics. This code was published last year in the Official Gazette and entered into force on January 1. It brings updates and clarifications mainly related to how to relate to the patient, the attitude related to competition and advertising. That is why it is important to see if and how these changes influence the way dental practices work and the way the dentist works.

MEDICAL AND ECONOMIC EFFICIENCY OF DENTAL ACTIVITY

Constantin Bogdan Mihăilă, Iulian Costin Lupu, Cosmin Oniciuc, Silviu Cătălin Tibeică, Elena Mihaela Cărăușu

U.M.F. „Grigore T. Popa“ Iași, Facultatea de Medicină Dentară, Disciplina de Sănătate Publică și Management

In private dental practice, there is a close connection between medical and economic efficiency, they strongly inter-condition and influence each other. Therefore, they are not analyzed separately, but together.

-Medical efficiency refers to the quantitative and qualitative assessment of dental services as a medical activity.

-The economic efficiency of the private dental activity involves comparing the results/benefits obtained with the financial effort (expenses) for the provision of dental services to the population served.

In the post-pandemic period, the challenge that private providers of dental services will face will be to control/reduce the costs of medical and sanitary activity without affecting the quality of the medical/dental act itself, as this would lead to a decrease in the addressability of the population to dental services private.

Keywords: private dental services, medical efficiency, economic efficiency, private providers of dental services.

ELEMENTS FOR QUANTIFYING THE SUCCESS OF TREATMENT IN PARTICULAR SITUATIONS OF EDENTATION

Andreea Tibeică, Silviu Cătălin Tibeică, Norina Forna

Optimizing the prosthetic field through three-dimensional bone reconstruction, using guided bone regeneration techniques and materials, is a mandatory step in implant-prosthetic rehabilitation in clinical situations characterized by high bone tissue loss (Nicolae, 2009). The rehabilitation of bone tissue losses in patients with moderate or severe alveolar resorptions in particular edentulous situations, allows the realization of functional implant-prosthetic restorations and the increase of the long-term success rate (Forna, 2011). The complexity of implanto-prosthetic oral rehabilitation requires new approaches, techniques and study materials. Some limitations of bone substitute materials used in proprosthetic and proimplantation surgeries (immune reactions, possibility of infection, long resorption period, severity of resorption, absence of satisfactory primary and secondary stability) have led research groups and practitioners to orientate towards the association them with agents with osteogenic potential and with anti-inflammatory and bone tissue metabolism stimulating properties.

Data from the literature (Weissens&col, 2018; Esposito&col, 2009) show that the structure of bone grafts influences the survival rate of dental implants. The survival rate of dental implants is higher in the case of applying collagen membranes at the level of the lateral sinus window compared to situations where the sinus lift procedure does not include the application of the membrane at the level of the lateral sinus window.

PRGF is based on obtaining protein preparations collected from the patient’s blood; among these proteins possessing biological activity are the growth factors that stimulate and speed up tissue recovery.

Taking into account the financial, psychological and legal consequences of implant-prosthetic treatment failure, understanding the predictive factors for the occurrence of technical and biological complications will help practitioners to optimize the results of implant-prosthetic therapeutic solutions.

Key words: Grafting materials, PRGF, implant-prosthetic rehabilitation, partially extended edentulous

ASSESSMENT OF THE PREDICTIVE POWER OF CARIES RISK FACTORS IN YOUNG ADULTS 

Livia Bobu, Cătălina Iulia Săveanu, Carina Balcoș, Alice Murariu, Magda Bârlean, Irina Bamboi

Caries risk assessment is an essential element of diagnosis, constituting a basis for evidence-based treatment planning. The aim of the present study was to compare and order the predictive power of each caries risk factor for the carious lesions in young adults. Material and methods: cross-sectional study included 120 students attending the Faculty of Dental Medicine within “Grigore T. Popa” University of Medicine and Pharmacy in Iasi, who were assessed for caries risk, followed by the use of multiple regression analysis to compare and order the risk factors according to their predictive capacity. Results: bacterial plaque indices and caries experience indices were the elements with the highest predictive power.  Conclusion: the bacterial factor and previous dental caries are the elements with the highest predictive capacity for future carious lesions in young adults.

CLINICAL ASSESSMENTS OF BIOLOGICAL AND BIOMECHANICAL INDICES IN EXTENDED PARTIAL edentulous

Răzvan Curcă, Cosmin Crețu, Doriana Agop-Forna, Cristea Bardis, Walid Edlibi Al Hage, Norina Forna

The formulation of the treatment plan is preceded by a medical reasoning that reviews how the case under discussion meets the criteria corresponding to unsystematized treatment formulas, but which the doctor has in mind as treatment possibilities.

After confronting the palette of therapeutic possibilities selected from personal theoretical and practical experience, with the criteria on the basis of which the treatment plan is established, the project attempt is individualized as the primary form of the treatment plan.

In the orientation of the partial dentition, we must consider the following criteria: socio-economic, the criterion of technical endowment, the criterion of professional composition, biological, mechanical.

The biological criterion is related to the clinical state of the organism and the stomatognathic system. It accompanies the therapeutic plan with a real filter for drawing up the treatment plan; an evaluation of all the clinical-biological indices, established by the clinical and paraclinical examination, will be necessary, so that the treatment is as effective as possible. General, loco-regional and local clinical-biological indications will be considered.

The biomechanical criterion considers the reevaluation of the prosthetic field’s ability to bear pressure. Because normally, physiologically, the pressures are received by the teeth and the dento-periodontal support, we will take this into consideration, and the stress gradient to which we cannot oppose dento-periodontal resistance and which we try to complete by support muco-osseous. The treatment plan will be made based on the data collected from the clinical and paraclinical examination and re-examined when necessary. As a rule, we carry out this plan on the study model in several stages.

FEATURES AND BENEFITS OF DENTAL PULP MICROCIRCULATION – FROM HEALTH TO DISEASE

Loredana Liliana Hurjui, Ion Hurjui, Irina Gradinaru

„Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania

Recent research on the histophysiology of the dental pulp has tried to explain a number of aspects regarding the microcirculation of the pulp territory. The main functions of the dental pulp microcirculation are to supply the pulpal tissue with oxygen and nutrients in the necessary concentration and pressure level (through the arterial circulation), and to ensure the removal of metabolic products (through the return venous circulation). The circulation must be in accordance with the physiological needs of the pulpal tissue and the vascular intraluminal pressure must be in equilibrium with the tissue pressure.

In conclusion, a thorough knowledge of vascularization, innervation and pulpal hemodynamics, as well as its regulation in physiological and pathological conditions, are essential for the management of prophylaxis and therapeutics of dental pulp pathology.

Keywords: dental pulp, vascular hemodynamics, pathology.

Immediate Fixed Restoration of the Edentulous Maxilla After Implant Placement

Mihaela Mitrea, Claudia Cristina Tărniceriu, Irina Grădinaru, Adina Oana Armencia, Ion Hurjui, Claudia Cristina Tărniceriu, Carina Balcoș, Loredana Liliana Hurjui

„Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania

Immediate loading of the edentulous maxilla is possible when sufficient bone is available to provide primary stability of implants located in positions congruent with an ideal prosthesis. Treatment planning, implant placement with immediate provisionalization, and final prosthodontic rehabilitation are best integrated by a process that uses the immediate provisional prosthesis as a surgical and restorative guide. Designating the planned tooth position is a prerequisite step to the identification of possible implant positions. The cervical contours of the planned prosthesis are critical determinants of this relationship. Defining the planned tooth/residual alveolar bone relationship aids in selecting both the possible type of prosthesis and implant locations. When the treatment plan is transferred directly from the tomographic template to the surgical template to the conversion prosthesis used for immediate loading, the surgical and prosthodontic management of this procedure is well defined.

Key words: maxillary implants, edentulous maxilla, anatomic variables, psychological/psychosocial variables.

Implant-Supported Prosthetic Therapy of an Edentulous Patient: Clinical and Technical Aspects

Mihaela Mitrea, Irina Grădinaru, Carina Balcoș, Adina Oana Armencia, Ion Hurjui, Claudia Cristina Tărniceriu, Loredana Liliana Hurjui

 „Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania

Rehabilitation with implants is a challenge. Having previous evaluation criteria is key to establishing the best treatment for the patient. In addition to clinical and radiological aspects, the prosthetic parameters must be taken into account in the initial workup, since they allow discrimination between fixed and removable rehabilitation. We present a study protocol that analyzes three basic prosthetic aspects. First, denture space defines the need to replace teeth, tissue, or both. Second, lip support focuses on whether or not to include a flange. Third, the smile line warns of potential risks in esthetic rehabilitation. Combining these parameters allows us to make a decision as to the most suitable type of prosthesis. The proposed protocol is useful for assessing the prosthetic parameters that influence decision making as to the best-suited type of restoration.

Antioxidant Defense Systems In Periodontal Diseases Management

Ancuța Goriuc*, Ionuț Luchian**, Ioana Mârțu***, Raluca Jipu****, Liliana Foia*

*Department of General and Oral Biochemistry,Faculty of Dental Medicine, „Grigore T. Popa”  University of Medicine and Pharmacy Iași

**Department of Periodontology, Faculty of Dental Medicine, „Grigore T. Popa”  University of Medicine and Pharmacy Iași

***Department of Dental Technology, „Grigore T. Popa”  University of Medicine and Pharmacy Iași

****Department of Physiology, Faculty of Medicine, „Grigore T. Popa”  University of Medicine and Pharmacy Iași

Periodontal disease is an inflammatory disorder that leads to tissue damage and bone loss as a result of complex interactions between pathogenic bacteria and the host’s immune response. The recent focus on the progression of periodontitis is on the molecular aspects of host modulation. The discovery of the role of free radicals in chronic disease is as important as the discovery of the role of microorganism in inflammatory disease. In recent years, reactive oxygen species (ROS) have gained more and more attention, because of their central role to the progression of many inflammatory diseases. Under physiological conditions, ROS are effectively neutralized by antioxidants, which prevent ROS-mediated tissue damage. When inflammation happens, ROS production is drastically increased mainly due to cells of innate immune system, e.g., neutrophils and macrophages during the process of phagocytosis via the metabolic pathway of the “respiratory burst”. Subsequently, high levels or activities of ROS cannot be balanced by the antioxidant defense system, which leads to the oxidative stress and tissue damage. Over the past few years, numerous clinical and basic experimental studies have shown a strong association between oxidative stress and periodontitis. Getting a better understanding of this association can give us a deeper insight into the pathogenesis of periodontitis, relationship between periodontitis and systemic inflammation, and therapeutic strategies.

THE INFLUENCE OF THE COVID-19 PANDEMIC ON DENTISTRY AND ACADEMIC ENVIRONMENT

Darius SANDU*, Ancuța GORIUC*, Ionuț LUCHIAN***, Monica TATARCIUC****

*Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore. T. Popa”, 700115 Iași, România;

**Disciplina de Biochimie, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore. T. Popa”, 700115 Iași, România; ancuta.goriuc@umfiasi.ro

***Disciplina de Parodontologie, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore. T. Popa”, 700115 Iași, România;

****Disciplina de Tehnologie a Protezelor Dentare, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore. T. Popa”, 700115 Iași, România;

Among medical practitioners, dentists and dental staff have an increased risk of being infected with airborne pathogens such as SARS-CoV-2 because they are always exposed to droplets and aerosols produced during specific treatment procedures. Hence, The American Dental Association (ADA), as well as most European dental organizations, have implemented new guidelines, such as patient screening before visiting the clinic, allowing only one patient at a time in the waiting room, measuring staff and patients’ temperatures, hand washing and sanitizing, access to sanitizers for patients, disinfection of surfaces, personal protection equipment for the medical team, disposable shoe covers for patients, use of UV lamps and other air purifiers and high-efficiency aspiration during treatments. In addition, telemedicine has proven to be an effective tool in mitigating some of the effects caused by the imposition of restrictive measures during the COVID-19 pandemic. The use of teledentistry has expanded considerably in pediatric dentistry, orthodontics, oral medicine and periodontics in order to address oral and dental health issues during the COVID-19 pandemic while minimizing virus transmission. Thus, teleconsultation, telediagnosis, teletriage, teletreatment and telemonitoring have emerged as valuable tools not only in the delivery of care, but also in the academic and research training of dental health professionals. Academics working in the field of dentistry have been subjected to a high level of stress during the COVID-19 pandemic, not only related to teaching and research activities but also to concerns related to the possibility of contaminating their family members. On the other hand, the COVID-19 pandemic has led to an increase in negative emotional states among students. Students were the population group most affected by the pandemic, showing an increased prevalence of stress, anxiety and insecurity. This study summarizes the current literature on the impact of the pandemic on dental care, dental staff and dental education, with an emphasis on how newly emerging protocols and technologies can be successfully utilized as integral parts of various branches of the dental practice and their future implications without compromising patient care.

CLINICAL-TECHNOLOGICAL INTERACTIONS OF TREATMENT IN PARTIALLY EXTENDED EDENTULOUSNESS

Magda Antohe, Ovidiu Stamatin, Daniel Paval, Andreea Tibeica, Cosmin Bida, Norina Forna

Faculty of Dental Medecine, „Grigore T.Popa” University of Medecine and Pharmacy, Iasi, Romania

The choice of the therapeutic solution in the complex territory of the partially extended edentulousness is the result of a careful analysis of the particularities of the prosthetic field, a particular attention being paid to the evaluation of the periodontal support, of the muco-bone support, of the presence of local, loco-regional, or general complications in conjunction with the aspects of the paraclinical evaluation. The study aimed to individualize the classical versus digital therapeutic methods of prosthetics, anchored in partially removable prosthetics with metallic or non-metallic infrastructure. The detection by clinical and paraclinical methods of the whole range of post-edentulous complications constitutes an essential condition of targeted therapy but also a starting point for the rigorous selection of the dental materials involved and the requirements related to the rendering of a high-fidelity morphology grafted on the particularities of the clinical case. For greater precision in the clinical-technological algorithm of partially extended edentulousness rehabilitation, digital models were also recorded. The advantage of this technique is the high accuracy, but also the saving of time and materials. Elastic non-metallic biomaterials associated with the injection technique can be considered a very good solution for partially removable dentures, they offer resistance over time, they are flexible, so they do not bother the patient, they are 100% biocompatible, they integrate perfectly with the dental tissues.

Modern techniques and technologies of intraoral scanning and digital design of the therapeutic solution contribute significantly to the development of a high-performance clinical-technological algorithm, oral scanning eliminates many of the classical steps of making the prosthesis and provides greater accuracy of recording impressions, and digital designs will eliminate the classical step of casting models avoiding changes that can occur through contact reactions of the plaster.

Key words: edentulous patients, removable prostheses, dental materials;

ECOLOGICAL HYPOTHESES IN THE ETIOLOGY OF CARIOUS DISEASE

Prof. Univ. Dr. Sorin Andrian

The etiology of caries has been debated for centuries and 3 key hypotheses have been proposed: chemo-parasitic, chelation and proteolysis-chelation. There is no doubt that the etiology of enamel caries can be explained mainly by the chemo-parasitic theory, in which the bacterial biofilm produces acid from sugar and the resulting acidic pH induces enamel demineralization. Dentin and root caries can also be explained by this theory; however, the fact that dentin and root surfaces contain a considerable amount of organic material such as collagen has led to the assumption that the notion of protein degradation (proteolysis theory) may also play a role in the development of caries in these tissues. Bacterial biofilm ecological hypotheses assume that microorganisms that are involved in the etiology of dental caries may be present in biofilms on healthy enamel surfaces, but at too low a level to be clinically relevant. The disease is the result of a disadvantageous change in the ecological balance between the microbial species that compose the resident oral microbiota, this being induced by dramatic changes in the intraoral environmental conditions with a direct effect on the pH value that will decrease to critical values for hydroxyapatite crystals. Such “acid shots” repeated in the biofilm through the phenomenon of dysbiosis, will select an increased number of aciduric or “acid-tolerant” bacteria, followed by acidogenic ones that will inhibit the growth and development of beneficial bacteria for the oral ecology that normally live at a pH-neutral. Consequently, according to this ecological hypothesis the disease can be controlled not only by directly addressing the responsible microbial agents but also by interfering with the factors that induced these dramatic changes in the pH of the oral environment.

Is Oral Microbiome a Biomarker of Oral Squamous Cell Carcinoma?

Mădălina Mocanu*, Mihaela Paula Toader*, Cristina Popa*, Ana Maria Sciuca*, Victor Vlad Costan**, Ștefan Toader***

*University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Oral Medicine, Oral Dermatology

**University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Oral and Maxillo-facial surgery

***University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Faculty of Dental Medicine, Discipline of Physiopathology

Squamous cell carcinoma is the most common epithelial neoplasm of the head and neck, and it is estimated to represent over 90% of oral neoplasms. Despite therapeutic advances, morbidity and mortality from oral squamous cell carcinoma have not improved significantly in the last 30 years, mainly due to the detection of cases in advanced stages.

While tobacco and alcohol use are major risk factors for oral cancer, other known causes are: genetic mutations, dietary deficiencies, prolonged exposure to UV radiation, immunosuppressive conditions, oral or systemic infections. Poor oral hygiene, gingival or periodontal chronic inflammatory conditions, as well as chronic oral erosive lesions favor the appearance of oral infections. Bacterial colonization and adjacent pro-inflammatory status induce the initiation and progression of oncogenic processes by stimulating cell proliferation, angiogenesis, and mutagenic processes.

Studies investigating the oral microbiome, performed on people with precancerous or neoplastic lesions, have shown a decrease in microbial diversity and abundance, especially of the species Firmicutes and Actinobacteria together with the increase in the representation of Lactobacillus.

Two theories are formulated to clarify the relationship between the oral microbiome and oral squamous cell carcinoma. The first discusses bacterial colonization as a direct pathogenic cause of carcinoma, the second describes microbiome abnormalities after tumor onset. In both concepts, metagenomic and transcriptomic changes occur in the oral microbiome and influence oral cellularity and the immune response. In addition, a combination of both theories is very likely to occur during the progression of oral carcinoma.

The analysis of the human microbiome as a biomarker for the detection of potentially malignant oral lesions and early oral carcinoma is an innovative and non-invasive method that offers promising prospects. To standardize it, there are numerous molecular and genomic biology studies in progress, extensive studies, including new therapeutic approaches to oral carcinoma by correcting oral microbiome dysfunction.

Oral premalignant lesions – a still valid problem

Prof. Dr. Șerban Țovaru, Disciplina Patologie Orală, Facultatea Medicină Dentară, Universitatea de Medicină și Farmacie Carol Davila

Oral premalignant lesions remain an incompletely resolved problem. The most common encountered is leukoplakia. The first step in the management of these lesions is to remove all similar clinical lesions caused by other oral mucosa diseases. This requires a very precise and in-depth differential diagnosis. The remaining lesions are true leukoplakia with a risk of malignant transformation in varying percentages from 1% to over 30%. The most common cause is smoking or other forms of tobacco use. According to the protocol proposed by van der Waal, the first step in addressing premalignant oral lesions is the elimination of irritants, including smoking. This often has a beneficial effect, especially for short-term smokers (under 5 years of smoking). The remaining lesions will be evaluated histopathologically and can then be treated in two ways; the first option is for cases with reduced, diffuse lesions and not involving high risk areas and it consists of a clinical follow-up and the periodic control of the lesions (wait and see attitude). The second option is surgical ablation, which must be followed by follow-up. Non-smoking leukoplakia is the most serious problem, their prognosis depending on the duration, location, clinical form, single or multiple, the degree of dysplasia. The recommended treatment is surgical, with a 12% risk of recurrence. The histopathological evaluation determines the dysplasia degree which together with tumoral markers and genetic tests are indicative for prognosis. Classical or laser surgery can be used to remove the lesions. The method selection will be made according to the clinical appearance, the site and the extent of the lesion. The risk of malignant transformation, even in treated patients, is estimated at between 3 and 17%. Careful follow up and monitoring of all patient groups is mandatory.

Dental services quality management- literature review

Silviu Cătălin Tibeică, Constantin Bogdan Mihăilă, Iulian Costin Lupu, Lucian Ștefan Burlea, Elena Mihaela Cărăușu

The concept of quality has been defined (Maxwell, 1984) as a multidimensional one. Maxwell suggested six dimensions of quality- access, effectiveness, efficiency, equity, relevance, and social acceptability. Subsequently, Donabedian (2003) suggested two other dimensions- legitimacy and optimization. Such dimensions/attributes, in any combination, or taken individually, are a definition of quality in health domain.

SR EN 9000-2001 defines the concept of management as representing a series of coordinated activities to guide and coordinate an organization. Based on this general acceptance, the concept of quality management is defined as the set of activities to guide and coordinate an organization in terms of quality. Thus, coordination and control over the quality of dental services provided to the population included: stability of quality policy, quality objectives, quality planning, quality control, quality assurance, and improvement of the quality of dental services provided to the population. The ISO 9004 standard on the fact that the state must be involved in quality management in health, because it “gives a meaning to public health, being at the same time a factor in building societies and civilization.”

Quality is the adequacy between the needs expressed (by the customer) and the service provided (by the supplier), adequacy respected by contract or commitment as Opincaru suggests, since 2004. According to ISO 9000: 2, the quality of the category “the set of properties and characteristics of an entity that gives it the ability to meet the expressed and explicit needs”.

In the field of dentistry, quality, related to dental medical consumption, and the evolution of costs, has led to the development of the field of quality management of dental services. Thus, in dentistry, quality management refers to the dental medical act itself, to the dental services offered to the population, and to the support activities that contribute to the accomplishment of the dental medical act.

Keywords: Quality management, quality of dental services, dental medical consumption

BIOPHYSICAL MECHANISMS INVOLVED IN MODULATION OF THE CONTROLLED RELEASE OF CHX IN PERIODONTAL THERAPY

Oana BUTNARU*, Ionuț LUCHIAN**, Giorgio Marian NICHITEAN***, Ancuța GORIUC****, Decebal VASINCU*

*Disciplina de Biofizică, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași

**Disciplina de Parodontologie, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași

***Student, anul VI, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași

****Disciplina de Biochimie, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași

Introduction. Chlorhexidine gluconate (CHG) is an extremely effective antiseptic and disinfectant with multiple medical applications. CHG can be successfully associated with periodontal therapy to increase the predictability of results. CHG is available in multiple forms of presentation, but the main problem of its use is represented by the limited time of action at the level of periodontal structures.

Material and method. To carry out the present study, we selected a group of 30 patients with periodontal disease and at least one site whose depth on survey was at least 5 mm. An initial periodontal assessment was performed by recording probing depth (PD) and PBI. The patients included in the study were randomly and equally divided into three groups A, B and C. The patients included in group A benefited from supra and subgingival scaling and root planning (SRP) without application of CHG post treatment. For patients in group B, SRP was performed and GHC was applied topically in the form of Glucosite Gel (Cerkamed). At the level of group C, SRP was performed and in the bags with a minimum probing depth of 5 mm, CHG was applied in the form of PerioChip (Dexcel). The results were evaluated after 30 days.

Results and discussions. The study demonstrated that for all three types of treatment the post-treatment PD values were significantly lower compared to the initial values (p>0.05), but in the case of group C (SRP+PerioChip) the decrease was significantly higher.

Post-treatment PBI values were significantly lower in the case of the treatment instituted in group C (SRP+PerioChip) compared to the values recorded in group A (SRP) (p=0.00053) or group b (SRP+Glucosite) (p=0.0178 ).

Conclusions. CHG is a real and viable adjunct to SRP-type therapy, but its slow release at the level of the periodontal pockets significantly increases the predictability of the treatment.

Medical personnel knowledge and compliance to infection control procedures in Oral and Maxillo-Facial Surgery Clinic Iași

Magda Călina Bârlean*, Eugenia Popescu**, Monica Mihaela Scutariu*, Carina Balcoș***, Georgiana Macovei*, Livia Bobu***

„Grigore T.Popa” University of Medicine and Pharmacy Iași, Faculty of Dental Medicine

*Department of Oro-Dental Diagnosis and Geriatric Dentistry

**Department of Oral and Maxilo-Facial Surgery

***Department of  Oro-Dental Prevention

The aim of this study was to investigate the attitude and compliance with recommended infection control procedures among medical staff in Oral and Maxillo-Facial Surgery Clinic Iași. Materials and methods. A questionnaire-based study was conducted involving 30 medical staff members, aged between 25 and 67 years.  62,4% of the subjects were men and 37,6% were women. The questionnaire included 24 questions regarding the attitude, knowledge and compliance to infection control procedures. Data were statistically analysed  using SPSS 20.0 system and compared using Chi-square test (p <0.05). Results. 90.9% of doctors and 100% of nurses consider the training of the medical staff on infection control procedures to be extremely necessary. 36,3% of doctors and 57,8%  of nurses are vaccinated against hepatitis B, while only 18,1% and 31,5%, respectively, against the flu. A high percentage of subjects (91.6%) consider that the equipment for individual protection should be complete, irrespective of the patient’s medical status or required treatment. All the subjects use rubber gloves, 90,9% wear masks and 54,5% use protective goggles. The gloves are replaced after each patient by all the doctors and 72,2% of nurses. Out of the subjects who use protective glasses, 90,2% disinfect them using antiseptic solutions. Hand hygiene,  essential  for  infection control in healthcare facilities, is performed before applying  protective  gloves  (48,8% ),  before  each  patient  (78,7%), after each patient (71,6%) and in case of deterioration (65,5%). The most used products for hand hygiene were the antibacterial soap (78,7%) and alcohol based solutions (53,3%). Out of the study subjects 25,4% use the facial shield. 45,4% of subjects consider air contamination control by UV light and natural ventilation to be highly effective. Conclusions. Up-to-date information and compliance to infection control are essential in order to promote a safety culture in medical facilities. Training should be improved and updated by educational programs and protocols for improving the quality of healthcare.

MODERN-MINIMALLY INVASIVE METHODS OF DIRECT RESTORATION OF POSTERIOR TEETH

Conf. Dr. Ada Gabriela Delean, UMF „Iuliu Hațieganu” Cluj-Napoca

The prevalence of carious lesions is increasing globally, and the demand for solving them as early as possible is intensifying. This demonstrates that preventive education encompasses an ever-larger group of people. For this reason, efforts are being made to develop new cavity preparation methods, such as air abrasion and modern obturation techniques, so as to help the dentist shorten the execution time.

The increasing demand for aesthetic restorations approached minimally invasively has caused an expansion of the use of composite materials in the lateral area of the dental arches. In addition to the sensitivity of restorative techniques for these materials, there is the difficulty of properly reconstructing the proximal tooth surface and especially the interproximal contact point.

The SonicFill system comprises a KaVo handpiece that allows sonic activation of Kerr’s specially created composite and is presented in a convenient single-dose cannula form. By activating the composite with sonic energy, a specific element for the SonicFill system, the viscosity of the material is significantly reduced, which allows fast and efficient obturation. SonicFill is a nanohybrid composite specially created to allow clinicians to perform posterior restorations in one time, if the depth of the cavity is up to a maximum of 5 mm, and to combine the advantages of a flowable composite with those of a universal one.

The practitioner is the one who will decide according to the clinical situation the material to use, currently having a wide range to choose from, so that a high-quality restoration can be made.

REGENERATIVE METHODS – PARADIGM CHANGE IN ENDODONTIC THERAPY

Dr. Monica Dana Monea

Profesor universitar, Disciplina de Odontologie și Patologie orală, Universitatea de Medicină, Farmacie, Științe și Tehnologie „George Emil Palade” Târgu Mureș

For several decades, specialists have been looking for biological methods of treatment that allow the restoration of the tissues of the pulp-dentin complex destroyed as a result of infection or trauma. The remarkable progress achieved was initially based on numerous in vitro studies that allowed the identification of multipotent stem cells, capable of differentiating into specialized osteoblast-like cells. At a later stage, in vivo experiments allowed the formulation of the basic concept for the application of these tissue engineering techniques in clinical activity. Regenerative endodontic treatment primarily aims to eliminate clinical symptoms and restore lost tissues, being a common goal with traditional therapy. On the secondary level, however, unlike the classic methods that replaced the dental pulp with inert obturation materials, the purpose of regenerative therapy is to ensure the conditions for the continued development of the root, following the filling of the endodontic space with a tissue similar to the pulp. The introduction of tissue engineering methods in endodontic therapy has attracted enormous interest, due to the widening of the possibilities of preserving natural teeth on the arch, using therapeutic protocols different from the classical ones. Initially applied to young permanent teeth, this concept has been extended to adult patients, with various pathologies, who represent the majority group in terms of the need for treatment, although the therapeutic stages are different from those applied to pediatric patients. In this presentation, I aim to review the main stages that led to the development of these techniques, along with the presentation of a selection of protocols indicated in different clinical situations.

Low levels of Vitamin D and periodontitis: is there a strong link between the two?

Alexandra Cornelia Teodorescu, Silvia Teslaru, Bogdan Vasiliu, Ioana Rudnic, Ioana Andreea Sioustis, Sorina Mihaela Solomon.

Vitamin D deficiency is a matter of public health worldwide and it is thought to be linked to numerous inflammatory diseases, such as periodontitis. Vitamin D is a hormone that seems to be involved in the development and progression of periodontitis by three different ways: influence in maintaining bone levels, anti-inflammatory and antimicrobial effects. The aim of this systematic review is to analyze the in-depth connection between serum levels of vitamin D and periodontitis and the influence of vitamin D supplementation in periodontitis patients.

NEW DIGITAL DIAGNOSTIC TECHNOLOGIES IN DENTAL MEDICINE

Micea Cătălin Ivănescu, Georgeta Zegan

U.M.F. „Grigore T. Popa” Iași, România

Worldwide technological progress is making its presence felt more and more in dentistry through innovative digital systems that far surpass analog systems. Digital registration systems help practitioners transfer information to CAD software for diagnosis and design of future constructions. SDi Matrix X, Zebris and MODJAW are three of these new generation systems. With the classic face bow, the position of the jaw can be transferred to the articulator according to certain reference planes and an axis of rotation of the condyles, and through additional measurements, the values of the Benet angle and the inclination of the articular slope can be identified. The digital facebow additionally offers the transfer of these values into CAD software for the actual movements of the mandible in relation to the maxilla, which facilitates the diagnosis of static and dynamic dental occlusion and the realization of much more predictable and functional orthodontic, orthognathic and prosthetic treatments. Also, the design and manufacture of osteofixation plates in orthognathic surgery is more individualized and easier to achieve. New digital diagnostic technologies in dentistry are an important asset and offer practitioners a new professional experience for viewing the therapeutic results of the treatment plan.

PAINFUL TEMPOROMANiDBULAR DISORDER RESOLUTION AFTER CORRECTION OF DENTO-SKELETAL ANOMALIES BY SURGERY FIRST APPROACH

Andreea Simionescu, Florin Sava, Prof. Dr. Irina Zetu, Prof. Dr. Victor Vlad Costan

Introduction: Temporomandibular disorders (TMDs) represent a heterogenous group of diseases responsible for impaired function of temporomandibular system, involving orofacial pain, articular sounds and limitation in jaw movement and function. Although the etiology of this condition is incompletely elucidated, a number of occlusal factors have been identified in the development of TMD. Severe malocclusions require association of orthodontic and surgical treatments which causes tridimensional changes, involving the TMJ and consequently may influence TMJ’s signs and symptoms. Conventional orthognathic surgery presents the shortcoming of the long duration of the “pre-surgical orthodontic” stage. The new current in orthognathic practice, “Surgery First Approach” (SFA) reduces the treatment duration and the pre-existing TMD may progress to improvement or resolution.

Purpose: This study investigates the situation of dento-maxillary anomalies and the treatment in terms that TMD was the main complaint.

Materials and methods:  From all cases presenting TMD and dento-maxillary anomalies, were selected some clinical situations whose particularities recommended SFA.

Results and discussion: Performing surgery at the beginning of the treatment had a positive result on the TMJ’s symptoms. Although, SFA is a common option for cases mainly motivated by aesthetic issues, the immediate normalization of functional framework represented by the skeletal ratios, muscles and soft tissues is also reflected at the TMJ level.

Conclusion: These favorable results aim to emphasize the importance of individualized treatments in the therapeutic challenge of TMD, corroborating the clinical data, the technical possibilities and the patient motivation to follow a certain treatment.

Key words: Temporomandibular disorder, Surgery first approach.

PREDICTABILITY OF SUCCESS OF SURGICAL INTERVENTIONS TO PREPARE DENTAL-PERIODONTAL SUPPORT

Doriana Agop-Forna, Emilia Bologa, Carmen Stelea

Cone beam computed tomography has become an essential tool in the diagnosis and planning for oral surgery. New hardware and software developments have emerged to help surgeons to successfully adopt and use different systems in patients requiring prosthetically driven implant dentistry. However, there is the need to develop an adequate planning protocol that includes appropriate acquisition/data manipulation, appropriate use of software tools for interpretation, and appropriate application of such systems during surgery. This scientific research examines essential characteristics of the entire guided surgery planning process and points out potential sources of error that could affect clinical accuracy outcomes.

Keywords: planning, oral surgery, implant, bone density, CBCT

POSSIBLE ADVERSE EFFECTS OF DENTAL MATERIALS

Irina Grădinaru, Carina Balcoș, Mihaela Mitrea, Adina Oana Armencia, Ion Hurjui, Claudia Cristina Tărniceriu, Loredana Liliana Hurjui

„Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania

Nowadays in dental medicine is used an extensive variety of materials for restoring lost dental hard tissues or for replacing teeth. These materials placed into the oral cavity are intended to remain for several years at this level. Their placement at the mentioned level for a long time period might yield unwanted reactions. For this presentation were considered the data collected from the PubMed and Scopus databases. In order to find relevant publications were used the words: “adverse effects” AND “dental materials”. The results showed that allergies and a wide variety of dental/oro-facial findings were found in patients complaining about adverse effects from dental materials. There is a need to better describe the content of the materials. It is mandatory to establish specialized consultations and close collaboration with experts from other fields. A dental materials adverse event registry would be useful to detect the occurrence of low incidence events.

Keywords: adverse effects, dental materials, dental medicine

PROVISORY THERAPIES APPLIED IN PATIENTS WITH DYSFUNCTIONAL SYNDROME OF STOMATOGNATHIC SYSTEM

Laura Elisabeta Checherita, Alina Mihaela Apostu, Iulian Costin Lupu, Ovidiu Stamatin, Petru Bogdan Bulancea, Liana Aminov, Nicoleta Ioanid, Ioana Rudnic, Elena Mihaela Cărăușu

The clinical nowadays reality confers on the provisional prosthesis stage, essential functions of control and management of the periodontal and aesthetic-levels of occlusal parameters. Through this clinical stage of the transitory type prosthesis, is remarked a better biological integration of gnathological point of view in the future dental prosthesis. The concept in manufactured process and the materials from which the prosthesis is customized are the rehabilitation objective goal for preserving the biological support elements but also a final balance in it integration of the stomatognathic system in order to prevent TMJ dysfunctionality.

Challenges in the implant-prosthetic rehabilitation of edentation

Implant-prosthetic therapy is a cutting-edge solution for the rehabilitation of edentation in order to make the morpho-functional restoration and re-establish the affected functions of the stomatognathic system. The challenges that a practitioner can have in this territory are represented, on the one hand, by the particularity of the clinical case, on the other hand, by the contemporary techniques and technologies characterized by a high degree of precision. The complications of partial edentation offer multiple facets at local, loco-regional, and general level, their clinical and paraclinical evaluation representing the initiation of a complete and complex therapeutic algorithm, individualized to each clinical situation. The preparations specific to the prosthetic field for implantation are correlated with the negative clinical-biological indications that need to be rehabilitated. The reduced bone capital in the vicinity of the maxillary sinus or mandibular canal attracts specific preparations for implantation, represented by sinus lift, of different types of bone augmentations. Aesthetic requirements aim at specific gingival interventions in the specific preparations in order to obtain optimal long-term results. The practical aspects of the implant-prosthetic rehabilitation algorithm are anchored in both the classic and the modern register, benefiting from the contribution of digital technologies corroborated with contemporary non-metallic biomaterials that satisfy the biological and biomechanical criteria but also the aesthetic ones.

Keywords: implant-prosthetic rehabilitation, augmentation, bone deficit, digitized techniques

The Role of Salivary MMP-9 Concentration in Quantifying Periodontal Inflammation

Șef lucr. Dr. Ionuț LUCHIAN, Șef lucr. Dr. Ancuța GORIUC

Universitatea de Medicină și Farmacie „Grigore T. Popa” Iași-România

Facultatea de Medicină Dentară, Disciplinele de Parodontologie și Biochimie Generală și Orală

Periodontitis is one of the most common immune-mediated inflammatory conditions resulting in progressive destruction of periodontium. Metalloproteinase-9 (MMP-9), an enzyme that is involved in the degradation of gelatin and collagen and present in the gingival crevicular fluid, is markedly increased in periodontitis.

During periodontitis, it has been hypothesized that MMP-9, together with CRP (C reactive protein), may inhibit the synthesis of nitric oxide (NO), which, in turn, may adversely affect the endothelium and the arterial vascular tone and eventually lead to endothelial dysfunction and an increased risk of cardiovascular disease.

Nonetheless, recent evidence suggests that salivary MMP-9 seems to be a more sensitive marker for periodontal inflammation during orthodontic treatment, which opens new perspectives and approaches in reducing periodontal hazards during such treatments.

Targeted therapy focused on inhibiting MMP activity could be an ideal therapeutic option in the treatment of periodontal disease, in addition to scaling, root surfacing, and bone surgery.

SPECIFIC DISEASES AND ORAL HEALTH – A CONSIDERABLE ASSOCIATION

Ion Hurjui, Irina Grădinaru, Loredana Liliana Hurjui

With a great prevalence, diseases of the oral cavity and respective tissues are a highly relevant global health problem. The common oral diseases, such as tooth loss, chewing deficiencies and quality of life impairment, oral and systemic disease interaction are apparent. It is very clear already that systemic diseases and conditions have the ability to create a risk of developing oral diseases for example periodontitis; on the other hand, inflammation of oral tissue have an effect on cardiovascular, metabolic, respiratory or bone health. Moreover, several general diseases are related to a potential risk of complications in dental therapy.

Keywords: oral health, systemic diseases, periodontitis.

STANDARDS, GUIDELINES AND TRENDS IN PREVENTING THE TRANSMISSION OF INFECTION IN DENTAL MEDICINE

Catalina Iulia Saveanu

Approach of the concepts of prevention of the transmission of infection in dentistry is made in a continuous dynamic depending on the incidence of communicable diseases, individualized on the existing risk factors. Awareness of the therapeutic act in risk conditions was a determining factor in improving the parameters of clinical activity. However, there are controversies regarding different work attitudes. Thus, the presentation aims to identify gaps in the transmission of infection at the professional and future professional level in dentistry, risk factors, disinfection levels, types of surfaces, monitoring patient traceability, medical team responsibility, working standards developed at national level and international. The materials used were given by questionnaires on various topics in the field and national and international rules. The results obtained in the deepening of these elements highlighted the fact that there are gaps in the information and the attitude of the medical staff, they are passages of information interpretable by the lack of an individualized information for certain situations. In conclusion, the prevention of the transmission of the infection in dentistry must be a continuous concern for both current practitioners and future professionals in the field.

Keywords: prevention, transmission of infection, dentistry

IN VITRO STUDY OF NANOTECHNOLOGICAL PROFILOMETRIC ANALYSIS OF FLUORIZED ENAMEL

Alexandra Ecaterina SĂVEANU, Oana DRAGOȘ*, Cătălina Iulia SĂVEANU

Universitatea de Medicină și Farmacie „Grigore T. Popa” Iași, Facultatea de Medicină Dentară

*Institutul de Cercetare Fizică

1.Introduction: Professional fluoridation with varnish is a recommended method in patients with increased caries risk, in cases of dentinal hypersensitivity, in patients wearing orthodontic appliances aimed at mineralizing the identarian structure.

2. Purpose: The purpose of this study was to highlight the topographic structure of the dental substrate by AFM analysis before and after the application of a fluoride varnish in different areas of the tooth.

3. Material and method: For the study we used enamel fragments obtained through the longitudinal section of some teeth extracted for orthodontic reasons. We made 4 longitudinal sections with the help of a tapered diamond cutter at high speed with cooling and I polished with polystyrene of successive granulation to the smallest. The samples were then stored in an isotonic saline vial. Subsequently, we applied Voco Pro fluoride varnish single dose (VOCO) 0.4 ml NaF5% according to the manufacturer’s instructions. Topography and roughness were analyzed by atomic force microscopy (Park SYSTEMS XE -100) for a size of 10μm × 10μm with a scan rate of 0.5 Hz and a resolution of 256 × 256 pixels with a resolution of 300 dots at a time. The three-dimensional topographic analysis was performed by analysis software (XEI – Image-Processing and Analysis). The surface roughness was measured for each section in nanometers. The average surface roughness of each sample was measured with a profilometer (MarSurf PS 1, MahrGmbH, Esslingen, Germany) for Rpv, Rq, Ra, Rz. 3D topographic data were analyzed with data analysis software (NanoScope III, Version 5.12r2, Digital Instruments, Santa Barbara, CA, USA).

4. Results and discussions: At the level of the enamel, the values ​​obtained were the following: Rpv = 282.56 nm versus 273.78 initial: Rq 50.47 versus 59.57 initial; Ra 50.0 versus 42.26 initial Rz 243.52 versus 221.39 initial p≤0.05. The results indicated differences between the initial surface of the enamel and the one after fluoridation. Lake fluoridation changed the topographic structure in order to improve it.

5.Conclusions: Topographic analysis by AFM, of the fluorinated enamel with varnish showed differences between its substructure initially and after fluoridation, in favor of the fluoridated one.

6. Key words: Fluoride varnish, AFM (atomic force microscope), enamel roughness.

STUDY ON PROFESSIONAL COMMUNICATION IN DENTISTRY IN THE CONTEXT OF THE COVID 19 PANDEMIC – FINAL RESULTS

Elena Mihaela Cărăușu, Iulian Costin Lupu, Lucian Ștefan Burlea, Silviu Cătălin Tibeică, Cristina Gena Dascălu, Laura Elisabeta Checheriță, Ioana Rudnic, Georgeta Zegan

U.M.F. „Grigore T. Popa“ Iași, Facultatea de Medicină Dentară, Disciplina de Sănătate Publică și Management

Purpose. The present study aimed to carry out an analysis of patient-dentist communication in the context of the COVID-19 pandemic. The main objectives pursued were: the assessment of each patient’s awareness of the need and importance of communication with the attending dentist; identifying the components of communication, it gives them greater importance; identifying the main weak points of communication and proposing solutions to optimize communication.

Material and method. The studied group included 150 patients, aged between 16 and 70 years, 36 females and 39 males. The main one used was the questionnaire. It contained 23 questions. The first 5 questions investigated the general qualitative level of patient-dentist communication, and questions 6-23, communication skills of the dentist as perceived by the patient.

Results and discussions. The subjects of the studied group value the communication process with the dentist differently, depending on age, gender and social category. The main results revealed that: in 22.67% of the situations the paraverbal language of the dentists is modified as a result of the protective equipment worn; in 25.33% of the cases studied, there are obstacles to verbal communication (wearing a mask/visor/goggles, using medical jargon, generalization, etc.); 14.67% of patients stated that they are not listened to carefully, their wishes are ignored or they accuse the dentist of a lack of empathy; 18.67% of patients are dissatisfied with the way the doctor explains the usefulness/necessity of the treatments performed; only 24% of patients believe that the practical fees of dentists are justified by the context of the COVID19 pandemic.

In conclusion, the Restructuring of professional communication imposed by the current pandemic context is perceived by the vast majority of patients and dentists as an important stress factor. In the current pandemic context, the dentist must be competent in two areas: cope with the high and prolonged level of professional stress, the demands of patients and their family members, colleagues and other medical professionals with whom they collaborate).

Keywords: professional communication, dentistry, communication skills, COVID-19 pandemic.

Surgical site healthcare associated infections evaluation in Oral and Maxillo-Facial Surgery Clinic Iași (2011-2018)

Magda Călina Bârlean¹, Eugenia Popescu², Monica Mihaela Scutariu¹, Carina Balcoș³, Georgiana Macovei¹, Livia Bobu³

„Grigore T.Popa” University of Medicine and Pharmacy Iasi, Faculty of Dental Medicine

¹ Department of Oro-Dental Diagnosis and Geriatric Dentistry

² Department of Oral and Maxilo-Facial Surgery

³ Department of  Oro-Dental Prevention

The healthcare associated infections (HAI) risk in oral and maxillo-facial surgery is closely related to the profile of the clinical activity which often requires emergency treatment, invasive interventions or purulent collections drainage. Surgical site infections (SSI) affect a large number of patients worldwide, significantly increasing the mortality rate and the financial losses associated with medical care.

The aim of the study was to evaluate the incidence and microbiological profile of SSI in the Oral and Maxillo-Facial Surgery Clinic Iași (OMF) (2011-2018).

Materials and methods. A retrospective study was carried out in the OMF Surgery Clinic regarding SSI incidence and etiology. For the statistical analysis the SPSS 20 system, Chi-square and Fisher tests were used. (p <0.05).

Results. 125 surgical site infections (54,1% of the total HAI) were diagnosed in 106 patients (66,6% of all patients with HAI). 23,2% of SSI were diagnosed in females and 76,8% in male patients. 46,6% of SSI were superficial and 54,4% were profound. 80,0% of SSI were associated with surgical procedures in patients diagnosed with head and neck cancer requiring extensive interventions and tissue or flap reconstruction. The SSI incidence was directly correlated with disease severity, type of surgery and type of reconstruction. For the patients diagnosed with SSI, the needed average hospitalization period was 30 days.Microbiological data revealed that for 65,6% of SSI a sole pathogen agent was identified, while 34,4% of them were associated with two or more pathogens. The most commonly identified pathogens from the 174 isolates were Klebsiella pneumoniae – 18,4%, Staphylococcus aureus 18,4%, Acinetobacter baumannii – 17, 2% and Pseudomonas aeruginosa – 14,4%. 78,6% of S. aureus strains were methicillin-resistant. A high resistance to antibiotics was reported for Staphylococcus aureus to ciprofloxacin, cefoxitin and erythromycin. Klebsiella pneumoniae proved to be highly resistant to gentamicin and amoxicillin-clavulanic acid, while Acinetobacter baumannii was least sensitive to meropenem, gentamicin and ciprofloxacin. Pseudomonas aeruginosa strains proved resistant to ciprofloxacin, gentamicin and imipenem.

Conclusions. Surgical site infections, frequently associated with tumor pathology surgery, are a major worldwide concern, with medical, financial, social and ethical implications. The most common pathogens in the etiology of SSI are resistant to a wide spectrum of antibiotics. Effective strategies in a global, multidisciplinary and innovative approach are recommended in order to prevent and control the SSI.

SOURCE OF PHOTOACTIVATION OF COMPOSITE RESINS USED FOR DIRECT RESTORATIONS: CLINICAL IMPLICATIONS

Conf. Dr. Simona Stoleriu

Departamentul Odontologie-Parodontologie, Proteză fixă, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie „Grigore T. Popa” din Iași, România

Although much of the restorative odontotherapy work is based on the photopolymerization process of composite resins, practitioners do not pay much attention to the source of activation. The source of photoactivation is perhaps the most underappreciated factor that can influence the properties of composite resins, which can affect the soft parts adjacent to the restoration or the pulpal status. Most of the studies that evaluated the light activation sources used in current practice drew attention to the fact that many of them provided inadequate light or were in unsuitable conditions for operation. In general, the increased values of irradiance reported by manufacturers result from measurements made at the level of the top of the source. In practice, we often see a significant decrease in irradiance when the source is positioned 2-8 mm away from the applied material. The recommendation is that when the irradiance decreases, the curing time should be extended. The light emitted by most LED lamps is not evenly distributed over the entire surface of the tip of the device, which means that certain areas of the preparation are not properly exposed to the light source. Recent studies have drawn attention to the fact that the spectral emission of many photoactivation devices is not homogeneous either. Manufacturers should make clear specifications regarding the parameters of the light source and the absorption spectrum of the composite resins. The aspects related to the variation of the radiant power during an exposure cycle and the variation of the spectral radiant power as a function of the light wavelength are still not sufficiently investigated.

MODERN PARACLINICAL DIAGNOSTIC TECHNIQUES VS. ICDAS II SYSTEM IN THE DETECTION OF INcipient PROXIMAL CARIES

Claudiu Topoliceanu, Gianina Iovan, Angela Ghiorghe, Simona Stoleriu, Galina Pancu, Irina Nica, Antonia Moldovan, Nicoleta Tofan, Andrei Georgescu, Ionuț Tărăboanță, Răzvan Brânzan, Mihaela Sălceanu, Sorin Andrian

Departamentul Odontologie-Parodontologie și Proteze Fixe, Facultatea Medicină Dentară,U.M.F.„Grigore T.Popa” Iași

The accuracy of the ICDAS II system (ICDAS 02 – non-cavitating proximal caries; ICDAS 03 – microcavitating proximal caries) in the detection of incipient proximal caries is lower than the values reported in the literature regarding the modern paraclinical diagnostic techniques recently introduced into dental practice. Paraclinical tools effective in prevention and odontotherapy include the DiagnodentPen (KaVo) device that uses the laser fluorescence technique, the DIAGNOCAM (KaVo) device that uses the Near-Infrared Light Transillumination technique. Data from the literature report the absence of statistically significant differences in diagnostic accuracy between the NILT technique and the laser fluorescence method in the detection of proximal carious lesions. Conclusion. The use of paraclinical diagnostic techniques has the advantage of increasing the sensitivity and specificity of the diagnosis of carious lesions, eliminating the stage of tooth separation in clinical diagnosis, reducing the time of examination of dental surfaces.

COMPUTER-ASSISTED DIAGNOSTIC TECHNIQUES AND MEANS IN THE EXPLORATION OF DYSFUNCTIONS OF THE DENTAL SYSTEM

Dragoș Frățilă, Georgiana Macovei, Amelia Surdu, Dragoș Virvescu, Monica Scutariu

Diciplina Diagnostic Oro-Dentar si Gerontostomatologie, Facultatea Medicină Dentară,U.M.F.„Grigore T.Popa” Iași

A computer-aided diagnosis system (CADIA- computer-aided diagnosis) must be relevant in relation to the treatment of the dental condition and must adapt to the requirements of a modern dental practice. Modern digital systems used in the diagnosis of dysfunctions of the stomatognathic system include CADIAX, T-SCAN and Gamma Dental Software. Computerized axiography (CADIAX) is a paraclinical examination technique that has the role of recording the functional movements of the mandible. Very good results are obtained by combining computerized axiography with the analysis of profile radiographs, obtaining a complex diagnostic system for patients affected by craniomandibular syndrome of articular origin. T-SCAN III diagnostic systems are used in computerized analysis of static and dynamic occlusion and allow time-sequential assessment of how occlusal forces are distributed across the dental arches. Gamma Dental Software is a digital diagnostic system that includes modules for the evaluation of odonto-periodontal status, occlusal relationships, articulator programming, cephalometric evaluation, temporo-mandibular joint evaluation. Conclusion. The use of computer-assisted systems presents numerous benefits in complex oral rehabilitation: it avoids the provision of subjective data by the patient, highlights pathogenic forces, detects imbalances in the stomatognathic system, tools for educating and motivating patients, reducing the number of treatment sessions.

CURRENT TRENDS IN PIT AND FISSURE CARIES PREVENTION BY SEALANTS

Șef lucr. Dr. Livia Bobu, Conf. Dr. Cătălina Iulia Săveanu, Șef Lucr. Dr. Carina Balcoș

Fissure caries continues to account for the majority of all carious lesions present in children and adolescents, which makes it necessary to prevent them by sealing. The continuous evolution of materials that can be used as sealants offers the possibility to choose from several available categories. However, the success rate of sealing depends on multiple factors. Currently, there are a number of methods that allow the integrity of sealing to be assessed with great accuracy. At the same time, there is a tendency to use materials that have additional cariopreventive effects, all of which are elements that can increase the efficiency of the method.

Additional Laser therapy in Periodontology: to use or to forget? A systemic review

Silvia Teslaru, Cornelia Alexandra Teodorescu, Irina Georgeta Șufaru, Liliana Păsărin, Ioana Rudnic, Ioana Sioustis, Odette Elena Luca, Bogdan Constantin Vasiliu, Diana Kristala Nițescu Kapenberg, Alexandra Mârțu , Ionuț Luchian, Sorina Mihaela Solomon

Laser therapy has different indications in Periodontology, from the decontamination of subgingival root and implant surfaces, to the bacterial reduction in the periodontal pockets, biostimulation, excision of soft gingival tissues or even osteoplasty and removing subgingival calculus. This systematic literature review is aimed at analyzing the most frequent occasions in which Laser therapy is used in Periodontology, depending on the wavelength, and what are the advantages and disadvantages in using such a therapy additional to the subgingival mechanical debridement.

DENTAL IMPLANT THERAPY IN PATIENTS WITH ORAL LICHEN PLANus

Sef lucr. Dr. Ana Maria Sciuca, Asist. Dr. George Alexandru Maftei, Drd. Andreea Onofrei, Conf. Dr. Cristina Popa

Universitatea de Medicină și Farmacie „Grigore T. Popa”, Iași, Disciplina de Patologie Orală

Lichen planus is a muco-dermatosis that is part of the wider pathological entity of “immune-mediated inflammatory disease” (IMID). Thus, its form of manifestation is mainly influenced by the function and structure of the affected subject’s immune system. The hallmarks of oral lichen planus are recurrence and associated clinical mucosal changes such as erosion, plaque-like keratosis lesions, atrophy, bulla, keratosis network and papule.

Dental implant therapy in the edentulous patient, diagnosed with a form of oral lichen planus and in particular, if the oral lesion comes in relation to the implant site, represents in many situations a challenge for both the patient and the clinician.

This study, by systematizing data from the specialized literature, focused on the results of dental implant therapy. It also aims at the safety and success rate of implant rehabilitation in patients whose mucosa presents a chronic inflammation specific to oral lichen planus.

The advantages of the digital impression in the orthodontic practice

Alina Sodor, Mihnea Iacob, Eduard Radu Cernei

U.M.F. „Grigore T. Popa” Iași

The orthodontic clinical examination aims to establish the correct diagnosis and to establish the best treatment plan. An extremely important step in achieving this goal is the dental impression. Based on the correct dental impression, the dental cast is obtained, and consequently will be performed on it the measurements needed to evaluate the space necessary for an optimal dental alignment that would allow to obtain an ideal occlusion and a good intermaxillary relationship.

The digitalization in orthodontics comes as a natural stage of the technological evolution and brings significant contributions in the orthodontic practice. Following the digital impression, a digital cast will be obtained that will allow measurements and casts printing on which different orthodontic devices can be made.

This paper aims to present the advantages and disadvantages of intraoral scanners analyzing both scientific literature and commercial product data. A wide range of features are assessed: data capture technology, representation fidelity, procedure time, human-computer interaction, storing and sharing solutions. The results of our study highlight the limitations of existing technologies, the key advantages of the available products and the necessity of a unified evaluation methodology due to the lack of regulation standards.

THE IMPACT ON ORAL HEALTH OF WEB -BASED SOFTWARE IN PATIENTS WITH SEVERE INHERITED COAGULOPATHIES

Claudia Cristina Tărniceriu, Irina Grădinaru, Carina Balcoș, Mihaela Mitrea, Adina Oana Armencia, Ion Hurjui, Loredana Liliana Hurjui

„Grigore T. Popa” University of Medicine and Pharmacy of Iași

Hemophilia A is a bleeding disorder that occurs as a result of factor VIII deficiency. Three forms of hemophilia A are described in the current literature: severe (Factor VIII<1%), moderate (Factor VIII 1-5%) and mild (Factor VIII 5-40%). Severe form of hemophilia A evolves with severe bleedings of osteoarticular system, mucosa of buccal cavity and affects the quality of life. Management of the diseases in patients with these disorders requires a personalized therapy to improve the quality of life directly correlated with oral health. The new protocols and clinical guidelines for treatments of bleeding disorders allow a good management of the diseases. The personalized therapy involves factor VIII prophylaxis taking into account the patient’s life style, physical activity as well as the patient’s phenotype. Optimizing the peaks and trough level of factor VIII through a personalized approach may improve the oral bleeding prevention. My Pkfit is a web-based software solution that allows physicians to personalize the treatment with octocog alfa and rurioctocog alfa and also supports patients adherence and inform activity decisions.

Key Words: HEMOPHILIA A, PERSONALIZED PROPHYLAXIS, MY PKFIT, ORAL HEALTH.

The importance of salivary markers in dental patient with associated neuropsychiatric pathology

Loredana Liliana Hurjui, Carina Balcoș, Mihaela Mitrea, Adina Oana Armencia, Ion Hurjui, Claudia Cristina Tărniceriu, Irina Grădinaru

„Grigore T.Popa” University of Medicine and Pharmacy Iași – Romania

Saliva is a hypotonic liquid secreted by the parotid, submandibular, sublingual and minor salivary glands that are distributed throughout the oral cavity. These glands are very permeable and surrounded by blood capillaries, allowing the molecules and biomarkers exchange, which can be secreted together with saliva. Thus, these biomarkers in saliva have been analyzed and used to detect local and systemic diseases, such as caries, periodontitis, oral and lung cancer, diabetes, cardiovascular diseases and viral infections. A growing interest in the usability of saliva has been observed recently used in toxicological diagnostics, drug monitoring, and forensic medicine. The usefulness of saliva as a biological marker has also been extended to psychiatry. The specificity of mental illness and patients limits or prevents cooperation and diagnosis. In many cases, the use of saliva as a marker seems to be the most sensible choice.

Keywords: SALIVA MARKERS, MENTAL ILLNESS, systemic diseases.

THE IMPORTANCE OF THE LABORATORY TESTS IN THE MULtiDISCIPILNARY APPROACH OF PATIENTS WITH INHERITED COAGULOPATHIES IN THE DENTAL OFFICE

Claudia Cristina Tărniceriu, Irina Grădinaru, Carina Balcoș, Mihaela Mitrea, Adina Oana Armencia, Ion Hurjui, Loredana Liliana Hurjui

„Grigore T. Popa” University of Medicine and Pharmacy of Iași

Aim of the study: to reveal the importance of the laboratory tests in the multidisciplinary team in the approach of the oral rehabilitation for the patients with inherited bleeding disorders

Material and methods: we analyzed the data from literature, and we studied the international and new national protocols for the treatment of the inherited coagulopathies.

Results and discussions: The management of oral rehabilitation depends on the severity of disease and the severity of oral procedures with a proper communication between the dentist, laboratory, and hematologist. In mild bleeding disorders, patients can be treated in a primary care after consultation with the hematologist. Patients with moderate and severe bleeding disorders are best treated in a hospital setting. The nerve block anesthetic injections are contraindicated unless the factor replacement therapy is provided. The diagnosis of the inherited coagulopathies and their treatment require a high-performance laboratory.

Conclusions: The management of patients with these disorders requires a multidisciplinary team that consists of a hematologist, hematology laboratory and a dentist.

Key words: INHERITED DEFICIENCY OF CLOTTING FACTORS, DENTAL OFFICE, HEMOSTASIS.

THE INFLUENCE OF DIFFERENT FINISHING AND POLISHING SYSTEMS ON THE SURFACE CHARACTERISTICS OF A BULK FILL COMPOSITE

Irina Nica¹, Gianina Iovan², Simona Stoleriu³, Cristina-Angela Ghiorghe³, Galina Pancu⁴, Claudiu Topoliceanu⁴, Nicoleta Tofan¹, Ionuț Tărăboanță¹, Sorin Andrian²

¹ Assistant Professor,  Department of  Odontology-Periodontology, Fixed Prosthesis / Discipline Cariology and Operative Dentistry,  Faculty of Dental Medicine, ”GrigoreT.Popa” University of Medicine and Pharmacy,  16 Universitatii Str., 700115, Iasi,Romania

² Professor, Department of  Odontology-Periodontology, Fixed Prosthesis / Discipline Cariology and Operative Dentistry , Faculty of Dental Medicine, ”GrigoreT.Popa” University of Medicine and Pharmacy,16 Universitatii Str., 700115, Iasi,Romania

³Associated  Professor,  Department of  Odontology-Periodontology, Fixed Prosthesis / Discipline Cariology and Operative Dentistry Faculty of Dental Medicine, ”GrigoreT.Popa” University of Medicine and Pharmacy,  16 Universitatii Str., 700115, Iasi,Romania

⁴ Lecturer,  Department of  Odontology-Periodontology, Fixed Prosthesis / Discipline Cariology and Operative Dentistry, Faculty of Dental Medicine, ”GrigoreT.Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi,Romania

Introduction. Obtaining a smooth surface is one of the main objectives of composite restorations, not only for aesthetic reasons but also for maintaining the oral health.

The aim of this study was to evaluate the surface of a bulk fill composite material after finishing and polishing with 3 different systems.

Material and Method. The material used was Filtek Bulk Fill Posterior Restorative Composite (3M ESPE St. Paul, MN, USA). 20 cylindrical samples of 5 mm diameter and 2 mm thickness were made using plastic conformers. They were randomly divided into 4 groups, each consisting in 5 samples. For group 1, the control one, the samples were not subjected to finishing and polishing. For the studied groups 2-4, samples were firstly finished using two tungsten carbide burs and then polished as follows: with the Occlubrush (KerrHawe SA, Switzerland) one step system – group 2, with the Sof-Lex (3M ESPE) two step system – group 3, and with the Super Snap multi-step system (Shofu, Inc. Kyoto, Japan) – group 4. The surface conditions of all samples were quantitatively analyzed by profilometry measurements and qualitatively by scanning electron microscopy.

Results. All three finishing and polishing systems determined an increased surface roughness comparing with the one in the control group.

Conclusions. The most abrasive systems were Occlubrush (KerrHawe SA, Switzerland) and Sof-Lex (3M ESPE) and the least abrasive was the Super Snap system (Shofu, Inc. Kyoto, Japan).

Keywords: bulk-fill composite, finishing and polishing systems, profilometry, SEM

THE ROLE OF SERUM FERRITIN IN LIVER CIRRHOSIS EVALUATION

IO Gavril^1,2, RS Gavril¹, DIANA Tatarciuc^1,2, Matei Eșanu¹, Crînguța Paraschiv^1,2,  Dragoș Gavril^1,2, Paloma Lascarache¹, Irina Eșanu^1,2

¹University of Medicine and Farmacy „Grigore T. Popa” Iași

²Hospital Cf Iasi

Serum ferritin is a marker for hepatic necroinflammation which is used as a prognostic marker in many studies among patients with liver cirrhosis.

The aim of the study was to corelate ferritin value with hepatic failure stages in patients with liver cirrhosis.

Material and methods: A prospective study was conducted for 2 years (December 2017 – November 2019), which included patients who were newly diagnosed with hepatic cirrhosis.

The exclusion criteria were: hemochromatosis, malignant lesions (with the exception of hepatocarcinoma) and acute infections during the last two weeks.

For the subjects who were included in the study serum ferritin level was evaluated and the stage of hepatic failure using Child-Pugh score.

Results: 62 patients were included (medium age 56 years old, 37 men and 25 women); 14 patients presented Child-Pugh A, 29 patients – Child-Pugh B and 19 patients Child Pugh C. The subjects were divided in two groups: group A (high serum ferritin level >160 ng/ml) and group B (normal level of serum ferritin 15-160 ng/ml). Group A represented 43% (28 patients) and group B 57%. The number of patients who were diagnosed with liver cirrhosis class Child A was lower in group A (7% – 2 patients) vs group B (33% – 12 patients). (p>0,01) The same relation was found for patients diagnosed with hepatic cirrhosis class Child B, group A (36% – 10 patients) vs group B (52% – 19 patients). (p>0,01) However, the number of patients diagnosed with liver cirrhosis class Child C was higher in group A (56% – 16 patients) vs group B (8% – 3 patients). (p<0,005)

Conclusion: This study showed that, in patients with hepatic cirrhosis, high values of serum ferritin (>160 ng/ml) presented a significant statistical correlation with hepatic failure class Child-Pugh C.

THERAPEUTIC APPROACHES IN DRY MOUTH CONDITIONS

Irina Grădinaru, Claudia Cristina Tărniceriu, Carina Balcoș, Mihaela Mitrea, Ion Hurjui, Adina Oana Armencia, Loredana Liliana Hurjui

„Grigore T. Popa” University of Medicine and Pharmacy Iași – Romania

Dry mouth conditions have negative impact upon the quality of life. Xerostomia, a symptom of dry mouth, is commonly associated with salivary gland hypofunction and, nowadays, has no definitive means for treatment. Most of the available therapeutic options are transient and not considered to be an optimal treatment solution. The PubMed and Scopus databases were consulted using as terms “dry mouth” OR “xerostomia” AND “treatment” to find relevant publications for the chosen subject. In the present paper are presented the most relevant modalities for xerostomia treatment. For patients with some degree of preserved salivary gland function, the symptomatic treatment by means of topical medications stimulating saliva production or increased fluid intake may be considered as sufficient. In patients with permanent destruction of salivary acini, in addition to palliative therapy, other forms of both local and systemic treatment may be necessary. The most common systemic agents are considered to be pilocarpine and cevimeline, which act as the agonist for the muscarinic receptors on the surface of the salivary cells. Bethanechol and anethole trithione are other drugs that exert their function via the parasympathetic system and have been shown to have some effect on dry mouth symptoms. Also, must be mentioned another drug such as amifostine, currently used in an attempt to prevent xerostomia in radiation therapy patients, due to its ability to scavenge free radicals. In the treatment of dry mouth, gene therapy is based on delivery of genes into the salivary glands. The electro-stimulation of the salivary glands and acupuncture can be used to increase the production of saliva. An efficient therapy in case of patients with dry mouth is very important to improve their quality of life. It is mandatory to treat the dry mouth symptoms and to minimize potentially painful oral infections and tooth loss.

Keywords: DRY MOUTH, XEROSTOMY, THERAPY.

TWIN BLOCK IN TWO STAGEs ORTHODONTIC TREATMENT

Șef lucr. Dr. M. Iacob, Conf. Dr. C. Romanec, Șef lucr. Dr. Alina Sodor Botezatu, Asist. Dr. Vieriu Raluca, Prof. Dr. Irina Zetu

Disciplina de Ortodonție și Ortopedie Dento-Facială, Facultatea de Medicină Dentară, UMF „Grigore T. Popa” Iași

The presence of a three-dimensional skeletal gap, associated with various types of malocclusions, adds an increased degree of difficulty to planning and performing orthodontic treatment.

In the case of children and adolescents, patients in whom the process of growth and development manifests itself, orthodontic treatment in two stages allows a gradual approach to the list of problems.

The Twin Block, introduced by William Clark, is one of the effective orthodontic appliances in the treatment of various types of dento-maxillary anomalies.

After the skeletal gap has been reduced in the initial phase of the treatment, the orthodontic movements in the second phase will be carried out more efficiently, facilitating the achievement of the final objectives.

Key words: biphasic orthodontic treatment, growth and development, Twin Block

Two faces of the same coin – Infectious diseases doctor and dental specialist

Georgiana Alexandra Lăcătușu¹, Cristina Sapaniuc¹, Florina Filip-Ciubotaru², Diana Tatarciuc², Carmen Manciuc²

1 „Sf. Parascheva” Clinical Hospital of Infectious Diseases

2 „Grigore T. Popa” University of Medicine and Pharmacy

Introduction The manifestation of numerous infectious diseases of bacterial or viral origin, can affect the Oral and Maxillofacial sphere.

Material and methods The paper proposes brief and illustrative overview of the main diseases with oral and maxillofacial manifestations.

Results We illustrate and present the most common viral and bacterial infectious diseases that can sometimes have a first sign in the oral and maxillofacial sphere like, herpangina, mononucleosis, measles, varicella, streptococcal pharyngitis, hepatitis and HIV. The initial exam performed by the dental specialist can sometimes raise different questions and can be the first step in the diagnosis of an infectious disease.

Conclusions A keen eye of a dental specialist can sometimes solve not only the medical problems in his area of expertise but also can raise suspicion of an underlying infectious disease being an important part of the multidisciplinary approach of a patient.

USE OF CBCT-PAI INDICES IN THE EVALUATION OF THERAPY EFFICIENCY OF PERIAPICAL LESIONS: CASE REPORTS

Mihaela Sălceanu, Cristi Giuroiu, Tudor Hamburda, Ylka Decolli, Cristina Antohi, Claudiu Topoliceanu, Anca Melian

Departamentul Odontologie-Parodontologie, Proteza Fixă, Facultatea Medicină Dentară, U.M.F. „Grigore T. Popa” Iași

The CBCT examination is an indispensable tool in endodontic practice, with numerous benefits compared to the classic and digital radiographic examination. The advantages are exposed through a case presentation (patients with early, medium, extensive chronic periapical lesions) at the level of the anterior and posterior dental group. The therapy of chronic periapical lesions was performed by mechano-chemical treatment, temporary root filling with Ca (OH)₂ paste for a period of 14 days, followed by root filling by cold lateral condensation technique with zinc-oxide-eugenol-based sealant and iodoform (Endoflas, Sanlor, Colombia). The definitive coronal restoration was made with Ketac Molar glassionomer cement (3M / ESPE) and Filtek 250 hybrid composite resin (3M / ESPE). The CBCT examination was performed pre-treatment and 3-6 months post-treatment with the PaX-Uni3D system (TVAPANO04, VATECH). Based on the CBCT images, the corono-apical, mesio-distal and vestibulo-oral dimensions of the periapical lesions were measured using Ez3D 2009 Plus. CBCT parameters were set for 20 second exposure time, 85 kV, 5mA. CBCT-PAI indices were used pre-treatment and 3 months post-treatment to evaluate endodontic treatment outcomes. The favorable evolution was associated with the reduction of CBCT-PAI indices at 3 months post-treatment. Conclusion. The measurement of CBCT-PAI indices with the help of a software application is an accurate, reliable and reproducible technique in the evaluation of the post-treatment evolution of chronic periapical lesions.

VULNERABILITY OF DENTAL STUDENTS TO SARS-COV-2 INFECTION DURING PRACTICAL WORK

Georgeta Zegan

U.M.F. „Grigore T. Popa” Iași

This study assessed the knowledge of 86 dental students and the risks of SarS-CoV-2 virus transmission during practical work through an anonymous questionnaire. The questionnaire about the COVID-19 pandemic from the specialized literature was structured in two sections: socio-demographic status (age, sex, specialization and years of study) and knowledge about SarS-CoV-2 infection. Statistical processing was done in SPSS 26.0 (SPSS Inc., Chicago, IL) for Windows, and descriptive statistics and the Pearson chi-square test were calculated. Students’ knowledge about the mode of transmission (45.3% students) and diagnostic methods (34.9% students) was better than the knowledge of the symptoms (4.7% students) and treatment (2.3% students) of SarS-CoV-2 infection, the measures of protection and prevention during dental practice. Some answers were statistically correlated with the gender, specialization (Dental Medicine and Dental Technique) and years of study (II, III and VI) of the students (p<0.05). The study revealed minimal knowledge and vulnerability of dental students to become infected and transmit the virus during practical work with the patient. It is also suggested to rethink dental practice by approaching virtual technologies in obtaining clinical skills to avoid patient contact during the COVID-19 pandemic.