romanian journal of oral rehabilitations3.amazonaws.com/zanran_storage/...romanian journal of oral...

Romanian Journal of Oral Rehabilitation

Vol. 2, No. 2, April 2010

1

Romanian Journal

of Oral Rehabilitation


Editor in Chief

Norina Consuela Forna, Iaşi, România

Vice-Editor

Viorel Păun, Bucharest, România

Senior Associate Editors

Pierre Lafforgue, Paris, France

Sammi Sandhaus, Lausanne, Switzerland

Robert Sader, Germania

Zhimon Jacobson, Boston, USA

Editorial Board

Marcel Agop, Iaşi, România

Corneliu Amariei, Constanţa, România

Vasile Astărăstoae, Iaşi, România

Mihai Augustin, Bucharest, România

Grigore Băciuţ, Cluj-Napoca, România

Constantin Bălăceanu-Stolnici, Bucharest,

România

Marc Bolla, Nice, France

Dorin Bratu, Timişoara, România

Alexandru Bucur, Bucharest, România

Eugen Carasevici, Iaşi, România

Radu Septimiu Câmpean, Cluj-Napoca,

România

Virgil Cârligeriu, Timişoara, România

Costin Cernescu, Bucharest, România

Yves Comissionat, Paris, France

Marysette Folliguet, Paris, France

Cristina Glavce, Bucharest, România

Emilian Hutu, Bucharest, România

Constantin Ionescu-Tîrgoviste, Bucharest,

România

Michel Jourde, Paris, France

Veronica Mercuţ, Craiova, România

Patrick Missika, Paris, France

Ostin Costin Mungiu, Iaşi, România

Ady Palti, Kraichtal, Germany

Mihaela Păuna, Bucharest, România

Phillipe Pirnay, Paris, France

Constantin Popa, Bucharest, România

Sorin Popşor, Tg. Mureş, România

Dorin Ruse, Vancouver, Canada

Valeriu Rusu, Iaşi, România

Adrian Streinu-Cercel, Bucharest, România

Dragoş Stanciu, Bucharest, România

Mircea Suciu, Tg. Mureş, România

Alin Şerbănescu, Cluj-Napoca, România

General Secretary

Magda Ecaterina Antohe, Iaşi, România

Legislation Committee

Delia Barbu, Bucharest, România

Technical Committee

Andrei Istrate, Iaşi, România

Volum realizat în cadrul Casei Editoriale DEMIURG



2

CUPRINS

FOREWARD (Prof. Univ. Dr. Norina Forna)

3

ANTIBACTERIAL THERAPY, UTILIZING OIL EXTRACTS

FROM CORN WASTE

S. Ciobanu

4

CORONAL-RADICULAR AND PERIODONTAL COMPLICATIONS IN CASES OF TEETH WITH

ENDODONTIC TREATMENTS IN MEDICAL RECORDS

Adriana Pirte, Andrea Zatykó, P. Lajosi, Alina Venter, Mariana Muresan

8

ADJUSTING OF A STABILIZATION SPLINT BY THE USE OF T-SCAN III - BIOEMG

INTEGRATED SYSTEM

S.Popsor, O.Szasz, Liana Claudia Şoaita, Liana Georgiana Hănţoiu

14

THE ANGLE II/1 CLASS MALOCCLUSION AND THE INCIDENCE OF THE SIGNS ASSOCIATED

TO THE CRANIO-MANDIBULAR DYSFUNCTIONAL SYNDROME

Roman Doru, Păcurar Mariana, Ieremia Lucian, Bică Cristina

21

STUDY ON CERTAIN POSTURAL CORRELATIONS IN ORAL REHABILITATION

O. Szasz, S. Popsor, Lia Maria Coman, Liana Claudia Şoaita

25

ORTHODONTO-PROTHETICS TREATMENT OF PARTIAL EDENTATION IN EARLY, JOINT AND

PERMANENT DENTITIONS

O.Solomon. L. Solomon

31

STUDY REGARDING NEODENTINOGENESIS, DENTINAL HYPERMINERALISATION AND

PULP CALCIFICATION IN DENTAL CARIES

Aunianu Mircea, Andrian Sorin, Iovan Gianina, Topoliceanu Claudiu,

Lãcãtuşu Stefan

35

CORRELATIONS BETWEEN OCCLUSION PRESURE AND MUSCLE ACTIVITY WITH K7

SYSTEM

Alina Apostu, Corina Cristescu

40

STUDY OF THE IMPACT OF TECHNOLOGICAL PROCESS ON

THE SURFACE ROUGNESS OF DENTAL ALLOYS

Ruxandra Voinea, Roxana Constantinescu, Maria Ursache

46

THE DEVELOPMENT OF CORTICAL BONE LEVEL DURING THE PLACEMENT OF DENTAL

IMPLANTS IN TWO SURGICAL STAGES WITHOUT MUCOPERIOSTEAL FLAPS

Valentin Topalo, Oleg Dobrovolschi, Dumitru Sîrbu, Nicolae Chele, Fahim Atamni

52

THE SECOND CONGRESS OF THE ROMANIAN DENTAL ASSOCIATION FOR EDUCATION

61



3

FOREWORD

The concept of oral rehabilitation governs the present

day medical practice, being present at the level of each

clinical entity, being based on a complex therapeutic

algorhythm, conditioned by a factorial kaleidoscope.

The vision in oral rehabilitation is built on clear

therapeutic stages, among which temporary prothesing

holds a special place together with the lower layer

resizing and cranio-mandibulary repositioning.

The therapeutic success reunites the latest generation

techniques and technologies their selection being in accordance with the clinical

case particularities. Clinical and paraclinical methods of assessment with their

modern and classical facets are paramount in creating a hierarchy of therapeutic

work within the therapeutic algorhythm.

The concept of oral rehabilitation is in close connection with the interference

between fundamental literature and the clinical case, and it has a deep impact

on the therapeutic process individualization. The general health condition is also

important for the selection of the proper therapeutic solution.

Prof. Univ. Dr Norina Forna

The President of Romanian Society ofOral Rehabilitation



4

ANTIBACTERIAL THERAPY, UTILIZING OIL EXTRACTS

FROM CORN WASTE S. Ciobanu

The Department of Stomatological Therapy

State University of Medicine and Pharmacy “Nicolae Testemitanu”

Abstract: The usage of "Izofural" 0.05%, obtained out of waste oil corn, determines the reduction of bacterial

plaque, the diminishing or even the disappearance of pain, gingivitis, edema, reduction. In the study there were

treated 30 patients, 13 male and 17 female, ages 20 - 55 years, with periodontal disease (gingival of different

forms, chronic marginal periodontitis). Izofural exceeds furacilini 2-20 times, to different species of

Staphylococcus and Streptococcus. As the result of clinical studies, Izofural 0.05% has proved to be an efficient

remedy, with pronounced anti-inflammatory effects. It is easy to use, non-allergic, without negative side effects,

cheap and beneficial to dentistry.

Key words: paradontitis, izofural, microflora, bacterial plaque.

INTRODUCTION

Periodontal disease is a long time real oral

health problem. The destructive nature

consciousness of periodontal disease and

importance of the efficient control on

bacterial plague in the periodontal therapy

the basis conception has been considered.

It represents on the first factor in the

periodontal disease while the hypothesis

there was confirmed, according to among

the local pathological effects it has an

impact on whole body health. In this way

many studies the correlation from

periodontal disease and cardiovascular

affection (atherosclerosis) diabetes

mellitus etc. Bacteria and their secretion

productions an indirect action, stimulating

the inflammatory process initiation of

biochemical mediators such as

prostaglandin or cytokine (IL – 1, TNF - α,

Dana T, Graves, Hesham Al - Mochat).

These mediators induce the production and

activity enzymes which the gingival

connective tissue have been destroyed in

this way stimulating osteoclast formation

which produce bone resumption. In

diabetic patients loss of bone tissue

capacity in the neoformation bone

production reaction which can normally

occur after bone resorption has been

observed. In the last years, new clinical

approaches and experiences indicate the

systemic impact of the periodontal

disease. The oral health maintance

represents an importance in the healthy

body. Thus beginning from the bacterial

plaque which represents the central factor

in all events that pistly have a healthy

parodentium ending with the inflammatory

process having teeth loss consequence that

is periodontal disease breaking. We can

refer to different laboratory and clinical

research works, that represent a new

impulse in the development of the new

technologies and medicines in many

benefits for oral health, especially in the

(biofilm) bacterial plague control and

fighting maintance. The using of any

obtained preparation from the vegetal

production produces not only a drainage of

the bucal cavity mucosa but determines

bacterial plaque reduction, decrease and

disappearance of the pain gingivorages,

edem, attack decrease and ill period.

Vegetal oil has an antimicrobial action

(bactericide) localy applicated, develops

an anti-inflammatory and quality

cicatrized effect that is izofural (from

Izonicotinoilhidrazone of 5 – nitro – 2 –

furancic aldehyde organic compound

(hydrazones) obtained from the processing

corn oil wastes). The study objectives

consist in the anti-inflammatory effect

assessment by clinical and laboratory test



5

– antibacterial action of 0,05% izofural in

the periodontal disease, study of side and

allergic effects in different group of

patients.

MATERIAL AND METHOD In this study there were treated 30 patients

(13 male and 17 female) aged from 20 to

55 year suffering from periodontal disease

(gingivitis – different form chronic

marginal paradontitis). Chemical study of

0,05% Izofural at the chair of the

Therapeutic Stomatology, Stomatological

Faculty State University of Medicine and

Pharmacy “Nicolae Testemitanu” has been

performed. The research project is called

“Obtains study antibacterial and

pharmaceutical proprieties, analytical

documents elaboration of the fixing quality

and preparation technologies and

implementation of the new pharmaceutical

preparation according to the prime local

substance using”. This project was

initiated at the Epidemiological

Department of the State University of

Medicine and Pharmacy “Nicolae

Testemitanu”. The patients there were

divided into 3 groups. (10 patients in each

one). The first group was treated with

isofural solution 0,01 – seria, the second –

0,02 and the third - 0,03 one. All patients

there were clinically and paroclinicaly

examined, establishing the diagnoses. For

the anti – inflammatory effect test of

Izonicotinoilhidrazone of 5 – nitro – 2

furancic aldehyde, Izofural of 0,05% - 30

ml 0,01; 0,02; 0,03. seria has been used.

Izofural of 0,05% with the Furaceline

structural prototype and analogues, has

analogical proprieties but 0,05% Izofural

exceeds 2 – 20 times furacecline activity

comparative with different staphylococcus

and streptococcus species; 2 times

comparative Klebsiella pneumonia and

Pseudomonas aeruginoasa and 9 of

Proteua vulgaris. Also Izofural inhibites

coli Escherihia increase, Salmonella

typhimurium and Enterococcus faecalis.

Izohidrafurol 0,05% solution completely

inhibits the streptococcus increase from

the 5 – 10 min. after contact but in

staphylococcus after 1h contact. Inhibition

increase of Proteus vulgaris E. coli, KL.

pneumonia begins from 2h and

consistently is decreased and in the 5 h is

registred the increase only 1 – 3 colonies.

The great importance represents the time

stability (11 – 12 months) of the 0, 05%

solution of medicine form, that was

demonstrated by monthly test of

antibacterial proprieties. Izofuralul being a

fluid substance needs a perfect sterility. It

can be sterilizes by autoclavation on 0,5

atm. pressure during 30 min or at 1 atm.

during 30 min. from another used

materials in this study the investigation

there were especially performed with the

chemical and laboratory criteria

specification gingival hemorrhages,

edema, hyperemia, serious and purulent

elimination, local pain, side effect,

subjective signs of the patients after IHF

application course, application count,

exposition etc. (absorbent) sterile paper

cone for material collection from

periodontal purses, solution transportation

boxes, photo – digital Canon Power Shot

SD 1000 (7,1 Megapixels) apparatus, 2007

for photo – video registering of the method

and obtained results. The test collection

test – after diagnosis establishment from

periodontal purses (and falseperiodontal

ones – in gingivitis) with sterile absorbents

(paper corn) the collected tests have been

introduced in the sterile glass boxes with

physiological serum. The second step

represents an ultrasonic detartrage,

distilled water irrigation (for the removal

of bacterial plaque waste and decollated

dental tartrum), the cotton tent application

with 0,05% izofural solution for 20 min. in

patients from the Ist group with 0,01 seria;

it the IInd

one solution with 0,02 and in the

IIIrd

one – sol. of 0,03. On expiration the

tents there were removal and from the

special the areas there were collected tests

with Nr. 2, localized in the sterile box

having an informative data (patients data,

application or test Nr. exposition). After

Nr. 2 collection test the installation in the



6

periodontal purses 0,05% Izohidrafural

for 24h have been aplified. The installation

there was recommended 24h but

practically their maintains from 4 – 11,5h

it has been possible which not influenced

the effect regards to Izofural that has

antibacterial action after 5 – 10 min. of

intimate contact (basis condition). It the

following course (the IInd

) the clinical

evaluation has been established (subjective

and objective - instrumental) and after that

the Nr. 3 test with preparation application

(installation Nr.3) for 20 min. has been

performed. After expiration Nr.4 test is

followed and after that (for 24h) the

preparation is applied again followed by

the IIIrd

course with Nr.5 for 20 min. and

Nr.6 for 24h. It is important to mentioned

that this study includes 3 causes minimum

(treatment days) in any cases the IVth

course with Nr.7 and Nr.8 has been

performed. The collected tests there were

sent to Intrahospital infection laboratory at

the Department of Epidemiology State

University of Medicine and Pharmacy

“Nicolae Testemitanu” during 2,5 – 3h

where there where performed the

insemination that is antibacterial effect test

of 0,5% Izofural solution as a basic

objective of this study.

RESULTS

Clinical study (clinical test) of Izofural

preparation represented in 0,5% solution

as a pharmaceutics production in

antibacterial activity demonstrated the

following: the preparation has a high

activity comparative pathogenic micro

flora from the bucal cavity especially in

the marginal parodontium level

inflammation. This is sustained by clinical

evolution results after each course and

confirmed by insemination (culture, Agar

with blood – from 200 colonies on

addressing to 20 colonies after the Ist

course, but in any patients without

increase). In all patients(from all three

groups with 0,01; 0,02; 0,03 seria) after

the first course with application by 0,5%

Izofural solution (intime contact) the

clinical situation significantly there was

improved whatever applicated seria.

Gingival hemorrhage, pain and serous or

purulent eliminations reduce and even

disappeared after the Ist day of the local

treatment (2 applications – installation, 20

min. and 4 – 11,5h respectively according

to the patient function of installation

maintaince) hyperemia tissular edema

rapidly yielded in the following course (in

the inflammatory gingivitis) but in

marginal ones, all the clinical pathological

signs there were in the rapid regression

with the obtained result after IIIrd

– IVth

course (having 5 – 6 applications –

installation in the Stomatological cabinet

as well as in those which must be to 24h.).

Evident distinction in the bacterial effect

of 0,05% Izofural solution with different

series there were not registered. The side

effects and any subjective signs (taste,

gustative sensibility modification,

vomiting reaction etc.) there were not

observed according to patients complains.

As a using modality of preparation it is

easy use in application in the periodontal

purces, economically and efficient.

DISCUSSION AND CONCLUSIONS

According to clinical tests 0,05% Izofural

solution it is demonstrated as a very

efficient antibacterial remedy with many

anti – inflammatory effects, easy in using,

non allergic, without negative secondary

effects, economical in the Stomatological

using. Above – mentioned the 0,05%

Izofural solution it is recommended as an

antibacterial election in the periodontal

disease treatment (gingivitis of bacterial

etiology, marginal parodontitis, etc).

REFERENCES 1. Constanta Liliana, Hăncianu Monica, Zetu l., Popovici Doina, Teslaru Silvia, Mârtu Silvia: Extracte

vegetale în tratamentul unor afectiuni gingivale; Studiul comparativ al preparatelor basilici extrasol si



7

collinae extrasol. Zilele Facultătii de Medicină Dentară. Editia a IX-a, Iasi, România, 4-6 martie, 2005,

P.73-74.

2. McCance KL, Huether SE, eds. Pathopysiology – The Biologic Basis for Disease in Adults and Children.

4th ed. Philadelphia, Pa: Mosby; 2002:207.

3. Mârtu S., Mocanu C.: Parodontologie clinică, Ed. Apollonia, 2000.

4. Offenbacher S.: Periodontal disease pathogenesis. Ann. Period. 1996, 1, 821.

5. Prisăcaru V., Buraciov S., Dizdari A. si al. Izonicotinoilhidrazona aldehidei 5-nitro-2-furanice”- compus

organic nou cu activitate antibacteriană. Comunicare I. Cercetări asupra actiunii antibacteriene. Anale

stiintifice ale USMF “Nicolae Testemitanu”-v.I. Probleme medico-biologice si farmaceutice - Chisinău,

2002.

6. Prisăcaru V., Svetlana Buraciov, Snejana Stoleicov, Ana Dizdari, E. Diug. Izohidrafurol – remediu nou

antibacterian. Comunicare I. Studiul actiunii antibactiriene. Anale stiintifice ale USMF “Nicolae

Testemitanu” - v.I. Probleme medico-biologice si farmaceutice - Chisinău, 2003.



8

CORONAL-RADICULAR AND PERIODONTAL COMPLICATIONS IN

CASES OF TEETH WITH ENDODONTIC TREATMENTS IN

MEDICAL RECORDS Adriana Pirte, Andrea Zatykó, P. Lajosi, Alina Venter, Mariana Muresan

University of ORADEA Abstract:

INTRODUCTION: to present the bring to attention the coronal – radicular and periodontal changes that might

occur in time, at the level of teeth that, have suffered an endodontic treatment in their medical history. At the

same time, some accidents have been monitored, that are likely to occur during endodontic treatment.

MATERIAL AND METHOD: In order to follow these dental-periodontal changes a retrospective study has

been performed. A number of 470 retrovalveolar, isometric and ortoradial radiographies have been analyzed.

Teeth on these radigraphies have been divided into two groups.

RESULTS: After analyzing the qualities of radicular obturations we have obtained the following results: correct

46%, incomplete 37%, with trans-passing 6%, false path 1%, un-obturated 5%. After analyzing those results by

teeth groups, the highest rate of correct obturations that we have discovered was in case of the frontal group

(55%), and the highest rate of incomplete obturations in cases of molars (40%). The aspect of apical periodont

in cases of teeth with endodontic treatment was as follows: 65% with no changes, 24,5% periodical granuloma ,

9,5% a slight widening of the periodical space and 1% radicular cyst.

CONCLUSIONS: The incidence of cases when teeth with endodontic treatment that require a new endodontic

intervention is quite increased.

Key words: endodontic, dental-periodontal, coronal-radicular.

INTRODUCTION The present research intends to identify the

coronal-radicular and periodontal

modifications which might appear in time at

the level of teeth which suffered an endodontic

treatment in medical records, as well as the

identification of various risk factors which

contribute at their appearance. This work tries

to accomplish a statistics of the number of

correctly obturated radicle channels, as well as

of the incorrectly obturated channels, and of

their consequences.

MATERIAL AND METHOD In order to pursue dental and periodontal

modifications of teeth which were subjected to

an endodontic treatment was done in

retrospective study. 470 retroalveolar,

isometric, ortoradial radiographies were done.

The radiographies were analyzed with a

negatoscope. The teeth from these

radiographies were divided in two groups. 319

teeth make part from group 1 (Endo)

representing endodontic treatments, with a

total of 504 channels. The radiographies were

done within 6 months - 3 years from the

achievements of the channel obturations. 450

teeth are part of group 2 (Vitali), without

endodontic treatment, considered vital.

The teeth from both lots were evaluated from a

point of view of the coronal-radicular

modifications and of the apical periodontitis.

Within the coronal-radicular modifications, we

followed the coronal and radicular fractures,

the relapses of decay and secondary decays,

radicular resorptions. Within the apical

periodontitis, we analyzed the presence of the

enlargement of the periradicular space as

skullcap (radiological image of chronical

fibrous apical periodontitis), presence of

granulomas and cyst. Conventionally, the

radiotransparence image over 0,5 cm was

considered a cyst, and under 0,5 cm a

granuloma.

On the other hand, we analyzed also the

correctness of radicular obturations, with

relations to their length and tightness. The

channel obturation was considered incomplete

if this was finished at more than 2 mm in

comparison to the radiological apex, correct, at

0-2 mm towards the radiological apex or

exceeding if the obturation material passed

over radiological apex (in compliance to the

criteria of the European Society of

Endodontology). The radicular obturation was



9

considered tight if it had a uniform density,

without porosities and free spaces.

RESULTS AND DISCUSSIONS

From the point of view of the odontal statute,

the teeth of the two lots were divided as such

(table I):

TABLE I.

Odontal statute of the teeth from the two lots

Odontal

status

Endo Vitaly

Prostethic

restoration

188 105

Coronal

obturation

131 204

No restoration - 141

Total 319 450

The coronal modifications analyzed at the

teeth with coronal obturations of the two lots

were the coronal fracture and secondary

decays, respectively the decay relapse. The

frequency of coronal fracture at the

endodontically treated teeth is 12.9% (17

cases), and 1.9% (4 cases) at the ones which

were not treated. This significant difference

may have as cause the low mechanical

resistance of the de-pulped teeth, through the

fragility of the organic component, sacrifice

exaggerated by the rough dental substance for

easing the access and the voluminous

obturations of mix. In which concerns the

frequency of secondary decays and decay

relapses, the difference between the two lots is

not significant: 32% (42 cases) at the Endo lot

and 30% (61 cases) at the Vitali lot (table II).

The similar values may be explained through

the common etymology of these decays in

both cases: lack of beveling and finishing of

the margins, lack of complete elimination of

the altered dentine.

The following graphic (fig. 1.) shows the

coronal modifications next to the radicular

ones revealed at the teeth of Endo group.

TABLE II. Fig. 1. Coronal-radicular modifications

Coronal modifications analyzed at the two teeth with endodontic treatment

lots

Endo Vitaly

No Percent

age

No Percent

age

Coronal

fracture

17 12.9% 4 1.9%

Relapse of

decay

/secondary

decays

42 32% 61 30%

Analyzing the quality of radicular

obturations at the teeth from the Endo lot, the

results indicated that 228 (46%) channels had

a correct obturation, 187 (37%) presented

incomplete obturations, 31 (6%) channels had

obturations in excess, 10 (2%) channels were

obturated non-tight, 27 (5%) channels were

not obturated at all, in 4 (1%) cases we found a

channel obturation on a false way, in a case we

noticed the radicular perforation fiven by a

DCR, and in 16 (3%) cases the apical area was

not correctly analyzed (tab. III).

Through the analysis of the quality of

separate obturations on groups of teeth

we obtained the following results (tab. IV),

(tab. V), (tab. VI):

internal radicular

resorption; 1

apical resection;

2coronary fracture;

17

radicular fracture; 1

decay relapse and secondary decay; 42



10

TABLE III. TABLE IV.

Quality of radicular obturations Quality of radicular obturations at the

incisor-canine group

TABLE V. TABLE VI.

Quality of radicular obturations at premolars Quality of radicular obturations at

molars

Looking at these results from an objective

point of view, the lowest value obtained at

molars might be due to a series of

morphological and topographical features,

such as their posterior position on the

arcade, reduced visibility, more difficult

accessibility, complicated and multiple

radicular and channel morphology with

frequent deviations from normal,

supranumeral channels and emphasized

curves. The most frequent example is the

presence of the MV2 channel at the first

superior molar.

In the frontal area, the endodontic

treatment is made easier, the access being

direct, good visibility, an adequate

isolation may be done and the channels are

unique, usually straight, or with slight

curves.

From the 769 teeth analyzed 137 (17,8%)

presented modifications of the apical

parodontitis, in the sense of the

appearance of the radiotransparence areas

characteristic for chronic apical

parodontitis (fibrous PAC, granuloma,

cyst). From the lot 1 (Endo) the image of

112 (35%) of teeth suggested the presence

of PAC, as follows (fig. 2). From adding

the various forms of apical parodontitis

results a percentage of 35% of the

frequency of PA at the teeth with

endodontic treatment. This value is

situated between the values of the results

of certain studies done in various countries

of the world, being closer to the results

Radicular

obturation

Number Percentage

Correct 228 46 %

Incomplete 187 37 %

In excess 31 6 %

Non-tight 10 2 %

False way 4 1 %

Non-obturated 27 5 %

Radicular

perforation

1 0 %

Inconclusive 16 3 %

Total 504 100 %

Radicular

obturation

Number Percentage

Correct 82 55 %

Incomplete 48 32 %

In excess 10 7 %

Non-tight 4 3 %

False way 2 1 %

Radicular

perforation

1 1 %

Inconclusive 1 1 %

Total 148 100 %

Radicular

obturation

Number Percentage

Correct 58 45 %

Incomplete 48 38 %

In excess 12 9 %

Non-tight 3 2 %

False way 2 2 %

Non-obturated 2 2 %

Inconclusive 3 2 %

Total 128 100 %

Radicular

obturation

Number Percentage

Correct 88 39 %

Incomplete 91 40 %

In excess 9 4 %

Non-tight 3 1 %

Non-obturated 25 11 %

Inconclusive 12 5 %

Total 228 100 %



11

obtained in France, Belgium, Germany, USA (1, 2, 3, 4).

Fig. 2. The aspect of apical parodontitis at the teeth with endodontic treatment

If we take as favoring factor of the

appearance of chronic apial parodontitis

the quality of endodontitic obturation, then

the results point out that there are indeed

very important statistical differences

between an incomplete endodontic

treatment and a complete one.

We made a comparison between the

quality of radicular obturations in the case

of the presence and absence of chronic

apical parodontitis. The four cases of cyst

granuloma were not taken into account

(fig. 3).

Noticing the results of these comparisons,

82% from the teeth which represented the

chronic apical parodontitis had incomplete

channel obturations and only 10% had

channel obturations considered correctly

done. From the teeth with periapical

modifications 61% presented radicular

obturations correctly done and 31% had

incomplete channel obturations. We have

to mention here that it is possible that from

the teeth with incomplete channel

obturations some might have a favorable

evolution of the infectious periapical

process, as well as, most probably, this

will happen with most of the cases which

present a correct obturation, after an

endodontic treatment correctly done, but

probably recent.

54 (17%) from the teeth of the first lot

presented coronal-radicular

reconstitutions (RCR), from which 30

were DCR (coronal-radicular device) and

24 pivots type Dentatus. This percentage is

significantly reduced than the values

obtained through studies done in France

(26%) and Sweden (59.4%) (fig. 4) (1,5).

Fig. 3. Quality of channel obturations Fig. 4. Comparison of the apical parodontitis

in the cases of the presence or not of PAC state of the teeth with RCR and without RCR

By adding the cases of fibrous and

granulous PAC cases we obtain a

percentage of 42.5% at the teeth with RCR

and 32% at those without reconstitutions.

The difference between the two groups is

not statistically significant. A study

regarding the quality of endodontic

treatment in Frace1 revealed an incidence

without changes;

65

the enlargeme

nt of perioradic

ular …

granuloma; 25 ; 1

0

50

100

PAC DA PAC NU

10

61

82

31

8 8

right short with overcoming

0

20

40

60

80

normal enlargement granuloma

53,5

16,526

66,5

8

24

teeth with RCR teeth without RCR



12

of 28,6% of PAC at the teeth which had a

DCR, meanwhile other authors found

values of 16% , 71%, 77% of PAC at this

type of teeth (1, 6, 7, 8).

In various studies was taken into

discussion the possibility to reinfect the

endodontic space when achieving the

preparation for DCR, especially that in the

last period it is more well-known the

negative role of the coronal

microinfiltration in the failure of

endodontic treatment. In these studies was

also analyzed the effect of mechanical

preparation in the radicular channel, in

order to achieve the space for DCR, and

the idea that, due to the vibrations of

rotating instruments obtained the adhesion

is affected (with a low value) of the

endodontic sealing at the walls of the

radicular channel walls (9, 10, 11).

CONCLUSIONS 1. The number of teeth endodontically

treated which require an endodontic

reintervention is high.

2. The qualitative level of endodontic

treatments is a low one, locally and

worldwide.

3. The highest frequency of incorrect

obturations was found in molars.

4. The PAC frequency at the teeth with

endodontic treatment is higher than at those

without radicular obturations.

5. The teeth with endodontic treatment are

associated frequently with PAC, especially at

those with incorrectly done radicular

obturations (especially those with a length of

over 2 mm shorter of apex).

6. The coronal modifications appeared at the

teeth with radicular obturations have a

medium frequency, but higher than at the

untreated teeth.

7. A low percentage of the teeth with

endodontic treatment were coronal-radicular

redone.

8. The preparation for the application of a

DCR cannot have a negative role through the

stimulation of appearance of chronic apical

parodontitis, and in the worst case may lead to

some radicular perforations. Thus we can

notice the importance of the accomplishment

of the space for DCR immediately after the

endodontic treatment when the clinician is

familiarized with the anatomy of the

respective radicular channel. In which

concerns the chronic radicular parodontitis,

their negative factor remains an inadequate

endodontic treatment, followed by an

incomplete channel obturation.

9. From an objective point of view, the

endodontic failures are due to the presence of

bacterial colonies, and in order to obtain a cure

of the lesions of endodontic origin we have to

eliminate or decrease them at the level of the

radicular channel systems. Also, it is necessary

to eliminate the nourishing support for these

bacteria and the endodontic level. The coronal

restoration must protect what was obtained

through apical sealing.

10. From a subjective point of view, the

doctor's abilities and his professional training

highly influence the quality and prognosis of

an endodontic treatment. The correct

preparation of the channel and the learning of

a correct radicular obturation technique are

indispensable for an adequate result.

The endodontic status of the population would

be better if the doctors would make an

endodontic treatment with max. 2 mm shorter

towards the radiological apex, and then they

would make in antiseptic conditions (isolation

with diga) the coronal restorations.

11. The accidents and incidents which appear

during the endodontic treatment are as a

consequence of not knowing in detail the

morphology of the teeth and especially the

morphological options for each tooth,

correlated with the topography of the areas

surrounding the tooth, of using an inadequate

instrument and an incorrect working

technique.

12. The indicators found show the importance

of obtaining a competence in endodontitis and

the training of as more specialists as possible

in endodontitis.



13

REFERENCES

1. Boucher Y., Matossian L., Rilliard F., Machtou P., Radiographic evaluation of the prevalence and

technical quality of root canal treatment in a French subpopulation, Int. Endod. J., 2002, vol. 35(3), 229-

238.

2. De Moor R.J., Hommez G.M., De Boever J.G., Delme K.I., Martenes G.E., Periapical health related to the

quality of root canal treatment in Belgian population, Int. Endod. J., 2000, vol. 33(2), 113-120.

3. De Cleen M.J., Schuurs A.H., Wesselink P.R., Wu M.K.., Periapical status and prevalence of endodontic

treatment in an adult Dutch population, Int. Endod. J., 1993, vol. 26(2), 112-119

4. Buckley M., Spangberg L.S., The prevalence and technical quality of endodontic treatment in American

subpopulation, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 1995, vol. 79(1), 92-100.

5. Eckerbom M., Magnusson T., Marttinsson T., Prevalence of apical periodontitis, crowned teeth and teeth

with posts in a Swedish population, Endod. Dent. Traumatol, 1991, vol.7(5), 214-220.

6. Kvist T., Rydin E., Reit C., The relative frequency of periapical lesions in teeth with root canal-retained

posts, J. Endod., 1989, vol. 15, 578-580.

7. Tronstad L., Asbjornsen K., Doving L., Pedersen I., Influence of coronal restorations on the periapical

health of endodontically treated teeth, Endod. Dental. Traumatol. 2000, vol. 16(5), 218-221.

8. Saunders W.P., Saunders E.M., Sadiq J., Cruickshank E., Technical standard of root canal treatment in an

adult Scottish sub-population, Br. Dent. J., 1997, vol. 182(10), 382-386.

9. Torabinejad M., Ung B., Kettering J.D., In vitro bacterial penetration of coronally unsealed endodontically

treated teeth, J. Endod., 1990, vol.16, 566-569.

10. Ray H.A., Trope M., Periapical status of endodonticcally treated teeth in relation to the technical quality of

root filling and the coronal restoration, Int. Endod. J., 1995, vol. 28, 12-18.

11. Trope M., Chow E., Nissan R., In vitro endotoxin penetration of coronally unsealed endodontically treated

teeth, Endod. and Dental Traumat., 1995, vol. 11, 90-94.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=Search&Term=%22Eckerbom%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=Search&Term=%22Magnusson%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=Search&Term=%22Martinsson%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract



14

ADJUSTING OF A STABILIZATION SPLINT BY THE USE OF T-

SCAN III - BIOEMG INTEGRATED SYSTEM S.Popsor, O.Szasz, Liana Claudia Şoaita, Liana Georgiana Hănţoiu

Universitatea de Medicină şi Farmacie din Tîrgu Mureş

Facultatea de Medicină dentară, Disciplina de Protetică dentară şi Reabilitare orală

Abstract:

Introduction. Occlusal splint,a well-established form of therapy, has been reported by many authors to have a

beneficial effect on caraniomandibular disorders. The articulating paper used to adjust the occlusal appliance is

incapable of measuring timing sequebce, occlusal force and pressure. The only way to precisely measure

occlusal forces and time is the T-Scan III.

Case report. There is presented a case of a pacient with myogenuous craniomandibular disorder. A stabilization

splint( full coverage splint) was constructed in the maxilla and the appliance was adjusted according to data

provided by the T-Scan III-BioEMG integrated system.

Results. Computer guided occlusal adjustments ensure improved force and time dynamics to balance and better

adjust the splint occlusal surface, confirmed by improved electromyographic activity and relief of symptoms.

Conclusions. (a) The concept of neuromuscular dentistry is one of great topicality. The integrated T-Scan III -

BioEMG system as part of this approach has been proved useful in monitoring the oral rehabilitation treatment ;

(b) The use of these computer-assisted diagnostic systems put the treatment on scientific bases and thus the

rehabilitation is an evidence-based one.

Key words: Stabilization splint, T-Scan III, BioEMG

INTRODUCTION

The efficacy of conservative occlusal

therapy through splints is a controversial

topic. A number of relevant studies have

highlighted the therapeutic efficacy of

these occlusal appliances [1,2,3,4], others

have reported contradictory results [5,6,7]

and others have denied the usefulness of

such of therapeutic means in

craniomandibular disorders [8]. As a great

part of craniomandibular disorders

involves the masticatory and cervical

neuromuscular system and on the other

hand the occlusion assessment as etiologic

factor is controversial , we used an

approach of patients wich include the use

of modern investigations specific to

neuromuscular dentistry: the T-Scan III

version V ( Tekscan Inc®) and the

BioEMG II ( Bioressearch Assoc Inc®

)

This integrated system allows the precise

monitoring of muscular behavior in

relation to occlusal factors. The T-Scan III

allows the evaluation of timing of

occlusion, the occlusal forces distribution

as well as their balance [9]. The average

integrated electromyographic data analysis

provided by the T-Scan III system is useful

to check and adjust the stabilisation

occlusal splint.

CASE REPORT.

Gy.M. patient, 23 years old, has presented

a charging characteristic symptoms of

craniomandibular disorder: diminished

limit of mouth opening ( 29 mm, elastic

end-feel), localized morning pain in the

areas of masseter and temporal muscles,

joint noises. Based on clinical

examination, the diagnosis of myogenuous

craniomandibular disorder was considered

(fig.1)



15

Fig.1 Diminished limit of mouth opening (29 mm)

A stabilization maxillary splint was made

as first therapeutic step. In order to avoid

arbitrary adjustments of the occlusal

appliance we used the T-Scan III occlusal

analysis system and the electromyographic

records at rest and in centric occlusion

both before and after splint wearing.

Fig.2. The BioEMG II device allows for the simultanous examination of eight muscles.

At the first visit the emg examination

showed a slightly increased rest activity of

the right temporal muscle while the T-

Scan analysis found a predominant

distribution of occlusal contacts on the

right side (62.2% on right side, 32.8% on

left side), with a clear shift of the center of

power to the right (fig.3) The most

pregnant occlusal contact was recorded on

the first upper right molar in the central

fossa area ( 23% of the entire occlusal

force of the dental arch)

Fig. 3. The T-Scan III analysis of the patient

The electromyographic exmination

showed an increased rest activity of the

right temporal and digastric muscles (

fig.4,5)



16

Fig. 4. Increased rest emg activity in right temporal and digastric muscles

Fig. 5 Graphic representation of increased electromyographic rest activity at the the right

temporal and digastric muscles

In centric occlusion an important muscular unbalance with predominance toward the right

side can be observed ( fig. 6,7,8).

Fig. 6. Electromyographic activity in centric occlusion

Fig. 7 The muscular unbalance in centric occlusion showed by the predominance of

electromyographic activity toward the right side



17

Fig. 8 Graphic representation of the muscular activity distribution in centric occlusion

The stabilization splint fabrication and its

usually adjustment with the aid of

articulating paper failed to improve the

simptomatology and the occlusal force

distribution.The electromyographic

activity showed the same predominance of

the right side (9).

Fig. 9 The muscular activity after the splint insertion. An important imbalance in centric

relation toward the right side (90%) can be observed.

But in rest, after the insertion of the

stabilisation splint the electromyographic

activity considerably decreased ( fig.

10,11)

Fig. 10 Rest electromyographic activity after the splint insertion: significant improvement of

the rest activity, with a slight increased activity of the right digastric muscle.



18

Fig. 11 Graphic representation of the rest electromyographic activity after the stabilization

splint insertion

Checking with articulating paper of the

occlusal surface of the stabilization splint

showed the unequal distribution of the

occlusal contacts ( fig 12), but this

topographic situation was not correlated

with the data provided by the T-Scan III –

BioEMG inegrated system.

Fig. 12 The image of occlusal contacts on the splint. A predominant left side distribution of

contacts can be observed, but the T-Scan III examination revealed that in fact the greatest

force level is situated on the right side at the teeth 1.6. ( 23% of the entire occlusal force !).

After the splint adjustment a more

balanced distribution of the center of force

was obtained (40% on the left side and

60% on the right side), as well as an

increased symmetric number of contacts

on the splint occlusal surface

(fig.13,14,15)

Fig. 13 The more balanced distribution of the occlusal contacts on the splint surface

From an electromyographic point of view,

the therapeutic succes of the splint therapy

was confirmed by the significant decrease

of the rest activity. Also, after 3-4 days of

splint wearing the complete disappearence

of subjective and objective signs of

dysfunction could be observed.



19

Fig. 14 T-Scan III examination after the splint insertion : the more balanced repartition of the

contacts on the splint can be observed

Fig. 15 Despite the predominance of muscular activity on the right side, the T-Scan III

examination showed a correct situation of the center of force after the splint adjustment

The current literature data, evaluated

through the prism of scientific evidence,

clearly suggest that the stabilization splints

used in the craniomandibular disorders

management to change de

craniomandibular relations have primarily

a behavioral therapeutic effect and not a

mechanical one [10]. Actually, a deliberate

induction of a change in vertically and

horizontally craniomandibular

relationships can be an issue because

usually this modification requires

subsequent adjustments of the occlusion.

The relevant literature support the

behavioural effect of the splint therapy

whereas the results of several studies

showed that the patinets who have used

these devices had better or equal results

compared with subjects who have resorted

to other similar therapeutic means such as

biofeedback or relaxation therapy[11,12].

Considering all pro and con available data,

it can be concluded that the oral

stabilization appliance has sufficient

evidence to support its use for the

management of localized myalgia and

arthralgia of the masticatory system. It is

much less likely to induce an inadvertent

malocclusion, wich is a strong negative

consideration when the clinician is

considering using the repositioning

appliance.The use of mandibular

repositioning appliances to treat

craniomandibular disorders is not

supported by the scientific literature

CONCLUSIONS.

(a) The concept of neuromuscular dentistry

is one of great topicality. The integrated T-

Scan III - BioEMG system as part of this

approach has been proved useful in

monitoring the oral rehabilitation ,

including the stabilization splint

adjustment ;

(b) The use of these computer-assisted

diagnostic systems put the treatment on

scientific bases and thus the rehabilitation

is an evidence-based one.



20

REFERENCES 1. Dao TT, Lavigne GJ: The crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol

med, 1998; 9:345-361.

2. Forsell H, Kalso E.: Application of principles of evidence-based medicine to occlusal treatment for

temporomandibular disorders: Are there lessons to be learned? J Orofac Pain, 2004; 18: 9-22

3. Kreiner M, Betancor E, Clark GT: Occlusal stabiliyation appliances.Evidence on their efficacy, J Am

Dent Assoc,2001; 132: 770-777.

4. Turp JC, Komine F, Hugger A.: Efficacy of stabilization splints for the management of patients with

masticatory pain:A qualitative systematic review, Clin OralInvestig, 2004; 8: 179-195

5. National Institutes of Health Technology Assessment Conference on Management of

Temporomandibular Disorders Proceedings, Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997;

83: 49-183.

6. Forsell H, Karlso E, Koskela P, Vehmanen R, Puukka P, Alanen P: Occlusal treatments in

temporomandibulat disorders: A qualitative systematic review of randomized controlled trials, Pain, 1999:

83: 549-560.

7. Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny AM: Stabilisation splint therapy for

temporomandibular pain dysfunction syndrome. The Cochrane Database of Systematic Reviews [website].

In: The Cochraine Library, Issue 1, 2004, Oxford, England. Disponibil la

:www.mrw.interscience.wiley.com/cochrane/clsysrev/

8. Marbach JJ, Raphael KG: Future directions in the treatment of chronic musculoskeletal facial pain: The

role of evidence-based care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997; 83: 170-177

9. Kernstein RB, Harty M., Radke J.A. : Force reproduction analysis of two recording sensors of a

computeriyed occlusal analysis system, Journal of Craniomandibular <practice, January 2006;24(1): 15-24.

10. Dawson P.E.: Functional occlusion. From TMJ to Smile Design, Mosby Inc., 2007.

11. Dahlstrom L.: Conservative treatment of mandibular dysfunction. Clinical, experimental and

electromyographic studies of biofeedback and occlusal appliances, Swedish Dental Journal, Suppl.24,1984

12. Laskin DM, Greene CS, Hylander WL: TMD„s. An Evidence- Based Approach to Diagnosis and

Treatment, Quintessence Publ., 2006



21

THE ANGLE II/1 CLASS MALOCCLUSION AND THE INCIDENCE OF

THE SIGNS ASSOCIATED TO THE CRANIO-MANDIBULAR

DYSFUNCTIONAL SYNDROME Roman Doru, Păcurar Mariana, Ieremia Lucian, Bică Cristina

Clinics of Pediatric Stomatology Tg. Mureş

Abstract: The present study desire to increase medical dental specialist’s attention regarding the importance of

epidemiologic investigation in finding, following-up and treating of the patients with and without cranio-

mandibular disorders (C.M.D.) and class II/1 Angle malocclusions. The closed end anamnesis index designed to

evaluate the functionality and dysfunctionality of the temporo-mandibular joint (T.M.J.) provided valuable

dates, really helpful in this way. The anamnesis index was fulfilled by 103 investigated patients, having age

range between 7-17 years old, together with their parents, 40 of them with class II/1 Angle. The dates mentioned

above orient the physician to the local somatic, psychic and general risk factors responsible by the C.M.D.

creation.

Key words: class II/1 Angle malocclusions, the temporo-mandibular joint, general risk factors

INTRODUCTION

In the last two decades growed up a

lot the interest in studying the T.M.J.

pathophisiology, neuromuscular system

and the static and dynamic interdental

gearing relations.

The orthodontic idea of align

conveniently the teeth in the normal

configuration of the arches was modified

progressively to include the actual concept

of getting a right balance between all hard

and soft pieces of the stomatognat

assembly.

As a consequence of this new vision,

many orthodontists express their wish to

know the multitude problems of the

T.M.J.’s inner and outer capsular

pathology, which heavily influence the

essential functions of the oro-facial system

(O.F.S.), underlining the importance

required by the epidemiologic

investigations in diagnosing, following up

and treating the two categories of morbid

entities: of the joint and the neuro-

muscular.

Authors like: P.H. Dupas (2000), P.G.

Giacomini and colab. (2004), U. Balottin

and colab.(2004), L. Ieremia and

colab.(2006), D. Roman and colab.(2008)

showed that, as a consequence of the

complex clinical aspect of the C.M.D., the

differential diagnosis and the diagnosis of

the ethiopathogenetic factors is difficulty

made.

MATERIAL AND METHOD.

To assess the functionality and

dysfunctionality of the T.M.J. we conceive

an anamnestic index with closed end with

whom we investigated a 103 subjects ,

both gender, with the age range between 7-

17 years, having I-st, II-nd and III-rd

Angle class. 40 subjects of this group have

presented II/1 Angle class malocclusions,

from who 16 were boys and 24 were girls.

RESULTS AND DISCUSSION

From the total amount of 40 subjects

having class II/1 maloclusions, there were

found 25 subjects with mandibular

diskinetic, 28 with clicking, 4 cases with

pain dynamic mandibular conditioned and

19 subjects diagnosed as using preferential

one hemi arch for mastication.

There were registered the following

aspects analyzing the quests forms fulfilled

by patients and their parents:



22

Malocclusions cases- frequency in this lot of 103 patients

ANAMNESTIC SIGNS

Table 1: Abnormal birth

Class II/1 Other classes General Total

Boys 1 2 3

Girls 1 2 2

Total 2 3 5

Table 2: Artificial feeding


Boys 3 1 4

Girls 7 8 15

Total 10 9 19

Table 3: Skull’s traumatism.


Boys 2 2 4

Girls 2 5 7

Total 4 7 11

Table 4: T.M.J. pain


Boys 0 0 0

Girls 5 2 7

Total 5 2 7

13,59

13,59

15,53

23,3

6,8

19,42

3,88

3,88I cl boys 14 cases

I cl girls 14cases

II/1 cl boys-16 cases

II/1 cl girls 24 cases

II/2 boys 7 cases

II/2 cl girls 20 cases

III clas boys 4 cases

III clas girls-4 cases



23

Table 5: Hearing noises in the ears when opening mouth.


Boys 0 0 0

Girls 4 6 10

Total 4 6 10

Table 6: Decreasing the maximum mouth opening amplitude.


Boys 0 0 0

Girls 2 0 2

Total 2 0 2

Table 7: Soft food orientation


Boys 0 0 0

Girls 3 4 7

Total 3 4 7

Table 8: Centric bruxism


Boys 4 7 11

Girls 5 3 8

Total 9 10 19

Table 9: Nocturnal bruxism

Boys Class II/1 Other classes General Total

Girls 2 3 5

Total 5 10 15

Boys 7 13 20

Table 10: Nightmares


Boys 2 6 8

Girls 6 10 16

Total 8 16 24

Table 11: Sleep talking


Boys 3 2 5

Girls 6 16 22

Total 9 18 27

Table 12: Sleep walking


Boys 0 0 0

Girls 2 3 5

Total 2 3 5



24

Table 13: Enuresis


Boys 0 0 0

Girls 2 1 3

Total 2 1 3

Table 14: Daytime restlessness


Boys 1 3 4

Girls 7 14 21

Total 8 17 25

Table 15: Headache

Class II/1 Other classes Total general

Boys 3 4 7

Girls 13 29 42

Total 16 33 49

CONCLUSIONS

The closed end anamnestic

questionnaire is a useful patient

investigation tool and orients the physician

toward the local risk factors, psychic and

generally responsible of C.M.D.

According to anamnestic

questionnaire, from the total 40 patients

having II/1 class malocclusions, each

subject presented at least one of the

orientation and causion signs of the

C.M.D. and 12 presented from 3 to 10

signs.

The presence of diurnal and nocturnal

bruxism, sleep talking, enuresis, sleep

walking and headaches in patients with

malocclusions create additional problems

for the orthodontist practitioner in

establishing the therapeutic plan and ruling

the treatment, the cooperation with other

medical disciplines being necessary.

REFERENCES 1. Balottin U., Nicoli F., Pitillo G., Ferrari Ginevra O., Borgatti R., Lanzi G.: Migraine and tension headache

in children under 6 years of age. Eur. J. Pain 2004; 8(4):307

2. Dupas P.H.: Diagnostic et traitement des dysfonctiones craniomandibulaires. Ed. CdP. Paris, 2000

3. Giacomini P.G., Alessandrini M., Evangelista M., Napolitano B., Luciani R., Camaioni D.: Impaired

postural control in patients affected by tension-type headache. Eur.J.Pain 2004; 8(6):579-583

4. Ieremia L., Bratu D. si colab.: Viziunea intersistemică în medicina dentară

Ed.Universităţii „Petru Maior” Tg. Mureş, 2006

5. Roman D., Ieremia L.: Disfuncţia cranio-mandibulară în ortodonţie şi posibila corelaţie cu malocluziile de

clasa a-II a Angle. Ed. University Press, U.M.F. Tg. Mureş, 2008



25

STUDY ON CERTAIN POSTURAL CORRELATIONS IN ORAL

REHABILITATION O. Szasz, S. Popsor, Lia Maria Coman, Liana Claudia Şoaita

University of Medecine and PharmacyTîrgu-Mureş

Faculty of Dental Medecine, Prosthodontic and Oral Rehabilitation Departement

Abstract:

Introduction. There is an obvious relationship between general body posture, cranial posture and the

masticatory system.The aim of our study was to establish correlations between certain postural parameters wich

may be involved in the oral rehabilitation.

Material and method. Sixteen subjects, 13 women and 3 men with average age 24.3 asked for informed

consent were investigated.The cranio-vertebral angle , the postural balance, the angle between interpupilar line

and the plan of occlusion , the angle of head inclination ( EAR-EYE angle) were calculated and the Beighton

rheumatological test was also applied. The statistical interpretation of the data was performed using the NCSS /

Pass Dawson Edition to calculate the correlation coefficient , coefficient of determination and regression

analysis, in order to assess the relationships between postural imbalance and the postural parameters .

Results. The regression analysis and the coefficients of correlation showed no correlations or only a weak

negative correlation (r = - 0.5416) between average postural imbalance and the postural parameters.

Conclusions: (a) the detection of head position is important for the dentist as it involves changes in orthostatic

position of mandible,with direct influence on the prosthetic rehabilitation; (b) alth ough the investigated group

was numerically small, preliminary results of our study are in concordance with the literature on values

determined for the investigated parameters; (c) In our study, only the relationship between postural imbalance

and IP-PO angle proved a medium negative correlation (r = -0.54).

Key words: postural imbalance, postural parameters, oral rehabilitation

INTRODUCTION

The involvement of the cranio-cervical

neuromuscular system in the

craniomandibular disorders is an essential

one.

After the International Congress in

Posturology held in Milan in 2000

emphasized the correlation existing

between occlusion, temporomandibular

joints, cervicocranial and the general body

posture, issues involving the postural

disorders in the orofacial pathology and

the mutual links between them has

continued to attract a particular interest

[1,2,3]. In the oral rehabilitation, all these

influences must be carefully examined.

The aim of this study was to evaluate

a sample of non-subjects in order to

establish the correlations between general

postural balance and craniocervical

postural features that could influence the

dental occlusion and consequently the

masticatory muscular activity.

MATERIAL AND METHOD

Sixteen subjects, 13 women and 3 men

with average age of 24.3 years were asked

to consent to research. The studied

parameters were the following:

- the cranio-vertebral angle [4]. This can

be determined either on a profile

radiography of the skull or on a profile

photo, the angle being defined by the line

joining C7 vertebrae with the tragus,

reported to either the vertically or

horizontally line through C7.

- the postural balance , assessed by

measuring body weight distributed on the

two states;

- the Beighton rheumatologic test score;

- the angle between the interpupilar line

and the occlusal plane;

- the EAR-EYE angle - angle of of the

head inclination ( tragus- external angle of

the eye line with the horizontal).



26

Fig. 1. The craniovertebral angle

Fig. 2. The performed records and the Beighton test to evaluate the general joint mobility

Two posturometric platforms, actually

two identical digital scales put together

and having identical calibration were used.

Digital photography of the subjects from

the front and from profile at standard

conditions have been made. The images

were processed through Adobe PhotoShop

program.

The statistical interpretation of the

obtained data was performed using the

NCSS / Pass Dawson Edition, to establish

the correlation coefficient r, the coefficient

of determination r2

and the regression

analysis, in order to find the relationship

between postural unbalance and recall

parameters.

RESULTS AND DISCUSSION

Summary of the findings is illustrated

in table no. I.

In this table it can be seen that the

most postural imbalance is in patient GR,

in which there are also changes in the

craniovertebral angle (cervical spine

extension) in eye-ear angle, the overall

posturologic diagnosis being that of

foreward head position.

Fig.3. Pacient GR. Foreward head position (cervical spine extension)



27

TABLE No I.

The values of the study parameters

The electromyographic examination

revealed rest hyperactivity at the right

temporal muscle and a slightly increased

level of the digastric muscles activity,

especially the left one, while in deglutition

the right masseter muscle hiperactivity

could be observed. Overall, from

neuromuscular point of view the dominant

feature is the masticatory system severe

muscular unbalance.

Fig. 4. The same electromyographic registration unfolded. The increased rest activity of the

right temporal muscle especially can be observed (miospasm)



28

Fig. 5. Electromyographic investigation in swallowing: very increased activity of the right

masseter muscle

Turning to the results of our study it

can be observed that statistically the values

of the craniovertebral angle related to

postural imbalance were linear distributed

(Figure 6, a).

The scatterplot analysis of data

showed the dispersion and a weak

correlation between the two parameters

(fig.6, b).

The regression analysis and the

correlation coefficients showed a weak

negative correlation of postural imbalance

with craniovertebral angle (r = - 0.40)

(fig.6, c).

Fig.6. Graphical representation of the statistical correlations between the studied parameters

In order to analyse the appropriate

cervicocranial posture several authors [5.6]

have proposed the use of the angle formed

by the line joining the tragus with the

external eye angle and the horizontal plane

or the Frankfurt plane (the angle of head

inclination E-E) Related to the Frankfurt

plane this angle has about 11 degrees, and

related to the horizontal plane this angle

has 15 degrees.

The recorded values of our study are not

correlated with the postural imbalance (r

and r2 = 0) (Fig 6, d). The only parameters

of the study that could suggest the

existence of a negative correlation (r = -

0.5416) were the postural unbalance and

the angle between the interpupilar line and

the horizontal plane. This is the expression

of a scoliotic postural attitude (fig.6, e)

The evaluation of the correlation between

the head inclination angle and



29

craniovertebral angle (Figure.6, f) led to

the finding of a weak linear correlation (r

= 0.2471). This is normal, given that up to

a certain limit, the craniovertebral angle

and the head tilt angle are independent.

All postural abnormalities, particularly

those that drive or determine cervical spine

extension, have an important sound in the

craniofacial area, particularly by changing

the craniomandibular relations and thus the

prosthodontic treatments in oral

rehabilitations [7].

From the oral rehabilitation point of view

the changes of the cervical lordosis;

particularly cervical spine extension

causes increased muscle activity as a

consequence lead to the lifted and retruded

lower jaw. On the other hand, the cervical

spine flexion decrease the muscular

activity muscle activity, leading to

downward and retruded position of the

mandible. There is a direct relationship

between the extended head and neck

posture and the mandible retruded position

having as consequence a decreased vertical

dimenssion in rest [8].

The cervical spine extension is identified

with the foreward head position, postural

attitude that is very often encountered in

the general population. A reference in this

regard, revealed that among the dental

medical students this postural attitude

reaches 60% of the examined subjects [9].

The foreward head position is particulary

important because it led to changes in

mandibular orthostatic posture, alteration

of the mouth closing trajectory and thus

causing changes in the initially occlusal

contact when closing the mouth. This has

both diagnostic and therapeutic important

implications in the oral rehabilitation. This

postural attitude increase the muscle

activity level and the tissue elasticity that

results in a retruded mandibular rest

position, decreasing the freeway space and

producing a retruded mandibular arc of

closure, both of these changing the central

occlusion (retruded occlusal contacts)

There are no available data at present

about the ``zero point``from wich to be

judged the flexion or the extension of the

cervical spine. The few data in the

literature accredits as normal for a balance

between flexion and extension

craniovertebral angle values between 40.6

and 41.1 degrees, values that can be

assessed photo examination [11].

Although the postural craniomandibular

relationships were considered by many

authors as etiologic factors for

craniomandibular disorders and this theory

still enjoy certain popularity, there are

well-documented scientific studies that

have shown that there are not postural

features to consistently differentiate the

patients with dysfunction from the normal

subjects [12].

CONCLUSIONS:

(a) the detection of head position is

important for the dentist as it involves

changes in orthostatic position of

mandible,with direct influence on the

prosthetic rehabilitation; (b) although the

investigated group was numerically small,

preliminary results of our study are in

concordance with the literature on values

determined for the investigated

parameters;

(c) In our study, only the relationship

between postural imbalance and IP-PO

angle proved a medium negative

correlation (r = -0.54).

REFERENCES

1. Ciancaglini R.: Riabilitazione orale.Piano di trattamento e terapia preliminare, Ed.Masson, 1999.

2. Huggare J, et al. Head posture and dentofacial morphology in subjects treated for scoliosis. Pro-

ceedings of the Finnish Dental Society, 1991;vol 87(1): 151-8.

3. Olivo SA, Bravo J, Magee DJ, Thie NM, Major PW, Flores-Mir C: The association between head and

cervical posture and temporomandibular disorders: a systematic review, J Orofac Pain, 2006; 20(1): 9-23.



30

4. Johnson G.M. : The Correlation Between Surface Measurement of head and Neck Posture and the

Anatomic Position of the Upper Cervical Vertebrae, Spine, 1998;23 (8):921-927

5. Jampel R.S. şi Shi D.X.: The Primary position of the eyes, the resseting saccade, and the transverse visual

head plane. Investigative Ophthalmology and Visual Science,1992; 33:2501-2510.

6. Hsiao H şi Keyserling W.M.: Evaluating posture behavior during seated tasks, International Journal of

Industrial Ergonomics, 1991; 8: 313-334

7. Silvestrini Biavati P, Guida P: Neuromuscular re-equilibration of the stomatognathic system: The

feedback system, 2002; www. dentaldepot.com

8. Visscher CM, De Boer W, Lobbonzoo F, Habets LL, Naeije M : Is there a relationship between head

posture and craniomandibular pain?, J Oral Rehabil, 2002, 29(11): 1030-1036

9. Pedroni CR, De Oliveira AS, Guarantini MI: Prevalence study and symptoms of temporomandibular

disorders in university students, J Oral Rehabil, 2003; 30(3): 283-289.

10. Dawson P.E.: Functional occlusion. From TMJ to Smile Design, Mosby Inc., 2007

11. Ankrum DR, Nemeth KJ: Head and neck posture at computerworkstations-what s

DXneutral?.Proceedings of the 14 th Triennal Congress of the International Ergonomics Association,

2000,5: 565-568

12. Laskin DM, Greene CS, Hylander WL: TMD`s. An Evidence- Based Approach to Diagnosis and

Treatment, Quintessence Publ., 2006



31

ORTHODONTO-PROTHETICS TREATMENT OF PARTIAL

EDENTATION IN EARLY, JOINT AND PERMANENT DENTITIONS O.Solomon.

1 L. Solomon.

2

Protetics and orthodontics Department

State University of Medicine and Pharmacy „N. Testemitanu”

Abstract: In this work had been described the orthodonto-prothetics treatment methods in diferent dentitions

and devices specific features in early, joint and permanent dentitions which allow us to have more prophylactic

measures and oclusion balance stabilisation.

New methods and devices elaboration in dento-maxilla maloclusion and relapse of final orthodontic treatment

prevention.

INTRODUCTION

Dental prothetics in children and

teenagers in diferent dentitions is a sure

method in functional keeping and oclusion

deformations prevention. There a lot of

prophylactic procedures in earl losinf of

teeth in lateral segment, because i tis

possible to forestall: encroaching upon of

hight oclusion process, dental archway

shorting, appearance of dento-alveolar

prelong and vicious habit, orizontal

moving of eruptive teeth, intra-bone

moving of unerupted teeth muds, maxilla

bone development normalization.

In the most of cases the patient ask

consultation from a prothetic way, he is no

table to imagine that, in his age, there are

possible dental moving and he need to

think about orthodontic and prothetics

posibilities.

We don’t have to neglect that in

ortohontics–prothetics treatment aplication

it doesn’t have in view ideal oclusion

obtaning but prothesis realization as

functional as esthetic.

For a right solution searching of

treatment determination in children and

teenagers prothetics for each case it is need

to determine how are dental archways

development and when can we say that

they are growth total.

In temporar oclusion between 3and 7

years old dental archways growth in

breadth. So, transversal size between

lateral incisors of up-maxilla is grown

between 16.65±0.11 mm and 40.65±0.17

mm and for temporar molars between

40.65±0.17 mm and 42.12±0.15 mm.

Between 12 and 15 age old lenght

and breadth of dental archways doesn’t

have much changes about its development.

The dates about maxilla development let

us to change frequently the prothesis

because of growth in temporar and joint

dentition.

In dental prothetics in children, for

prothesis, in early and joint dentition we

have to folow the next reasons:

- they need to be simple constructed;

- they don’t have to hinder igienic

conditions of oral cavity;

- they have to be estetic;

- they need to suit the age and the defect

of patient;

- the patients who had lining and

oclusion defects need to folow before an

orthodontic and prothetic treatment.

Dento-maxilla anomalies are

asociated with edentations which are

present in a lot of case in children from

Moldova, Republic of. The edentations are

coused by earl molars and first permanent,

but in most of cases we have reduced

frontal edentations folowed by estetic and

functional defects with dental moving and

oclusion anomalies. The treatment of

edentations in children and teenagers has

a lot of particularities by age, dentition,

growth and SS development.

In orthodonto-prothetics treatment

practice are used the next constructions:

crowns, fixed prothesis, removable



32

prothesis, prothesis with function of dental

growth stimulation, space mentainers,

adesive bridge, dental restauration of

decidual teeth.

MATERIALS AND METHODS

For the first, we mentioned the earl

dentition, because the orthodonto-

prothetics treatment has an orthodontic,

prophylactic and the recurrent aspect. The

orthodontoc treatment is for eruption

leading and development and prothetics

one has a prophylactic- recurrent aspect.

Prohylaxia and relapse in APD ist o

prevent dento-maxilla anomalies and

oclusion mentaining of unerupted teeth.

In the most of cases the oclusion

balance mentaining in earl dentition is

made using removable devices. They are

made by special criterion and are changed

from 6 in 6 months till all decidual teeth

eruption. In patients with earl dentition we

have made 8 removable plate were we

succeed right decidual teeth arangement

and ocluzal eruption at 6 ears old in

oclusion key in joint dentition.

In 2 patients we have made acrilic

crowns in estetics aim and for oclusion

part or tooth mastication keeping, making

a pin acrilic crowns and succesfully

maintain the crown part of the tooth.

Joint dentition treatment in early time

made reduced de severity of dento-maxilla

anomalies using some orthodonto-

prothetics devices. Usualy they are space

maintainers, prefabricated steel crowns,

decidual teeth restaurations.

3M crowns using (fig1) for decidual

teeth standard need to be kept obturations

in temporar molars and not to allow early

teeth extraction making insufficient space

for permanent teeth eruption.

At Prothetics and Orthodontics

Department we have made an Orthodontic

Trainer (fig. 2,3,4) with space maintainer

with wich we can solve dento-maxila

problems in frontal region and space

maintaining in lateral region.

Fig1 Fig 2

0,00%

5,00%

10,00%

Temporary detition

6,89%

1,72% 1,72%

Removable prosthesis Plastical crowns Plastical crowns with pin



33

Orthodontic trainer with space mentainer

Fig 3. Fig.4

After analysis of some dental bridges

for children we decided that we need to

make an acrilic cap which is made

individualy on a half-archwayor on both of

them with artificial teeth for space

mentaining for permanent teeth and

vertical and sagital dental removing

prophylaxy of erupted teeth.

Fig.5 Fig.6

In permanent dentition orthodonto-

prothetics methods are destined for

etiological factor removing, dento-maxila

treatment and relapse mentaining of made

orthodontic treatment. Mostly we used

removable prosthesis with orthodontics

elements because they are more efficient,

when maxilla is in development, more

hygienic and not so expansive for patients.

In 14 patients were used fix prosthesis

0,00%

10,00%

20,00%

30,00%

Mixt dentation

25,86%

3,44%1,72%

12,06%10,34%

Plastic space mentainers with artificial crown Removable space mentainers

3M crowns Orthodontics treiner with space mentainers

Space mentainers with plastical teeth



34

because of different forms of hypodontics

and oligodontics. This study was made on

4 patients using joint ortho-surgery-

prosthetics treatment where after

orthodontic treatment in edentation space

are used space mentainers after are

ghanged with intra-bone implants and

artificial crowns. In a group of 8 patients,

the edentation treatment was ghanged by

artificial crowns, adhesive bridges and

esthetics restaurations.

DISCUTIONS AND CONCLUSIONS

The prothetics construction in children

and teenagers, in each case is established

by growth and development of dental

archway revering wanted fisionomical

aspect and articular and muscular

disfunction prevention. Prothetics

construction used take off ocluzal

disfunction and fonetics relapse

prevention. This methods in relapse

orthodontic treatment can prevent dental

removing uncalled for patients and

doctors.

The orthodontic aim is oclusal balance

obtaining and stabil corection, for which

we used orthodonto-prothetics prevention

methods and we have made space

mentainers which could be used in

different clinic situations as beeing optim

solution for etiological factors removing

wich can couse to lose of oclusal balance.

REFERENCES 1. Proffit W.R.: Contemporary Orthodontics. Mosby St. Louis, 2003.

2. Andrews L.F.: Six keys to normal occlusion. Am Orthod 62:296,1972.

3. П.Д. Маилян: Новые средства ортодонтического лечения. Ереван 1998.

4. Ovidiu Grivu, Mohamad Makki, Vlad Curtuzan: Contenţia şi recidiva

în ortodonţie. Waldpress 2008.

5. Athanasio R.: Management of temporomandibular disorders and occlusion.

J. of Prosthodontics, September 2003; 12:230.

6. Dorobaţi Valentina, Stanciu D, Ortodonţie şi ortopedie dento-facială. Bucureşti 2003.

7. Georgeta Zegan, Ortodonţie şi ortopedie dento-facială. Tehnopress Iaşi 2005.

0,00%

10,00%

20,00%

30,00%

Permanent dentation

5,17%

24,13%

12,06%

3,44% 6,89%

Space mentainers for implants Orthodontic treatment and removable prosthetics

Orthodontic treatment and fix prosthetics Orthodontic fix sistem for surgery treatment

Orthodontic treatment for artificial crowns.



35

STUDY REGARDING NEODENTINOGENESIS, DENTINAL

HYPERMINERALISATION AND PULP CALCIFICATION IN DENTAL

CARIES Aunianu Mircea

1, Andrian Sorin

2, Iovan Gianina

2, Topoliceanu Claudiu

2,

Lãcãtuşu Stefan2

1 PhD Student,

Department of Odontology and Periodontology, School of Dental Medicine,

University of Medicine and Pharmacy, Iasi, Romania

2Department of Odontology and Periodontology, School of Dental Medicine, University of

Medicine and Pharmacy, Iasi, Romania

Abstract:

Introduction. The aim of study was to correlate dental-pulp reactions to dental caries with diverse localization,

evolution and depth.

Materials and method. The study was realized on a group of 87 patients with age ranging between 15-35 years.

222 posterior teeth with carious lesions were examined both on clinical and radiographs (ortopantomographs).

Type of pulp-dentinal defensive reactions visible on radiographs were as follows: neodentinogenesis with

advanced deposition of tertiary dentin, dentinal hypermineralisation, difuse pulp calcification. Parameters taken

in study were as follows: sex, age group, dental group, radiographic indices (depth, location). Data were

recorded in tables and expressed in Microsoft Excel graphs.

Results and discussions. Clinical and radiographic data showed correlation between deep chronic caries

localized on occlusal surfaces of mandibular molars and dentinal hypermineralisation reactions; deep chronic

caries localized on maxillary molars were associated with massive retraction of pulp room through

neodentinogenesis. Lack of pulp-dentinal complex reactions was observed especially for patients with age 15-25

and dental caries with acute evolution.

Conclusions. Age, localization and evolution of dental caries can be correlated with presence of specific forms

of pulp-dentinal reactions.

Key words: dental caries, evolution, depth, localization, hypermineralisation, neodentinogenesis.

INTRODUCTION

Morphological and functional

interrelations between pulp and dentine

provoke pulpal reactions even before

carious process reach the dentine.

Cariogenic bacteria from cavitated dental

caries exert their action on pulp-dental

complex through direct citotoxic effect or

through antigenic properties. (Lãcãtuşu

1998) (6). Pulp-dental complex reacts

through dentinal remineralisation or

hypermineralisation, deposition of tertiary

dentine through neodentinogenesis,

advanced retraction of pulp room, difuse

pulp calcification.

The aim of our study was to correlate

the diverse forms of defensive pulp

reactions with dental caries related to

specific parameters.

MATERIALS AND METHODS

The study was realized on a group of

87 patients with age ranging between 15-

35 years. 222 posterior teeth with carious

lesions were examined both on clinical and

radiographs (ortopantomographs). Type of

pulp-dentinal defensive reactions visible

on radiographs were as follows:

neodentinogenesis with advanced

deposition of tertiary dentin, dentinal

hypermineralisation, difuse pulp

calcification. Parameters taken in study

were as follows: sex, age group, dental

group, radiographic indices (depth,

location). Accordingly to age group,

patients were divided in age 15-25 years,

age 26-35 years. Dental teeth with caries

were selected from lateral teeth (bicusps,

molars). Radiographic indices were

Espelid&Tweit (E3-E5) for occlusal caries

and D3-D5 for proximal caries. Related to



36

extension in dentine, occlusal caries were

divided as follows: E3-external third

dentin, E4-medium third dentin, E5-

internal third dentin. Related to extension

in dentine, proximal caries were divided as

follows: D3-external third dentin, D4-

medium third dentin, D5-internal third

dentin. Data were recorded in tables and

expressed in Microsoft Excel graphs.

RESULTS AND DISCUSSIONS

Structure of patients group is

presented in tables 1-3 (sex, age group,

dental group). Tables 3-5 present

distribution of dental caries related to

dental group, dental caries evolution

(chronic; acute), radiographic indices

(location, depth). Tables 7-14 present

distribution of pulp-dentine defensive

reactions related to teeth with dental caries

(table 8), teeth with visible radiographic

pulp reactions (table 9), patients sex (table

10), patient age group (table 11), dental

group (table 12), dental caries evolution

(table 13), location and depth of dental

caries related to radiographic indices (table

14).

Table 1.Patients lot (sex)

Male Female

34 53

Table 2. Patients lot (age group)

15-25 years 26-35 years

62 25

Table 3. Teeth lot (dental group)

PM Mx PM Md M Mx M Md

11 16 106 89

Table 4. Distribution of dental caries (evolution)

Chronic Acute

159 63

Table 5. Distribution of dental caries (dental group)


11 16 106 89

Table 6. Distribution of dental caries (radiographic indices: location, depth)

E3 E4 E5 D3 D4 D5

17 32 44 25 25 79

Table 7. Pulp-dentinal reactions visible Rx

Neodentinogenesis Hypermineralisation Pulp calcification/

neodentinogenesis

Hypermineralisation/

neodentinogenesis

6 6 10 2

Table 8. Pulp-dentinal reactions visible Rx (% teeth with dental caries)

Neodentinogenesis Hypermineralisation Pulp calcification/

neodentinogenesis


neodentinogenesis

2,7% 2,7% 4,5% 0,9%



37

On radiographic images were detected

2,7% neodentinogenesis reactions, 2,7%

dentinal hypermineralisation reactions,

4,5% cases with difuse pulp calcification

associated with neodentinogenesis and

0,9% cases of dentinal hypermineralisation

associated with neodentinogenesis. Both

neodentinogenesis and dentinal

hypermineralisation were more frequent in

males patients group. There were no

significant differences in frequency of

diverse form of pulp-dentinal reactions

related to age group. Advanced

neodentinogenesis and pulp calcifications

were associated more frequent with

maxillary molars and dentinal

hypermineralisation was associated more

frequent with mandibular molars.

Table 9. Pulp-dentinal reactions visible Rx (% teeth with P-D reaction)

Neodentinogenesis Hypermineralisation Difuse pulp

calcification/

neodentinogenesis


neodentinogenesis

25% 25% 41,66% 8,33%

Table 10. Pulp-dentinal reactions visible Rx (%teeth with dental caries/sex)

Males Females

Neodentinogenesis HMZ Pulp

calcification/

Neodentinog


calcification/

Neodentinog

9,5% 6,3% 4,2% 7,1% 1,6% 4,8%


(% total number of teeth with dental caries/age group)

Age 15-25 Age 26-35


calcification/

Neodentinog


calcification/

Neodentinog

7,9% 3,6% 4,2% 8,6% 3,4% 5,1%


(% teeth with dental caries/dental group)


Ng. HMZ Calc. Ng. HMZ Calc. Ng HMZ Calc. Ng. HMZ Calc.

0% 0% 0% 0% 0% % 11,3

%

0,95

%

8,4% 6,75

%

7,85% 1,1%


(% teeth with chronic dental caries, acute dental caries)

Chronic dental caries Acute dental caries


calcification/

Neodentinog


calcification/

Neodentinog

11,3% 5,3% 6,2% 0% 0% 0%



38


(% teeth with dental caries/radiographic indices)

OCL/E3 OCL/E4 OCL/E5 P-OCL/D3 P-OCL/D4 P-OCL/D5

N H

M

Z

C N H

M

Z

C N H

M

Z

C N H

M

Z

C N H

M

Z

C N H

M

Z

C

0

%

0

%

0

%

3

%

0

%

3,1

%

16

%

18

%

6,8

%

0

%

0

%

0

%

0

%

0

%

0

%

8,8

%

0

%

7,6

%

On radiographic images were

detected 2,7% neodentinogenesis

reactions, 2,7% dentinal

hypermineralisation reactions, 4,5% cases

with difuse pulp calcification associated

with neodentinogenesis and 0,9% cases of

dentinal hypermineralisation associated

with neodentinogenesis. Both

neodentinogenesis and dentinal

hypermineralisation were more frequent in

males patients group. There were no

significant differences in frequency of

diverse form of pulp-dentinal reactions

related to age group. Advanced

neodentinogenesis and pulp calcifications

were associated more frequent with

maxillary molars and dentinal

hypermineralisation was associated more

frequent with mandibular molars. Related

to radiographic indices, advanced

deposition of tertiary dentine and dentinal

hypemineralisation were associated with

carious teeth with E5 radiographic indices

while pulp calcification was associated

with carious teeth with D5 radiographic

indices.

Fig.1. Dentinal hypermineralisation in Fig.2. Neodentinogenesis in deep

deep chronic carious lesion (4.6.) occlusal and proximal caries (1.8., 1.7.,4.7.)

DISCUSSIONS

Pulp-dentinal reactions visible on

radiographs are based on a series of

enzymatic and chemical reactions that take

place in pulp-dentinal complex.

Bjorndal&Darvann (1999) demonstrate the

implication of odontoblastic cells and non-

odontoblastic cells in tertiary

neodentinogenesis processes (2). Farges

JC.&col. (1993) demonstrate the

acceleration of colagen synthesis and

increase of alcaline phosphatase activity



39

before the initiation of reparatory dentin

formation (4). Pulp cells stimulation

following carious acid attack conducts to

fibrodentine formation. All these processes

are regulated by a series of organic

molecules (glicoproteins, proteoglicans,

growth factors) released from dentinal

tissues. Smith AJ&col.(1999) considers

that TGF factors released from dentinal

matrix play the principal role in

neodentinogenesis initiation (9). In deep

chronic dental caries, bacteries and their

toxins increase synthesis of MMP-1 and

MMP-2 by pulp cells, enzymes with role

in defensive pulp reactions modulation

(Nakata, 2000; Chang, 2001) (3,7).

Tjaderhane L.&col. (2001) demonstrate

role of odontoblasts in matrix

metalloproteinases synthesis (10). Most

teeth with lent-progressive dental caries

present defensive reactions but most pulp-

dental reactions are represented by

formation of sclerotic dentin and limited

neodentinogenesis visible on radiographs

as pulp horn retraction. A small number of

teeth present extremely advanced

defensive pulp-dental reactions visible on

radiographs as dentinal

hypermineralisation, advanced retraction

of pulp room, difuse pulp calcification. In

these teeth, studies demonstrate high

activity of alkaline phosphatase (Spoto

2001) (8).

CONCLUSIONS

Age, localization, depth and evolution

pattern of dental caries can be correlated

with the presence of specific forms of

pulp-dentinal reactions.

REFERENCES 1. Andrian S. , Lăcătuşu St. –Caria dentară.Protocoale şi tehnici –Ed.Apollonia –Iaşi 1999

2. Bjorndal L., Darvann T.-A light microscopic study of odontoblastic and non odontoblastic cells involved

in tertiary neodentinogenesis in well defined cavitated carious lesions. Caries research nr.33:50-60,

1999

3. Chang YC, Yang SF, Hsieh YS. Regulation of matrix metalloproteinase-2 production by cytochines and

pharmarcological agents in human pulp cell cultures. JEndod 2001; 27;679-682.

4. Farges JC, Joffre A, Magloire H. Response of odontoblastic and pulpal cells to carious lesions. C R

Seances Soc Biol Fil. 1993;187(5):582-95

5. Iovan Gianina. Diagnosis and Management of Patients with High Caries Activity. Edit.Apollonia, Iaşi.

2002

6. Lăcătuşu St. Caria dentară. Problemele mineralizării. Edit.Junimea 1998

7. Nakata K, Yamasaki M, Iwata T, Suzuki K, Nakane A, Nakamura H. Anaerobic bacterial extracts

influence production of matrix metalloproteinases and their inhibitors by human dental pulp cells. J

Endod 2000; 26; 410-413.

8. Spoto G.Alkaline phosphotase activity in normal and inflamed dental pulps. J.Endod. 2001:3:180-182

9. Smith AJ., Mouhews JB., Smith AJ. TGF-expression in human odontoblasts and pulpal cell. His and

Chem. J. 1999

10. Tjaderhane L, Palosaari H, Wahlgren J, Larmas M, Sorsa T, Salo T. Human odontoblast culture method:

the expression of collagen and matrix metalloproteinases (MMP). Adv Dent Res 2001; 15; 55-58.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Farges%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Joffre%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Magloire%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus



40

CORRELATIONS BETWEEN OCCLUSION PRESURE AND MUSCLE

ACTIVITY WITH K7 SYSTEM Alina Apostu, Corina Cristescu

Faculty of Dental Medicine,

University of Medicine and Pharmacy „Gr.T. Popa” Iasi

Abstract: trying to measure the occlusal pressure always represented a challenge for researchers, the methods

used were various from simple to complex ones. It is very important to be able to appreciate the forces born at

the occlusal level through both diagnose and treatment point of view, knowing that every dental treatment

(filling till complex rehabilitation) needs excessive attention in occlusion relationship reconstruction.

This was the main purpose of our study concerning forces developed in occlusion and their distribution. The

utility of research is evident in occlusion rebalancing treatment.

Key words: occlusion pressure, evidence based dentistry, K7 system

INTRODUCTION A correct maintained or rehabilitated

occlusion needs more than multiple, stable,

uniformly distributed static and dynamic

contacts, it also needs a harmonious and

symmetrical transmission of forces

produced by mandible muscles.

This was the starting point for our

study concerning the pressure born at the

occlusal level, and their distribution to the

dental level; the utility of our research earn

in the possibility of obtaining a perfect

occlusion equilibration, based on scientific

evidences.

MATHERIAL AND METHOD

The present study was based on a lot

of 34 patients with ages between 22 and 27

years old, 19 male and 15 female, with

complete dental arches or unidental

edentulism, stable occlusion (more than

100 centric stops), static and dynamic

fundamental relationships with clinical

correct parameters.

They were examined first clinically

insisting on static and dynamic occlusion

relationship: static occlusion parameters,

static inter arch relationship, terminal

occlusion and dynamic occlusion

(protrusion, laterality movements, active

and inactive parts, test movements and

positions), occlusion charts, then

complementarily with K7 system in the

Implantlogy Gnathology Esthetics Clinic,

University of Medicine and Pharmacy Iasi.

We used a part of K7 system

facilities as electromyography of master

and temporal muscles.

The patients were prepared, their skin

was degreased with alcohol and dried,

after hat we placed the surface electrodes

at the muscle level, we connected them to

the system and we set the registration

characteristics.

K7 system

We chose from the multiple

possibilities offered by system the

programmes Scan 9, Scan 11 and Scan 12,

first offering the possibility of checking



41

the rest position, the two others referring

directly to the muscle contraction force

which lead to dental contacts.

For Scan 9 program we ask the patient

to stay in rest position, the research crew

assuring the proper medium for the test, it

was set in the computer the needed option

and we registered the muscle for 15

seconds. The resulted values must be close

to zero (isoelectric line). We chose from

all the lot only the patients considered to

have a normal rest position (comparing

clinical exam results with EMG values).

Scan 9

The number of patients considered

able to respect including criteria was 31,

they were further investigated with Scan

11 and Scan 12, specific programs for our

study.

Scan 11 is a special created program

to measure the maximal force produced by

muscles in a forced byte with or without

an aliment between arches. As registration

protocol we asked the patients to byte hard

for 2 seconds, to relax 1 second and after

that to repeat the exercise. In a second

stage we asked the patients to byte hard on

cotton rolls placed bilaterally after the

anterior protocol.

Practically with this program we

registered the “maximal” muscle

contraction amplitude at the maseter and

temporal muscles level. It was permitted a

qualitative and quantitative analysis of

muscles contraction. Quantitative we

measured the amplitude of contraction in

mV, and qualitative we could compare the

symmetry of contractions.

Scan 11

Scan 12 is program which permit the

visualization of muscle contraction, the

order and symmetry of contractions, with

the possibility to investigate the first dental

contact.

We asked the patient to go from rest

position to maximal intercuspal position. It

is the terminal occlusion trajectory and the

contacts obtained, a evidence based

investigation of terminal occlusion, with

the possibility to detect premature

contacts.



42

Scan 12

RESULTS AND DISCUTIONS: We

wanted to investigate the amplitude of

muscle contraction in patients with natural

occlusion, effort (maximal intercuspal

occlusion), and the postural terminal

occlusion. Although all patients were

clinically accepted to the lot considered

healthy we tried to establish the amplitude

of muscle contraction, the symmetry of

trajectories, terminal occlusion contacts,

their distribution. It is known that the

presence of only one premature contact

can lead to great changes in muscle

activity from simple to complicated. The

prolonged muscle contractions due to the

bad dental contacts can lead to spasm and

muscle pain. Stomatognat system always

tries to rebalance the situation from two

mechanisms: bruxism for “self-grinding”

of teeth or to detour the obstacle with the

modification of the natural mandible

dynamic pathways, with reduced or great

consequences for the systemic

homeostasis.

That was the reason for our study, to

investigate the postural terminal occlusion

with modern techniques, which can offer

more precision than clinical exam. To

locate precisely a premature contact is

sometimes a real challenge even for the

most experimented dentist, program and

system K7 can offer a very exact occlusion

chart.

Also an instable occlusion represents

an etiological factor of dysfunctional

syndrome, the rapidity of clinical signs

appearance depending only by individual

adaptation capacity of each human

organism.

We made tables with values registered

to all patients, and the results were

astonishing. So in natural occlusion

(maximal intercuspal for 2 seconds) the

values were between 12 and 68 µV, and

for effort occlusion the values were 14 till

139 µV.

The significant difference between the

extreme registered values suggests the

individuality of each stomatognat system

which dictate the self mandible dynamics

and functions, specific and non specific

homeostasis, the self protection are the

main factors which dictate the intensity of

muscle contractions. The increased values

with percentages between 70 and 400% of

contraction amplitude in effort occlusion

are logical and show the necessity of

bigger forces in order to beat the aliment

resistance in the mastication process.

There were 4 cases in which the

registered values in effort occlusion were

almost the same with the ones registered in

normal occlusion, but we found out that



43

the patients had first mandible molars

missing bilaterally and one of them with

Class II Angle malocclusion. Rest of the

lot had increased values of amplitude of

the muscle contraction in effort occlusion.

A much profound analysis could be

the overlapping of EMG pathways when

we repeat the registrations, the symmetry

of diagrams suggesting a muscle activity

in normal parameters and its absence a

muscle dysfunction, with or without direct

correlation with normal occlusion.

The qualitative analysis of

registrations we observed that there isn’t

perfect symmetry, baut the values are very

closed and sometimes identical. Muscle

contraction knows trigger, organization,

modulation and rhythm leaded so

complexly that it is almost impossibly to

pretend a perfect symmetry of dynamic

pathways. In stomatognat system

dysfunction the values would be chaotic

and the images totally different, if in

healthy group there were found such

differences.

The next step of our study was based

on the research of muscles contraction in

terminal occlusion and the tracking of the

first dental contacts with the program Scan

12. We could appreciate the symmetry and

amplitude of muscles contraction in

postural terminal occlusion, and the

specific place where they are produced.

The program has all that facilities making

easier the dentist work when he make

dental chart.

On the registered diagrams on the

computer display appear the values of the

muscles contraction amplitude at the

maseter and temporal level. Under the

columns which materialize the amplitude

of contraction there are written the

differences left-right in percentages. The

producer considers that for values fewer

than 25% muscle can be considered with

the same degree of contraction high or

low. Percentages greater than 25 %

suggest that the contraction on left and

right side are in different records.

Following the charts displayed we could



44

establish the dental contacts first produced.

From all the lot 73% of patients presented

the following pattern:

This pattern of postural terminal

occlusion corresponds to patients with

stable and uniform distributed dental

contacts.

In lower proportion, 21%, the primary

contacts are in the anterior zone of dental

arches.

There were some cases (6%) when

first contact was placed at different levels

as premolar, molar, on one or two teeth, as

we can see in below graphics. This

contacts were lost at clinical analysis of

occlusion in the context of lack of other

dysfunctional signs or symptoms. They

correspond to the subjects with missing

teeth or malocclusion.

The present study it is considered the

first step in an ample research in which

after base conclusions about a clinically

healthy considered lot, it will be analyze

patients with dysfunctions making

comparison between groups.

CONCLUSIONS

1. Third millennium bring with it a

modern, an evidence based medicine, with

solid, holistic principles, in which the

individuality and in the same time

globality can be magistral demonstrated.

2. There are in dentistry near the sharp eye

of clinician a set of complementary exams

which can register muscle activity and

occlusion: T-Scan, EMG, K7 system

3. K7 analysis is not made as routine

exam, it assume special trained personal

and big costs, that’s why it is indicated in

patients with debut or manifest

stomatognat system dyshomeostasis,

4. There isn’t perfect symmetry in muscle

contraction in natural or effort occlusion,

the differences being lower than 20 %.

5. There is a high percentage (12%) of

preclinical dys-homeostasis at apparently

healthy subjects as result of bad

distribution of dental contacts.

6. There is a significant difference

between muscle contraction amplitude in

male and female category (15%), in male’s

favor.

7. The stomatognat system has a great

adaptability degree.

8. The patients with single missing teeth

had lower amplitude in muscle



45

contraction, they practically protected

marginal periodontium from exaggerated

pressure.

9. The values of amplitude of forces in

mastication process are obviously greater

than normal occlusion with 70% till 400%.

REFERENCES 1. Gnatologie, Vasile Burlui, Catalina Morarasu, Ed. Apollonia, Iasi 2000

2. Abekura H, Kotonih, Hamadat – Asymmetry of masticatory muscle activity during intracuspal

maximalclenching in healthy subjects and subjects with stomatognatic dysfunction syndrome, 1995

3. Aparatul dento maxilar, Ed. Helicom, Timisoara, 1997



46

STUDY OF THE IMPACT OF TECHNOLOGICAL PROCESS ON

THE SURFACE ROUGNESS OF DENTAL ALLOYS Ruxandra Voinea, Roxana Constantinescu, Maria Ursache

Abstract:

Introduction. The materials used in restorative therapy are often involved in the induction of oral pathologies as

singular factors in the mechanical effects of direct trauma of the periodontal structures or cytotoxic effect of its

components, but more often by surface appearance.

The aim of the study is to evaluate surface qualities of restorative material influenced by the technological

processing.

Material and method. Have been studied microscopic surface qualities of the 4 types of metal alloys available

on the market, from which the samples were made, what were subjected to processing and polishing with

abrasive material on a textile, grain with variable results to study. Metallographic microscope indicates

improving surface quality after each stage of processing and polishing, the final preservation of defects,

attributed to the structural heterogeneity from filling microparticles with temper differently for each structural

component.

Conclusions. A polishing and finishing of the restorative material is often difficult, leading to the emergence of

retention areas, more or less irregular, which would influence the mechanical and biological qualities of the

alloy.

INTRODUCTION In the last decade, the increasing

interest of practitioners for the surface of

restorative materials, was growing,

seeking solutions, so that bacterial

accumulation to be as low or even absent

[1].

Importance of dental alloys in the

study and submit for the introduction of

technologies that do not affect in particular

the primary structure of alloys and surface

quality of their. Or the quality of resistance

over time in relation to applications

against chemical agents or biological

environmental orally with highly corrosive

action are influenced on one hand the

quality of structural material, on the other

hand, technology processing them [2].

There are many methods of processing and

polishing of the restorations, whether used

in the oral cavity or in the laboratory, but

none offers maximum efficiency, having

regard to the anatomy of the tooth,

subgingivale sites less accessible, but also

the variety of restorative procedures.

Changes resulting in their mass, the

processing technology, or in superficial

layers or in the deep, negatively influences

the mechanical strength and surface

characteristics that impact particularly on

tissues neighborhood, through direct or

indirect effect.

In recent years, was introduced on the

market a wide variety of materials, hence

the need for knowledge and study of

physical-mechanical properties and the

mechanisms involved in the periodontal

pathology.

THE AIM OF THE STUDY

The study was focused on the

microscopic evaluation of surface qualities

of dental alloys in terms of processing and

finishing used.

MATERIAL AND METHOD

To assess the impact of technological

processing on the final state of the surface

roughness of materials used in restorative

therapy, have been studied 4 types of

metal alloys available on the market, used

in Prosthetic restorations: alloy-based Au,

alloy-based of Pd-Ag (Palliag), Cr-Ni

(Vera Soft) and alloy-based Cu -NPG

(USA).The research on quality assessment

of microscopic surface materials tested



47

were performed in the Laboratory of

metallographic analysis of SC MITTAL

STEEL IASI S.A. Has been made alloy

samples with dimensions corresponding to

microscopic analysis, at different stages of

production which were included in a

holder with Epoxi resin (Fig.1). Samples

of metal alloys were subjected to quality

analysis of surface using NEOPHOT

Metallographic microscope 21, designed

for the study in light reflected (Fig.2).

Fig.1

Fig.2

Superficial layer of the microstructure

of samples was analyzed by eye of the

microscope and by projection on a

particular screen (with Fresnel lens) and

photographed by automated system.

Processing and finishing was done with

abrasive paper discs with medium, fine

and ultrafine granulations attached to

rotating media (Fig.3). Optical microscope

image (MO) for each material was

analyzed according to the abrasive

granulations (Fig.4) used as follows:

a- prior to processing

b-400X MO image to 80 x grain

c- 400X MO image to 120 x grain

d- 400X MO image to 240 x grain

e- 400X MO image to 600 x grain

f- 400X MO image to 800 x grain

g- 400X MO image to 1000 x grain

h- 400X MO Image after finishing diamond paste (0.25 ц) on a textile support

Fig.3 Fig.4

100 µm



48

RESULTS

The finishing procedures determine

some aspects of variables depending on

the material investigated and the technique

used. Finishing and polishing of

restorative materials is an important stage

of the therapeutic process, whether it is

done directly in the oral cavity, or that is

done in the laboratory.

Metallographic microscopic

examination reveals the defects of the

surface material in the form of porosity

that could be a risk factor in the

periodontal pathology, and open areas of

corrosion in the oral environment.

When examining the gold alloy is

observed that the strength and density does

not allow to obtain a perfectly polished

surfaces, regardless of method or material

used for this purpose even with diamond

paste on a textile support and granulations

0.25 μ, which we would suggest that the

surface texture obtained after processing

and finishing should still be accessible for

bacterial accumulation in conditions of

poor hygiene in the oral cavity (Fig. 5).

a b c

d e f

g h

Fig.5.

Due structural heterogeneity caused

by filling micro particle, presenting a

different temper of each component, it is

impossible to obtain a mirror sheen, with

preservation of surface defects, which

influences the final quality of both surface

alloys of gold and the other alloys tested

Palliag(Fig.6).



49

a b c d

e f g h

In the case of alloys based on Pd-Ag,

to the situation (a) after polishing can find

important surface irregularities caused by

the abrasive material with large

granulations (80, 120, 240) for later in

other parts disappear gradually defects, but

not disappear entirely some structural

defects (Fig. 6h). And in the case of

nenobile alloys by lack of homogeneity

NPG alloy, occurring surface defects with

some highlighting of important scratch,

what cannot be completely removed by

polishing and finishing (Fig. 7, Fig. 8).

Although final processing using abrasive

paste and textures with very fine

granulations continues to persist in some

areas the characteristic appearance of the

“earth scratch” which crosses the surface

on large areas.

Final image shows an improvement in

the surface roughness with an appearance

more typical slick but with impregnation

particles from the abrasive material,

images found in some studies in the

literature [3]. Microscopic image obtained

from samples of alloys based on Cr-Ni,

after processing in various stages of use

abrasive materials with the decreasing

granulation size shows a progressive

reduction of surface defects that resulted

from the casting process, the impossibility

of removing all them, as justified by the

increased hardness of the material (Fig. 9).

Fig.7 Fig.8



50

DISCUSSION

Fig.9

Surface qualities rated from

microscopic studies show a variability of

images that can be influenced not only by

the material itself but also by its structural

components, the casting process and in

part on the final processing. Few or no

weaknesses in technology have occurred

during casting of the alloy, as those that

occur during processing and polishing

leaves microscopic surface defects noticed

in the form of depressions, holes, cracks,

scratch or protuberance which may be

ecological niches for bacterial flora while

mechanical factors may be local irritation

of the gingival tissues (microlesions) and

points to irreversible macroscopic changes

(corrosion). Superficial defects (pores,

cracks, holes,) encountered in metal alloys

may form in the oral environment areas of

differential, organic retention and reduced

salivary flow, especially when are placed

subgingival making the electrochemical

potential of these areas to differ from the

rest of the prosthetic surface, fact which

generates some galvanic micropile, with

the installation of electrochemical

corrosion [4.5] and fostering a vicious

circle with a role in the initiation,

maintenance or worsening of periodontal

conditions. A gold alloy, with increased

environmental and noble metal, has a fine

crystalline structure and limits the grain

with very low foreign inclusions to explain

resistance while surface corrosion.

Conversely, alloys based on Cu,

containing a small amount of elements for

protection against corrosion, will produce

original gloss surface but degrades over

time in the oral environment, especially in

poor areas.

Microscopic analysis indicates that the

surfaces of materials subjected to various

methods of polishing, there are differences

that should be forever linked with the

composition of materials.

CONCLUSIONS The appearance of the area is one of the

peculiarities to be taken into consideration

the purpose of any restorative treatment

for sustainability in the oral environment.

Trends to remove some alloys in dental

practice is justified by the results of the

studies on surface qualities, which might

influence the biological and mechanical

qualities of the

A polishing and finishing of the restorative

material is sometimes difficult, because

the component is not wear in the same

extent, leading to the emergence of land

more or less irregular.

It is very important for achieving a perfect

polishing and finishing with obtaining the

so called "mirror shine, not just to

influence the behavior of restorative

materials in the oral cavity and negative

influences that you may have.



51

REFERENCES 1. Marsh PD. Plaque as a biofilm: pharmacological principles of drug delivery and action in the sub and

supragingival environment. Oral Diseases 2003; 9(s1): 16-22.

2. Jefferies SR. The art and science of abrasive finishing and polishing in restorative dentistry. Dent Clin N

Am 1998;42:613-627.

3. Bollen CM, Lambrechts P, Quirynen M.-Comparison of surface roughness of oral hard materials to the

threshold surface roughness for bacterial plaque retention: a review of the literature.: Dent Mater. 1997

Jul;13(4):258-69.

4. Pătraşcu I. Materiale dentare, Ed Horanda Press, Bucureşti, 2002, 7-40 şi 143-203.

5. Lacefield W.R.,Lucas L.C.,Wendt S.L. et al. Microstructure and mechanical characteristics of cooper-

aluminium alloys. J Dent. Res, 1989,, 68, 303-306.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&term=%22Lambrechts+P%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&term=%22Quirynen+M%22%5BAuthor%5D



52

THE DEVELOPMENT OF CORTICAL BONE LEVEL DURING THE

PLACEMENT OF DENTAL IMPLANTS IN TWO SURGICAL STAGES

WITHOUT MUCOPERIOSTEAL FLAPS Valentin Topalo, Oleg Dobrovolschi, Dumitru Sîrbu, Nicolae Chele, Fahim Atamni

State University of Medicine and Pharmacy “Nicolae Testemiţanu”

Department of Orthopedic Dentistry, Oro-maxillo-facial Surgery and Oral

Implantology

Abstract: The present study has been carried out for a comparative assessment of periimplantory cortical bone

level changes during the osteointegration of the dental endosseous implants placed according to the standard

method and of those placed without mucoperiosteal flaps. The study included 98 persons. The comparative

study showed that the resorption level of the periimplantory cortical bone at implants placement according to the

suggested method is veridically less (p < 0,001). The mucoperiosteal flaps cause the bone resorption of the

periimplantory bone. This phenomenon can be prevented or reduced by flapless implants placement.

Key words: Implant, flap, bone resorption.

Obtainance and maintainance of

implants osteointegration, as well as

„preservation”of the periimplanted bone

have a major importance in the social and

anatomo-functional rehabilitation of

people with different edentations through

implant based dentures. [21, 29].

Loss of bone is the main factor which

leads to implant failure. There are

[2,15,31] two varities of periimplantory

bone loss: first - early loss of bone which

includes the phase of recovery

(osteointegration) and phase of

„accomodation” of the adjacent bone

during the first year of implant loading (its

activation) and the second – late loss of the

bone which takes place during the next

years of implant functioning.

Loss of periimplantory bone while

using Brånemark system, was for the first

time described in 1981 by Adell and

colleagues [1]. It was shown in this study

that early loss of bone varies between o

and 3mm. In their research studies it was

reported that during the first year of

implant loading (system Brånemark too)

the bone loss is in average 0.93mm, with a

variation between 0.4 and 1.6mm, but it

continues annually by 0.1mm [25]. Further

researches have proved that early loss of

crestal bone is radiographically revealed

around any type of implants [12, 23, 33].

Esposito M. And colleagues [15] have

mentioned that both aetiology and

pathogenesis of early failures of dental

implants are insufficiently studied.

Moreover, the directions of research of this

problem are not specified. It was assumed

[7,19] that more factors can cause early

loss of the periimplantory bone at the

alveolar ridge such as: excessive surgical

trauma during implant placement,

mucoperiosteal flaps, microfissure position

abutment – implant body, abutment micro-

movements, bacterial invasion, delay of

recovery, early implants loading,

biological incompatibility. Knowledge and

removal of the harmful action of the

factors that cause loss of the

periimplantory crestal bone and early



53

failure of the implants is the way to

enhance the success rate of the implants

and good functioning of the dentures

which rely on them [21].

Surgical trauma is considered to be

one of the main aetiological factors at the

initial phase of early loss of the

periimplantory crestal bone [5,15,33].

Nowadays in the oral implantology in

the majority of countries placement of

dental implants in two surgical stages with

mucoperiosteal flaps lifting is considered

to be a standard one. Besides its positive

aspects, the standard method is aggressive

by both its excessive trauma and its

subsequent consequences. Some days after

implant placement a post-operatory edema

of the adjacent soft tissues develops along

with haematoma, painful syndrome. The

patients become anxious and subsequently

they can not exercise their regular

functions, etc. [16,17]. To avoid the

mentioned above drawbacks of the

standard method there were proposed

some techniques of flapless implant

placement (flapless surgery), which imply

emphasizing the alveolar ridge apophysis

on a limited sector through excision of a

gum circle with a circular knife [8, 24],

through creation of a small semilunar flap

[27], and mini-incisions [16] or through

penetration of the gum with the drills of

the respective system of implants. The

proposed procedures regarding flapless

implants placement are used to exclude the

second surgical stage and to perform the

implants loading immediately or early. But

at present the early or immediate implants

loading, regardless of the placement

method (with flap or flapless), is not

unanimously accepted. However the

conventional protocol is prioritized

[30,32]. The data published in the medical

literature [3,26,28], concerning the bone

loss (assessed radiographically) at the

alveolar ridge apophysis one year after the

loading of the placed flapless implants,

vary from 0.7mm up to 2.6mm. It should

be mentioned that in all these studies the

implants were immediately loaded.

Besides the impact on the periosteum , the

bone loss was also influenced by the

surgical trauma and early or immediate

implants loading.

One of the main questions present in

this study is: „Does elevation of the

mucoperiosteal flaps influence the degree

of loss of the periimplantory cortical

bone?”.

OBJECTIVE OF THE STUDY

To carry out a comparative evaluation

of the changes of the periimplantory

cortical bone level during osteointegration

of the dental endosseous implants placed

according to the standard method and the

mucoperiosteal flapless implants

placement but carried out in two surgical

stages.

MATERIAL AND METHODS

The study comprised 98 patients (21

men and 57 women) with different

edentations. The patients were divided into

2 groups. The first group (of reference)

comprised – 52 persons, who were placed

implants (79 on the mandible, 48 on the

maxilla) using the standard method,

namely flap surgery. The second group (of

study) comprised 46 patients whose fixed

gum had a breadth of more than 5mm.

Patients from the second group were



54

inserted flapless implants (58 on the

mandible, 51 on the maxilla), according to

the method elaborated by us [34]. The

implants were inserted in such a way that

their crown part was situated between the

bones: at the level of the cortical alveolar

apophysis or1-2 mm below it, similarly to

the reference group (Picture 1).

Pic.1. Patient K., 32 years old. Absence of tooth 36. Excerpt from OPG SFB implant (t. – 4.2; 1-

13mm) placed downward the cortical surface, in the anterior side by 0.22mm, in the posterior one –

by 0.26mm

The second surgical stage on the

mandible was carried out in 3-4 months,

on the maxilla in 5-6 months. In both

groups the implants platform was

uncovered through an excision with the

surgical circular knife. Gum circles which

covered them were done with laser or by

means of small mucoperiosteal flaps. The

level of the periimplantory marginal

cortical bone was visually evaluated

comparing it with the implant platform.

Evaluation of the level of the cortical bone

was determined through measurements on

OPG carried out by means of the

electronic callipers. Changes during the

recovery phase in patients from both

groups, on both anterior and posterior

sides of the implant were assessed through

the difference between the distance from

the implant apex up to the alveolar ridge

determined on OPG1 immediately after

the surgery and on OPG2 carried out

before their denudation. While assessing

the real dimensions during each

measurement, it was taken into

consideration the error which had occured

on OPG studied before.

To reveal the eventual influence of the

lift of mucoperiosteal flaps on the level of

the periimplantory cortical bone there was

carried out a comparative study (T – test

Student) between the values of bone

resorption from the reference group and

study group.

RESULTS

At the second stage, after uncovering

the macroscopic implants, it was stated

radiographically on OPG2 that

periimplantory cortical bone, did not



55

undergo any changes around some

implants. It was on the post-insertional

level. Around others it had marked signs

of resorption, while in other cases it

covered them partially or completely.

Implants with platform covered by bone

were noticed only in patients from the

study group, in 18 (35,2%) cases on the

maxilla and in 11 (18,9%) on the

mandible. The bone was removed through

milling and scraping with a curette so that

the implant platform was uncovered

(Picture 2.a,b)

A. B.

Picture 2. Patient I-va, 45 years old. Six months after the flapless ADIN implant placement (

t.– 4,2; l – 13mm). A. Condition after excision of the gum circle and partial removal of the

bone; it is visible the overlaping screw covered with newly formed bone. B. Removal of the

overlaping screw.

Changes of the level of the

periimplantory cortical bone (the degree of

resorption and apposition) have been

detailed studied comparing the indices

from OPG1 with the indices from OPG2

(Picture 3.a,b).

A. B.

Pic.3 Excerpts from the radiogram of patient R.:

A. Excerpts from OPG1 – implant on the level of t.45 placed subcortically – in the anterior

side by 0.14, in the posterior one - by 0.04mm. Implant at t.45 placed subcortically – in the

anterior side by 0.02, in the posterior one – by 0.06mm.

B. Excerpts from OPG2 – bone apposition at the alveolar ridge: at implant 45 – anterior

0.08. posterior – 0.12mm; at implant 46 – anterior – 0,2, posterior – 0.04mm.



56

The mandible measurements on OPG

proved that the level of resorption of the

periimplantory cortical bone in the

reference group is more frequently

revealed. It is more marked and it varies

between 0.00 and – 2.83mm. In the

anterior side of the implants, in average it

is - 0,75 ± 0,09, in the posterior one - -0,59

± 0,09.

In the study group, the changes at the

level of the periimplantory cortical bone,

were varied too – between +0.81

(apposition) and – 1.39(resorption). In the

anterior side of the implants the average of

the level of resorption was - 0,22 ± 0,08

mm, in the posterior - -0,14 ± 0,07mm.

The values of the level of resorption of the

periimplantory cortical bone on the

mandible in the both groups are

represented in tabel 1.

The comparative study (t-Student) has

proved that the level of resorption of the


mandible, in case of implants placement

according to the method proposed by us,

is veridically less (P < 0,001).

On maxilla, measurements on OPG

had proved that in the period of

osteointegration the resorption of the

periimplantory cortical bone in the

reference group is more frequently

recorded and it is more marked and it

varies between 0,00 and – 3.42mm. In the

anterior side of the implants it is in

average -0,72 ± 0,18, in the posterior one

it is -0,83 ± 0,17mm.

In the study group, modifications at

the level of the periimplantory cortical

bone were varied too-between +1,80

(apposition) and – 1,55 (resorption). In the

anterior side of the implants the mean of

resorption is - -0,10 ± 0,08mm, in the

posterior - -0,14 ± 0,10mm. The values of

resorption of the periimplantory cortical

bone on the maxilla in both groups are

represented in tabel 2.

Implants placed according to the

standard method

Flapless implants placement

Anterior

position

Posterior position Anterior

position

Posterior position

Average (A) - 0,75 -0,59 -0,22 -014

Standard

deviation 0,84 0,77 0,63 0,50

Standard error

(m) 0,09 0,09 0,08 0,07

Tabel 1. Values of the level of resorption of the periimplantory cortical bone on the mandible,

prior to carrying out the second surgical stage



57

Implants placed according to the

standard method

Flapless implants placement

Anterior position Posterior position Anterior position Posterior position

Average (A) -0,72 -0,83 -0,10 -0,14

Standard

deviation 1,22 1,17 0,55 0,72

Standard error

(m) 0,18 0,17 0,08 0,10

Tabel 2. Values of the level of resorption of the periimplantory cortical bone on the maxilla,

prior to carrying out the second surgical stage

The comparative study has proved that

the degree of resorption of the


maxilla, in case of implant placement

according to the method proposed by us is

veridically less (P < 0,001).

DISCUSSIONS

Analysis of the obtained results has

proved that on both mandible and maxilla,

in the reference group, the level of


bone, compared with that recorded in the

study group, is for certain (p < 0,001)

more marked. The resorption of the

periimplantory cortical bone in the period

of recovery was studied by many authors.

Ericsson I. and colleagues [14], while

placing implants on the mandible

according to the standard method, have

proved the degree of resorption of the

cortical bone in the period of recovery to

be in average 1,3mm. Similar results are

described by other scientists [8,16,20].

Some authors consider the bone loss to be

accounted for the bacterial colonization of

the space from the implant body. In our

study, while placing the implants on the

mandible according to the standard method

(reference group) the degree of the bone

resorption in the anterior side was -0,75 ±

0,09, in the posterior one -0,59 ±

0,09mm. This level was even more

reduced in the study group, being

respectively, -0,22 ± 0,08 and -

0,14±0,07.

When Drouhet G. and Missika P. [13]

uncovered implants (the second stage) in

the posterior sector of the superior maxilla,

which had been placed according to the

standard method they revealed a level of

bone resorption around the implants neck

in average 1,85mm. Comparing these data

with the data obtained by us, we stated that


bone on the maxilla was much more

reduced in the reference group: in the

anterior side - -0,72 ± 0,18; and -

0,83±0,17mm in the posterior side. This

level was more reduced in the study group,

it being - 0,10 ± 0,8 and -0,14 ± 0,10mm.

This aspect has a major importance when

elevation of the floor of the maxillary

sinus is carried out through crestal ridge,

by simultaneous placement of the

implants. In case of significant resorption

in the phase of recovery of the residual

subantral bone, the success of implant

placement is doubtful [35]. The

comparison of the data obtained by us with

those described in the medical literature is

quite relative, because the methods of

measurement of the degree of resorption

are different.



58

Carter D. and Giori N. [10] consider

that in the period of recovery one of the

main factors in the initiation and

maintainance of differentiation of the

mesenchymal cells on the osteogenic way

which is important for the implants

osteointegration, is saturation of the bone

tissue with oxigen. This process is

dependent on its vascularization.

Numerous researches [4,18] have proved

that bloodstream in the maxillae with

integral dental arches is centrifugal.

The endosseous vascular net and the

periodontal plexus are dependent on the

presence of teeth and their functioning.

When the teeth are present, the

intraosseous vascular net anastomozes

with the intra-alveolar arteries and the

periodontal plexus. In their turn the intra-

alveolar arteries and the periodontal plexus

anastomoze with the periosteal plexus,

which is joined with the vessels from the

soft perimaxillary tissues. When teeth loss

takes place, the periodontal plexus and the

dental apical arteries get obliterated.

subsequently an abnormal blood

circulation (centripetal) occurs, that is the

arterial blood flow runs from the periosteal

plexus inside the bone [9, 18].

Summarizing all the above

mentioned, we can conclude that in this

situation the role of the periosteal vascular

plexus in the regeneration of the bone

wounds, especially on the cortical bone, in

the edentulous sectors, obviously

increases.

Thus, we can suppose that elevation of

the mucoperiosteal flaps disturbs for a

while the bone vascularization, mainly of

the cortical one. This gives rise to (along

with other factors) its resorption.

This hypothesis is supported by the

studies concerning the role of the

periosteum in the vascularization of the

maxillae. It has been proved that maxillae

get over 70% of nourishment from the

periosteum [11]. Nosaka Y. And

colleagues [22] have proved that the

periosteum trauma, mainly on the maxilla,

causes an obvious resorption of the

cortical bone.

As it had been mentioned before, in

the study group, 18.9% of implants on the

mandible and 35,2% of those on the

maxilla were partially or completely

covered with bone. This situation was not

recorded in the reference group. This

phenomenon can be explained by the fact

that vascularization of the periimplantory

cortical bone is not disturbed (or it is less

disturbed) and the conditions of its

regeneration are more favorable, compared

with those noticed in the reference group.

CONCLUSIONS

We can conclude that the technique of

the mucoperiosteal flaps contributes to the


bone. This phenomenon can be prevented

or reduced by the implants placement

using flapless surgical techniques.

At the same time, we have to mention

that the proposed tehnique of flapless

placement (transgingival) of the dental

endosseous implants is difficult and can be

used by experienced doctors in the oral

implantology. A compulsory condition of

this method use is presence of a fixed gum

not less than 5 mm in breadth.



59

REFERENCES 1. Adell R. et al. A 15-year study of osseointegrated implants in the treatment of the edentulous jav. In:

Int. J. Oral. Surg. 1981, nr. 10, p. 387-416.

2. Albrektsson T. et al. The long-term efficacy of currently used dental implants: A review and proposed

criteria of success. In: Int. J. Oral Maxillofac. Implants. 1986, nr. 1, p. 11-25.

3. Becker W. et al. Minimale invasive flapless implant surgery: a prospective multicenter study. In: Clin.

Implant Dent. Relat. Res. 2005, nr. 7, Suppl. 1, p. 21-27.

4. Bell W.H, Levy B.M. Revascularization and bone healing after anterior mandibular osteotomy. In: Int. J.

Oral Surg, 1970, nr. 28, p. 196-203.

5. Branemark P-i. et al. Intra-osseous anchorage of dental prostheses. In: Scand. J. Plast. Reconstr. Surg.

1969, nr. 3, p. 81-100.

6. Buser D. et al. Long-term evaluation of non-submerged ITI implants. Part 1:8-year life table analysis of a

prospective multi-center study with 2359 implants. In: Clin. Oral Implants Res. 1997, nr. 8, p. 161-172.

7. Canullo L. et al. Platform switching and marginal bone-level alterations: the results of a randomozed-

controlled concept. Clin. Orel Impl. Res. 2010,21,115-121.

8. Campelo L.D., Camara G.R. Flapless Implant Surgery: A 10–year Clinical Retrospective Analysis. Int. J.

Oral Maxillofac. Implants. 2002; 17:271-276.

9. Castelli W.A., Nasjleti C.E., Diaz-Perez R. Interruption of the arterial inferior alveolar flow and its effects

on mandibular collateral circulation and dental tissues. In: J. Dent. Res. 1975, nr. 54, p. 708-715.

10. Carter D.R., Giori N. J. Effect of mechanical stress on tissue differentiation in the bone implant bed. In:

Davies JE, ed. The bone-biomaterial interface. Toronto: University of Toronto Press, 1991, 367-369 p.

11. Chanavaz M. Anatomy an histophysiology of the periosteum: Quantification of the periosteal blood supplz

to the adjacent bone with 85 Sr and gamma spectrometry. In: J.Oral Implantol., 1995, nr. 21, p. 214-219.

12. Chung D. et al. Factors Affecting Late Implant Bone Loss: A Retrospective Analysis. In: Int. J. Oral

Maxillofac. Implants., 2007, nr. 22, p. 117-126.

13. Drouhet G, Missika P. Pose immédiate d,implant dans le maxillaire postérieur par élévation du plancher

sous-sinusien par abord crestal. Étude rétrospective sur 8 ans. In: Implant. Chirurgie-Prothèse. 2008, vol.

14, nr. 1, p. 17-34.

14. Ericsson I., Nilner K. Early functional loading using Branemark dental implants. In: Int. J. Periodontics

Restorative Dent. 2002, nr. 22, p. 9-19.

15. Esposito M. et al. Biological factors contributing to failures of osseointegrated oral implants. (II).

Etiopathogenesis. In: Eur. J. Oral Sci. 1998, nr. 106, p. 721-764.

16. Fortin T. et al. Effect of flapless surgery on pain experienced in implant placement using an image-guided

system. In: Int. J. Oral Maxillofac. Implants. 2006, nr. 21(2), p. 23-29.

17. Hashem A.A., ClaffeyN.M., O’Connell M. Pain and Anxiety Following the Placement of Dental

implants. In: Int. J. Oral Maxillofac. Implants. 2006, nr. 21, p. 943 - 950.

18. Hellem S, Ostrup L.T. Normal and retrograde blood supply to the body of the mandible in the dog. II. The

role played by periosteo-medullary and symphyseal anastomoses. In: Int. J. Oral Surg, 1981, nr. 10, p. 31-

42.

19. Jaffin R.A. et al. Immediate loading of implants in partially and fully edentulous jaws: a series of 27 case

reports. In: Journal of Periodontology. 2000, nr. 71, p. 833-838.

20. Job S., Bhat V., Naidu M. In vivo evaluation of crestal bone heights following implant placement with

flapless and with-flap techniques in sites of immediately loaded implants. In: Indian J. Dent. Res. 2008,

nr. 19(4), p. 320-325.

21. Misch C. E. Contemporary Implant Dentistry. Third Edition. St. Louis: Mosby Year book, Inc. 2008. 1102

p.

22. Nosaka Y. et al. Endosseous implants in horizontal alveolar ridge distraction osteogenesis. In: Int. J. Oral

Maxillofac. Implants., 2002, nr. 17, p. 846-853.

23. Oh T. et al. The Causes of Early Implant Bone Loss: Myth or Science? In: J. Periodontol. 2002, vol.73,

nr. 3, p. 322-333.

24. Oh T-J. et al. Flapless Implant Surgery in the Esthetic Region: Advantages and Precautions. In:

International Journal of Periodontics and Restorative Dentistry. 2007, vol. 27, nr. 1, p. 26-33.

25. Quirynen M.et al. Fixture design and overload influence marginal bone loss and fixture success in the

Branemark system. In: Clin. Oral Implants Res. 1992, nr. 3, p. 104-111.

26. Rocci A. et al. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined

positions, and prefabricated provisional restorations: a retrospective 3 –year clinical study. In: Clin.

Implant Dent. Relat. Res. 2003, nr. 5(suppl 1), p. 29-36.

27. Rompen W. Vers une simplification des protocoles pour une efficacite a court terme et une a fiabilite a

long terme. In: Implant. 2007, vol.13, nr. 3, p. 185-190.



60

28. Sanna A.M. et al. Immediately loaded CAD-CAM manufactured fixed complete dentures using flap-less

implant placement procedures: A cohort study of consecutive patients. In: J. Prosthet. Dent. 2007, nr. 97, p.

331-339.

29. Santoro F, Maiorana C. Osteointegrazione Avanzata. Milan,Italy: R.C. Libri,2001,71-81 p.

30. Smet E.D. et al. Timing of Loading, Early or Delayed – in the Outcome of Implants in the Edentulous

Mandible: A Prospective Clinical Trial. Int. In: J. Oral Maxillofac. Implants. 2007, nr. 22, p. 580-594.

31. Smith D E, Zarb G A. Criteria for success of osseointegrated endosseous implants. In: J. Prosthet. Dent.

1989, nr. 62, p. 567-572.

32. Susarla S.M., Chuang S-K., Dodson T.B. Delayed Versus Immediate Loading of Implants: Survival

Analysis and Risk Factors for Dental Implant Failure. In: J. Oral Maxillofac. Surg. 2008, nr. 66, p. 251-

255.

33. Tonetti M, Schmid J. Pathogenezis of implant failures. In: Periodontology. 2000, nr. 4, p. 127 -138.

34. Topalo V., Dobrovolschi O. şi al. Metodă miniinvazivă de instalare a implantelor dentare endoosoase. In:

Buletinul Academiei de Ştiinţe al R. Moldova. Ştiinţe medicale. Ediţia 1(15), Chişinău, 2008, p.153-156.

35. Topalo V.,Dobrovolschi O. şi al. Rata succesului implantaţiei dentare în elevaţia planşeului sinusului

maxilar prin acces srestal. In: Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe medicale. Ediţia 2 (21),

2009, p. 193-198.

36. Wittwer G. et al. Navigated Flapless Transmucosal Placement in the mandible: A Pilot Study in 20

Patients. In: Int. J. Oral Maxillofac. Implants. 2007, nr. 22, p. 801-807.



61

THE SECOND CONGRESS OF THE ROMANIAN DENTAL

ASSOCIATION FOR EDUCATION

A special event was hosted in Iasi between April, 27 –May,1, 2010. It was organized by

The Dental Association for Education, affiliated to ICOI (International Congress of Oral

Implantologists), in collaboration with The Faculty of Dental Medicine, UMF “Gr. T. Popa”,

Iasi, The Dentist College from Iasi, The Romanian Society for Oral Rehabilitation, under the

auspices of The Romanian Academy and the extraordinary participation of The French

Academy of Dento-Alveolar Surgery, of The Ministry of Health from Tunisia, of The Dentist

College from Tunisia and of The Dentist College from France. The Congress chairperson was

Univ. Prof Dr Norina Consuela Forna, the Dean of the Faculty of Dental Medicine, Iasi.

What is the novelty brought by this Congress? It was the first time when two Academies-

the Romanian and the French ones –were reunited, together with three colleges of dental

medicine, all the faculties of dental medicine from Romania and The Faculty of Dental

Medicine from Chisinau.

The first day was dominated by academic spirit, conferences being held by Univ Prof Dr

Constantin Balaceanu Stolnici, Member of Honour in the Romanian Academy, Univ. Prof.

Dr. Cristiana Glavce, manager of the Institute of Antropology, Francisc I Rainer, Bucuresti,

Univ Prof Dr Norina Forna, den of the Faculty of Dental Medicine, Iasi, Deputy Theodor



62

Paleologu,and the members of The French Academy of Dento-Alveolar Surgery-Univ Prof

Dr Yves Commissionat and Univ Prof Dr Chedly Bccouche (Tunisia).

Notable representatives of dental medicine from the USA –Univ Prof Dr Zhimon

Jacobson, the Head of the Postgaduate Study Department, The Boston University, and

Thomas Van Dyke, the President of the International Academy of Parodontology, together

with participants from Germany-Univ Prof Dr Ady Palti, pastpresident ICOI and Univ Prof

Dr Dietr Wember Matthes, specialist in implantology, the French Univ Prof Dr Yves

Commissionat and techn. Richard Abulius the President of the French Society of Dental

Aesthetics.Tunisia was represented by Univ Prof Dr Chedly Baccouche and Univ Prof Dr

Monhi Hassouna, Principal Private Secretary of the Health Ministry from Tunisia, while Italy

had as representative Univ Prof Dr Giusseppe Collele. Prominent Romanian specialists were

also present at the event.

The hands-on and round tables organized on the occasion were of great interest for the

participants. The Dentist Colleges from Romania, France, and Tunisia as well as The Health

Ministry from Tunisia were involved. The volume of proceedings published by the Romanian

Academy provides an accurate record of the congress activities.

Univ Prof Dr Norina Forna

Dean of the Faculty of Dental Medicine Iasi



63



64



65



66



67



68



69



70

romanian journal of oral rehabilitations3.amazonaws.com/zanran_storage/...romanian journal of oral...

Documents